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North Yorkshire Horizons Outstanding


Inspection carried out on 27 & 28 November 2018

During a routine inspection

We rated North Yorkshire Horizons as outstanding because:

  • Clients were protected by a comprehensive safety system with a proactive approach to anticipating and managing client risk. Risk management was discussed as a multidisciplinary team between the partner organisations and utilised the support of external agencies where applicable. Staff used technology to ensure prompt information sharing and support integrated care. Clients were supported to manage their risks at home. Staff maintained effective clinical audits. They introduced batch prescribing to avoid delays in clients’ receiving medicine. Lone-working protocols were embedded to safeguard staff. The team had a focus on openness, transparency and learning when things go wrong.
  • Outcomes for clients were better than expected when compared with other similar services. Staff worked with partner organisations and external services to provide holistic care. All staff had associated specialisms, such as sexual health. Staff exhibited excellent knowledge of associated national guidance. They had submitted treatment outcomes that were above the average listed by national benchmarking services. They were identified as engaging increasing numbers of detoxification clients, which contrasts the national trend. Harrogate was trialling new urine drug tests. Staff planned discharge in advance to ease care transfer. Staff monitored client’s physical health, encouraged healthy lifestyle choices and offered tests and vaccinations for blood borne viruses. Staff would transport clients to appointments external to the service if required.
  • Clients were truly respected and valued and empowered as partners in their care, practically and emotionally, by an exceptional service. Staff developed respectful relationships with clients, treating them with kindness and dignity. Clients felt staff “genuinely care”. Staff went above and beyond to support clients’ and carers’ emotional and social needs. Staff introduced links with communities and local support networks. Staff offered flexible support to meet clients’ needs. Clients informed treatment choices and their feedback informed services changes.
  • Services were tailored to individual’s needs and delivered in a way that ensured flexibility, choice and continuity of care. They delivered person-centred pathways to clients with complex needs, through relationship development. Staff were active in re-engaging clients and overcoming barriers to clients accessing care. Staff ran clinics in isolated, rural locations or attended clients’ homes to encourage engagement. Staff kept short appointments free to stay responsive to service need. Staff were proactive in understanding and responding to the needs of clients with protected characteristics. Information was available in different formats according to communication needs.
  • Leadership, governance and culture were used to drive and improve the delivery of high-quality, person-centred care. Leaders at all levels were compassionate, inclusive and highly experienced. Staff morale was very high, they were proud of the service provided and felt valued. Managers acknowledged staff strengths and supported their development. Managers supported staff work-life balance. Leaders understood the challenges and priorities of the service. There was a focus on service improvement and reflective practice. Staff could contribute to service development. Governance structures adhered to best practice.

Inspection carried out on 24 and 25 February 2016

During a routine inspection

We do not currently rate substance misuse services.

This inspection was undertaken looking at the Spectrum arm of North Yorkshire Horizons.

We found the following areas of good practice:

  • staff treated clients with compassion, dignity and respect, were non-judgemental in their approach and protected their privacy and dignity

  • staff assessed the needs of clients and worked with them to develop their own recovery plans. Clients developed and managed their own recovery plans; clients and family members felt involved in recovery plans and had good access to doctors

  • staff understood their responsibility for reporting incidents of harm or risk of harm and concerns related to safeguarding people from abuse. Clients were seen in their own homes or in a safe and comfortable alternative place to the office

  • staff followed guidance in line with the National Institute for Health and Care Excellence and UK clinical guidelines on clinical management 2007

  • clients either self-referred through a single point of access or were referred through a partner agency and comprehensive assessments were carried out by a third agency. This information was shared with NYH. These agencies worked collaboratively to ensure clients received a seamless service

  • staff followed up cancelled appointments and unexpected discharges to ensure that vulnerable people were not left without support. Staff were responsive to the needs of all their clients

  • the service had enough staff with the appropriate skills, experience and training to provide safe care. Staff received specialist training that enabled them to carry out their role safely

  • staff received mandatory training, regular supervision and other professional training identified in their supervision

  • the service had a formal complaints procedure but had not received any complaints in the 12 months leading to our inspection

  • the provider had a clear vision and values, which staff understood and worked towards

  • there were clear lines of management through the organisation and good leadership at local level

  • the service had a risk register that meant everyone in the organisation was aware of any risks and what action had been taken to reduce them

  • the organisation was committed to improving services for the clients, and sought client views through questionnaires