East Kent Substance Misuse Service - Thanet

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Staff completed appropriate daily checks in the clinic room which was clean, tidy and well equipped. There was an emergency grab bag located for ease of access. Staff completed a monthly clinical infection control audit which included comments and actions required.

• We observed an emergency medical review where staff discussed treatment options and how the client could mitigate future risks. Staff covered all major domains of risk within the review.

• Staff discussed details of vulnerable clients on the safeguarding register during the business and clinical meeting. There was a safeguarding lead at the service that staff could speak to for advice.

• Staff used information gathered during the assessment process to identify where a client required additional support. Staff could access specialist support such as an interpreter where required.

• The service submitted TOP data to the national drug treatment monitoring service which showed that the service was in the top quartile for substance misuse services.

• Doctors completed a comprehensive assessment for all new clients and completed regular medical reviews for clients receiving medically assisted treatment. We observed a medical review which was structured and comprehensive. The service contacted a client’s GP prior to and after prescribing any medication

• The service followed the National Institute for Health and Care Excellence (NICE) and Drug Misuse and Dependence clinical guidelines. The service provided one to one key working appointments and a range of group work that followed NICE guidelines.

• Staff worked with a range of external agencies including GP’s, midwives, the community mental health team, young person’s drug and alcohol service and supported housing providers to provide comprehensive and holistic care for clients.

• The service provided naloxone to opiate using clients. Staff facilitated training to clients and carers in how to administer naloxone. Naloxone is an opiate antidote medicine used to rapidly reverse an opioid overdose.

• Staff were knowledgeable and experienced for their role. The service had identified staff who acted as ‘champions’ in various roles including safeguarding and multi-agency risk assessment conference (MARAC).

• Staff contacted drug services to arrange a smooth transition of care if a client was moving to another area. Staff had regular contact with prisons to ensure that appropriate support and treatment was in place for somebody released from prison.

• Staff were non-judgemental and treated clients with respect when discussing their care. Staff were compassionate and keen to maintain client’s dignity.

• We obtained feedback from 17 comments cards from the service. Clients spoke highly of the support received and said that staff were non-judgemental, supportive, friendly and considerate. Clients said that they felt listened to and that staff had met their needs.

• Staff demonstrated a good knowledge of the local demographic and used local knowledge and insight to influence care and treatment. Staff had knowledge and experience of working with a diverse range of vulnerable clients from a variety of cultures and backgrounds.

• The service offered a drop-in every afternoon so that staff could see people without an appointment. There was a late clinic one evening a week to reduce barriers to accessing treatment and so that staff could see employed clients outside of normal working hours. There was a single point of access telephone number for clients to use outside of normal working hours.

• A needle exchange service was available for everyone including people who were not engaged in structured treatment. Staff provided harm reduction and safer injecting advice to people accessing this service.

• The service offered appointments and groups at three satellite services in Ramsgate and Broadstairs. Where possible, staff arranged home visits for clients with complex needs or who found it difficult to attend the service.

• The service had a range of rooms for staff to see clients for one to one appointments and group work. There was a comfortable reception and waiting area with clean, well maintained equipment.

• The provider had facilitated co-design workshops for clients, carers, staff and professionals during the initial part of the contract to participate in the design of the new service. The provider had worked closely with stakeholders and partner agencies to design their treatment model. The service planned to implement the new model in January 2018.

• Managers had regular meetings with the commissioners and stakeholders involved in the service to monitor and review performance. Feedback from the commissioners was that the provider had managed performance of the service well during the transition period.

• Staff demonstrated the organisation’s shared vision of client recovery in their work. Staff spoke of a smooth transition from the previous provider with no impact on client care.
• There was a clear governance structure within the service. Regular meetings took place to monitor service delivery. We saw evidence of regular audits involving staff, managers and the clinical team.
• The service had an operational risk register to identify priority risks and implement an effective plan to mitigate risks. Staff had oversight of dashboards to monitor caseload, risk, care plans and client care and treatment.

• Staff morale was good and they felt their workload was manageable. The staff had worked as a team for some time and had developed positive working relationships.

• There was a staff recognition reward scheme to recognise improvements to quality and innovation. Staff knew the senior management team and felt able to communicate with them.

• The manager demonstrated a good knowledge of the model of delivery for the service and felt able to use their knowledge and insight to influence commissioning approaches.

  However, we also found the following issues that the service provider needs to improve:

• The risk register did not include timeframes for actions to be completed.

• Four staff, including the safeguarding lead, had not completed the policy and compliance mandatory training which included modules on safeguarding adults and safeguarding children. No staff had completed root cause analysis, emergency first aid at work or fire warden training.

• Data provided by the service showed that five of 13 staff had not completed all of the mandatory training. There were no records available to confirm if staff had previously completed this training.

• The provider was embedding policies into the service. However, the prescribing and treatment policy did not reference current national drug misuse and management clinical guidelines which were updated in June 2017.

• The provider had completed an analysis of staff training needs. However, they had not acted on the information provided. This meant that the service had not acted on gaps in training for staff.

• The provider did not offer Mental Capacity Act training for staff. Staff knowledge of the Mental Capacity Act was limited. However staff could explain how to respond if a client attended under the influence.

• There was conflicting information concerning staffing levels. For example, the training matrix provided before the inspection listed 13 staff and information provided on the day of the inspection listed 21 staff. However, after the inspection the provider confirmed there were 12 staff working at the service.​

• Although the service displayed advocacy posters, staff knowledge of support available was limited.