Email update from the Care Quality Commission
22 January 2016Ref no: EC284
Update on inspections of substance misuse treatment services
We write to inform you of our recent findings about the safety of people who use substance misuse treatment services, to ask you to consider whether these might be relevant to your service and to ask you to take any action that might be necessary.
In July 2015, CQC published a handbook that sets out how we inspect and regulate the specialist services that provide care for people who have substance misuse problems. On seven of the first 16 inspections we have completed using this new approach, we have found problems with the safety of the healthcare provided to people who are addicted to alcohol and/or opiates. We have taken appropriate enforcement action against these providers to protect the people under their care. However, we are concerned that these might not be isolated findings. We will therefore pay particular attention to these issues at all future inspections.
Our inspectors’ assessment of the safety and effectiveness of the care of people undergoing assisted withdrawal from alcohol or opiates is informed by best practice guidance published by the National Institute for Health and Care Excellence, the Department of Health, the General Medical Council, The Nursing and Midwifery Council, the Royal College of General Practitioners and the Royal College of Psychiatrists. Our most serious concern is the poor management of the treatment and care of people who are undergoing assisted withdrawal from alcohol or opiates. Specifically, we have found:
- Providers with no written protocols in place in respect of assisted alcohol or opiate withdrawal.
- Staff who are not trained and competent to provide safe care to people who are undergoing assisted withdrawal.
- Units where staff have failed to create an adequate care plan that addresses the potential risks for people undergoing assisted withdrawal.
- Units where staff do not make an adequate physical health assessment before a person starts assisted withdrawal and/or fail to carry out regular physical health checks to identify withdrawal symptoms.
- Doctors who have prescribed medication for patients by telephone or by email when it is doubtful that the doctor has adequate knowledge of the patient’s health.
- Poor medicines management. This includes procedures for ordering, receipt, storage, administration and disposal of controlled drugs that are not in accordance with the Misuse of Drugs Act 1971 and its associated regulations.
While our first responsibility is to protect people using substance misuse services, we also want to support all providers to deliver care that is safe and effective. To this end, we are working with Public Health England to plan and deliver a joint national event for providers of residential substance misuse services. The purpose of this will be to make sure all providers of residential substance misuse treatment services are clear about their responsibilities in relation to clinical care and governance. We will contact you shortly with a date for this event, and would urge you to attend.
David Behan Paul Lelliott
Chief Executive Deputy Chief Inspector of Hospitals
Care Quality Commission Care Quality Commission