H&WB Executive Group Item 10
ADP Quality Standards
Purpose
1.
To update members on the development of the Quality Improvement Framework for
drug and alcohol treatment services, and to provide an opportunity to see the first draft
of the proposed Quality Principles: Standard Expectations of Care in Alcohol and Drug
Services.
Recommendations
2.
It is recommended that members:
i.
ii.
Note the development of a Quality Improvement Framework for Drug and Alcohol
services;
Comment on the Quality Principles attached at Annex A
Quality Improvement Framework
3.
Last year, a short life working group was established to define new National Quality
Standards for Substance Misuse Services in Scotland. This work has involved a range of
stakeholders including Alcohol and Drug Partnerships (ADPs), the Care Inspectorate,
Healthcare Improvement Scotland, Scottish Prison Service, and provider organisations.
4.
These standards will be positioned within an over-arching Quality Improvement
Framework and aligned to the next phase of the ‘Road to Recovery’, Scotland’s national
policy framework for drug and alcohol misuse. The Quality Improvement Framework will
drive a culture of self-assessment, with ADPs commissioning services based on
evidence of meeting principles of care, which can be measured by a range of tools
including indicators of recovery.
5.
Nationally defined quality principles, improved data and evidence, and planning and
reporting protocols will all contribute to effective Recovery Orientated Systems of Care
(ROSC) across Scotland, which will assist with the further development of an integrated
approach to service planning, commissioning, design and delivery. ADPs will also be
able to devise their own improvement goals and measures to drive quality improvement
at a local level.
6.
Discussions are being progressed with the Care Inspectorate and Healthcare
Improvement Scotland (HIS) to explore their scrutiny role in validating the results of selfevaluation at the ADP level.
7.
A key element of the Quality Improvement Framework is the application of Quality
Principles across all ADPs. The first draft of these Quality Principles is attached at
Annex A. The principles were developed in partnership and were informed by the views
of people who use drug and alcohol recovery services. Many of the standards are
designed to reinforce a person centred approach; others focus on training and
supervision; while others again focus on access times. Members may question whether
access times should be contained within the standards but we are comfortable that
these can be reasonably met within existing resources: currently 29 of Scotland’s 30
ADPs exceed the access times defined.
8.
A final draft of the standards will be agreed by the working group in October – and we
anticipate significant changes to the bill of rights given feedback from users of services;
in the meantime, we felt it important that members of the Executive Group were
provided with an opportunity to comment on their development.
Commissioning
9.
As part of the Quality Improvement Framework, and to support the provision of services
in a recovery oriented system of care, the role of ADPs as ‘commissioners’ of integrated
services will be strengthened. This will:
•
Enhance the strategic relationship between ADPs and service providers;
•
Encourage best practice of self-assessment and validation of services; and
•
Support commissioning based on evidence of recovery.
10.
The development of stronger commissioning regime will sit comfortably within the
emerging arrangements for health and social care integration, where the joint board will
assume responsibility for the development of a strategic plan. Many ADPs have made
considerable progress already in developing recovery oriented systems of care and we
anticipate that the location of ADPs within health and social care partnerships will further
drive and consolidate integrated working more generally.
11.
The planning and reporting guidance for ADPs, and the optional reporting template that
has been created, take account of the broader Quality Improvement Framework, health
and social care integration and community planning processes. At the request of ADPs,
a standard reporting template has been designed, to facilitate the sharing of information
across Scotland.
Independent Review of Opioid Replacement Therapies
12. In October 2012 Scottish Ministers commissioned an independent expert group, led by
the Chief Medical Officer for Scotland, to review the delivery of opioid replacement
therapies. As part of the review, the group surveyed all ADPs regarding treatment
delivery and local plans to support recovery. The report, ‘Delivering Recovery’, which
was published in August this year, found that there is considerable variation across
ADPs with regard to the delivery and development of recovery oriented systems of care
(ROSC) across Scotland. We are meeting the Minister for Community Safety and Legal
Affairs on 8th October to discuss this matter. As it is, the independent expert group has
recommended the use of an improvement methodology, which is in line with the
programme of work already in place to develop a Quality Improvement Framework for
alcohol and drug services.
Next Steps
13. Members’ views will be fed into the development of a final draft of the Quality Principles.
We then intend to bring a paper to Leaders in November, to agree final sign off of the
Quality Principles and to lay the groundwork for any further reform of ADPs on the back
of the Opioid Replacement Therapies report.
Conclusion
14. Members are invited to note the on-going development of the Quality Improvement
Framework and provide any comments on the attached Quality Principles.
Ron Culley
COSLA
Health and Social Care
0131 474 9257
Lester Macdonald
Scottish Government
Drugs Policy Unit
0131 244 3562