Via - R3 - Redbridge

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• 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 good.

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

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We reviewed 12 care and treatment records. Staff completed comprehensive assessments with clients on accessing the service. Assessments covered their history of drugs and/or alcohol use, who the service can contact, personal details, accessibility needs, social needs, physical and mental health needs, neurodiverse needs, family and language needs and treatment goals. 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.

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.

Risk assessments included areas of potential risk, such as overdose or relapse, suicidal ideation, 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.

The recovery plan identified the client’s key worker. Individual needs and recovery plans, including risk management plans, were updated every 12 weeks, in line with the service’s policy. 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. Clients we spoke with knew who their allocated recovery worker was.

Staff met with clients face to face for assessment prior to prescribing medicines. This initial appointment for medication was with the psychiatrist.

Staff supported clients to safely reduce alcohol and stop their drug and alcohol use through the appropriate use of withdrawal symptoms audit tools and by following national guidance on detoxification.

Staff developed and shared a plan for unexpected exit from treatment. This included information about physical health risks from abstaining from alcohol suddenly.

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 local hospitals, to avoid the risk of clients not attending if asked to attend another centre. This had been developed in response to referrals and client needs.

The service provided care and treatment based on national guidance and evidence.

The interventions included rehabilitation groups, 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 (BBV) testing was undertaken by staff. Prescribing and vaccination was undertaken by appropriate staff.

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 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 regularly. Managers provided staff with supervision and appraisal of their work performance. The percentage of staff that had an appraisal in the last 12 months was 95%. 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 clinical leads and a voluntary mental health first aider, who provided specialist support to clients with mental health needs.

The service was involved in various pathways. An example was a BBV pathway and family and friends pathway.

The service had a dual diagnosis pathway to support people experiencing substance use and mental health needs. This had been established for 3 years and involved joint care planning. The joint working protocol had been developed with people who use services. Staff from the service visited mental health inpatient services as well as meetings with the mental health Home Treatment Teams to identify those with support needs. In addition, staff had set up and delivered drug and alcohol awareness groups for inpatients. This was arranged with 3 other boroughs, so anyone could attend regardless of borough. Clients receiving care could be seen at their choice of venue, the mental health services or substance use services.

The service participated in a provider wide, evidence-based contingency management scheme to encourage clients to engage with the service. The 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.

The service was an original pilot site for long-acting injectable Buprenorphine (Buvidal). After the pilot, they were commissioned to use this with specific groups of clients. This included rough sleepers and those experiencing multiple disadvantages. The service secured funding to offer this to other service users who could benefit. Staff were trained on Buvidal and nurses were trained to administer this on a named-patient bases. Benefits of this treatment can include more stable treatment, lower overdose risk and improved retention. The service monitored outcomes in the patient group and saw positive results in representation for treatment.

The service carried out a wide range of activities to raise awareness and knowledge amongst other local teams and services of the risks of opiate overdose and how to respond to this. In response to feedback from some partners and service users who did not feel comfortable carrying something with a needle, the service had options for nasal as we as injectable Naloxone.

The service had a good working relationship with external agencies.

Via staff worked alongside local probation services, homeless services, and local mental health teams.

Staff from different disciplines worked together as a team to benefit clients. The service had a range of staff from a range of specialisms, including recovery practitioners, registered nurses, social workers and medical doctors. Where appropriate, they also sought external professional input such as children and family services, social workers and mental health teams.

The service had regular team meetings. During our onsite inspection we observed the daily morning meeting. During these meetings staff discussed cases of concern, service updates, staffing, information surrounding incidents and 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. We saw that these meetings were well facilitated, all staff were encouraged to speak up and all staff were in attendance, with no one leaving early or entering late, which can be disruptive.

Staff worked closely with external agencies and GP's to ensure relevant information was transferred as needed.

We spoke to various external agencies who all described having a positive working relationship with Via staff. They stated that the service provides a high standard of care to its clients and that they contribute actively to multi-agency working.

Since the last inspection in 2020, the service had worked to improve engagement with the local mental health trust. This focused on understanding one another's services, what was offered and referral pathways. This had encouraged and resulted in more effective joint working. Staff from both providers, as well as service users and carers, discussed what was missing for people with co-occurring mental health, alcohol or drug use, what was wanted and what barriers they had experienced. The service and the local NHS Trust had collaborated to deliver trauma informed care training sessions and staff now regularly attended a range of meetings with staff from the NHS Trust. These included a monthly Dual Diagnosis Panel, a weekly Home Treatment Team Zoning Meeting, High Intensity User Forums and mental health multidisciplinary team meetings. Joint care planning meetings held with service users could take place at the service location of their preference.

The service delivered training to other organisations across the borough every 2 months. This was opened to the public as well as any professionals. The service provided bespoke training to other organisations on demand. This had recently included Ketamine training and Black Market Medication training following a request from the Mental Health Trust where this was identified following learning from their serious incident.

Staff supported clients to live healthier lives. For example, smoking cessation and supporting clients with information surrounding sexual health. The service had condoms available on site in bathrooms.

The service had embedded tobacco dependence support. A specialist smoking advisor could support service users to access 12 weeks free nicotine replacement therapy, vape and smoking cessation medications and behavioural support. This also supported the improve outcomes for cannabis users with secondary nicotine dependence. The service had developed a 5 language resource on non-traditional tobaccos used in some local communities and worked with local partners to roll out information about this.

The service would regularly request a FibroScan (similar to an ultrasound) service to conduct a scan for clients to check if they had sustained liver damage.

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 provided during different times of the year flu vaccinations. They also referred clients for vaccination for example, Hepatitis C.

Staff participated in clinical audits to help provide assurance on the quality of care and treatment delivered. This included audits of prescription stock check, clinical audit, risk register and business continuity.

Staff completed a treatment outcome profile (TOP) with clients to assess the degree of substance use. This was used for initial, review and exit stages. This could be for substance misuse, injecting behaviour, crime and social functioning.

The service monitored outcomes for people using the service and used this information to make improvements or developments to the service.

In all the records we reviewed, staff had obtained clients' written consent to treatment.

Staff supported clients to make decisions about 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. We saw staff discussing this when talking about specific cases, and how to manage this when a client was under the influence of a substance.