Live Well East

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This is the first assessment for this service. This key question has been rated good.

Staff assessed the physical and mental health of all clients on first contact with the service or soon afterwards. They developed individualised care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for clients based on national guidance and best practice. Teams included or had access to the full range of specialists required to meet the needs of clients using the service. Staff from different disciplines worked together as a team to benefit clients. Staff understood their roles and responsibilities under the Mental Capacity Act and discharged these well.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We looked at 17 care records in total during our assessment, 6 of which made specific reference to the East service. However, clients were sometimes moved between the sites depending on their required needs.

We saw evidence in care records that staff completed a comprehensive mental health assessment of the client in a timely manner at, or soon after, their first contact with the service.

Staff assessed clients’ physical health needs in a timely manner at first contact with the service. We saw evidence in care records that staff had obtained physical health information from the client’s GP or a prescriber within the service had undertaken a physical health assessment.

Staff developed care plans that met the needs identified during assessment. Staff created recovery plans which were personalised, holistic and recovery-oriented. They included information about the client’s motivation to change, strengths and goals, evidence of blood borne virus testing being offered, previous access to treatment, injecting history, and completed questionnaires about alcohol use. Notes within care records also evidenced that recovery plans were developed in partnership with the client.

Staff reviewed recovery plans during each appointment with clients and updated them accordingly.

Staff provided a range of care and treatment interventions suitable for the client group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. They included blood borne virus testing, substitute prescribing, harm minimisation advice, psychosocial interventions, group sessions, employment support, smoking cessation, a lung health clinic and outreach support.

Staff ensured that clients had good access to physical healthcare, including access to specialists when needed.

Staff participated in clinical audit and quality improvement initiatives. These included audits relating to health and safety audits, prescribing stationery, care records, incidents, emergency drugs and risk assessments/risk management plans. There was a compliance lead in the service who monitored compliance within the service, including mandatory training, supervision, appraisals, incident reporting and client feedback.

The team included or had access to the full range of specialists required to meet the needs of clients using the service. This included doctors, nurses, prescribers, recovery workers, social workers, mental health professionals, pharmacy services and outreach workers.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the client group. Other staff members had previously worked for other substance misuse providers.

Managers provided new staff with appropriate induction to the service and organisation. The induction included mandatory training modules in anti-terrorism, freedom of information, fraud, whistleblowing awareness, infection control and incident reporting.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. The percentage of staff that had had an appraisal in the last 12 months was 100% and the average compliance with supervision was 93%.

Managers ensured that staff had access to regular team meetings. Wednesday mornings were set aside for all-staff team meetings and meetings were taking place during our assessment.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Any areas for development were identified during supervision and appraisal sessions or team meetings.

Managers ensured that staff received the necessary specialist training for their roles. Staff were undertaking degree-level courses for which they had paid time off to work on. The provider enabled staff to undertake specialist training as it had strong links with the local university.

Managers dealt with poor staff performance promptly and effectively. The provider had a performance management system in place to enable managers to deal with staff performance issues in a timely and appropriate manner.

Staff held regular and effective multidisciplinary meetings. These included daily meetings for clients with opiate addictions and weekly meetings for clients with alcohol addictions and young people.

We observed a multidisciplinary meeting for two clients with addiction to opiates. The first client had fallen out of treatment and attendees discussed plans as to how to re-titrate the client’s substitute medicine so it could be reintroduced in a safe and effective way. The client’s capacity to collect their medicine from a pharmacy was considered and it was confirmed the client had a lockable storage box to keep their medicine in due to children being at the home. The second client was due to attend the service later that day. Staff had arranged for an interpreter to support the client as their English was limited and also discussed their current housing situation.

Staff shared information about clients at effective handover meetings and ensured care records were updated in relation to the client’s progress.

The teams had effective working relationships, including good handovers, with other relevant teams and partner agencies within the local authority.

The teams had effective working relationships with teams outside the organisation such as mental health services, GPs, social services, criminal justice services and partner agencies within the local authority. Staff attended multiagency children’s hub meetings with external agencies such as child protection services, the police and social care to discuss serious concerns about child welfare.

Staff supported clients to live healthier lives. We saw evidence in care records that staff had provided clients with advice about healthy eating and harm minimisation. We also saw evidence that staff referred clients to services that could improve clients’ health and wellbeing such as a lung clinic or smoking cessation service.

Staff used recognised rating scales to assess and record severity and outcomes. This included:

• the AUDIT tool and severity of alcohol dependency questionnaire (SADQ)
• PHQ-9 client questionnaire
• Generalised Anxiety Disorder Questionnaire (GAD-7)
• CIWA score (measurement of the severity of alcohol withdrawal)
• Mini-ACE (a brief cognitive screening test that evaluates four main cognitive areas - orientation, memory, language and visuospatial function)
• Treatment Outcome Profiles (TOPS)
• drug and alcohol STAR tool and,
• the Clinical Opiate Withdrawal Scale (COWS).

Staff used technology to support clients effectively. Staff used social media platforms for raising awareness about addiction issues and for campaigns. Staff used assistive systems for communicating and supporting clients, had access to data analytics reports and could produce digital prescriptions.

Staff took all practical steps to enable clients to make their own decisions.

For clients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When clients lacked capacity, staff sought advice from the two mental health professionals working within the service or from the safeguarding lead. If the client’s capacity was impaired as a result of being intoxicated, the appointment was rescheduled and if a client’s ability to engage was impaired due to potential mental health problems, staff referred the client to the local mental health trust for support.

We saw evidence in clients’ care records that clients had agreed and signed consent to treatment forms. We also saw evidence that staff had recorded which parties clients had agreed for staff to share information with about their care, treatment and current health status.