Archived: Addaction - Bradford Clinical Support Services

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

• The provider had not taken action to address the recommendations made following the inspection in October 2016. This was in relation to ensuring that the systems in place with regard to the transport, storage and recording of prescriptions was safe or ensuring that service continued to work with partners and commissioners to fully integrate governance at a strategic level with the partner organisations in the Bradford recovery system.

• At this inspection in March 2017, the systems in place remained insufficient for Addaction to be assured that the transfer, recording and storage of prescriptions in, and between, the host services was safe. Also, the integrated clinical governance structure did not adequately allow the service to address service delivery issues such as interruptions to client appointments and the safe and secure transfer and storage of prescriptions between partner services.

• The provider had in place a Controlled Drug Policy and Standard Operating Procedures that was revised following the inspection in April 2017. This policy included guidance on batch prescribing and audit. However, during the inspection senior staff were not aware that there was a policy or operating procedure regarding batch prescriptions in place that was underpinned by national guidance.

However, we also found the following areas of good practice:

• Addaction Bradford Clinical Support Services were now meeting Regulations 10 and 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

• Staff were up to date with policy changes, and now followed the policy for taking blood samples from clients. The system that ensured prescribers reviewed the client treatment record before signing a prescription where there had been a change that was not in line with the original treatment plan was working well in practice.

• The provider had taken action in response to the recommendation at the last inspection and staff received regular management supervision in line with the policy.

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

• Staff did not always follow Addaction’s procedures for blood borne virus screening and allowed a client to take their own blood in the clinic appointment. Staff did not always consult with the electronic client record before signing prescriptions for controlled drugs, like methadone or buprenorphine. They also compromised the confidentiality, privacy and respect for two of their clients by signing a client’s prescription during the appointment of another client. The serial numbers of the prescriptions used and given to clients was not recorded.

• Addaction did not have fully integrated governance at a strategic level with the partner organisations in the Bradford recovery system. Except for the quarterly quality visits completed by senior managers and internal quality auditors that reviewed the governance systems and the service delivery, there was no routine clinical audit schedule in place. The service did not routinely collect and monitor data to use proactively to manage risks associated with prescribing medication, and to support staff to fulfil their role.

• There was no contingency plan to provide staff with documented managerial supervision when the service manager was no longer at the service. The personnel records that we reviewed showed that staff had not received managerial supervision for at least two months prior to inspection. However, there were weekly team meetings and staff told us they could always access supervision if they needed it.

However, we also found the following areas of good practice:

• Addaction had sufficient staff to deliver care and treatment. Agency staff were rarely used as the service employed sessional prescribers to cover additional shifts. Staff mandatory training compliance was above 98%. Team meetings that all Addaction staff attended included detailed case discussion about clients and practice with input from all the Addaction team, as well as updates on safeguarding and the new procedures implemented. Staff employed by Addaction demonstrated a good understanding of Addaction’s values and guiding principles, and staff knew who the senior managers were. They told us that they felt well supported and staff were able to progress through the organisation.

• The clinical assessments completed by doctors and non-medical prescribers were detailed and included discussions about risk and assessments of the client’s physical and mental health, and social circumstances.Staff had a good understanding of child and adult safeguarding procedures. Training, guidance, systems, and a named safeguarding lead, were in place to support staff. All treatment was underpinned by national guidance and staff had a good understanding of the best practice guidance that was appropriate with regard to prescribing and physical health care. Staff followed cold chain procedures with regard to the storage and transport of vaccines to ensure they remained at the correct temperature required to ensure they worked properly. Information was available for clients about treatment and medication, and consent and confidentiality was explained to clients.

• Addaction had late night prescribing clinics available and also had a women’s clinic every week. Staff could access language line for clients whose first language was not English and could provide a sign language interpreter for deaf clients. Most of the clients told us that the doctors and nurses were kind, caring and polite. All clients knew how to complain. Complaints were responded to by the service in a timely manner, investigated where appropriate and any identified learning was cascaded to the teams.

• Addaction provided data to the local commissioners on their outcomes and were performing well on these targets. The role of the medical lead focused on building partnerships, reviewing policies and procedures to ensure they fitted in with national guidance, and service development. Client feedback and staff feedback was collected to inform service delivery.