Draft National Quality Standards for Substance Misuse Services

Draft National Quality Standards for Substance Misuse Services - Report on Pilot Projects

2 Forth Valley Substance Action Team Pilot Project Report

Background

The Action Plan in October 2004, which was preceded, by the Executive's Review of Drug Treatment and Rehabilitation Services recommended development of national standards with an emphasis on outcomes for service users, together with systems for monitoring and evaluation.

This recommendation addresses the lack of an overarching agreed framework which describes the quality of provision and delivery required in services for drug misusers and people with alcohol problems.

A Steering Group was established with representatives drawn from drug and alcohol services, service commissioners and regulatory bodies such as the Care Commission and the Social Work Inspection Agency. This group met with the Executive to develop a framework of quality standards which focus particularly on the practical aspects of quality and integration of services for people with substance misuse problems.

The Steering Group agreed the following which should underpin the development of quality standards

There should be a set of common standards across Scotland, published by Scottish Ministers but with local ownership.
There should be no added burden on services (in the form of another layer of inspections) without being of clear benefit.
Any evaluation of the use of quality standards should be supportive and address those aspects of practice not covered in existing inspections.
The standards will cover both drug and alcohol services.
The implementation of the standards will seek to improve services.
Development should build on existing good practice.
There should be substantial service user and community input to any evaluation of the implementation of the standards.

The Forth Valley SAT Co-ordinator was invited to become of member of the steering group and thus had the opportunity to pilot the standards locally with interested services. This enabled Forth Valley Drug and Alcohol Services to build on work already started on improving integration and quality of local services.

Methodology

In Forth Valley, service providers meet together every two months at a Process of Care meeting, the purpose of which is to enable discussion on service delivery and development. This group is tasked with developing and monitoring referral protocols and pathways and has recently undertaken to develop a Key Worker Manual for each service.

Information regarding the draft standards was circulated to all drug & alcohol services (including family support services). At the January meeting services were invited to become involved in a local pilot/consultation on the proposed standards. Services were also encouraged to consult their own service users on the draft standards. Five services volunteered to participate, they were:

Community Alcohol & Drug Service ( NHS)
FV Criminal Justice Drug Treatment Service (Local Authority/ NHS Partnership)
Signpost Forth Valley (Voluntary Organisation)
Family Support Network (Group includes representatives from local Family Support groups) (Voluntary Organisation)
ASC (Alcohol Support Counselling) - (Voluntary Organisation)

Interviews were arranged with representatives from each service and a checklist and copy of draft standards send to the service prior to the interview.

Each interview lasted approximately ninety minutes. Service providers were asked to provide examples of documentation they would use to help demonstrate standards were being met.

The main focus of the discussions was on how services would demonstrate that they were meeting the standards. The emphasis was not on the wording of the standards themselves. Indeed there was little comment on the wording of the standards. All services felt they were comprehensive and that there were no obvious gaps. However, there were comments of exactly what services were included and whether all services would "really be treated equally when it came to implementing them".

During the interviews service providers provided various amounts of evidence, some had recent copies of client information leaflets, assessment sheets, specific policy and procedures.

Most services acknowledged that leaflets for clients and other professionals would benefit from a "makeover" and that many polices had not been reviewed recently. Perhaps unsurprisingly, given recent events many services had reviewed their Child Protection Policy in the past few months, however the overall standard, readability and evidence of implementation of policies and procedures was an area that services felt could be improved.

Discussion

The overwhelming view of the standards was positive. All services expressed support for the principle of having documented standards for drug and alcohol services with many stating that it was "somewhat embarrassing" that it had taken so long to get to this stage. Family support groups welcomed the fact that family members and the local community should be involved in the on-going development of services.

All services stated that the publication of these draft standards gave them the opportunity to review materials they produced for clients and professionals. A couple of services stated that it also provided them with the opportunity to discuss with the staff team their whole record keeping process, particularly the issue of personal plans and the review process for them.

Concerns that were expressed ranged from funding of IT systems, though in general discussion it was recognised that such systems should already be in place and the responsibility for maintaining and updating them rested with the service provider. There was discussion about whether commissioners and funders of services adequately understood the "administrative burden" on services. However, it was accepted by services that they had an obligation to inform funders of this through monitoring groups.

The issue of the rights and responsibilities of clients was raised by all those consulted and while no service disagreed with the statements there was discussion as to how this would work in practice and the "culture shift" required by many staff members to change how they viewed clients of services.

A recurring theme was whether these standards "really would apply to all services, irrespective of funding source or how long they had been in existence". Specific concerns were raised regarding those services that are "not currently subject to any regular reporting arrangements, those services that have never been evaluated". Whilst it was acknowledged that such services might actually find it harder to demonstrate how they met the proposed standards there was concern that "exceptions would be made for them and it will be back to one rule for use and one for them".

The proposed greater emphasis on service user involvement prompted much discussion - in the case of family support groups they were also sceptical as to whether services "really will be required to consult with family and involve them". All those involved in the discussion of the standards welcomed and supported such involvement however there were differences as to the degree of difficulty services would face in improving service user involvement. The majority of services consulted do not currently have a standardised mechanism for consulting service users. Two services were unable to demonstrate any evidence of service user involvement. Those who did varied from "end of treatment evaluation sheets", comments boxes/books, regular questionnaires conducted with service users.

Demonstrating involvement of family members and local community was underdeveloped. Further advice would be welcomed as to how services could involve family members and consult with the local community. It was felt that such advice should be provided nationally rather then interpreted locally.

On the whole services consulted felt that having a checklist such as provided in this case helped them to understand how meeting the standards could be measured and how demonstrating that they were meeting proposed standards could become an integral part of service review and development.

A significant area of discussion during the interviews was the actual process for implementation, whilst service were advised that this was an area that had yet to be decided all involved had a similar view that it was critical that implementation was not left to "local arrangements".

There was strong support for an "independent body" and for "some sort of inspections and written report given to the service with specific recommendations". Those services that have had experience of bidding for funding or have fixed term funding thought such a process would help them with funding. There was strong support for the implementation process to be seen as an opportunity for service to demonstrate what they did well but that if areas for improvement were identified that they should be given a set time to do so. A number of services did comment that the standards as currently written "should be seen the minimum required for a publicly funded service". This is not to say that meet the standards would not be a challenge but that it was viewed as a welcome challenge.

The frequency and transparency of the checking process of whether services met standards was discussed. This was linked to discussion about current funding arrangements for example, it was stated that there was a need to link an evaluation as to whether services met standards with the length of funding. However most services felt that the implementation process could involve a number stages including self-evaluation, peer evaluation, local stakeholders, and independent evaluation.

On the subject of acceptance and recognition of standards all felt that it was imperative that the standards were accepted by all funding bodies and that documenting as to how they are met should not result in duplication of and reports. It was also stated that perhaps the implementation of standards would be seen as an opportunity to streamline reporting arrangements and "get rid of having to provide the same information in six different ways, to six different timetables and not get any feedback from any of them".

Conclusion

This exercise was undertaken primarily to assess the how services interpreted the draft quality standards for drug and alcohol services and how would service "prove" whether they met them. A secondary issue was how service providers would perceive the actual process.

In Forth Valley the services involved viewed the development of draft quality standards as rectifying a significant gap in overall service provision. Most services saw the implementation of the standards as an opportunity to "prove that they were providing a good service". Concern was expressed as to whether the "process and way of comparing each service against the standards really will be fair". This does reflect a certain degree of cynicism about how services are currently viewed and the belief that there "different rules for different services, a pecking order of services.

It will be for all involved to ensure that such fears do not become reality.

Forth valley substance action team logo

Quality Standards for Drug & Alcohol Services - Checklist

The following checklist is provided to assist you in gathering appropriate documentation to evidence that your service meets the standard statements as stated.

Some documents will meet the needs of more that one statement. In each case where a document is requested it will be necessary to explain the review process and frequency and service user involvement.

Standard Statement 1 : You will be provided with all the information you need to help you decide about using this service.

The Scottish Government

Publications

On this page:

Draft National Quality Standards for Substance Misuse Services - Report on Pilot Projects

2 Forth Valley Substance Action Team Pilot Project Report