Via - New Beginnings - Brent

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 means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question good. At this inspection the rating has remained the same.

This meant that people’s outcomes were good, and people’s feedback confirmed this.

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.

Via staff were involved in assessing and managing risks to clients and did this well. During the inspection, we reviewed the assessments and risk assessments of 10 clients including those on the alcohol or opiate pathways and found that these were up to date. Staff completed a comprehensive health assessment of clients’ needs at their first appointment. Assessments covered clients’ mental and physical healthcare needs, as well as their social circumstances. They included an assessment of the client’s drug or alcohol dependence level using a recognised evidence-based tool, such as Alcohol Use Disorders Identification Test (AUDIT) and Severity of Alcohol Dependence Questionnaire (SADQ) for alcohol dependency. A full injecting history was recorded where relevant, and clients’ motivation to change was monitored. Staff created and made use of client risk management plans. Staff had completed risk assessments on admission for each client. Risk assessments included areas of potential risk, such as overdose or relapse, suicidal ideation, and concerns around children and families mental and physical health. The assessment also included what clients wanted from treatment. They were reviewed at least three-monthly, or more frequently when necessary.

Staff worked with clients to develop individual care plans and updated them as needed. Care plans reflected their assessed needs, were personalised, holistic and recovery oriented.

Each client had an assigned recovery worker, matched to members of staff with specific skills and experience. For example, clients with suspected alcohol related physical health needs were allocated to one of the specialist substance misuse nurses employed by the partner NHS trust. The name of their recovery worker was recorded on the client record system. Clients we spoke with knew who their allocated recovery worker was.

Staff developed recovery care plans with each client with a focus on harm minimisation. The care plans we reviewed were personalised, included clients’ views and strengths. Care plans included thorough contingency planning, for example in the event of a client’s unexpected exit.

Staff took steps to ensure that clients’ physical health needs were assessed and met. Via staff were trained to carry out physical health observations for clients and supported clients to access support from their GP and other services when necessary. In addition to clients coming to the centre, staff saw some clients at GP surgeries, to avoid the risk of clients not attending if asked to attend another centre. In some cases, staff supported clients to attend hospital appointments.

Staff provided a range of care and treatment suitable for the clients in the service.

The service provided care and treatment based on national guidance and evidence. The interventions included medically assisted treatment, psychological therapies and wellbeing activities. Staff ensured that clients had good access to physical healthcare, including access to specialists when needed. Blood borne virus testing was undertaken by Via and NHS staff. Prescribing and vaccination was undertaken by the partner NHS trust.

The service offered treatment and support with alcohol, opiates and non-opiates. The National Institute for Health and Care Excellence (NICE) guidelines were used to form treatment pathways.

Staff received appropriate mandatory training to ensure that the service provided appropriate treatment to clients. The day programme that was on offer was a 5 day a week abstinence rehabilitative programme for clients, facilitated by the clinical psychologist. The programme covered areas such as well-being and cognitive behavioural therapy one a one-to-one basis with a keyworker. Once clients graduated from the programme the service provided a range of aftercare interventions including non-structured post treatment support groups.

The team included or had access to the full range of specialists required to meet the needs of clients in the service. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the client group. Managers ensured that staff met as a team regularly. Managers provided staff with supervision and appraisal of their work performance. The percentage of staff that had had an appraisal in the last 12 months was 81%. Managers ensured that staff received the necessary specialist training for their roles. Managers dealt with poor staff performance promptly and effectively.

Where the service had identified specific needs for certain groups, they had introduced staff leads, to better deliver specific care. For example, a Chemsex Lead who provided specialist support to clients who engaged in this. (Chemsex is sexual activity under the influence of drugs).

The service was involved in piloting new Via pathways, led by both Via and the NHS partner. Via staff could refer relevant clients to this where appropriate. An example was a new pathway to support clients to complete opiate detoxifications when clinically suitable, in less than 90 days.

The service participated in a provider wide, evidence-based contingency management scheme to encourage clients to engage with the service. This reward scheme was developed in consultation with clients. Staff encouraged clients through a contingency management scheme to attend for vaccinations. Points earned on the scheme could be spent on local community services.

Through their NHS partner, Via staff could refer clients to psychological treatment interventions, and eye movement desensitisation reprograming for trauma and behavioural couples’ therapy (BCT).

The service had a good relationship with their NHS partner and participated in quality improvement projects on reducing supervised consumption of prescribed medications and wellbeing training that included clients.

Via staff worked alongside NHS partner staff to provide multidisciplinary input into clients’ comprehensive assessments. NHS partner staff included medical staff, a pharmacist, nurses, and a psychologist. Input from the clients’ social workers was also sought where appropriate. Contact from all staff was recorded in all clients records we looked at.

The service had regular team meetings. Staff met in daily morning meetings to discuss cases of concern, staffing, and any service updates. Staff shared pertinent information at these meetings including incidents and new safeguarding referrals. Multidisciplinary staff met weekly, to look at staff cover, expected appointments, clinics, clients who had not attended, sharing issues of concern, and good practice.

Staff worked closely with NHS community mental health teams and GPs to ensure relevant information was transferred as needed.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff discussed with clients the importance of living healthier lives if they wanted to make changes. Staff encouraged clients to give up smoking and referred them on to smoking cessation services. The health trainer for the service had been a peer support worker and worked with individual clients and a weekly health and wellbeing group including taking positive steps such as keeping active, nutrition, and forming connections.

Staff could refer their clients internally for a fibro scan (similar to an ultrasound) to check if they had sustained any liver damage. Subsequently they could refer to a hepatology nurse (specialising in liver health), who visited the service to do a regular surgery for clients to access further treatment.

Staff were involved in providing a pre-tox group prior to clients undertaking any detoxification. This included alcohol awareness, relapse prevention, what to expect after detox, triggers, and awareness of risk situations.

The service provided clients with blood borne virus assessments. The service also discussed eating healthier with clients. They also provided clients with referrals to access food bank vouchers. The service also referred clients for vaccinations for example Hepatitis C. We saw this in clients’ care plans and keywork sessions.

The service received a weekly fruit delivery, which they made available to clients to support healthy nutrition.

Staff used recognised rating scales to assess needs, monitor people’s care and treatment, and whether outcomes were positive and consistent. Measures used included the Alcohol Use Disorders Identification Test (AUDIT) and Severity of Alcohol Dependence Questionnaire (SADQ).

Staff participated in local audits, which we reviewed. This included case management, safeguarding, information governance, investigations and learning, clinical, medicines management, health safety and wellbeing and premises, data and performance, people and culture and learning and development.

In all the records we reviewed consent to treatment was obtained from clients prior to treatment. This was obtained through a form.

Staff supported clients to make decisions on their care. Staff followed the provider’s policy on the Mental Capacity Act 2005 and knew what to do if a client’s capacity to make decisions about their care might be impaired.