East Kent Substance Misuse Service - Dover & Shepway

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The clinic room was clean, tidy and well equipped. Staff completed regular checks to ensure equipment was in date. The provider had an infection control policy in place to monitor the cleanliness of the environment.

• The provider had established the staffing levels required through consultation with the service commissioners. The service reported a service caseload of 530 clients in treatment at the time of our inspection. The service redistributed caseloads in the event of staff absence.

• Staff completed and regularly reviewed client risk assessments. Risk assessments included risk management plans. Staff discussed risk during meetings and monitored risk using electronic dashboards.

• There was a robust assessment process for clients referring into the service. Doctors completed a comprehensive medical assessment for clients referring in for medically assisted treatment. Staff contacted the client’s GP prior to and after prescribing any medicines.

• Care plans were comprehensive and holistic with realistic time framed goals. Care plans showed client involvement and other services involved in the clients care.

• The service provided evidence based interventions that met National Institute for Health and Care Excellence guidelines.The treatment offered included brief advice and information through to more structured clinical and group psychosocial interventions.

• The service provided naloxone to opiate using clients. Staff provided 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 dual diagnosis.

• The service worked alongside other services such as community midwives, the community mental health team and young person services in order to establish links and joint working. We observed good evidence of staff sharing information during a daily allocations meeting.

• We observed staff treating clients with respect and showing a genuine interested in their wellbeing. We observed a daily allocations meeting and saw that staff were non-judgemental, and treated clients with respect when discussing their care.

• We spoke to seven clients who used the service and obtained feedback from 16 comments cards from the service. Clients' spoke highly of the support received and said that staff were friendly, welcoming, helpful and responsive.

• The service offered a drop in service, which provided the opportunity for people to speak to staff without an appointment. There was a late clinic one evening a week so that staff could see employed clients outside of normal working hours. Staff offered appointments at satellite clinics in more rural areas. Where possible, staff arranged home visits for clients with complex needs or who found it difficult to attend the service due to travel.

• Needle exchange provision was available, including to people who were not engaged in structured treatment. Staff provided harm reduction and safer injecting advice to people accessing this service.

• Staff were able to arrange interpreters for clients where required. Staff had knowledge and experience of working with a diverse range of vulnerable clients from a variety of cultures and backgrounds.

• Staff demonstrated the vision and values of the organisation in their work. Staff knew senior managers and said that they were visible in the service. 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. We saw a medically assisted treatment audit that the provider rated using the five key lines of enquiry safe, effective, caring, responsive and well led. The audit generated an improvement action plan with objectives, actions to be taken, person responsible and timescales.

• Managers had regular meetings with the commissioners to discuss the performance of the service. Feedback from the commissioners was that the provider had managed the performance of the service well during the transition period.

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

  • The provider had invited clients to attend co design workshops and encouraged clients to participate in the design of the new service.

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

• Data provided by the service showed that staff had not completed all mandatory training. There were no previous training records to confirm previous training completed by 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 of alcohol or drugs.

• 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 service had an operational risk register to identify priority risks and implement an effective plan to mitigate risks. However, the register did not include timeframes for actions to be completed.

• The service was embedding relevant policies. However, the prescribing and treatment policy did not reference the updated drug misuse and dependence guidelines on clinical management.

• Managers did not have immediate access to Disclosure Barring Service check information for volunteers and peer mentors.