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Archived: Addaction - Cornwall

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Inspection report

Date of Inspection: 2, 3, 8, 9 January 2014
Date of Publication: 11 February 2014
Inspection Report published 11 February 2014 PDF | 95.92 KB

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 2 January 2014, 3 January 2014, 8 January 2014 and 9 January 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff, reviewed information given to us by the provider and took advice from our specialist advisors. We were accompanied by a specialist advisor.

Our judgement

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Reasons for our judgement

People who used the services of Addaction Cornwall were very positive about the service provided. We were told staff were “very supportive”, “non- judgemental” and “respectful.”

Addaction Cornwall had undergone substantial change from 1 April 2013. From this date the service, in addition to the delivery of a wide range of psychosocial interventions, Addaction now delivered the majority of the clinical services for addictions treatment in Cornwall. Previously clinical services were provided by an NHS trust.

Addaction was subsequently responsible for prescribing opiate substitution therapy for around 800 clients. It now employed two psychiatrists (a consultant and a staff-grade specialist doctor). The service contracts, on a sessional basis, with eight general practitioners with a special interest (GPwSI), and employed six nurse prescribers.

We were told, by staff and people who used the service that the changes had been challenging as they resulted in significant changes in how the service operated.

We assessed governance and risk management systems in place. Systems were still being refined. We judged there was a clear governance and risk management structure at national level within the organisation. These processes fed into, and received responses from, regional hub meetings. This included the organisation’s South West regional hub responsible for management of regional governance and risk issues. Matters considered included incidents, complaints, practice development, safeguarding, health and safety, risk, finance and human resources, and clinical issues. Within Cornwall good governance was achieved by a series of monthly or bi-monthly meetings including a Senior Management Team meeting, a Local Clinical Governance Group meeting, and an Integrated Medical Management Group.

We viewed two sets of minutes of the Integrated Medical Management Group. The minutes outlined there had been reviews, amongst other areas, of the role of non-medical prescribers, caseloads, provision for continuous personnel development and training, management and support to general practitioners with a special interest (GPwSI), professional relationships with local enhanced services general practitioners (LES GPs), and the revision of some clinical protocols.

We also inspected two sets of minutes from the Clinical Governance Group which reviewed two incidents, reviewed specific tasks which Addaction nurses provided, as well as a variety of other clinical topics.

Referrals came from a variety of sources such as General Practitioners, housing and homeless organisations, job centres, young people’s services and the probation service. A Substance Misuse Practitioner was based during office hours each day at each of the organisation’s centres. People could also self-refer or drop in for assessment and support.

We were told a triage appointment was usually offered within 7-10 days. We were told assessments were discussed at a weekly clinical meeting and an appointment to proceed with treatment was usually provided within a further week. Thus a typical person would have embarked on a definitive treatment journey about 2-3 weeks from referral. We were reassured there was capacity to fast-track people into treatment sooner if there were particular needs which would make that appropriate.

The people, who used the service, said in their particular cases there had not been any significant delays in receiving assessment and treatment. We were told waiting times were generally good and keyworkers were becoming skilful at tailoring individual treatment programmes. The Chair of the Cornwall User Forum (UFO) told us initially the service had been a little patchy but this had now much improved.

Each person who formally used Addaction’s services had a ‘Recovery Plan’ (Care Plan). The recovery plan was drawn up by the Substance Misuse Practitioner and the person who used the service. The recovery plan used an internet web based system. The