Doncaster Metropolitan Borough Council INVITATION TO TENDER SECTION ONE PART B YORTender Ref: 9RFM-3E4FNF Adult Substance Misuse Recovery System Closing Date: 12:00 noon 30/06/2015 SERVICE SPECIFICATION Service Specification No. Service Adult substance misuse recovery system Authority Lead Helen Conroy Provider Lead Period 2016/17 - 2019/2020 Date of Review 2019/20 1. Population Needs 1.1 Introduction Doncaster Metropolitan Borough Council has been through a process of redesigning the previously separate drug and alcohol treatment services into an integrated recovery focused service with a single point of access function. The Council is seeking to further reshape service delivery to procure a ‘whole system’ recovery focused substance misuse model. The new service will include all aspects of substance misuse interventions ranging from needle exchange, harm reduction, brief interventions, structured psychosocial interventions, prescribing, structured day care, recovery and aftercare support, inpatient detoxification and access to residential rehabilitation. The term ‘substance misuse’ refers to all illicit and performance enhancing drugs, new psychoactive substances (‘legal highs’), alcohol and prescribed and ‘over the counter’ medications. This specification outlines the framework which will contribute to the outcomes that the Council wishes to achieve. One service provider will be appointed to deliver the service through a single contract and must demonstrate within their tender return how they will structure the service to meet the outcomes outlined in this specification. The Provider is encouraged to demonstrate innovation and added value in their service design. The Council reserves the right to review and amend the Service Specification on an annual basis (or more frequently if appropriate) to take account of changes in national policy, funding and local needs. Any reviews and subsequent amendments will be undertaken in consultation with the service provider, no amendments will be implemented without the agreement of the service provider. The commissioning functions at the Council are currently based with the Public Health Team with funding secured from the Public Health Grant. This specification has been developed following consultation with key stakeholders, service users, families and carers in line with national and local strategies and other policy 2 drivers. 1.2 Strategic Context This service specification has been developed in line with national and local strategies and policies including (but not limited to): The National Drugs Strategy: Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life (Home Office, 2010) sets out the Government’s approach to tackling drugs and addressing alcohol dependence. The Strategy recognises the need to respond to emerging issues, considering dependence on all drugs and alcohol, not just heroin and crack, in addition to addressing the complex causes and drivers of dependence to support people to enter sustainable recovery. The strategy also sets out a shift in power to local areas that will have responsibility for designing and commissioning services which meet the needs of their local communities. The strategy has two overarching aims with regard to treatment: Reduce illicit and other harmful drug use, and Increase the numbers recovering from dependence. The Public Health Outcomes Framework 2013-16 (Department of Health, 2012) sets out the desired outcomes for public health and how these will be measured: Successful completions of drug treatment. People entering prison with substance dependence issues who are not previously known to treatment. Alcohol related admissions to hospital. The Government’s Alcohol Strategy (Home Office, 2012) outlines the need for local commissioners to work together to meet local needs as identified in the Joint Strategic Needs Assessment and ensure specialist treatment is available. Substance Misuse has been identified as a key strategic priority in Doncaster: Borough Strategy A_Plan_for_Doncast er_-_Doncaster's_Borough_Strategy_2010-1537-90875.pdf Doncaster Health and Wellbeing Strategy HW&B Strategy_revised Feb2013_final_tcm33-109613.pdf 3 Doncaster Substance Misuse Strategy 2014-17 Doncaster Substance Misuse Strategy 2014 (4).docx 1.2.1 Vision The Council is seeking to procure a recovery-focussed substance misuse system which will support individuals to reduce and stop using alcohol and drugs and underpinned by a recovery approach which involves three overarching principles – wellbeing, citizenship and freedom from dependence. The recovery system will enable service users to develop their potential, improve their overall health and well-being, build relationships with others, achieve their goals, and contribute to their community. This will involve addressing people’s substance misuse earlier, and developing and building an individual’s ‘recovery capital’ – the assets needed to start, and sustain recovery from drug and alcohol dependence. These assets are defined as: Social capital - e.g. family, partners, children, friends and peers. Physical capital – e.g. financial assets, stable accommodation. Human capital – e.g. employment, education, skills, mental and physical health. Cultural capital – e.g. values, beliefs and attitudes held by the individual. To maximise and sustain recovery outcomes the Service must work collaboratively with partners and mutual aid and recovery networks to increase opportunities within the community throughout treatment and on leaving the system. The Service will be easy to access and deliver a range of effective, evidenced based interventions which meet the individual needs of the service user whilst also having a holistic whole family approach. 1.3 Substance Misuse Profile- Doncaster (As of Q2 14/15) In Treatment 1535 Opiate clients 173 Non-Opiate clients 499 Alcohol clients 131 Alcohol and Non-Opiate Time in Treatment 530 Opiate clients, under 2 years 316 Opiate clients, 6 or more years 5 Non Opiate only clients, 2 or more years Average years in treatment 4 4.1 Opiate 1.6 Non-Opiate Living with Children 832 Opiate clients 73 Non-Opiate clients 190 Alcohol clients 54 Alcohol and non-opiate Successful completions 6% of Opiate clients 46.2% Non-Opiate clients 39.5% Alcohol 35.1% Alcohol and non-opiate Re-presentations 13.1% of Opiate clients 5% of Non-opiate clients 11.4% of Alcohol clients 13.3% Alcohol and non-opiate clients Measures of recovery Public Health Outcomes Framework, who successfully complete treatment and did not represent within 6 months of leaving treatment 7.1% Opiate clients 36.5% Non-Opiate clients Clients in contact with criminal justice system In Treatment 536 Opiate clients 21 Non-Opiate clients 32 Alcohol clients 16 Alcohol and non-opiate clients Successful completions 4.1% Opiate clients 28.6% Non-Opiate clients 40.6% Alcohol 25% Alcohol and Non-opiate clients Community Pharmacy Based Consumption 73 Pharmacies 143,081 Supervised consumptions/year Needle and Syringe Programmes 18 community pharmacies 32,306 exchanges/year 2. Key Service Outcomes 2.1 Outcomes Key outcomes for service users within the treatment and recovery system are: Freedom from dependence on drugs or alcohol. Prevention of drug related deaths and infection by blood borne viruses. A reduction in crime and re-offending. 5 Sustained employment. The ability to access and sustain suitable accommodation. Improvement in mental and physical well-being. Improved relationships with family members, partners. 3. Scope 3.1 Aims and objectives of service Aim To reduce Illicit and other harmful substance misuse and increase the numbers recovering from dependence Objectives This will be achieved by: Improving and increasing access and engagement into the system for those needing support for their substance misuse. Developing an asset based approach, which values the capacity, skills, knowledge, connections and potential in individuals, families and communities. Co-ordinating and delivering a personalised recovery package of care for all people entering the system and ensure continuity of care on entry, during and on leaving Supporting and promoting the use of peer recovery networks across all stages of system delivery and beyond. 3.2 Service description/pathway The treatment and recovery system will have a hub and spoke structure as described in the diagram attached below Hub and Spoke Model.docx The following service elements are to be delivered to meet the outcomes outlined in this Specification: Needle and Syringe Programmes The Provider must ensure needle and syringe programmes are available for the provision and safe disposal of needles, syringes and other injecting equipment. Needle and syringe programmes will be delivered from a variety of locations and settings across the Doncaster district including pharmacies to ensure easy access. Opening times must be flexible to 6 meet local need and demand and include some evenings and weekend provision. Currently there are sixteen fixed site pharmacy needle exchanges and one specialist exchange at the Depot drug team in Mexborough. In addition the provider will establish a further specialist exchange site in Doncaster town, but not in the Thorne Road area which is served by a 100 Hour pharmacy. The Provider will be responsible for managing and coordinating pharmacy needle and syringe programmes with a view to develop expanding provision in areas to meet identified need, in consultation with the Public Health Team. Pharmacy sites: Pharmacy DONCASTER NEEDLE EXCHANGE SCHEME Updated April 2013.doc The Provider must ensure a range of appropriate equipment is available that meets local need and is provided alongside harm reduction interventions including (but not limited to): Advice on safer injecting; Advice on stopping injecting; Inspection of injecting-site infections and referral for wound care; Advice on safe and responsible storage and disposal of injecting equipment; Facilitating access into structured treatment; Harm reduction advice and overdose prevention; Referral to and access to interventions to reduce Blood Borne Viruses including the offer of Hepatitis B vaccination and Hepatitis C screening; Provision must be delivered by competent staff and in accordance with NICE PH52: Needle and Syringe Programmes and local guidance All costs related to the provision of needle exchange programmes (including pharmacies) such as the purchase of equipment, storage, distribution, disposal of all equipment, payment of contractors, training in accordance with local guidance, or accreditation will be met by the provider. Assessment The vision for Doncaster’s Recovery Treatment system is for a single point of access, single referral, assessment and recovery planning process. This will facilitate quick and easy access into treatment and enable the delivery of holistic, multi-disciplinary recovery plans. The single point of access will be a functional entity which delivers assessment, open access interventions, recovery planning, a unified case management system and referral into structured interventions. The Provider shall deliver a screening and referral tool and process for professionals to use to assess the needs of all Service Users, which utilises recognised screening instruments which are inter-changeable between services 7 and are agreed by all parties. The Provider shall develop a universal assessment framework which will be used within the Provider Services, with both drug and alcohol clients. This will include an initial assessment and a full, comprehensive assessment In line with national guidance, the assessment framework will include a screening tool and a full comprehensive assessment. It will adopt an holistic approach and include the Alcohol Use Disorder Identification Test (AUDIT) and the Severity of Alcohol Dependency (SAD) questionnaire (where appropriate) for all individuals using alcohol Every new Service User entering the Service will receive an initial assessment on their first contact with the Service and a comprehensive assessment prior to starting specialist structured treatments The comprehensive assessment will fulfil the requirements of the drug and alcohol minimum data sets including all current and future requirements of the National Drug Treatment Monitoring System database and include as a minimum: a) Current and previous drug and / or alcohol use b) A physical health assessment, including GP/dental registration, a screening for blood borne viruses, smoking cessation, nutrition, sexual health and contraception c) a mental health screening tool d) Recording any current and/or previous involvement in the Criminal Justice System e) risk assessment f) domestic violence risk g) housing needs h) safeguarding (children and adults) needs i) emotional needs j) social networks including family life and relationships k) personal, life and education, training and employment skills and needs l) future aspirations and beliefs around recovery The assessment framework will be used by the Provider to determine the tier of intervention (tier 2 and up), and develop a recovery plan with the Service User which will be reviewed and updated, by the Provider and with the Service User, at a minimum of every three months and according to changing needs and 8 circumstances of the Service User Where additional needs are identified, where appropriate and with Service User consent, the Provider will make a referral and follow up with appropriate onward referral All Service Users will have a single recovery plan throughout their recovery journey. Initial and comprehensive assessments will be updated, but not duplicated as the Service User moves between different settings/modalities (with Service User consent) The Provider shall ensure that every Service User receives a full explanation of how their information will be processed and in what circumstances it may be shared with other agencies Where Service Users are not registered with a GP the Providers will support them in identifying and registering with one A risk assessment will be completed for every new Service User including their level of risk awareness. Where risks are identified, the Provider shall develop and implement a risk and/or vulnerability management plan, linked to the Service User’s recovery plan. The Provider shall regularly review the plans with the Service User. Information relating to risk will be shared with other organisations by the Provider and acted upon according to the local procedures and protocols as notified to the Provider by the Commissioner In line with Hidden Harm (children who are affected by living with substance misusing parents/Carers) and the whole family approach, the assessment will identify those Service Users who are parents and/or who come into regular contact with children. For these Service Users, the comprehensive assessment should identify the needs of the child in relation to the impact of the parent’s substance misuse. The assessment will capture as a minimum the following information: a) the name of the main carer/s for children b) the age of children c) the name of health visitor if applicable d) CAF status (current / previous) e) Child in Need status (current / previous) and f) Child Protection status (current / previous) Young person’s capacity to consent (Laming compliancy) where the service user is a young person in transition The Provider shall carry out initial, and on-going, assessment of the impact of substance misuse on parenting capacity - in line with changes to patterns of misuse/relapse etc - and have mechanisms in place with local Children’s Services to make appropriate Child In Need/Child Protection referrals. This will be based on g) 9 a risk and resilience model, taking into account protective factors Where it is established that there may be children affected, the Provider shall work with the Service User to put in place appropriate measures to mitigate risk to include, for example, safe needle storage, Blood Borne Virus-related factors and record and review this via the Service User’s Recovery Plan Where a potential or actual risk to children is identified, the Provider shall have mechanisms in place to be able to appropriately contribute to the multi-agency Common Assessment Framework (CAF) In line with Supporting and Involving Carers, (NTA 2008) the Provider shall give family members and significant others the option to be involved in assessment, planning and review, where appropriate and with the consent of the service user. Assessment will be available in a range of settings, by arrangement with the relevant individual/organisation, including; specialist services, primary and secondary care settings, GPs, home (in keeping with identified lone working policy) and criminal justice settings, to suit the needs of the Service User, their family and wider strategic priorities When explaining issues of confidentiality and consent to the Service user, the Provider shall include reference to the Commissioner’s information requirements and access to data for audit, service development and performance management purposes. Case Management and Recovery Co-ordination A single recovery co-ordination and case management process will underpin the treatment system and will be used to maintain Service User engagement and facilitate recovery outcomes. Recovery/Care Planning: The Provider will ensure that all Service Users accessing structured/specialist interventions will have a Recovery Plan, signed by both the key worker and the Service User. This will be developed from the needs identified in the initial and comprehensive assessments and include as a minimum: a) Initial Assessment, including child needs/risk assessment (where applicable) – see Assessment Section; b) level of drug and/or alcohol use throughout treatment and associated goals/timescales; c) physical health, including injecting and blood borne virus status and sexual health (including screening and access to contraception); d) emotional/mental health issues and relevant plans/referrals; e) on-going risk assessment & associated management plans; f) current and/or previous involvement in the Criminal Justice System; g) housing requirements/goals; h) family/Carer needs, including affected children and referrals for Carers Assessment/services; 10 i) social/support networks including family life and relationships; j) personal, life and education, training and employment goals; k) recovery goals and progress; l) Relapse Prevention Plan and m) Treatment Exit Plan The Provider shall undertake a Recovery Plan review for each service User as a minimum of once every three months Recovery planning and review will involve the Service User and appropriate professionals from partner agencies involved in the Service User’s on-going recovery. This will include the Service User’s family and/or significant others where appropriate and with Service User consent Where Service Users are expectant parents/parents/Carers of children, the Provider will develop appropriate links with safeguarding teams (where required); maternity services and other relevant services – in line with local safeguarding procedures The Provider will ensure that a treatment outcome profile (TOP) – as defined by the National Treatment Agency - is routinely completed for all substance users at treatment entry, at recovery plan review and on planned exit from treatment. A minimum threshold of 100% starts, 100% reviews and 98% exit TOPs will be implemented. A ‘recovery check-up’ will also be completed at a 3 month, post discharge follow up (subject to client consent). All Recovery Plans will be specific, measurable, attainable, relevant and time-bound and will incorporate the TOP process The Provider will take particular measures to promote accurate and meaningful completion of all TOPS treatment questions including those which relate to offending The Provider will adopt, where possible, a lead officer (care co-ordinator) approach, with one allocated key-worker assuming responsibility for co-ordination of all elements of the Service User’s recovery journey. Every Service User will be allocated a single key worker/Recovery Manager within 5 working days of comprehensive assessment, once the appropriate structured intervention is identified. Where another agency e.g. Probation, Job Centre Plus or Children’s Services, are involved with the Service User or their children – on either a voluntary or statutory basis - the Provider shall share relevant information, co-work and attend review meetings with such agencies as required The Provider will ensure that the level and frequency of intervention reflects the Service User’s initial and on-going need and risk assessment The Provider will allow the PH commissioning team access for anonymised case 11 file audit purposes at least annually Treatment Exit Planning: The Provider will work in partnership with Service Users, Carers and other agencies to ensure that pro-active exit planning, aftercare and relapse prevention plans are part of the on-going recovery planning process To encourage Service Users to achieve a planned exit, and to minimise relapse and re-presentation into the Service, the Provider will offer a basic level of support following planned exit from treatment. This will include: a) links to continued access to positive health and leisure activities and wraparound support where needed e.g. ETE (education, training and employment), housing etc b) identification of generic services or other organisations which can continue to support the Service User in their recovery e.g. mutual aid organisations, Job Centre Plus, ETE and housing support agencies c) a three month follow-up contact to identify if the Service User is successfully continuing in their recovery and/or has any additional needs. Data Confidentiality and Access Issues The use of robust case management and information management tools will enable controlled but wide sharing of information and ensure that the data collected is accurate, reliable and will support the continual assessment of drug and alcohol related needs in Doncaster. The Provider will be expected to supply their own IT system that will support full NDTMS reporting, or the Provider should utilise DET/DAMS, as available from Public Health England. The Provider will be responsible for funding any required upgrades and ensuring compliance with NDTMS requirement – as defined by the PHE – at all times. Open Access Interventions The Service will work to the principle that all interventions are also Public Health interventions. Open access interventions will provide a gateway into the wider recovery system providing an initial point of assessment and advice, and where required referral on into more structured interventions. They will also provide specific interventions including: Identification and Brief Advice (IBA) and extended interventions for alcohol; brief and extended interventions for drugs; and harm minimisation The Provider shall provide a single point of access function for screening, advice and onward referral at a central location in Doncaster Town as a minimum, and hubs in Bentley, Thorne and Mexborough, with flexible hours to suit the needs and 12 lifestyles of Service Users. It is recognised that additional delivery hubs based on need may be developed in agreement with commissioners. Open access will be a safe space for drug and alcohol users to access information, support and motivational interventions. The Provider will signpost and refer individuals into related agencies and appropriate treatment depending on their needs including advice on areas such as housing access, education, training and employment and benefits The Provider will work with partner agencies including Local Authority, Probation, Police, Citizens Advice Bureau and health Providers to maximise engagement opportunities across a range of settings; particularly to target hard to reach and vulnerable groups The Provider will ensure that all advice and information on treatment options are offered in a variety of methods and languages according to need Identification, Brief Advice and Extended Interventions: An alcohol brief intervention typically occurs and comprises a single 5-15 minute session, and up to a maximum of four, sessions of engagement with a patient and the provision of information and advice designed to achieve a reduction in risky alcohol consumption or alcohol-related problems. A brief intervention has five essential steps: assessment of drinking behaviour and feedback; negotiation and agreement of goal for reducing alcohol use; familiarisation of the patient with behaviour modification techniques; reinforcement with self-help materials; followup telephone support or further visits The Provider will use AUDIT for identification and brief advice for alcohol, unless this has been completed by a referring agency. Where a Service User scores 16 – 19 the Provider will offer extended interventions which will comprise a minimum of a 20 minute session and a follow up appointment at three months. Where a Service User scores 16 – 19 with additional risk factors or 20+ the Service User will be offered specialist intervention The Provider shall develop a similar identification, brief advice and extended interventions structure for those with drug misuse issues. This will include the targeting of unmet need within the 18-24 years stimulant/party drug/legal high using priority group Harm Minimisation: The Provider will deliver screening/testing for hepatitis B, C and HIV, and will work in conjunction with Public Health for hepatitis A issues as required. The Provider should provide appropriate information for Service Users and their families around protection from, and reducing the risk of transmitting, BBV and sexually transmitted infections The Provider shall supply free condoms to prevent the transmission of BBVs and 13 STI’s It is expected that with the Service User’s consent nurse-led referrals are made to appropriate services including the Hepatitis Nursing Service for all Service Users testing positive with hepatitis B or C, and onward referrals for HIV The Provider will deliver immunisations for hepatitis A and B. The Provider will deliver advice and support on safer injecting, on reducing frequency of injecting and on reducing initiation of others into injecting The provider will deliver advice and support on preventing risk of overdose and drugs and alcohol related deaths Harm Reduction Strategy 2014-15.doc Wraparound Interventions Wraparound Interventions should be a ‘core offer’; available for all Service Users, accessing any type of treatment, and at all stages of recovery, including those accessing harm minimisation services and those who require abstinence based support. This should include provision for those who have successfully exited structured treatment. The Provider should provide a link and broker wraparound interventions to Service Users as part of the Service and should include, as a minimum: a) access to a range of positive social, art and leisure activities b) support with Education, Training and Employment c) support with housing d) Complementary Therapies e) developing life skills e.g. parenting, cooking, gardening f) support with general healthcare including support with registration and engagement with dentists, opticians and GPs etc g) debt advice including links with Citizens Advice Bureau Psycho-Social Interventions and Counselling: Psychosocial interventions will form a key part of the Service User’s recovery journey and will be offered to Service Users in both one to one and group-work sessions. All psychosocial interventions and counselling will be delivered in line with NICE guidelines and other best practice guidelines 14 The Provider will offer a range of psychosocial interventions to each Service User according to need and changing circumstances. These should include as a minimum: a) motivational interviewing b) solution focused brief therapy c) international treatment effectiveness project (ITEP) d) improving access to psychological therapies (IAPT) – referring on to generic Provider in accordance with any local pathways as notified to the Provider by the Commissioner from time to time e) relapse prevention – including the options of 1-2-1 and/or group work in a range of settings f) behavioural couples therapy in line with NICE guidance The Provider shall make available psychosocial interventions to all Service Users at all stages of their recovery journey including pre-contemplation, contemplation, active change and relapse prevention and will address drug and alcohol use including poly/cross use The specific needs associated with stimulant use are often different to those using other drugs, so the Provider will ensure that interventions specific to these needs are available and incorporated into the recovery planning process where appropriate The Provider will make sure that all staff who will deliver group-work are appropriately qualified and have received appropriate level group-work skills training and on-going specific support. Structured Counselling: The Provider shall provide structured counselling services as part of the Services to Service Users (where appropriate) The level and duration of counselling support provided to a Service User will be based on comprehensive assessment of need. It is anticipated that this will usually be between six and twelve sessions Where longer term counselling support is identified in relation to issues such as childhood trauma, sexual assault and bereavement, the Provider will endeavour to identify and refer the Service User to an appropriate alternative specialist services The Provider will utilise both accredited and volunteer counsellors (who are working towards their accreditation) in delivering the counselling services The Provider shall have robust systems in place for on-going training and professional supervision of all Staff involved in the delivery of the counselling services 15 Pharmacological interventions Medication to support behaviour change and abstinence from alcohol and drugs is a necessary component of treatment for many. Pharmacological interventions, where needed, must be fully integrated with harm reduction interventions, evidenced based 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 Technology Appraisals. A clinical assessment must be completed prior to prescribing which will build on and contribute to the comprehensive assessment already undertaken. Such pharmacological interventions will include: Opioid substitution therapy. Opioid detoxification. Stabilisation and withdrawal from illicit benzodiazepines or other prescribed drugs. Alcohol detoxification. Prescribing to prevent relapse. 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). Detoxification will be community based with a number of exceptions such as: Several previous unsuccessful formal community detoxification episodes. Significant co-morbid physical or mental health requiring medical/nursing care; Complex poly detoxification requirements e.g. opioids with alcohol or benzodiazepines; Significant social issues which will limit efficacy; For people in acute alcohol withdrawal with, or who are assessed to be at high risk of developing, alcohol withdrawal seizures or delirium tremens. Clinics will be arranged to facilitate rapid access to prescribing, on the same day where needed and appropriate, and within a maximum 2 – 5 working days. For service users who are released in a planned or unplanned way from prison on a maintenance prescription, the prescribing programme shall continue without any interruptions to the service user. Prescribing interventions shall have clear protocols around prescribing regimes and reviewed at the earliest opportunity to ensure that they are contributing towards overall recovery plan goals. Prescribed drug selection, dose and dispensing frequency for each service user must remain a clinical decision based on service user need and risk. However, Providers shall need to evidence within this, that prescribing is carried out in a cost effective manner and in line with local guidelines. Prescribing Costs The provider will be responsible for the prescribing budget and will be expected to manage the total cost of prescribing for the service 16 Supervised Dispensing The Provider will be responsible for facilitating arrangements with all participating pharmacies for the supervised consumption of medication for opioid substitution therapy and detoxification. This includes all relevant costs associated with the provision of this service. Doncaster Commissioners wish to promote a model of delivery which maximises local geographical access of supervised consumption pharmacy outlets for clients. The provider will supply methadone safe storage boxes to clients. Drug Testing The Provider must ensure local protocols and appropriate facilities are in place for biological testing and service users are provided with sufficient information about the uses of drug testing, including how it is used to inform the treatment they receive, so that an up to date picture of any illicit drug use is maintained. The Provider will be responsible for all costs related to drug testing including the purchase, testing and disposal of equipment. GP/NMP Shared Care Clinics The Provider will manage and deliver a system of shared care key workers to complement General Practitioner/Non Medical Prescriber led Shared Care clinics in a Doncaster Town, Thorne, Bentley and Mexborough. The provider may wish to deploy GPs, NMPs or both to deliver the prescribing component of the shared care clinics. The Provider and Commissioner will keep the capacity and location of these clinics under constant review in order to respond to changing patterns of drug and alcohol use and demographics across the Borough. During 2015-16 the GPs providing substance misuse shared care services are: Drs P. Hurley, W. Barker, M. Coleman, S. Arif, E. Njoku and A. Paul. Primary care based locally commissioned services for alcohol screening, brief interventions and referral The provider will manage contracts for and further develop provision of primary care based locally commissioned services for alcohol. A specification for the delivery of these services was developed during 2014-15 and the commissioner is seeking to further develop and extend the provision in order to adopt an ‘upstream’ approach to alcohol interventions, via the delivery of screening and brief interventions in primary care settings. Access to services for criminal justice clients Referral systems will be agreed with staff based in, or working in the custody suite, i.e. an arrest referral function will be provided. The intention is that all prisoners held within police cells will be offered the service, i.e. being given to those who test positive as a result of the drug testing procedure. Referral pathways are as follows: All custody staff will refer proactively where appropriate; Those staff involved with drug testing of detainees will refer proactively, and ensure 17 that all those with positive tests are referred under the Drugs Act 2005; Those staff involved in cell sweeps will refer proactively; Those clients who could not be seen whilst in custody will be offered a domiciliary visit or an appointment at a convenient time and place; Referrals from courts under bail restrictions; Referrals from prison CARAT and Health Care teams (as per locally agreed pathways); a prison liaison function will be provided between the service and local prison establishments Referrals from Direct Access; Referrals from other partner agencies such as National Probation Service/Community Rehabilitation Company or the IOM; Referrals from any relevant MDT forum and individual service providers, for outreach, throughcare and aftercare support where appropriate. Work in a complementary fashion with schemes such as Liaison and Diversion Drug Rehabilitation Requirements/Alcohol Treatment Requirements: The Provider will work in partnership with the National Probation Service/CRC to support the delivery of Drug Rehabilitation Requirements (DRR) and Alcohol Treatment Requirements (ATR) in Doncaster. NPS/CRC will care coordinate Service Users on DRRs and ATRs; the Provider will participate, as required, including involvement in three-way care plan reviews The Provider will assess all offenders referred for a DRR/ATR for suitability according to a comprehensive assessment of need. Where offenders are assessed as not suitable, appropriate information will be provided to the offender to encourage voluntary referrals into the Service The Provider will work with all suitable offenders to prepare and co-ordinate a recovery-focused treatment plan based on their assessment of need and where possible Service User choice. The Provider will support delivery in line with local NPS/CRC DRR and ATR targets The Provider will report to the NPS/CRC or court as required on the progress and compliance of Service Users subject to a DRR or ATR including, where appropriate, supplying evidence to support breach or revocation proceedings Binge Drinkers group work: the provider will support NPS/CRC with local initiatives such as the development of binge drinkers groups for NPS/CRC clients. Socially Supported Detoxification Social care model: the provider will deliver four beds of CQC registered social model inpatient provision offering a 14 /21 day community based detox or stabilisation (based on individual assessment on an exceptions basis) from illicit drug and alcohol use within a supported environment, including regular testing, key working, activities and daily chemist runs. The remit for this provision excludes more complex cases such as heavy benzodiazepine use. The treatment provision should also have capacity to look at rapid intake if voids occur and possible extensions to the 14 day experience depending on 18 spaces. The provision should offer an extended treatment interface for clients leaving medical model in- patient detox if needed. There is an assumption that all clients would aim to engage in Structured Day Programme post detox. In patient detoxification and Residential rehabilitation The Provider will deliver or will contract 2 beds of medical model in-patient detoxification capacity for drugs and alcohol. This should be delivered / contracted from an appropriate facility, which is CQC registered and with an appropriate level of clinical cover. The Provider is required to provide assessment and care coordination for access to planned in-patient detoxification. Ensuring continuity of care for service users is particularly important with respect to unplanned discharges. The care co-ordinator will still remain responsible for tracking the service users progress on their treatment journey whilst they are in residential rehabilitation including TOPs recording and other data collection and recording. Residential rehabilitative treatment provides a safe environment, a daily structure, multiple interventions and can support recovery in some people with substance misuse problems who have not benefitted from other clinical interventions or recovery options. For people with substance misuse problems to make an informed choice about residential rehabilitative treatment, taking into account personal preferences, it is important they are aware of the NICE eligibility criteria (Clinical Guideline 51). The Provider will offer access to residential rehabilitation in line with the requirements of the NHS and Community Care Act (1990). This will require additional assessment and care co-ordination. A residential rehabilitation pathway will be produced by a Provider which will be available to service users, carers and other agencies, in liaison with the Local Authority. Structured Day Care/Structured Day Programme Structured Day Programme The provider will deliver a 12-18 week rolling programme based on cognitive restructuring within a therapeutic environment (including outreach projects) offering a range of therapeutic groups and 1-1 interventions, workshops, life skills, diversionary activities and qualifications. Clients will have an individually tailored recovery plan drawn up on the outset and reviews each 4 weeks. A rolling programme will be delivered and clients will be illicit drug free on the day of presentation, and expected to work towards detoxification from prescribed medications during the Structured Day Programme. Screening will take place regularly. The timetable will be client centred through the care/recovery plan, though core groups need to be attended. The Provider will work with the commissioner and other Providers to develop a stepped recovery pathway for drug and alcohol clients, which encompasses a progression as well as a step down from the structured day programme, into the structured day care/social space activities. Six week aftercare component A 6 week aftercare programme of the SDP will be designed to offer both therapeutic and 19 practical life skills to enable clients to move through the transition stage towards independent living. Using lower tiered interventions and IAPT, shared care and other such appropriate support networks. The aftercare will focus very much on securing meaningful exit strategies whilst supporting individuals in this process addressing job applications, budgeting etc. These will take the format of 1 group per week alongside 1-1 work and key working. This group is not exclusive for people completing the first 12-18 weeks of the SDP programme and will be run on an evening so there will be inclusion for those who work. Completion & discharge planning including suitable aftercare arrangements, including external, post SDP support: Clients will have successfully completed a SDP intervention and confirmed attendance in a suitable aftercare, structured support or follow-up. These are likely to include, but are not restricted to Residential housing support Floating support Another suitable statutory and/or non- statutory service Structured day care/social space provision The provider will develop a social space provision where clients can drop in and socialise, with a structured day care approach, which incorporates activity and interest groups. This provision with act as a step up or step down from the Structured Day Programme. Dual Diagnosis For the purposes of this specification, dual diagnosis is defined as being: ‘Individuals with both diagnosed severe and enduring mental health illness and problematic drug and/or alcohol use. This includes any drug use which is seen to be either, exacerbating the symptoms of a mental illness, or, interfering with an effective treatment response. The Provider shall work alongside generic mental health services to provide an integrated and inclusive treatment response for Service Users presenting with a dual diagnosis need The Provider will ensure that Provider Staff have appropriate training and competencies to address dual diagnosis The Provider will provide screening, assessment and establish links with mental health services to address the identified issues via existing pathways The Provider will promote and facilitate joint recovery planning and risk assessment for Service Users with Dual Diagnosis as identified by mental health services 20 The Provider will regularly review care pathways and operational protocols Joint Working With Hospital Liaison Worker The Provider will ensure close working relationships with the Drug and Alcohol Nurse Specialist based at Doncaster Hospital, in order to maintain care pathway arrangements between the hospital and community settings. Targeted Services for Vulnerable People The Provider will deliver targeted drug treatment services and intensive social support to drug and alcohol misusers from vulnerable groups and hard to reach groups, with chaotic and complex lifestyles who may be marginalised from and find difficulty accessing other generic services. Target client groups will include but not be limited to: BME groups/asylum seekers Female substance misusers especially sex workers Homeless substance misusers Stimulant/NPS users Steroid users LGBT clients Clients with a learning disability or learning difficulty The full range of open access and structured interventions will be available to these groups, taking account of vulnerability factors such as the need for the use of interpreters, or the need for an assertive approach due to chaotic lifestyles. Mutual Aid Support The Commissioner is committed to the development of recovery networks to provide a diverse and comprehensive range of support to those in recovery – in treatment and beyond. 21 The Provider will utilise the emerging evidence base around recovery and work with recovering drug and/or alcohol users to support the development of non- clinical, non- professional support groups across the borough The Provider shall ensure information about and pathways into these groups are accessible for all Service Users through-out the treatment system The Provider will support the identification and development of recovery champions to promote the peer-led recovery agenda locally The Provider will develop working links with Narcotics Anonymous, Alcoholics Anonymous and SMART recovery to ensure that a variety of meetings are easily accessible for all Service Users The Provider will work with mutual aid organisations to ensure that assertive linkage and onward referral are available into mutual aid and peer support for all Service Users engaging in or leaving treatment, including residential rehabilitation. Peer Mentoring and Volunteering The Provider will develop and co-ordinate an effective volunteering and peer mentoring system, including the delivery of regular accredited mentoring training, developing and maintaining links with Doncaster CVS. The peer mentors, who will themselves be in recovery, and volunteers, shall be supported to become recovery champions and have a growing visible presence within the whole system, helping to motivate and support others to take steps towards recovery and avoid relapse The Provider will provide appropriate supported placement opportunities for volunteers and mentors throughout the system Mentoring of Offenders The Provider will offer support and guidance to offenders, resident within the Doncaster area, identified as IMPACT Offender status, and who either are or not subject to statutory supervision by the South Yorkshire probation service to : Contribute to the reduction in the incidence of re-offending by the IMPACT Offenders identified, registered and reviewed by the Doncaster Local Offender Management Panel Assist IMPACT nominals to access accommodation services Assist IMPACT nominals to access drug and alcohol advice and treatment services Assist IMPACT nominals to access education, training and employment services Provide support to IMPACT nominals to help them resolve personal, social and family relationships Individuals will be referred via the National Probation Service/CRC, and engaged into a mentoring arrangement and a range of support services which will assist them to resettle, access accommodation, medical care, and suitable training and employment opportunities. Support with addressing personal and emotional issues will also be provided with the objective of reducing the risk of re-offending. Training to Professionals The provider will offer a comprehensive range of drug and alcohol training to local non22 specialist agencies in order to increase knowledge of substance misuse issues, and enhance local referral and care pathways. 12 training sessions will be conducted per annum on localised request. Public Information The provider will ensure that electronic and paper information about services is available, e.g. websites, to meet the needs of local populations. Public Health Campaigns Periodically the Public Health team may require the assistance of the provider in the delivery of specific local or national campaigns. This will not exceed 4 campaigns per year. Hosting of Specialist Substance Misuse Midwife The Provider will host the Specialist Substance Misuse Midwife post employed by DBHFT, in order to deliver a seamless service for pregnant substance misusing women. 50% of the cost of the post will be borne by the provider, and a formal arrangement will be made as such with DBHFT. Service User and Family/Carer Involvement The Commissioner encourages Service Users, ex-Service Users and families /Carers to be given the opportunity to be involved in the design and delivery of local services at all levels. The Provider will ensure all Service Users and family members/Carers if appropriate, are aware of their rights and responsibilities at the point of engagement with the Services, specifically around information sharing and consent The Provider will ensue there are mechanisms which allow anonymous feedback from Service Users and informal Carers The Provider will have a clear Dangerous Patients’ policy which will govern the decision making process for excluding a Service User from the Services (including consultation with the Commissioner) and managing associated risk. This policy will promote risk-assessed on-going contact with Service Users who may have been excluded from certain locations. The Provider will support the involvement of Service Users and families/Carers within local strategic planning by active links with Doncaster PH commissioning team The Provider will encourage the recruitment of, and provide support for, Service User representatives across the service The Provider will develop a range of volunteer and peer opportunities within the service. The Provider will ensure there is a clear policy governing the recruitment of ex-Service Users both as paid staff and volunteers, including CRB check issues The Provider will promote regular consultation with Service Users and Carers in order for their views and experiences to be used as a tool for performance 23 monitoring and continuous service improvement. Family Interventions and support for Carers Evidence clearly shows that Service Users have a much greater likelihood of achieving and sustaining recovery where protective factors and recovery networks, such as close family/Carer involvement, are in place. Equally, evidence shows that the people surrounding a substance misuser are also more likely to have issues/complex needs to address. In order to ensure recovery of the client, the Provider must, therefore, also provide support to the family/Carers. The Provider will have in place appropriate mechanisms to identify and respond to the safeguarding of children and vulnerable adults at all times through-out delivery of the Services The Services will operate within the context of the substance misuse section of Doncaster’s safeguarding procedures, between adult drug/alcohol services and Children’s Services. Staff will be trained to level 3. The Services will collect a minimum dataset on Service Users with families and those living with children – see Assessment Section The Services will offer specific interventions for parents based on the impact of drug and/or alcohol use on parenting, the role of social services, positive parenting and the safe storage of medication. The provider will ensure staff are available to participate in the local delivery of MPACT (Moving Parents and Children Together) training and interventions to families, funding and facilitating up to 4 cohorts per year. The Provider will assess the needs of Service Users who are parents and encourage and support them to access and utilise mainstream family services. This will include the development of referral pathways with Sure Start and other mainstream Providers. Where a Service User is pregnant, the Provider will flag with maternity services to ensure post-natal follow up e.g. in respect of potential neonatal abstinence or foetal alcohol syndrome The Provider will collaborate fully with Doncaster’s Stronger Families programme. The Provider will develop working links with community health services including health visitors, parenting support workers and school nurses Where Service Users are identified as living with children, or in regular contact with children, supportive home visits will be offered. This will where possible be in partnership with appropriate community services. Home visits must be made in the context of a lone working policy and appropriate risk assessment procedures The Provider will provide Carers’ Assessments and onward referral into generic Carers’ services in Doncaster The Provider will support the development of parent and carer support groups as 24 required by local needs Reducing Drug and Alcohol Related Deaths Key to the reduction of drug and alcohol related deaths are: Robust information sharing systems, care co-ordination and the delivery of integrated pathways Staff training and commitment to ensure that service users have access to the appropriate harm minimisation advice and support Service delivery that focuses on recovery focussed engagement Appropriate risk assessments and risk management processes Provision of take home naloxone Moving in and out of the criminal justice service and following detoxification and rehabilitation are high risk periods to which the Provider shall pay particular attention. The Provider shall assist in the development and implementation of any plans to reduce drug or alcohol related deaths, following any recommendations highlighted to clinical governance leads from confidential enquiry panels. The provider will fully co-operate with supplying information to the PH commissioning team regarding any service user or former service user death or critical incident, and will attend the DRD steering group. 3.3 Population covered The services cover the geographical area of Doncaster Metropolitan Borough Council and are for Doncaster GP registered clients. However it is recognised that some Doncaster area clients may be homeless/in insecure accommodation, or not registered with a GP. 3.4 Any acceptance and exclusion criteria and thresholds The NHS Zero Tolerance guidance (DOH circular, 1999) describes a process where service users can be excluded for behaviour which breaches acceptable rules and standards but within a structure of user’s rights and responsibilities which should be made clear to clients from the outset. However given the situation where there is limited choice for drug services within the Borough, decisions to exclude clients from all or some aspects of the treatment system should only be made by the service manager/ clinical lead, and this decision and the reasons for it should be communicated within 24 hours to the commissioner in order that consideration can be given for ongoing care of the individual. The service is for clients age 18 and over, and the Provider will develop a transition policy with the Young People’s risk taking behaviour service. 3.5 Interdependencies with other services The Provider shall: involve Service Users and develop strong working relationships with mutual aid and 25 peer support groups develop links with other relevant services e.g. maternity services and safeguarding/children’s services develop interdependencies with ETE Providers e.g. Job Centre Plus and other wraparound provision e.g. CAB services make appropriate links with community-based criminal justice agencies to ensure coordination of work with substance misusing offenders The Provider shall attend key partner agency groups that facilitate recovery coordination, such as task and steering groups and forums, to ensure that the Services meet objectives. Through attendance at these meetings and partnership working the Provider will demonstrate the Services relationship to the whole treatment system including strategic relevance, meeting local needs, originality and impact of the Service, how the Provider manages resource effectively, working with diversity and its financial management to meet outcomes set. The Provider shall develop specific links with other elements of the treatment system including: Provision of a clinical intervention service that will work in close partnership with community mental health teams, palliative care, sexual health, hepatology/BBV nursing service and other specialist services to ensure a seamless and holistic service for Service Users Provision of a clinical intervention service that will work in close liaison with prison medical services to ensure defined and accessible pathways between prison and community treatment services for prisoners on release. The Provider, in conjunction with the prison service, will ensure that mechanisms will be in place to ensure those who are prescribed substitute medication from prison receive seamless continuity of care into community services working with established acute health care services to ensure clear effective pathways between acute health care and community drug/alcohol treatment services developing working relationships with local community pharmacists, utilising existing protocols around supervised consumption pathways to In-patient services developing Psycho-social Interventions on interdependencies with Providers of specialist and/or generic counselling services (other than substance misuse specific) e.g. IAPT pathways links with Primary Care services and on-going development of GP Shared Care clinics as required 26 3.6 Workplace Health Providers are expected to demonstrate a commitment to the health and wellbeing of their employees by working towards the standards set out in the Workplace Wellbeing Charter: National Award for England. This may include adopting tobacco control, healthy catering policies and active travel plans. Employment policies should facilitate stop smoking and promote abstinence including no smoking policies during paid working hours. Staff with service user contact should not be identifiable as smokers i.e. they should not smell of tobacco smoke or smoke whilst wearing provider identification. The Provider will work with Public Health to support workplaces across the Borough towards standards set out in the Workplace Wellbeing Charter: National Award for England. This will include providing support and advice relating to actively promoting an environment and culture which supports healthy choices, including identifying existing training which is delivered across the Borough to support and enhance where appropriate, to avoid duplication and ensure consistent messages across a number of arenas. 4. Applicable Service Standards 4.1 Applicable national standards eg NICE The Provider must deliver the service in accordance with national guidance including (but not limited to): Medications in Recovery: Re-orientating Drug Dependence Treatment (NTA, 2012): http://www.nta.nhs.uk/uploads/medication-in-recovery-main-report.pdf Medications in recovery: Best practice in reviewing treatment. Supplementary advice from the Recovery Orientated Drug Treatment Expert Group (PHE, 2013): http://www.nta.nhs.uk/uploads/medications_in_recovery-reviewing_treatment.pdf Clinical Governance in Drug Treatment: A good practice guide for providers and commissioners (NTA, 2009): http://www.nta.nhs.uk/uploads/clinicalgovernance0709.pdf Drug Misuse and Dependence: UK guidelines on Clinical Management (DH, 2007): http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf NICE Guideline CG51: Drug Misuse – Psychosocial Interventions (2007): http://publications.nice.org.uk/drug-misuse-cg51 NICE Guideline CG52: Drug Misuse – Opioid Detoxification (2007): http://publications.nice.org.uk/drug-misuse-cg52 Routes to Recovery: Psychosocial Interventions for drug Misuse. A framework and toolkit for implementing NICE recommended treatment interventions; the National Treatment Agency for Substance Misuse (NTA, 2010): http://www.nta.nhs.uk/uploads/psychosocial_toolkit_june10.pdf NICE Technological Appraisal TA114: Drug Misuse – Methadone and Buprenorphine for the management of opioid dependence (2007): http://publications.nice.org.uk/methadone-and-buprenorphine-for-the-managementof-opioid-dependence-ta114 NICE Technological Appraisal TA115: Drug Misuse – Naltrexone for the management of opioid dependence (2007): 27 http://publications.nice.org.uk/naltrexone-for-the-management-of-opioiddependence-ta115 NICE Guideline CG110: Pregnancy and Complex Social Factors: A model for service provision for pregnant women with complex social factors (2010): http://publications.nice.org.uk/pregnancy-and-complex-social-factors-cg110 NICE Public Health Guidance PH18: Needle and Syringe Programmes (2009): http://publications.nice.org.uk/needle-and-syringe-programmes-ph18 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_dr dpro.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 Joint Guidance on Development of Local Protocols between Drug and Alcohol Treatment Services and Local Safeguarding and Family Services (DCSF/DH/NTA, 2009): http://www.nta.nhs.uk/uploads/yp_drug_alcohol_treatment_protocol_1109.pdf Parents with drug problems: How treatment helps families (NTA, 2012): http://www.nta.nhs.uk/uploads/families2012vfinali.pdf Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children, 2013: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/2813 68/Working_together_to_safeguard_children.pdf NICE Guideline CG115: Alcohol Use Disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (2011): http://publications.nice.org.uk/alcohol-use-disorders-diagnosis-assessment-andmanagement-of-harmful-drinking-and-alcohol-cg115 NICE Guideline CG100: Alcohol Use Disorders: Diagnosis and clinical management of alcohol-related physical complications (2010): http://publications.nice.org.uk/alcohol-use-disorders-diagnosis-and-clinicalmanagement-of-alcohol-related-physical-complications-cg100 NICE Public Health Guidance PH24: Alcohol-use disorders – preventing the development of hazardous and harmful drinking (2010): http://publications.nice.org.uk/alcohol-use-disorders-preventing-harmful-drinkingph24 Review of the effectiveness of treatment for alcohol problems (NTA, 2006): http://www.nta.nhs.uk/uploads/nta_review_of_the_effectiveness_of_treatment_for_ alcohol_problems_fullreport_2006_alcohol2.pdf Supporting information for the development of joint local protocols between drug and alcohol partnerships, children and family services (NTA, 2011): http://www.nta.nhs.uk/uploads/supportinginformation.pdf Turning Evidence into Practice: Biological testing in drug and alcohol treatment (PHE, 2013): http://www.nta.nhs.uk/uploads/teip_testing_2013.pdf Turning Evidence into Practice: Optimising opioid substitution treatment (PHE, 2014): 28 http://www.nta.nhs.uk/uploads/teip-ost-14.pdf Facilitating access to mutual aid: Three essential stages for helping clients access appropriate mutual aid support (PHE, 2013): http://www.nta.nhs.uk/uploads/mutualaid-fama.pdf Good Practice in Harm Reduction (2008,NTA): http://www.nta.nhs.uk/uploads/nta_good_practice_in_harm_reduction_1108.pdf Drugs and Alcohol National Occupational Standards (DANOS): www.skillsforhealth.org.uk/component/docman/doc_download/137-danos... General Healthcare Assessment (NTA, 2006): http://www.nta.nhs.uk/uploads/nta_general_healthcare_assessment_guidance.pdf Care Planning Practice Guide (NTA, 2006): http://www.nta.nhs.uk/uploads/nta_care_planning_practice_guide_2006_cpg1.pdf Employment and Recovery: a good practice guide (NTA, 2012): http://www.nta.nhs.uk/uploads/employmentandrecovery.final.pdf The Joint-Working Protocol Between Jobcentre Plus and Treatment Providers (NTA, 2010): http://www.nta.nhs.uk/uploads/joint-workingprotocolwithjcp.pdf Club drugs: Emerging Trends and Risks (NTA, 2012): http://www.nta.nhs.uk/uploads/clubdrugsreport2012[0].pdf The Role of Residential Rehab in an Integrated Treatment System (NTA, 2012): http://www.nta.nhs.uk/uploads/roleofresi-rehab.pdf The Provider will be expected to accept and adopt relevant updates to existing guidance as well as new guidelines as and when issued. 5. Location of Provider Premises The Provider will source their own premises as per the structure outlined in this specification and include the full accommodation costs within their own budgets. For details of potential available DMBC properties please contact Chris.fairbrother@doncaster.gov.uk (Property Manager) 01302 737363 29