Barnsley Recovery Steps

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 client’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 as good. At this inspection the rating remained good. This meant people’s outcomes were consistently 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 scored the service a 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service monitored all client’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of clients themselves. Clients were involved in discussions about planning their own outcomes including their goals and specific achievements.
We reviewed 6 care records and saw that staff completed a comprehensive initial assessment of the client in a timely manner. Staff assessed clients’ physical health on admission and arranged referrals to external services for identified physical health needs. Staff monitored ongoing physical health needs during one-to-one sessions.
Recovery plans were personalised, holistic and recovery oriented. The plans we reviewed identified the client’s individual needs, wishes and preferences and set out ways to manage any risks. Staff updated care plans when necessary and staff responded promptly to any sudden deterioration in a client's health, for example management and response to relapse or deterioration in mental health.

We scored the service as 4. The evidence showed an exceptional standard. The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards. 

The service continuously planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. Staff followed up-to-date policies to plan and deliver high-quality care according to best practice and national guidance. At the time of our inspection, Barnsley Recovery Steps were the 8th best nationally performing local authority out of 151 when it came to treatment progress.

Staff provided a range of care and treatment interventions suitable for the client group. The service adopted the use of the long-lasting injectable buprenorphine (Buvidal). This gave clients further treatment options when traditional opioid substitution treatment did not fully meet their needs. What began as a pilot had since been embedded as a core, evidence-based, clinically governed treatment pathway. The service had continued to develop personalised approaches across different client cohorts, including people who struggled with daily pharmacy attendance, those at risk of diversion, people excluded from pharmacy provision, prison leavers, working people, parents, and women involved in sex work where daily supervised consumption can increase stigma, risk or instability. The service also offered naloxone to clients at risk of opiate overdose. Managers made sure staff received any specialist training for their role. This included training on substance misuse and the impact on the body, harm reduction techniques, and training in how to reach out to people who were underrepresented within substance services.

Since our last inspection, Barnsley Recovery Steps had developed an in-house Individual Placement and Support service (IPS) for people accessing drug and alcohol treatment. 
The service delivered an evidence-based employment model as part of treatment, rather than as a separate intervention. This supported wider recovery outcomes, including independence, confidence and social inclusion. This provided practical, personalised support with job searching, CV writing, application forms, cover letters, interview preparation, understanding job roles and ongoing in-work support. This helped people build confidence, routine, financial stability, purpose and independence as part of their recovery journey.

Barnsley Recovery Steps 'Rough Sleeper Outreach Team' were part of the homeless outreach provision and provided substance misuse intervention where required and supported and encouraged individuals to access the service whilst also providing harm reduction interventions. As a result of this, the team was nominated in the 'team' category of the public health and communities directorate at The Directorate Recognition Awards. Executive Director for Public Health and Communities said;

“The Rough Sleeper Team is a partnership between the Council, SWYT and Recovery Steps. Going out at least twice a week at 6am. They work tirelessly to offer support around housing, substance misuse and health, taking a persistent approach to engagement. They really are a special group of people making a big difference in Barnsley”.

Barnsley Recovery Steps Identified a gap in healthcare provision for the local homeless population. The service initiated a fortnightly drop-in clinic from 10am-12pm at the McLintock Building to provide healthcare interventions such as wound care treatment.

The Supportive Treatment Exit Pathway (STEP) initiative has been implemented at Barnsley Recovery Steps. Since this initiative was implemented, the service has seen an increase of 21% in alcohol and non-opiate successful exits, a 21% decrease in non-opiate drop-outs and a 29% increase in successful opiate exits.

Staff ensured that clients had good access to physical healthcare, including access to specialists when needed. Staff routinely offered blood borne virus testing to clients and supported them to access treatment for any viruses detected. 
Staff protected the rights of clients subject to the Mental Capacity Act. This included referring clients to mental health services where necessary. The service was also in the process of seconding staff from local mental health services to improve links and understanding between substance misuse and mental health.
We observed a daily flash meeting, which staff used to hand over information and updates about clients. This included any hospital admissions, risk alerts, and safeguarding concerns. During the meeting we saw that staff referred to the psychological and emotional needs of clients, their relatives and carers.
Staff we spoke with told us they had the opportunity to discuss training needs with their line manager and were supported to develop their skills and knowledge. We saw evidence of a host of additional training programmes that staff could access. These included Ketamine training, neurodiversity awareness training, sexual harm training and mobile Electrocardiogram (ECG) training.
Staff also had access to a number of apprenticeship opportunities, such as 
• level 2 health and social care
• level 3 team leadership
• level 4 management and leadership
• level 5 operations manager- standard and diploma
• level 7 senior leadership apprenticeship
During the previous 12-month period, the compliance rates for supervision was 99.5% and the compliance rate for appraisals was 100%.
Managers identified poor staff performance promptly and supported staff to improve either through one-to-one support or by implementing performance plans with support from the human resources team. There was a performance management policy which was up to date and subject to regular review.
We found that managers took a very proactive approach in recruiting and training volunteers to work with clients in the service. Staff had ongoing discussions with clients about the volunteer programme throughout their pathway, to encourage them to take part where it was appropriate. They also reminded them about volunteering opportunities during aftercare.
 

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff and client interviews, care records and a review of various documents provided by the service showed that staff worked across health care disciplines and with other agencies when required to care for clients. There was evidence of proactive joint working with social work teams, mental health services, GP practices and the local hospital. There were 2 social workers seconded into the service which enabled any risks and concerns to be addressed sooner and provided links to local social services for more effective working relationships.
Staff held regular and effective weekly multidisciplinary meetings to discuss clients and to help improve their care. Recovery workers alerted managers to any clients they felt were at increased risk and needed to be discussed or clients they needed support or guidance about. Multidisciplinary team meetings were well attended and included managers, doctors, nurses, clinical leaders, team leaders and recovery workers and volunteers.
There was many joint working arrangements set up to support the needs of the local community. For example, the service had undertaken outreach work with Barnsley council and also signpost and refer individuals to the correct housing support services such as ‘Thrive Barnsley’ which provided supported accommodation for individuals who were homeless, struggling with mental or physical health challenges.
Staff regularly liaised with GPs, and the electronic records system showed effective two-way communication. Staff liaised with GPs regarding prescribing or medicines issues, and alerted GPs to any treatments they provided for clients.
There was evidence of good joint working with the local hospital’s alcohol care team, pain management clinic, wound care clinic and Hepatitis C clinics, with regular information sharing taking place. Staff shared information with the general hospital to escalate client’s physical health concerns and provide advance notice that a client was due to attend the hospital.
The service worked alongside Barnsley district general hospital and played a key role in supporting the alcohol care team implementation and development. This included training hospital staff, providing shadowing within community services and sharing clinical expertise to improve identification, brief intervention and referral for alcohol-related need.
The service also developed a practical alcohol toolkit for hospital colleagues, offering clear guidance on identifying need, treatment options and referral pathways.
This work actively strengthened the interface between hospital and community care, ensuring clients received timely, appropriate support rather than being discharged without follow-up.
A senior nurse at Barnsley district general hospital said, “The offer from Barnsley Recovery Steps is much more than we expected” and “The teams are learning from each other. This is a particular benefit to staff who have worked in acute general care as they are gaining the crucial knowledge around community offers of treatment and recovery interventions. This is seldom seen nationally as many acute trusts are unaware of community services or their value in a person’s care, without this strong link we would always fail the individual.”

Staff and managers knew who the designated points of contact were in the local mental health crisis teams, inpatient mental health services and local authority. There was evidence of effective working relationships with social care services and housing teams.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported clients to live healthier lives through participation in smoking cessation schemes, providing healthy eating advice, meditation and sound bath groups, managing cardiovascular risks, screening for cancer, and dealing with issues related to substance misuse.
The service provided relevant information promoting healthy lifestyles and support at each site. One client told us about the ‘recovery rambles’ a walking group that attended local parks and beauty spots and the service were also planning the Yorkshire 3 peaks walk.
Clients told us staff supported them in creating plans to prevent relapse, reducing their potential future need for care and support. This included providing access to a range of internal group sessions, and signposting clients to external services including Alcoholics Anonymous and Narcotics Anonymous.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service monitored client’s care and treatment to continuously improve it. The service used technology to effectively support clients such as electronic dashboards that tracked priority and risk. At the time of our inspection, the service was piloting an artificial intelligence tool that automatically documented interviews. This was seen as being more therapeutic, allowing staff to focus on time with the individual and ensure notes are comprehensive. This was also considered to be more time effective than a staff member taking handwritten notes.

Staff used recognised rating scales to assess and record severity and outcomes and used recognised withdrawal scales to monitor detox and ensure medicines were reviewed and adjusted accordingly. This included the use of the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIW-AR) and the Severity of Alcohol Dependency Questionnaire (SADQ). The service also accessed The National Drug Treatment Monitoring System; a national database used across England to collect anonymised information on adults and young-people receiving treatment for drug and alcohol misuse. This allowed providers to track whether treatment interventions were successfully helping people achieve recovery.

Recovery plans contained appropriate assessments which were updated frequently to measure outcomes and progress. Managers completed audits of care records to ensure these were comprehensive and that recovery plans and risk assessments were updated and reflected individual client need.
We observed that clients discussed their expectations around outcomes for the care they received with their recovery workers. Staff discussed clinical and personal expectations during individual and group sessions. We saw staff communicating positive progress with clients during the group sessions we observed.

The service monitored outcomes of clients receiving treatment for opiates, non-opiates, alcohol and alcohol and non-opiates. In the latest period, 8.1% of opiate, 36.8% of non-opiate, 41% of alcohol and 36.9% of alcohol and non-opiate clients successfully completed treatment. This data was fed back to the National Drug Monitoring Treatment System (NDTMS).
 

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable clients to make their own decisions. For clients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately and would carry this out on a decision specific basis with regards to significant decisions.

Staff assessed and recorded capacity to consent clearly each time a person needed to make an important decision and there was evidence in care records that staff routinely recorded client’s consent to care and treatment.
Staff received and kept up to date with training in the Mental Capacity Act. At the time of our inspection, compliance rates for Mental Capacity Act training was 96%.
Staff we spoke with understood how and when to assess whether a client had the capacity to make decisions about their care. They understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act and Mental Capacity Act and they knew who to contact for advice.