Archived: We are With You - Hartlepool Specialist Prescribing Service

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

• Care records did not capture sufficient information about clients’ care and treatment needs and were not person-centred. This issue was identified in our previous inspection in November 2016 and during the provider’s internal audit in July 2017 but had not been addressed.
• Health and safety was compromised. Only 47% of staff had completed their mandatory health and safety training. Risk management plans were not appropriate to mitigate the risks associated with clients. Fire wardens and first aiders were not easily identifiable. Hand sanitiser gels were being used beyond their expiry date and sharps bins were not signed and dated.
• Infection control was compromised as chairs in the main clinical room could not be cleaned effectively .
• Staff did not have a good understanding of the Mental Capacity Act or apply it in practice.
• Supervision and appraisal was not recorded effectively and some staff did not receive supervision or appraisal.
• Some staff did not know about the advocacy services available to clients or how to arrange for an interpreter to make translations on behalf of a client.
• Nine out of 12 clients we spoke with said that some staff were abrupt, uncaring and unsupportive. We overheard one staff member speaking to a client on the phone in an abrupt manner.

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

• Rooms contained alarms, which sent alerts to the main office. Clinic rooms contained equipment, which was calibrated and correct. The service was accessible for all the people who used the service.
• There were sufficient numbers of experienced and qualified staff to safe deliver care and treatment, staff turnover and sickness absence was low and bank and agency staff were rarely used. There were effective systems for handling medical emergencies, safeguarding issues, incidents and complaints and lessons learned were used to improve practice. Staff engaged in audits of the service’s medicines management arrangements, medical notes and the service as a whole within the 12 months prior to our inspection.
• The service’s medicines management arrangements were effective. Medicines and prescriptions were appropriately stored and produced from a designated printer. The service’s processes and procedures followed guidance from the National Institute for Health and Care Excellence, the Drug Misuse and Dependence: UK guidelines on clinical management and the British Association for Counselling and Therapy, Nursing and Midwifery Council.
• Staff referred clients to their GPs for physical health checks or if there were concerns about physical health deterioration, encouraged clients to lead healthier lifestyles and provided interventions around harm minimisation and motivational interviews. A clinical support worker ran a weekly alcohol group for clients.
• The service worked in partnership with other services effectively. The service held monthly huddles with the mental health service to discuss clients’ mental health needs. The service had a GP liaison who shared information about individual clients with their GPs and a midwife and Hepatitis C nurse visited the service each week to give support and advice to clients.
• The service dealt with late or missed appointments effectively. The service treated all clients who were 10 minutes late consistently and clients knew what the expectations were. The service rang clients who had missed their appointments and alerted the police if there were concerns about the client’s welfare.
• Addaction’s website had translation facilities and supportive software for people with dyslexia, literacy and mild visual impairment. Clients had access to signers. Noticeboards in the reception area contained information and advice about harm reduction, helplines and groups, drug and alcohol misuse and other topics.