During an assessment of Substance misuse services
Live Well South is a community-based service delivered by Middlesbrough Borough Council. It provides comprehensive support to clients struggling with a range of substance use issues. There are two other locations within the service: Live Well East and Live Well West. All 3 locations are separately registered with the Care Quality Commission and as such, needed to be assessed individually. None of the 3 locations have been assessed previously. The service has a registered manager and the regulated activity for which it is registered with the Care Quality Commission to carry out is treatment of disease, disorder or injury.
In the national context, Middlesbrough is rated the 9th most deprived local authority of 354 in England and has some of the highest rates of people struggling with drug and alcohol addictions.
We received an anonymous whistleblowing alert which included allegations there was a poor culture within the service and staff turnover was high. Given the nature of these concerns, we undertook an assessment of all 3 locations on 4, 5, 6 and 12 February 2025. We announced the assessment to the provider 2 working days in advance to allow the registered manager to notify us of activities taking place during our visit and plan the availability of staff members we needed to speak with. We ultimately found no evidence of a poor culture within the service and staff turnover was mainly due to issues recruiting and retaining staff into fixed term posts which were created through government grant funding.
The service comprises specialised teams that provide support services for young people and adults with drug and alcohol addictions. The service operates on a locality basis, offering clients treatment at the building closest to them ensuring ease of access.
The clinical team focuses on providing person-centred treatment that addresses both physical and mental health needs. The team provides a range of specialised interventions, including medical assessments, pharmacological treatments, harm reduction strategies, and mental health support, ensuring that every client's care plan is individualised. This team is a vital part of the service's overall efforts to prevent harm, improve health outcomes, and support long-term recovery.
The criminal justice team supports people currently within the criminal justice system. It works in partnership with probation services, courts, and prisons. The team is focussed on integrating substance misuse treatment within justice pathways to enhance rehabilitation outcomes and reduce reoffending rates.
The compliance team monitors and maintains the service's compliance with healthcare regulations and service quality standards, ensuring that all operational processes are aligned with the necessary frameworks.
The entry into service/assessment team serves as the primary point of contact for new clients. Staff within the team conduct assessments covering health, wellbeing, and social needs to develop personalised treatment plans in collaboration with individuals.
The outreach and harm minimisation team operates in community settings. It delivers harm reduction services, including needle and syringe programmes, overdose prevention through Naloxone provision, and engagement with hard-to-reach groups. Naloxone is a medicine that rapidly reverses an opioid overdose, potentially saving the person's life.
The housing support team provides dedicated housing-related support. Staff within the team collaborate with housing providers, local authorities, and services for homeless people to help individuals secure and maintain stable accommodation.
The family team provides enhanced support for parents affected by substance use, delivering targeted interventions that address parenting capacity and family stability. It collaborates closely with social care and safeguarding services to provide coordinated, whole-family support for recovery.
The young person's team provides services ranging from early intervention to intensive support. The team works with young people up to 25 years of age. Staff offer support in various settings including schools, youth clubs, and community hubs, and deliver age-appropriate interventions.
The rehabilitation, detox and moving-on team provides comprehensive support throughout the client's recovery journey, including detox support, community detox pathways, rehab placements, and reduction plans. The integrated approach is geared towards providing appropriate levels of support, stabilisation, and relapse prevention for sustainable recovery.
The non-opiate team provides specialised support for individuals using cocaine, cannabis, and recreational drugs. Staff deliver evidence-based interventions including harm reduction strategies and structured psychosocial interventions, working to eliminate barriers to accessing treatment.
The hard-to-reach vulnerable women's clinic operates at night times and offers support to women who sell sex. The service offers dual diagnosis, smoking cessation support, sexual health and support with infectious diseases.
Mental Capacity Act
Staff received mandatory training in the Mental Capacity Act. At the time of our onsite assessment, 96% of staff had complete this training.
Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
The provider's safeguarding policy incorporated guidance around the use of the Mental Capacity Act. Staff were aware of the policy and had access to it.
Staff knew where to get advice regarding the Mental Capacity Act. The safeguarding leads within the service could provide advice and support. The provider had funding for two members of staff from a local mental health trust to work within the service who also gave advice and support to staff about the use of the Act.
The service had arrangements to monitor adherence to the Mental Capacity Act. The safeguarding lead and compliance lead in the service conducted audits of care records and fed back any areas of learning in relation to the use of the Act to staff at team meetings or during supervision sessions. Staff within the service could also seek advice from the local mental health trust.