2013-16 Service Specification September 6Th V9

2013-16 Service Specification September 6th v9

Cornwall & Isles of Scilly Community Alcohol & Drug Service Specification

Adults 2013-2016

Reducing Harm, Promoting Recovery

A Drug and Alcohol treatment system that: 1. is simple for people to access;

2. has a clear range of pathways, options and choices that are easy for people to navigate;

3. is delivered through co-ordinated partnership working, and 4. achieves positive outcomes by supporting recovery and community integration for service users, children, families and local communities.

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2013-16 Service Specification September 6th v9 Service Specification No.

Service Provision of Community Adult Drug and Alcohol Recovery and Treatment Service Commissioner Lead

Provider Lead

Period April 2013-March 2016

Date of Review March 2014

Purpose NHS Cornwall (CIOSPCT) is tendering an outcome focused, recovery oriented, community alcohol and drug treatment system (the Service) on behalf of the CIOS Drug and Alcohol Action Team (CIOSDAAT) partnership. The DAAT commissioning functions are currently based within NHS Cornwall and will be transferring to Cornwall Council in April 2013. This service specification has been developed with key stakeholders of the partnership. The drug and alcohol tender process provides the opportunity to establish a fully integrated and comprehensive, recovery-orientated system in CIOS; ensuring value for money and the delivery of continuous improvements in recovery outcomes and harm reduction. This is in line with national strategies and other policy directives.

The provider will submit a service design that will deliver outcomes for 2013/14 and beyond and will provide monthly performance management information of the highest quality that demonstrates progress towards achievement of these outcomes.

Local commissioners want to procure a system model which is sensitive to the different needs of Service Users in CIOS. The service should deliver evidence based interventions that are recovery focused for both drug and alcohol users, and which take into consideration the transfer of care between the community and prisons as well as effective transition between Young People’s and Adult Treatment services.

The commissioner requires a service which places service users at its core and embeds a culture of active and inventive methods of service user involvement which permeates service delivery. The service will embody an ethos of ambition for individual success and demonstrate a proactive approach and entrepreneurship in developing opportunities for individual success and sustainable recovery.

This specification will be reviewed regularly and may need to be amended dependant on changes in national policy, identification of changing local need, change in best practice and changes to financial allocations. The provider must be prepared to enter into negotiations with the commissioner if such changes are required and allow for variation of this specification as a result.

Unforeseen situations may emerge which have not been planned for or included within the service specification and the provider may need to work beyond the remit of this specification to ensure that

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2013-16 Service Specification September 6th v9 a service users’ health needs are fully met. These incidences should be reported to the commissioner to inform future service specification development.

1. Strategic Context:

1.1 National Context

1.1.1 The national Drugs Strategy 20101 has two overarching aims with regard to treatment:  Reduce illicit and other harmful drug use, and  Increase the numbers recovering from dependence.

The strategy describes the elements of recovery:

‘Recovery involves three overarching principles – wellbeing, citizenship, and freedom from dependence. It is an individual, person-centred journey, as opposed to an end state, and one that will mean different things to different people. We must therefore, put the individual at the heart of any recovery system and commission a range of services at the local level to provide tailored packages of care and support. This means that local services must take account of the diverse needs of their community when commissioning services’ ‘One of the best predictors of recovery being sustained is an individual’s ‘recovery capital’ – the resources necessary to start, and sustain recovery from drug and alcohol dependence. These are:  Social capital - the resource a person has from their relationships (e.g. family, partners, children, friends and peers). This includes both support received, and commitment and obligations resulting from relationships;  Physical capital - such as money and a safe place to live;  Human capital – skills, mental and physical health, and a job; and  Cultural capital –values, beliefs and attitudes held by the individual.

In order to deliver recovery-oriented services, there is an acknowledgment that links with housing, employment and family services must be firmly established and integrated into overall treatment services and that supportive relationships with families, carers and social networks must be promoted’. The strategy includes working with alcohol dependence and also covers new plans for monitoring the performance of drug treatment services.

11 ‘Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life’, Home Office, 2010http://www.homeoffice.gov.uk/publications/drugs/drug-strategy/drug- strategy-2010?view=Binary

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1.1.2 Recovery Orientated Drug treatment- an interim report (NTA 2011) 2

The report by John Strang, chair of the Expert Group formed “to provide guidance to the drug treatment services on the proper use of medications to aid recovery and on how to care for those in need of effective and evidence-based drug treatment is more fully orientated to optimise recovery.”

1.1.3 Medications in Recovery. Re-orientating drug dependence treatment NTA (2012)3

Provides a framework for meeting the ambition of the Drug Strategy 2010 to help more heroin users to recover and break free of dependence.

1.1.4 The national Alcohol Strategy 20124 adds the following aims: . A change in behaviour so that people think it is not acceptable to drink in ways that could cause harm to themselves or others;  A reduction in the amount of alcohol-fuelled violent crime;  A reduction in the number of adults drinking above the NHS guidelines;  A reduction in the number of people “binge drinking”;  A reduction in the number of alcohol-related deaths; and  A sustained reduction in both the numbers of 11-15 year olds drinking alcohol and the amounts consumed.

1.1.6 The Drug Interventions Programme (DIP) is a key part of the government's strategy for tackling drugs and reducing crime which seeks to facilitate access to help at any point in the criminal justice system. This has been extended to allow the inclusion of alcohol and drugs other than Class A. 1.1.7 Integrated Offender Management (IOM) the TurnAround project is the overarching framework that allows local and partner agencies to come together to ensure that the offenders, whose crimes cause the most damage and harm locally, are managed in a coordinated way.

1.1.8 The Troubled Families Programme In 2011, the governement unveiled plans for a Troubled Families proramme5 for families with ‘serious problems’ including parents not working, mental ill health and children not in school, and causing crime and anti-social behaviour. In March 2012 the DCLG’s announced The Troubled Families programme: Financial framework for the payment-by-results scheme for local authorities.

1.1.6 National Outcomes – Public Health Outcome Framework

2 http://www.nta.nhs.uk/uploads/rodt_an_interim_report_july_2011.pdf

3 http://www.nta.nhs.uk/uploads/medications-in-recovery-main-report.pdf

4 http://www.homeoffice.gov.uk/publications/alcohol-drugs/alcohol/alcohol-strategy?view=Binary

5 ‘Tackling Troubled Families: New Plans Unveiled’, available at www.number10.gov.uk/news/tackling-troubled-families-new-plans- unveiled

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2013-16 Service Specification September 6th v9 CIOS DAAT has responsibility for delivering against the following 3 national outcomes locally:

“Successful “Reducing Alcohol- “Identifying people entering prison with completion of drug related admissions to substance dependence issues who are and alcohol hospital” previously not known to community treatment” treatment and engaging them in Public Health Domain treatment” Public Health Domain 2.18 2.15 Public Health Domain 2.16

CIOS DAAT also contributes to the delivery of :

1.8 Securing employment for those with a long term health condition 1.11 Reducing domestic abuse 1.13 Reducing re-offending 1.15 Reducing statutory homelessness 2.8 Improving the emotional wellbeing of looked after children 2.10 Reducing hospital admissions as a result of self-harm 2.23 Self-reported wellbeing 4.3 Reducing Mortality from causes considered preventable 4.8 Reducing mortality from communicable diseases 4.6 Mortality from liver disease 4.10 Preventing suicide 4.11 Reducing emergency re-admissions within 30 days of discharge from hospital

1.2. Local context:

1.2.1 Alcohol

The three objectives of the Cornwall and Isles of Scilly alcohol strategy are to:

1) Enable people to make informed choices about alcohol. 2) Increase services to reduce harm caused by alcohol. 3) Create partnerships to reduce alcohol’s impact on the community.

 Of the total 441,000 population aged 16 and over in Cornwall, 102,000 are drinking above the recommended safe levels (just under a quarter), according to public health estimates. In addition, an estimated 66,500 are 'binge drinkers’.

 1,428 adults engaged in structured treatment in 2009/10 for alcohol as their primary problem substance, 9% of the estimated number of dependent drinkers in Cornwall.

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2013-16 Service Specification September 6th v9 1.2.2 Local Context – Drugs

 The latest figures estimate that there are between 2,100 and 2,500 opiate and / or crack users (OCUs) in Cornwall and the Isles of Scilly, with a mid-point estimate of 2,285.  The estimated unmet need (people requiring treatment but not in contact with services) is between 550 and 1,300 people.6  Drug users in Cornwall are more likely than the national average to also have a problem with alcohol.  Two thirds of parents in treatment have children living with them.  The rate at which people are discharged from treatment is lower than average and around a fifth of people in treatment have been in for 4 years or longer.  Drug use is a risk factor for a third of offenders on the Probation caseload.  Across a range of performance indicators, in 2009/10 Cornwall did not compare favourably with the South West for getting offenders into treatment. Once in treatment, however, we are successful on the whole at retaining them and successful in diverting them away from crime.

1.2.3 Cornwall Works for Families

Cornwall Works with Families is part of DWP’s European Social Fund Convergence programme to get members of workless families working together to get closer to the labour market and back into work.

1.2.4 Troubled Families

Alcohol and drug problems are key risk factors in families with complex multiple problems and vulnerabilities.

Based upon local needs assessments, the Cornwall Troubled Families Strategy Group has selected problem drinking and drug taking as one of their local indicators to be added to the national indicators for eligibility to the programme.

1.2.5 Service Users and stakeholders

CIOS DAAT undertakes an annual consultation with service users, providers, clinicians and other stakeholders as part of its needs assessment and review processes. Over the past two years, this has focussed upon how recovery oriented the local treatment system is. This process identified the following priorities for improvement:  A clearer vision of recovery and understanding of what this means by service providers  Continue to Improve Access to Treatment to attract and proactively engage people in treatment earlier, including increasing self referrals. To include clearer information about what is available and how to access  Delivering recovery and progress within treatment, increasing the range of services

63 www.nta.nhs.uk/facts-prevalence.aspx

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available, through more flexible responses to individual needs. Recovery to be made more visible to people immediately upon entry. To include: - Improved care co-ordination - Daily availability of services and interventions to support recovery - Post treatment recovery support - Service user involvement in planning , developing and reviewing services - Access to housing to support recovery 1.2.6 The Wellbeing, Early Intervention and Prevention Strategy7 is one of a series of three strategies that set out Adult Care and Support’s commissioning intentions for the next three years. The commissioning intentions identified in the Strategy include:

• Embedding Changing Lives principles pioneered by the voluntary and community sector in Cornwall. These include:  Developing services based on evidence of multiple outcomes and shared impact  Not layering solutions but working to connect local services and people together  Mainstreaming prevention throughout • Safeguarding included in procurement, contracting and monitoring • Co-producing services with the people that use and provide services • Good quality services that are innovative, outcomes focused and responsive to local need • Supporting individuals to live in their own homes in the community The strategy provides the context for supported accommodation commissioned services for young people and people with complex needs.

1.2.7 Transition Local transition policies seek to ensure that young people aged 18 & over with drug and/or alcohol problems who continue to need treatment are transferred smoothly to services for adults. Good transitional arrangements will ensure that treatments are provided consistently, with no loss of effectiveness, and that risks to the young person are minimised.

7 The Commissioning Strategies, together with more details about the Changing Lives principles, may be accessed here - http://www.cornwall.gov.uk/default.aspx?page=30592

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2013-16 Service Specification September 6th v9 2. Scope:

2.1 Aims of service

2.1.1 Aims The aims of the adult drug and alcohol treatment system are for drug and alcohol users to achieve long term abstinence from their substance of dependency and to reduce the harms associated with any other alcohol and drug use. The aims of the adult drug and alcohol treatment system are in accordance with local Prevention Strategy ‘Changing Lives’ principles that organisations should work towards to help with reducing health inequalities, tackling social exclusion, and improving community cohesion. 2.2 Objectives

2.2.1 Increase the numbers of people accessing effective treatment year on year Particularly young adults and offenders– and to facilitate earlier engagement. People entering treatment in Cornwall have historically been likely to be older than the national average and are likely to stay in treatment longer.

2.2.2 Increasing numbers who a) successfully complete treatment and b) then do not re present for at least 1 year

2.2.3 Improving outcomes for individuals, their children, families and local communities.

2.2.4 Demonstrate that the service is designed and continuously improved via effective consultations with service users, their families and other stakeholders.

2.3 Values and beliefs – Service Essentials

 Everyone has capacity to change and take control over their own lives.

 Behavioural change requires concerted effort and focus. It requires a range of internal and external resources to initiate and maintain.

 Services are ambitious for service users and for families and support them to realise their hopes and aspirations

 The service takes full responsibility for proactively engaging service users and families

 Service users are actively involved in developing and achieving their recovery care plans

 Services users are supported in any step they can take, however, small, towards their own health and wellbeing (low threshold services and harm reduction)

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2013-16 Service Specification September 6th v9  Service users are actively encouraged to support each other and increase the support they have through self help and mutual aid groups

 The service integrates learning from history (harm reduction and recovery), best evidence, and experience in order to innovate. This is a learning contract which seeks to develop new ways of working to improve outcomes as well as demonstrates the incorporation of best practice.

 The best outcomes will only be achieved through service users, providers and commissioners working in partnership with each other and partner organisations in an integrated way to deliver pathways to physical and mental health, housing and social support, employment, education and training opportunities.

 Safeguarding children and vulnerable adults are integral.

 An excellent service depends upon excellent customer care, attaining the trust and respect of service users, families and carers and other agencies involved.

 A well trained & supported workforce will impact positively on client recovery as an inspiring recovery oriented workforce.

 Training and supporting non-specialist, generic services reduces the stigmatisation of problem drinkers and drug takers and promotes their recovery through raising the awareness and ability of partner agencies

2.4 Service Outcomes

In commissioning local services, the key service outcomes for services users are:

1. Freedom from dependence on drugs or alcohol

2. Improvement in mental and physical health and wellbeing and reducing drug and alcohol related deaths

3. Prevention of blood borne viruses

4. A reduction in crime and re-offending

5. Sustained employment

6. The ability to access and sustain suitable accommodation

7. Improved relationships with family members, partners and friends

8. Improved capacity to be an effective caring parent

Equality and human rights are integral to each of these 8 areas, with implications for equitable service delivery and improved access, encompassing gender, sexual orientation,

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2013-16 Service Specification September 6th v9 disability, age, isolation, vulnerability, ethnicity, religion and beliefs.

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2013-16 Service Specification September 6th v9 3. Service description and Pathways for a Recovery Oriented System

3.1 Overview

The service model will deliver:  ‘Front end’ interventions to attract, engage and motivate people into treatment  ‘Harm Reduction’ interventions to reduce the risks associated with problematic drinking and drug taking  Recovery pathways for dependent drinkers and drug takers  Effective arrangements for transition for young people reaching 18.

‘Recovery Pathways’ will:

 Be Person Centred  Optimise and Build Recovery Capital  Be appropriately phased and layered  Be based upon individual need, aspirations and risk, the input of service users and the contribution of families/carers and other professionals where appropriate As this is a learning contract, pathways will be subject to change according to individual circumstances

The provider is strongly encouraged to be creative and to deliver added value through:

 Utilising service user experience to motivate and engage others  Providing other evidence-based interventions to improve engagement  Providing evidence of working in partnership with local voluntary/third sector providers/businesses to enhance the treatment journey of the service user  Demonstrating innovation and entrepreneurship building service user engagement in meaningful activities beyond formal interventions and developing recovery communities  Generating additional income streams to increase the resources available to support recovery and innovation

3.2 Description of Interventions/service required

The requirement is for the provider to design a service with at least the following components and consistently deliver a range of interventions for all service users in line with an individual ‘recovery plan’ based on needs, innovative solutions and risks.

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3.2.1 Local Area Single Point of Access and Information

The Service will deliver:

 The Single Point of Contact (SPOC) specifically for DIP/criminal justice, Multi Agency Referral Assessment Centre (MARAC), Employment (JobCentrePlus), Children and Families Services Multi Agency Referral Unit (MARU) and healthcare, acting as the specialist source of support and development to these organisations and teams.

 A Telephone helpline (24/7) for out of hours support and DIP access

3.2.2 Brief interventions and Harm Reduction These interventions will be delivered via open access arrangements as well as forming part of structured packages of care and will include at a minimum:

 Up-to-date and accurate advice and information on drug related harms, risk of drug related death, blood borne viruses, how to reduce and cease use and access structured treatment  General Health Assessment - Initial (triage) assessment

- Teaching and skills

 Brief opportunistic Interventions and guided self-help as described within NICE CG51  Brief Psychosocial Interventions (Including Identification and Brief Advice – IBA)

 Brief Interventions for Alcohol

In deploying alcohol specific brief interventions the provider will:

 Use validated screening tools appropriate to the setting, including: Alcohol Use Disorders Identification Test (AUDIT) and where appropriate abbreviated version such as AUDIT- Consumption (AUDIT-C).  Use recognised evidence-based resources for brief advice

Brief interventions for hazardous and harmful drinkers include:

 Advice and Information  Guided self help  Facilitated access to recovery and Alcoholics Anonymous or other mutual aid/peer support networks  Structured brief advice on alcohol for adults who have been identified via screening as drinking a hazardous or harmful amount  Extended brief (Motivational) intervention for adults who have not responded to structured brief advice or who may benefit from an extended brief intervention.

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2013-16 Service Specification September 6th v9 3.2.3 Other Open Access services

 Advocacy

 Peer Mentoring

 Mutual Aid

 Recovery Support

 Area-wide Safer Injecting Needle and Syringe Scheme (fixed site and outreach/detached meeting the level 3 criteria as specified within NICE PH18: Needle and Syringe Programmes).

 Wound care  Overdose prevention and basic life support  Referral/engagement into effective structured treatment

 Family support

 Access to interventions to reduce Blood Borne Viruses to include the offer of Hepatitis B vaccination and test for Hepatitis C and treatment if required

3.2.4 Criminal Justice interventions

For Integrated Offender Management ( IOM) :

 Delivering tier 2 interventions for the TurnAround (IOM) project  Deliver drug and alcohol arrest referral in custody suites and courts  Enhanced Care Co-ordination for IOM/DIP/CJIT cases  Addressing offending behaviour by ensuring appropriate services are offered  Co-ordination of housing referrals for IOM cohort  Manage individual budgets for IOM cohort

For Offender Management not IOM:

 Delivering Tiers 2 interventions for offenders subject to statutory controls  Deliver drug and alcohol arrest referral in custody suites and referrals pre sentence at court  Enhanced Care Co-ordination for DIP/CJIT cases

3.2.5 Marketing regarding access needs to be both universal and targeted, including:

• Clear engagement strategies • Minimal bureaucracy • Flexible approaches

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2013-16 Service Specification September 6th v9 • Tier 1 professionals to be aware of services • Tier 1 professionals should be able to provide advice or brief interventions where possible • Range of services in a single setting • Outreach and home visits for the most vulnerable • Services need to be local • Supported access

3.2.6 Structured Community Specialist Alcohol and Drug Treatment

The provision of care co-ordination, case management arrangements and care-planned interventions that meet the threshold for structured drug and alcohol treatment, determined following comprehensive assessment for the purpose of stabilisation, detoxification and recovery.

It is expected that a clear set of integrated pathways and care co-ordination approaches are in place and that systems exist to ensure their efficiency and effectiveness including clinical audit. NICE guidance, the International Treatment Effectiveness Project (ITEP), the Birmingham Treatment Effectiveness Interventions (BTEI) and the new national recovery skills framework describe the structured psychosocial interventions that best contribute to effective treatment. This contract specifies expectations with regard to the delivery of these interventions as part of individualised recovery packages.

The principals which should underpin this approach are:

 Comprehensive Assessment of individual need (and effectively respond to needs that arise from any protected characteristics, such as age, gender identity, disabilities [including mental health, learning disabilities, visual and hearing impairments], sexual orientation, culture, language needs [including British Sign Language and Easy Read], religion/ belief, pregnancy/ maternity and family circumstances)  Collaboratively planning the individual service user led Recovery Journey  Risk Assessment and Risk Management of individual Recovery Pathways  Organisation of resources for the individual recovery journey internal and external to the “Treatment System”  Oversight of the arrangements for the individual recovery journey and ensuring that the available and relevant treatment interventions as well as support services/activities are in place over time, at the appropriate time.  Review the recovery plan using the Treatment Outcomes Profile to monitor individual progress on a regular basis  Agree (planned) treatment completion with the service user  Discharge of care upon completion of After Care

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2013-16 Service Specification September 6th v9 3.2.7. Formal Psychosocial Interventions and Community Rehabilitation To be delivered as part of individual recovery care plans and in support of the ‘Home & Dry’, Community Hospital Alcohol Detoxification (CHAD) and Drugs Misuse LES schemes.8

The suite of interventions deployed will be appropriate and as defined within: Routes to Recovery: Psychosocial Interventions for Drug Misuse and NICE CG 51: Drug Misuse Psychosocial Interventions; and NICE Guideline CG115: Alcohol Use Disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. Interventions will be delivered in one to one and group settings or as part of a ‘structured day programme’ and will include:

 psychosocial interventions which form the mainstay of the recovery plan  psychosocial interventions delivered as part of a wider treatment package (including for service users who are currently using substances, accessing prescribed interventions or abstinent)  Pre-detox and Preparation for Change Groups  Post Detox Support Groups  Interventions and liaison that specifically secure specialist housing and accommodation, employment, training and education input.

The provider will ensure that they have a suitably skilled, balanced and qualified clinical workforce to:

 Meet the general healthcare needs of service users  Meet the common mental health problems of service users  Manager complex cases of co-morbidity particularly Dual Diagnosis

Where appropriate, and where the client consents, we expect that the provider would have appropriate mechanisms in place to engage family members/carers/social support networks within the treatment approach.

3.2.8. Pharmacological and Medical Interventions

Medication to support behaviour change and abstinence from drugs is a necessary component of treatment for many but medication alone is unlikely to be sufficient to support an individual achieving recovery. These interventions must be delivered alongside discreet formal psychosocial interventions and in accordance with Drug Misuse and Dependence: UK Clinical Guidelines for the Management of Substance Misuse and the applicable NICE Guidelines and Technological Appraisals.

These will include:

 Appropriate methods for initial confirmatory and ongoing drug testing (e.g. urinalysis)  Medical and Non-Medical Prescribing

8 CIOS Drugs Misuse LES

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2013-16 Service Specification September 6th v9  Opioid maintenance (appropriately risk managed and reviewed longer term prescribing)  Opioid detoxification  Naltrexone for relapse prevention  Benzodiazepines (for short term symptomatic relief of opioid withdrawal and Benzodiazepine detoxification)  Pharmacological treatments for stimulant dependence  Naloxone (in conjunction with training to identify and intervene in opioid overdose situations)

The provider will provide facilities for the initiation of supervised consumption as well as working alongside pharmacies contracted by the Provider to ensure supervised consumption of Opioid Substitution Therapy where indicated.

In delivering Opioid Substitution Therapy it is expected that the provider will employ protocols which assure an appropriate and risk managed balance between maintenance and timely detoxification; these protocols will reflect the key recommendations of Recovery Orientated Drug treatment- an interim report (NTA 2011) and Medications in Recovery (NTA, 2012).

The provider will also employ protocols for the safe prescribing of benzodiazepines (and ‘Z’ drugs) as well as well as other prescribed medications including for Alcohol withdrawal.

Interventions for dependent drinkers will be delivered appropriate to individual need described within the CIOS Stepped Approach to Alcohol Detoxification and without exception alongside an appropriate psychosocial interventions; in accordance with NICE CG115 for individuals with a moderate or severe Alcohol dependence requiring assisted withdrawal; and where appropriate relapse prevention medication. These interventions will include:

 Short term Detoxification medication  Induction onto Anti craving medication - Acamprosate  Relapse prevention medication; Naltrexone or Disulfiram

3.3 Family Interventions

Specifically accepting referrals and providing consultancy advice to Cornwall Works for Families, Children and Families Services, and the Troubled Families programme. To include:

 Delivery of an accredited Parenting programme

 Family Interventions where one or more member is affected by problematic drinking and drug taking

3.4 Residential interventions (Tier 4)

3.4.1 Assessment, Stabilisation and Withdrawal

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2013-16 Service Specification September 6th v9 The provider will ensure timely referral to provision of 24 hour care for those individuals assessed as having appropriate need (and for opioid users meeting the criteria outlined in NICE CG52 and dependent drinkers assessed as meeting the criteria outlined in nice CG115) who require inpatient assessment, detoxification or stabilisation as part of an integrated treatment system. It is also for substance misusers who are sufficiently severe and/or complex that they require brief medical, psychiatric and psychological care.

3.4.2 Residential Rehabilitation (Residential Rehabilitation placement budget is not part of tender)

The provider will ensure the delivery of:  Community Care Assessment for those individuals identifying Residential Rehabilitation within their Recovery Plan  Referral for financial assessment  Referral and presentation to Tier 4 panel for financial decision  Group or individual programme of preparation for Residential Rehabilitation  Care Coordination for those referred for and receiving Residential Rehabilitation Interventions to maximise the gains of residential treatment options and minimise unplanned exits from treatment  Ongoing Care Coordination for those exiting Residential Rehabilitation who are either re- entering treatment or moving into Aftercare interventions

3.5 Employment Related Support

Will be delivered (including in conjunction with partner agencies or other community resources identified by the provider) in one to one and group settings, may form part of a structured day programme and will include:

 Effective liaison with Job Centre Plus and local employment support organisations  Support service user engagement with the ‘Work Programme’  Identification and promotion of volunteering opportunities  Employment skills training and development (e.g. Life Skills, job search, CVs)  Unemployment Benefits advice and advocacy  Access to education and training opportunities  Including ‘Cornwall Works for Families’  Support for service users with the changing landscape of Welfare reform and its associated requirements

3.6 Recovery Support

The provision of effective recovery support will be a critical component of the service and a means of promoting and enabling independence and sustained recovery.

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2013-16 Service Specification September 6th v9 We invite the provider to be innovative in developing methods and models of meaningful re- integrative activities and community based support mechanisms and networks.

In forming the recovery support package the provider will deploy a range of interventions in a one to one or group setting, to support reintegration and sustained recovery for clients successfully completing structured treatment; and at a minimum will include:

 Brief interventions for Relapse Prevention  Employment related support  The essential elements of housing related support  Access to housing (including with support)  Mutual Aid and peer support

3.7 Criminal justice Interventions

In addition to the general expectation that the provider will engage with each individual to reduce their offending behaviour linked to their drug and alcohol use the provider will be required to provide a specific service for the Turnaround Integrated Offender Management [IOM] & Drug Intervention Programme [DIP], the Drug Rehabilitation Requirement [DRR] and the Alcohol Treatment Requirement [ATR]. This will also apply to any future requirements or specific services that may be introduced via changes to a Criminal Justice Act, by the Home Office, by the Ministry of Justice or the Police and Crime Commissioner. The provider will be required to work in partnership with Criminal Justice agencies, [Devon and Cornwall Probation Trust and Devon & Cornwall Police] to accept referrals and deliver the following:

3.7.1 Community Based Criminal Justice Interventions [IOM/DIP]

The requirement is to provide sufficient drug and alcohol workers/case managers to work within the IOM Unit to provide a service in line with the DIP operational Handbook for IOM cases. These workers will be required to provide assessment, assertive engagement and referral within custody suites and courts in Cornwall, case manage non statutory drug/alcohol IOM cases and case supervise statutory cases as required by the Offender Managers in the IOM Unit to achieve the aims and objectives of TurnAround in Cornwall IOM .

DIP/IOM case managers staff will be required to be vetted to police standards and trained to use police and probation IT systems and committing to information sharing to meet the objectives of the Crime & Disorder Act.

3.7.2 Drug Rehabilitation requirement [DRR]

The DRR is a requirement of a Community or suspended sentence order. The purpose is to reduce offending by providing interventions for cases sentenced by the Court which have a link between drug misuse and offending.

The service will provide suitable assessment and interventions in line with all other requirements in this specification for all DRRs made by the Courts. Based on analysis of previous years this is

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2013-16 Service Specification September 6th v9 estimated to be a maximum of 80 commencements per year

3.7.3 Alcohol Treatment Requirement (ATR)

The ATR is a requirement of a Community or suspended sentence order. The purpose is to reduce offending by providing interventions for cases sentenced by the Court which have a link between alcohol misuse and offending.

ATRs will be proposed to the Court by Offender Managers for offenders found guilty of any offences where alcohol dependency is a significant background factor, with the offender's Audit score being 25 or above.

The service will provide suitable care planned treatment interventions following an assessment during a court adjournment, with a final referral by the Offender Manager after the order is made by the Court. This is in line with national guidance and all other requirements in this specification for all ATRs made by the Courts.

In 2010-11 there were 32 recorded commencements, and 7 completions. There is no reason to anticipate a reduction in referrals though the probation service expectation is for 10 commencements in 2012/13.

3.8 Blood Borne Virus Service

3.8.1 Immunisations

All patients in treatment should be offered access to immunisation for Hepatitis A and B. 90% of patients who have ever injected should be immunised or have received a full course of immunisations within the last 5 years.

3.8.2 Testing

Anyone with any history of injecting or at high risk of Hepatitis C should be provided with access to Hepatitis C testing. All should be offered access to Dry Blood Spot Testing (DBST). 90% of patients should be tested within 12 months of entering treatment.

Patients should be offered a re-test every 6 months following a negative result, and be given harm reduction advice prior to undertaking a test.

For those patients who are not engaged in structured treatment, DBST will be available in needle exchange pharmacies in the county.

The costs of testing are not within the budget for this tender.

3.8.3 Treatment

 A GPwSI and NMP-led Hepatitis C treatment service offering prescribed treatment for those

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2013-16 Service Specification September 6th v9 identified as suitable to undertake this option by the MDT in Gastroenterology at RCHT or Derriford Hospitals.

The service will:  co-ordinate immunisation and testing programmes within the treatment system  work with patients who have a positive BBV test to prepare for access to treatment  work directly with Gastroenterology at RCHT and Derriford to offer prescribed treatment for Hepatitis C at locations across the county as NMPs, with the priority of engaging those who find it hard to access existing services and facilitating successful completion of treatment.

3.9 Mutual Aid, Support and Mentoring

The provider will foster a culture of ‘mutual aid’ and peer support at every point of delivery. The provider will deploy effective methods of developing this principal to generate ‘recovery communities’.

The provider must deploy at a minimum:  Provision of an area-wide recovery programme  Facilitated access to mutual aid networks and fellowships such as Alcoholics Anonymous and Narcotics Anonymous  Provision of premises for the purpose of support group/fellowship meetings  Suitably trained, supported and supervised peer mentors at all delivery sites and within this develop and maintain Recovery Champions

3.10 Reducing Drug Related Deaths Initiatives

An essential aspect of the service is to reduce drug and alcohol related deaths locally. This includes a range of activity to manage and minimize the risk of deaths with other services, service users, families and carers:

 Advice and information to service users and their families (and accommodation projects in particular)

 Ensuring the high quality of risk assessments, risk management and information sharing

 Implementation of learning from previous drug and alcohol-related deaths, particularly in confidential enquiries

 Participating in drug and alcohol-related death reviews

 Ensuring all service users and family members are trained in Basic Life Support and Overdose preventions

 Naloxone for opiate users and their families and carers

 Participating in annual campaigns organised locally

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2013-16 Service Specification September 6th v9 4. Accessibility/Acceptability:

4.1 Population covered

Residents of Cornwall and Isles of Scilly aged 18 years of age and over concerned about their own or someone else’s drinking or drug taking.

Transition plans for young people in specialist alcohol and drug services from the age of 17.

4.2 Referral route

 Referrals can be made by telephone, face to face or in writing electronically. An initial assessment will be undertaken to establish needs for structured treatment within 5 working days.

4.3 Any acceptance and exclusion criteria

 Pregnant women will be care co-ordinated through the Specialist Midwife service (Substance Misuse).

Anyone who does not meet the eligibility criteria for structured treatment but requires assistance can access tier 2 interventions and will be signposted to other services that can help

4.4 The full range of interventions will be available in each of the 4 localities (West Cornwall, North & East, Central and Isles of Scilly) and the 2 IOM hubs (West Cornwall and St Austell) at a minimum.

4.5 Interventions to continue to be available on a sessional clinic basis through GP surgeries (see MOI).

4.6 This is a learning contract which seeks to establish how best to:

 Increase the accessibility of the treatment system and engage hitherto underserved groups of people, in particular women, people with children, LGBT people, people with learning difficulties, people from local BME backgrounds and meeting the challenges of rural communities and poor transport infrastructure within CIOS.  Support recovery and reduce the rate of relapse and representation

4.7 Days/Hours of operation

This is a 52 weeks per year service which should be available weekdays and for at least one evening or weekend session per week per locality to meet the needs of people who cannot attend during weekdays.

4. 8 Response time & detail and prioritisation

The provider will need to demonstrate equity of access and outcomes across the protected characteristics established within the Equality Act 2010

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2013-16 Service Specification September 6th v9  Telephone contact and written referrals will be responded to within one working day.

 Admission to Structured Treatment interventions will be delivered within 21 days of referral date for those eligible.

 Timescales for transfer of young adults from young peoples’ services should be decided on the basis of the needs of the individual service user

The following should be considered as priority groups:

 Pregnant Service Users and their partner (where the partner is also currently using either drugs or alcohol)  Drug and Alcohol misusing Parents (of children under 18)  Service Users with significant physical and/or psychological co morbidity (Dual Diagnosis)  Injecting drug users  Ex-prisoners re-entering the community from prison  Sex workers  Prolific and or offenders posing a high risk to others (including MAPPA)

4.9 Marketing and Communications

The Provider will ensure that they implement a comprehensive communications strategy to support service design and delivery, detailing how they will respond to the full range of communication requirements including a response to general enquiries, on-going care management issues and the handling of crisis/emergency situations.

The Service Provider is expected to implement a range of communication methods including the use of technology as a means of underpinning effective service delivery.

5. Discharge and recovery planning

5.1 Discharge and recovery planning commences at the start of treatment and continues throughout.

5.2 All service users participate in the drawing up of their recovery care plan to meet their treatment goals. As part of this process, a contingency plan will also be drawn up covering safety, risk, overdose prevention, harm reduction and support arrangements available to them should they leave structured treatment in an unplanned fashion. This will also cover opportunities for re-engagement and will be reviewed as part of care plan reviews.

5.3 The full range of treatment options available will be covered at Comprehensive Assessment, through the development of the individual recovery care plan and, thereafter, at each care plan review. Where other services are involved, referral will be made by the keyworker and care co- ordination arrangement agreed. Where the care is to transfer to another structured treatment

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2013-16 Service Specification September 6th v9 provider, a new keyworker will be identified and care co-ordination arrangements reviewed.

5.4 For those completing treatment in a planned fashion, referral to and support in accessing/engaging with aftercare and mutual aid groups will be facilitated.

6. Promoting Sustainable Recovery

An evidence-based approach tailored to meet the individual need of the service user. In developing a recovery care plan, the following should be available where appropriate to best meet the needs of the service user:

. Motivational Interviewing . ITEP mapping tools . BTEI . CBT interventions . Life and Social skills . Managing common mental health problems of depression, anxiety and sleep problems. . IBA for alcohol . Overdose prevention . Basic Life Support . Relapse prevention . SMART Recovery . Peer mentoring . Mindfulness

Alongside facilitated access to the following services from other providers:

. Accommodation support . Employment and training initiatives . Debt counselling . Family support . Parenting and family interventions . Couples therapy . Nutrition . Budgeting and financial management

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2013-16 Service Specification September 6th v9 7. Interdependencies with other services:

7.1 Whole System Relationships

The service will provide specialist liaison, consultancy, training and support to generic services who may be working with people experiencing alcohol and drug problems, in particular hospitals, Adult Care and Support, Children’s and Family Services, Young peoples’ services, mental health, housing, employment and education services.

Local services will work with local communities, networks and service groups to forge strong relationships to increase the support available to facilitate recovery and encourage local ownership of services. The provider care co-ordinates packages of care involving other specialist and non-specialist services and participates in delivering plans care co-ordinated by others.

Local stakeholders, including people with alcohol and drug problems, their families and other services must be involved in service planning, delivery, review and development and their views sought to improve local delivery.

The service must engage with Primary Care, Criminal Justice, Adult Care & Support, Employment and Children & Families services to deliver joint outcomes.

7.2 Interdependencies

The provider is commissioned to work closely in partnership with primary care, serving clusters of GP practices.

The delivery of a more recovery oriented system not only depends upon local community and residential providers working together as a system, but also upon good working relationships with mutual aid groups, education, training, employment, housing and mental health services in particular.

As part of the Integrated offender management project ‘TurnAround’, the provider works in partnership with probation (Offender Managers), Police, Prison Healthcare and other prison based teams.

Interagency Liaison

• Communication of care/support/risk management plans within and beyond the drug and alcohol treatment and recovery system needs to be co-ordinated • Wider needs must be acknowledged and addressed in care packages • Structural barriers to attendance/compliance need to be addressed • Liaison needs to be supported by clear and publicised care pathways, and operational protocols • Wraparound services are integral to recovery planning including housing, Education Training Employment (ETE) and positive social/leisure opportunities

7.3 Relevant networks and screening programmes

7.3.1 The Provider (s) is/are required to participate in the following:

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2013-16 Service Specification September 6th v9  Needs Assessment Expert Group

 IOM/CJIT Managers

 Electronic Case Management System (ECMS) Board/Data Quality Forum

 Prescribing & Pharmacy Group

 Providers Forum with local residential provider

 Drug Related Deaths Review Panel

 Controlled Drugs Intelligence Network

 Peninsula and Regional Criminal Justice intelligence Network

 Treatment Task groups, as required

 Screening programmes

 Identification and brief Advice (Alcohol)

 Dry Blood Spot testing for blood borne Viruses (BBV)

 Hepatitis B vaccination programmes.

8. Applicable Service Standards:

8.1 Applicable national standards

8.1.1 Drugs  Models of Care (2002) and Models of Care Update (2006): http://www.nta.nhs.uk/uploads/nta_modelsofcare_update_2006_moc3.pdf  Clinical Governance in Drug Treatment (2009): http://www.nta.nhs.uk/uploads/clinicalgovernance0709.pdf  Care Quality Commission’s Essential Standards of Quality and Safety (2010) http://www.cqc.org.uk/_db/_documents/Essential_standards_of_quality_and_safety_March_2010_FINAL.pdf  The Drug misuse and dependence UK guidelines on Clinical Management (2007) http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf  NICE Guideline CG51: Drug Misuse – Psychosocial Interventions http://publications.nice.org.uk/drug-misuse-cg51  NICE Guideline CG52: Drug Misuse – Opioid Detoxification http://publications.nice.org.uk/drug-misuse-cg52  Routes to Recovery, (Psychosocial Interventions in Substance Misuse) a framework and toolkit for implementing NICE recommended treatment interventions; the National treatment Agency for Substance Misuse http://www.nta.nhs.uk/uploads/psychosocial_toolkit_june10.pdf  NICE Technological Appraisal TA114: Drug Misuse – Methadone and Buprenorphine http://publications.nice.org.uk/methadone-and- buprenorphine-for-the-management-of-opioid-dependence-ta114  NICE Technological Appraisal TA115: Drug Misuse – Naltrexone http://publications.nice.org.uk/naltrexone-for-the-management-of- opioid-dependence-ta115

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2013-16 Service Specification September 6th v9  NICE Guideline CG110: Pregnancy and Complex Social Factors http://publications.nice.org.uk/pregnancy-and-complex-social-factors- cg110  NICE Guideline CG120: Psychosis with Coexisting Substance Misuse http://publications.nice.org.uk/psychosis-with-coexisting- substance-misuse-cg120  NICE Public Health Guidance PH18: Needle and Syringe Programmes http://publications.nice.org.uk/needle-and-syringe-programmes- ph18  NICE Public Health Guidance PH37: Tuberculosis – Hard to Reach Groups http://publications.nice.org.uk/identifying-and-managing- tuberculosis-among-hard-to-reach-groups-ph37  Towards successful treatment completion: A good practice guide; NTA 2009 http://www.nta.nhs.uk/uploads/completions0909.pdf  Reducing Drug Related Deaths: Guidance for drug treatment providers. NTA 2004 http://www.nta.nhs.uk/uploads/nta_guidance__for__drug__treatment__providers_drdpro.pdf  Supporting and Involving Carers: a guide for commissioners and providers NTA 2008 http://www.nta.nhs.uk/uploads/supporting_and_involving_carers2008_0509.pdf  The NTA overdose and Naloxone training programme for families and carers http://www.nta.nhs.uk/uploads/naloxonereport2011.pdf  Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers. Royal College of Psychiatrists and Royal College of General Practitioners, London, Council Report CR131 http://www.rcpsych.ac.uk/files/pdfversion/cr131.pdf  Medications in Recovery – Re-orientating Drug Dependence Treatment, NTA 2012 http://www.nta.nhs.uk/uploads/medication-in- recovery-main-report.pdf

In addition the provider will be expected to accept and adopt relevant updates to existing guidance as well as new guidelines as and when issued.

8.1.2 Criminal Justice . The Ministry of Justice National Offender Management System Drug Strategy 2008 – 2011 . http://www.justice.gov.uk/publications/noms-drug-strategy-2008-2011.htm . Drug Misusing Offenders: Ensuring the continuity-of-care between prison and community (2009) . http://webarchive.nationalarchives.gov.uk/20100419081707/http://drugs.homeoffice.gov.uk/drug-interventions- programme/guidance/continuity-of-care/ . The DIP Operational Handbook (2009) http://www.nta.nhs.uk/uploads/dip_operational_handbook.pdf . Probation Circular 57/2005 Effective Management of the Drug Rehabilitation Requirement and Alcohol Treatment Requirement . National Standards for the Management of Offenders 2007. Standards and Implementation Guidance

8.1.3 Alcohol . Local Routes: Guidance for developing alcohol treatment pathways (2009) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4136806 H_110423 . ‘Signs for Improvement – commissioning interventions to reduce alcohol-related harm’ (Department of Health, 2009) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_102813 . NICE Guideline CG115: Alcohol Use Disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence . http://publications.nice.org.uk/alcohol-use-disorders-diagnosis-assessment-and-management-of-harmful-drinking-and-alcohol-cg115

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2013-16 Service Specification September 6th v9 . NICE Guideline CG100: Alcohol Use Disorders: physical complications . http://publications.nice.org.uk/alcohol-use-disorders-diagnosis-and-clinical-management-of-alcohol-related-physical-complications- cg100 . NICE Public Health Guidance PH24: Alcohol-use disorders – preventing the development of hazardous and harmful drinking . http://publications.nice.org.uk/alcohol-use-disorders-preventing-harmful-drinking-ph24 . Models of Care for Alcohol Misuse (2006) http://www.alcohollearningcentre.org.uk/_library/BACKUP/DH_docs/ALC_Resource_MOCAM.pdf (esp. p20-23)

8.1.4 Other  Safeguarding the children of drug misusing parents. (2008, NTA) www.nta.nhs.uk/areas/treatment_planning/treatment_plans_2009_10/docs/safeguarding_the_children_of_drug_misusing_parents_1 208.pdf  Outcomes of Waiting Lists Study (OWLS) (2005,NTA)  Waiting times guidance. (2006, NTA) www.nta.nhs.uk/areas/waiting_times/guidance.aspx  Mental health policy implementation guide. Dual diagnosis good practice guide. (2002, Department of Health) www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009058  Routes to recovery part 2. The ITEP manual: delivering psychosocial interventions. (2009) www.nta.nhs.uk/publications/documents/itep_routes_to_recovery_part2_180209.pdf  Routes to recovery part 5. The BTEI exiting treatment manual: mapping achievable goals. (2009, NTA) www.nta.nhs.uk/publications/documents/itep_routes_to_recovery_part5_240309.pdf  Routes to recovery part 6. The BTEI building motivation manual: enhancing a style of working. (2009, NTA) www.nta.nhs.uk/publications/documents/itep_routes_to_recovery_part6_240309.pdf  Good Practice in Harm Reduction, (2008,NTA)  Drugs and Alcohol National Occupational Standards (DANOS)www.alcohol-drugs.co.uk/DANOS.htm Skills for Health.  Workforce development. (2009, NTA) www.nta.nhs.uk/areas/workforce/default.aspx  Substance Misuse Skills Consortium http://www.skillsconsortium.org.uk

 General Healthcare Assessment, NTA 2006  Drug Misuse and Dependence. UK guidelines on Clinical Management, DH 2007  Drug misuse Psychosocial Interventions. National Institute of Health and Clinical Excellence clinical guidelines 51, July 2007.  Care Planning Practice Guide, NTA 2006.

8.2 Applicable local standards

8.2.1 Quality Assurance and Governance Arrangements The service provider/s will have in place appropriate structures with which to continuously improve the quality of the service, safeguard high standards of care, and create an environment in which excellence can flourish. The service will have in place the following structures either as stand alone or as part of a clinical governance or quality assurance policy and will at a minimum include:  Established clinical and operational standards in the form of service policies which cover all main aspects of the service  A staffing structure whereby all staff receive advice, support, training, clinical guidance and supervision, appropriate to their role within the organisation, from suitable qualified, experienced individuals  A system to ensure that all staff receive an appropriate induction in terms of the values, philosophy, aims and objectives, culture of the organisation and their own role and function within it  A system in place where all staff and managers have opportunities to develop at a personal and professional level  A documented system of risk assessment and risk management

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Clinical governance which specifically pertains to the management of controlled drugs, as defined within the Misuse of Drugs Act, the service will at a minimum have the following:

 Registration with the Care Quality Commission as an Independent Healthcare Provider and meeting all requirements pertaining to the registration  A lead clinician with suitable training, skills and experience to provide clinical advice, supervision and leadership to the: o GPs with A Special Interest (GPwSIs) and other medically trained staff employed or contracted to work directly with the service. o Supplementary and or non-medical prescribers employed or contracted to work directly with the service. o A system of reviewing specific areas of clinical practice and its effectiveness through a clinical audit. o A process, agreed with the CIOS Lead Pharmacist for reporting errors and incidents concerning medication prescribed by the service.

8.2.2 Safeguarding Children and Hidden Harm

All services (including services specifically for adults) have a duty of care towards children as part of the Children Act 1989. Section 11 of the Children Act (2004) outlines a ‘duty to co-operate’ amongst key people and bodies to promote the welfare of children.

The provider will appoint a Safeguarding Lead; they will possess the appropriate knowledge and skills to fulfil the role. They will be a senior manager within the organisation and they will be Single Point of Contact for all Relevant matters.

The provider will ensure that standard operating procedure requires that the service actively seeks to identify service users with a parental responsibility and who are in frequent contact with children (under 18). When working with substance misusing parents the child’s welfare is the paramount consideration.

The Provider will agree to work within the bounds of the CIOS Joint Protocol Parental Substance Misusing Parents and will adopt and deploy the agreed screening tools prescribed within.

The provider will ensure that in the provision of the service it will deploy screening, risk assessment (and risk management) tools which effectively identify parental substance misuse and the potential impact on their parenting and risk to the child.

The provider will work with the Troubled Families Group to develop and deploy a Care Pathway for Adult Substance Misusers who have contact with children and a Care Pathway for the Impact of Parental/Adult Substance Misuse on the child.

The provider will follow local protocols in instances where there are concerns about a child’s care, development or welfare, to enable proper assessment of the child’s circumstances.

It is expected that where there are concerns that a child may be suffering significant harm, or may be likely to, will always override a professional or agency requirement to keep information confidential. The provider will ensure that workforce development plans incorporate Safeguarding and Child Protection Training for all relevant to staff role.

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Further information regarding the Cornwall Safeguarding Children Board including policies, protocols and training schedules can be found at: www.safechildren_cios.co.uk Guidance on how agencies should work together is set out in Chapter 3 of Working Together to Safeguard Children 2010. All agencies have a duty to comply with the South West Child Protection Procedures (http://www.swcpp.org.uk/

8.2.3 Safeguarding Adults

A Vulnerable Adult, is defined as anyone who is 18 years or over;

“Who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, against significant harm or exploitation” (No Secrets, DoH 2000).

The provider will ensure that their policies and procedures are linked with the CIOS Safeguarding Adults Multi-Agency Policy and Procedures; which can be found at www.cornwall.gov.uk safeguarding adults information for professionals.

The provider will have a Policy on Abuse with robust procedures on how to deal with alleged or suspected cases of abuse, regarding both the person experiencing the abuse and the perpetrator. The provider will include in their Policy on Abuse an adherence to the CIOS Safeguarding Adults Multi Agency Policy and procedure.

The provider will include in their Policy on Abuse that any incidence of alleged or suspected abuse must be reported to the Safeguarding Adults Team and commissioners.

The provider will ensure that all members of staff cover Protection from Abuse, Code of Conduct and Professional Boundaries and whistleblowing in their Induction programme.

The provider will ensure that members of staff involved with Care/Support/education delivery are adequately trained in Protection from Abuse and receive on-going training on a regular basis.

The provider will have and issue a Service User handbook or leaflet (or other appropriate format) that includes a section on Abuse, explaining the types of abuse and giving examples of what may constitute abuse, in an appropriate language and format for that particular client group.

The provider will ensure that all Service Users have an up-to-date Recovery Plan that incorporates their views and aspirations, and specifies the tasks required to be delivered by the Clinician/Support worker.

The provider will have a Recruitment and Selection Policy and procedure that aims to eliminate discrimination and ensures fair treatment for all applicants.

The provider will have procedures for ensuring all those working for the provider including volunteers’ and mentors have a CRB check or enhanced CRB check and a POVA register check before taking up a position working with vulnerable people. They will have procedures for ensuring that references for all successful applicants are sought before acceptance into the post.

The provider will have a Code of Conduct for the guidance of staff, and processes for eliminating personal gain through position.

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9. Delivering an Inspiring Recovery-oriented Workforce

A shared understanding of recovery oriented treatment is required across the workforce deployed, including the understanding that the therapeutic alliance is key. Individual choices, preferences and needs must be reflected in care plans and staff need a knowledge of specialist and non-specialist provision.

All job descriptions; person specifications and recruitment processes will be expressed in line with the Drug and Alcohol National Occupational Standards and other relevant national occupational standards. The service provider will be able to demonstrate that an appropriate level of funding is allocated to the training and development of staff at all grades, including managers.

9.1 Minimum Workforce Standards The Provider will undertake an annual Training Needs Analysis and produce an action plan to ensure:  All workers and their line-managers have, or are working towards, evidence of their basic competence in the field.

 All workers and their line-managers have completed, or are undertaking, a training course regarding Safeguarding Children and Adults commensurate with role

 All line managers have completed, or are undertaking, a training course in line-management.

 All workers and their line-managers have, or are working towards, evidence of basic IT literacy

9.2 Competency

All interventions will be provided by staff that are assessed by the service as being appropriately trained, skilled and competent to provide them, in line with the Drug and Alcohol National Occupational Standards (DANOS).Effective interventions require competent practitioners who must have basic occupational competencies (e.g. DANOS). Front line staff must have competence in motivational approaches and brief interventions. https://tools.skillsforhealth.org.uk

Addiction specialists, consultant psychiatrists (or other consultants) and GPs working in addiction should have training and competencies in line with both guidance from the Royal College of Psychiatrists (monitored through appraisal and professional revalidation procedures), Royal College of General Practitioners (RGCP Management of Substance Misuse Cert 1 and 2 at a minimum) and the Drug and Alcohol National Occupational Standards (DANOS).

The Provider will continually work towards achieving a workforce which is fully competent and able to demonstrate its competence in line with the joint NTA/Home Office Development Plan i.e. that all managers and staff have a recognised competency assessed or professional qualification appropriate to their role and are pursuing relevant continuous development. This will be evidenced via performance monitoring.

All providers to ensure they have a named workforce development lead who will attend partnership Workforce Planning and Development working group meetings and report on their agency’s workforce competency and continuous professional development.

10. Service User and Carer Involvement

The provider will nominate a named lead for both Service Users and for Carers within the service. These individuals will champion and

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2013-16 Service Specification September 6th v9 support the work and also be proactive in working in partnership with the commissioner.

The provider will deploy appropriate mechanisms to actively engage service users to provide peer support systems embedded throughout the delivery of the recovery journey.

The provider will take every opportunity to engage Carers and significant others within the treatment process.

The provider will take every opportunity to engage Service Users, Carers and other stakeholders to enable them to contribute at all levels of the organisation within the development of the Service.

The provider will undertake regular service user satisfaction surveys and feedback their findings at quarterly contract review meetings.

The provider will have a process to demonstrate that service user feedback has been heard and changes have been made where possible and appropriate or if it has not been possible, that decisions are explained.

11. Premises

The provider will give details of service design to include proposed locations for delivery of the required service and component interventions.

The provider will need to provide accommodation strategies before the implementation of the contract.

The Service will be delivered in range of environments appropriate to Service User need, geographical location, operational considerations and clinical effectiveness. These will include:

 Fixed-site multi-disciplinary premises (“One-Stop-Shops”)  Satellite sites  Service User’s home/Outreach  The provider might also consider the use of “mobile” treatment centres

The service may also be delivered via:

 Other premises/opportunities consistent with the system model; as identified by the provider

The provider will be responsible for securing and developing a number of fixed-site premises. The fixed sites will be suitable to accommodate open-access, as well as scheduled one to one appointments and group activities; additionally they will act as the central bases for Multi-disciplinary Teams.

Premises will be fully compliant with all requirements of the Disability Discrimination

Act in respect to accessibility. Location of the fixed sites will give full consideration to the needs of the local treatment population, relative levels of localised demand and public transport links.

The Service Provider is expected to provide and operate all required premises within the Contract Price.

It is the responsibility of the Service Provider to ensure that all premises (including vehicles) being used for the Service are fit for the

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2013-16 Service Specification September 6th v9 purpose of providing the Service.

The Service Provider will conduct regular risk assessments on all premises utilised.

The responsibility for the rent, maintenance, running costs, safety and upkeep of the premises used for the provision of the service will be the responsibility of the service provider. The CIOSDAAT/NHS Cornwall & Isles of Scilly will have no responsibility for the accommodation costs or management of the satellite sites.

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12. Minimum Information and Intelligence Standards

The provider will have the capability to create, maintain, store and retain Service User Records. Any such records would need to be kept in a secure location and be compliant with the Data Protection Act, Access to Health Records Act 1990, consent requirements, and the Common Law Duty of Confidentiality.

The provider will also be expected to comply with the NHS Code of Practice on Confidentiality, Protecting and Using Patient Information (A Manual for Caldicott Guardians), the NHS Information Governance Toolkit, and the security management standard BS 7799-2.

The provider will be data controller for the lifetime of the contract in that they are responsible for the processing and storage of records pertaining service users in receipt of direct care and information used for reporting purposes. At cessation of the contract the provider will supply the commissioner with an electronic copy of service user records and performance relevant information to allow facilitated transfer of records to an incoming provider.

Information sharing is needed to assure continuity of care and treatment. It is important to ensure consistency in terms of what, when and how information is shared. The provider will collect sensitive and personal data through the assessment process and subsequent recovery journey; the Data Protection Act 1998 and Human Rights Act 1998 apply.

The provider will ensure that they have a policy and procedure for dealing with service user (or representative) requests to view their records (‘subject access’ requests) in accordance with Section 7 of the Data Protection Act 1998. The request does not have to contain the terms ‘subject access request’ or data protection to be considered a valid request.

Wherever possible, the informed consent of the service user will be obtained before information is shared. ‘Informed’ means that the individual understands what information may be shared and the reason why.

The provider will deploy or adopt the HALO Clinical Case Management System which will be the single authoritative record of clinical information for an individual as they progress through the entirety of their recovery journey, both within and across providers (as part of any sub-contracting arrangements).

The provider will ensure that the system will also be able to provide a robust mechanism for collecting data and producing NDTMS reports and DIRWEB. The provider must be able to provide datasets to commissioners and to analyse and produce reports on substance misuse treatment information as determined by the Commissioner. All data and reports must meet NTA/NDTMS and Commissioner requirements and the system must be ‘future-proofed’.

There will be quarterly monitoring meetings of the Service Provider and the Commissioner. Monitoring arrangements will be further developed between the Service Provider and Commissioner following contract award.

The provider will submit accurate and true information to the National Drug treatment Monitoring System on a monthly basis as is required within the national submission schedule and nationally defined processes This information will be 100% complete and of high quality (exceeding the DAMS 100% validation metrics) and it will reliably reflect the actual activity of the treatment system For assurance purposes the provider will provide a monthly data quality exceptions report and remedial action plan to the commissioner.

The provider will ensure compliance with Treatment Outcomes Profile (TOP) requirements and will use TOP as their primary means of measuring individual and caseload improvement and outcomes. The provider will ensure that the TOP is integral to clinical practice and will have processes to share TOP outcomes reports at all levels within the organisation to continually improve service standards and motivation of staff. The provider will use the information gathered through the TOP as the basis for reporting relevant outcomes to the commissioner.

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2013-16 Service Specification September 6th v9 The provider will deploy a suitably robust system to capture comprehensive needle exchange activity data. The provider will produce and supply the commissioner with quarterly Needle Exchange activity reports for both specialist needle exchange provision. The specialist needle exchange report will include at a minimum, basic demographic profile of clients, number of visits, number of new contacts, drug of choice, injection sites used, amount and type of equipment distributed and the interventions delivered.

The provider must assure the commissioner that they have the capability and robust mechanisms to routinely collect Service User level data regarding all the protected characteristics and to identify where extra needs arise due to protected characteristics (linked to NDTMS data gathering); in particular referrals, access, service user experience and outcomes (as measured by the Treatment Outcomes Profile).

The provider will analyse and understand where there is inequality of access and where there is inequality of outcomes across the protected characteristics. The provider will undertake an annual equality impact assessment which will be supplied to the commissioner to support Needs Assessment and Treatment Planning processes.

The Commissioners have a duty to monitor contract compliance and standard of the service provided to Service Users by the Provider. This will be done by reviewing and monitoring the service as detailed in the Service Specification.

As part of the monitoring arrangements, the Successful Provider will be required to meet agreed performance indicators based on evidencing progress on meeting the outcomes identified in the specification. The final set of local indicators will be developed and agreed between the Successful Provider and Commissioner following the award of contract.

The Commissioners will carry out a Monitoring visit at least once during the Agreement Period. The Monitoring visit will include policies, procedures, written -plans and strategies within the service; staff files and Service User files; complaints log; adverse incident reports; clinical audits, staff training records; and other relevant matters as specified by the Commissioner. The monitoring visit may include informal talks with Service Users and/or staff. The Commissioner retains the right to visit the Provider without prior notice.

13. Intellectual Property Rights

The provider will agree, by 1st April 2013, with the commissioner the name of the service that will be provided in the County. The Commissioner will own the name.

The Provider shall not in connection with the performance of the Service, use, manufacture, supply or deliver any process, article, matter or thing, the use, manufacture, supply or delivery of which would be an infringement of any Intellectual Property Rights.

The Provider must fully indemnify the Commissioner on demand against all losses, action, claims, proceedings, expenses, costs and damages of whatsoever nature arising out of the breach of the warranty in this Clause.

The Provider must defend, at its expense, any claim or action brought against the Commissioner alleging that there has been, in connection with the delivery of the Service, any infringement of any copyright, patent, registered design, design right or trademark or other intellectual property right and must pay all costs and damages.

Any and all Intellectual Property Rights developed for the purpose of providing the Service under this Agreement or arising generally from the provision of the Service by the Provider shall belong to the commissioner and the Provider agrees that it shall execute or cause to be executed (by its staff if necessary) all deeds, documents and acts required to vest such intellectual Property Rights in the Commissioner.

The Provider shall keep strictly confidential, and shall ensure that it’s staff keep strictly confidential, any and all information which is learnt or obtained by the Provider and/or its staff in the provision of the Service and shall enter into a confidentiality agreement with the Council

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2013-16 Service Specification September 6th v9 should this be required by the Council.

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2013-16 Service Specification September 6th v9 14. Performance Requirements

Requirement Indicator Threshold Method of By substance By Incentive Measurement (OCU, non- locality Payment OCU and Alcohol)

Problem Drug 1200 OCUs Of whom at NDTMS Users in Effective least 300 are treatment new treatment episodes Aiming to track above the national average

Aiming to track 600non OCUs Of whom at NDTMS above the national least 100 are average new treatment episodes

Number and % 70% NDTMS PDUs in treatment in Primary Care

Number and % in 30% NDTMS treatment in Secondary Care

Problem Drinkers 1200 NAMS

Home & Dry LES

CHAD LES

Secondary 90

DIP 120 Arrest 120 NDTMS referral contacts (drugs and alcohol) per month

Offer NDTMS assessments to 100% of referrals from Prison.

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2013-16 Service Specification September 6th v9 DI 1 60% of initial NDTMS contacts to be assessed dirweb

DI 2 85% of assessments taken onto caseload

DI 3 95% taken onto the caseload to engage in treatment

To provide post 80 NDTMS tier 2 services commencemen post DRR ts (MAX) completion

60% completion

Waiting Times 3 weeks (21 days) 90% NDTMS from referral date to admission

Community Opiates Report activity NDTMS Detoxification by substance, Home & Dry locality, gender, HALO age and CHAD outcome HALO

Hepatitis B 90% NDTMS Vaccination

Hepatitis C testing 90% DBST NDTMS

DBST Other

By locality, service, gender and age

Hepatitis C By locality, treatment referrals service, gender completing and age

Data quality 100% NDTMS

OUTCOMES

TOP completion 90% NDTMS

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2013-16 Service Specification September 6th v9 Successful OCUs Above average NDTMS completions for cluster Non OCUs groups

Opiate abstinence 70% TOP reliably improved

No longer injecting 70% TOP

No reported 85% TOP housing need

Reduce drop out OCUs Below average NDTMS rates drop out rate for Non OCUs cluster group

Drug/Alcohol Numeric HALO related deaths of people in HM Coroner treatment or who have been in treatment

Re-offending rate Top quartile in TOP complexity group

Sustained Top quartile in TOP employment complexity group

The ability to Top quartile in TOP access and complexity group sustain suitable accommodation

Improved Top quartile in HALO relationships with complexity group family members

Improved Top quartile in HALO capacity to be an complexity group effective caring parent

Safeguarding See Appended Children Reporting Sheet

Safeguarding See Appended Adults Reporting Sheet

INDICATORS

Referrals by Numeric 2011-12 HALO source baseline for self referral

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2013-16 Service Specification September 6th v9 Dual Diagnosis Numeric

With dependent Numeric children

Contacts by type Numeric HALO (telephone, face to face, outreach)

Requests (coded)9 Numeric HALO

Responses Numeric HALO (coded)

Days/Hours of Times Report and operation publicity

Overdose Number of HALO prevention and sessions, clients Basic Life Support and localities sessions delivered

Translation (by number of Half Year sessions required clients, sessions, Performance locations and review languages)

Initial Number Converting into HALO Assessments structured treatment rate

Friends. Families, Telephone and HALO affected others drop-in Contacts

Family Support Agency records HALO Groups – 1 per locality per week minimum

-numbers attending

Number of CAFs initiated

Number of CAFS completed

Other Telephone and HALO professionals drop-in Contacts

Brief Interventions ECMS HALO

9 Codes: Interventions: Advice and Information; Consultancy/professional request; Training; IBA; Structured Psychosocial Intervention; Initial Assessment; Other. And by Telephone; Drop in; Outreach; Detached; Email; other

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2013-16 Service Specification September 6th v9 Mutual Aid Report by activity HALO Support

Peer Mentoring By agency and activity and locality capacity report

Outreach to re- Activity Conversion to HALO engage structured treatment rate Pre-detox groups/Preparatio n for Change Groups

Post detox HALO Support groups

Needle & Syringe Activity NEXMS/HALO

Staff turnover rate Org records

Org records

Sickness levels

Agency/bank Org records spend

Caseload per wte Org records (to not exceed 45)

Vacant posts

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2013-16 Service Specification September 6th v9 Safeguarding

Referrals Made children and young people

Category of Abuse Number of referrals made Number of referrals which go to initial Child Protection Conference Physical Sexual Emotional Neglect

Multi-Agency Meeting Number of meetings Number of meetings non-attended but report attended with reports submitted Child Protection Strategy meeting (S47) Initial Child Protection Conference (Initial Child Protection Investigation completed and decisions made: does child need a CP Plan) Core Group Planning (Child Protection Plan is modified and reviewed within 10 working of initial conference and at regular intervals) 1st Child Protection Review Conference (3 monthly review) Subsequent Child Protection Review Conferences (6 monthly) Child and Family Support Meetings (Section 17 Child in Need) Initial Assessment and

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Planning Meetings (When working with young sexual offenders) Team around the Child (TAC) (Early intervention informed by CAF assessment)  Number of children young people with a Child Protection Plan  Number of Children in Care:  Number of Adults in Care:

Referrals Made adults

Category of Abuse Number of referrals made Number of referrals investigated Physical Psychological Financial Neglect Sexual Discrimination Institutional

Safeguarding Training children

Course Title Date Number %age of all staff Safeguarding Training Level 1 Safeguarding Training Level 2 CAMAT Training Other identify Child Protection Leaflet circulated

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Safeguarding Training adults

Course Title Date Number %age of all staff Safeguarding Training Level 1 Safeguarding Training Level 2 Other identify Alerters guide

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