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
a service users’ health needs are fully met. These incidences should be reported to the
commissioner to inform future service specification development.
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2013-16 Service Specification September 6th v9
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.
1 ‘Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life’, Home Office, 2010
http://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
CIOS DAAT has responsibility for delivering against the following 3 national outcomes
locally:
“Successful
“Reducing Alcohol-
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
“Identifying people entering prison with
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
completion of drug
and alcohol
treatment”
Public Health Domain
2.15
related admissions to
hospital”
Public Health Domain
2.18
substance dependence issues who are
previously not known to community
treatment and engaging them in
treatment”
Public Health Domain 2.16
CIOS DAAT also contributes to the delivery of :
1.8
1.11
1.13
1.15
2.8
2.10
2.23
4.3
4.8
4.6
4.10
4.11
Securing employment for those with a long term health condition
Reducing domestic abuse
Reducing re-offending
Reducing statutory homelessness
Improving the emotional wellbeing of looked after children
Reducing hospital admissions as a result of self-harm
Self-reported wellbeing
Reducing Mortality from causes considered preventable
Reducing mortality from communicable diseases
Mortality from liver disease
Preventing suicide
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)
2)
3)
Enable people to make informed choices about alcohol.
Increase services to reduce harm caused by alcohol.
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.
1.2.2 Local Context – Drugs

The latest figures estimate that there are between 2,100 and 2,500 opiate and / or crack users
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





(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
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
3 www.nta.nhs.uk/facts-prevalence.aspx
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- 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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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.
Values and beliefs – Service Essentials
2.3

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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2.4

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
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,
disability, age, isolation, vulnerability, ethnicity, religion and beliefs.
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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 AUDITConsumption (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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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
Tier 1 professionals to be aware of services
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•
•
•
•
•
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
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’,
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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:




8
Appropriate methods for initial confirmatory and ongoing drug testing (e.g. urinalysis)
Medical and Non-Medical Prescribing
Opioid maintenance (appropriately risk managed and reviewed longer term prescribing)
Opioid detoxification
CIOS Drugs Misuse LES
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



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
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
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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
tender)
(Residential
Rehabilitation placement budget is not part of
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 reentering 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:








3.6
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
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.
We invite the provider to be innovative in developing methods and models of meaningful re-
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2013-16 Service Specification September 6th v9
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:





3.7
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
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
estimated to be a maximum of 80 commencements per year
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2013-16 Service Specification September 6th v9
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
identified as suitable to undertake this option by the MDT in Gastroenterology at RCHT or
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2013-16 Service Specification September 6th v9
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 coordination arrangement agreed. Where the care is to transfer to another structured treatment
provider, a new keyworker will be identified and care co-ordination arrangements reviewed.
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2013-16 Service Specification September 6th v9
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 w
alcohol and drug problems, in particular hospitals, Adult Care and Support, Children’s and Family Services, Y
health, housing, employment and education services.
Local services will work with local communities, networks and service groups to forge strong relations
available to facilitate recovery and encourage local ownership of services. The provider care co-ordina
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 b
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 Childre
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 p
system, but also upon good working relationships with mutual aid groups, education, training, employment, hou
in particular.
As part of the Integrated offender management project ‘TurnAround’, the provider works in partnership with p
Police, Prison Healthcare and other prison based teams.
Interagency Liaison
•
•
•
•
•
Communication of care/support/risk management plans within and beyond the drug and alcohol treatm
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 Em
social/leisure opportunities
7.3 Relevant networks and screening programmes
7.3.1 The Provider (s) is/are required to participate in the following:

Needs Assessment Expert Group
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2013-16 Service Specification September 6th v9

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
 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.pd
 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-misus
 NICE Guideline CG52: Drug Misuse – Opioid Detoxification http://publications.nice.org.uk/drug-misuse-cg
 Routes to Recovery, (Psychosocial Interventions in Substance Misuse) a framework and toolkit for impleme
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.nic
buprenorphine-for-the-management-of-opioid-dependence-ta114
 NICE Technological Appraisal TA115: Drug Misuse – Naltrexone http://publications.nice.org.uk/naltrexonedependence-ta115
 NICE Guideline CG110: Pregnancy and Complex Social Factors http://publications.nice.org.uk/pregnancy-a
cg110
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2013-16 Service Specification September 6th v9









NICE Guideline CG120: Psychosis with Coexisting Substance Misuse http://publications.nice.org.uk/psycho
misuse-cg120
NICE Public Health Guidance PH18: Needle and Syringe Programmes http://publications.nice.org.uk/needl
ph18
NICE Public Health Guidance PH37: Tuberculosis – Hard to Reach Groups http://publications.nice.org.uk/id
tuberculosis-among-hard-to-reach-groups-ph37
Towards successful treatment completion: A good practice guide; NTA 2009 http://www.nta.nhs.uk/uploads
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
Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers. Royal Colle
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/u
main-report.pdf
In addition the provider will be expected to accept and adopt relevant updates to existing guidance as well as ne
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-interven
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 T
 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_4136
 ‘Signs for Improvement – commissioning interventions to reduce alcohol-related harm’ (Department of H
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_102813
 NICE Guideline CG115: Alcohol Use Disorders: diagnosis, assessment and management of harmful drin
 http://publications.nice.org.uk/alcohol-use-disorders-diagnosis-assessment-and-management-of-harmful
 NICE Guideline CG100: Alcohol Use Disorders: physical complications
 http://publications.nice.org.uk/alcohol-use-disorders-diagnosis-and-clinical-management-of-alcohol-relate
cg100
 NICE Public Health Guidance PH24: Alcohol-use disorders – preventing the development of hazardous
 http://publications.nice.org.uk/alcohol-use-disorders-preventing-harmful-drinking-ph24
 Models of Care for Alcohol Misuse (2006)
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2013-16 Service Specification September 6th v9
http://www.alcohollearningcentre.org.uk/_library/BACKUP/DH_docs/ALC_Resource_MOCAM.pdf (esp. p
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_o
.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 He
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, NT
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 Ski
 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 guid
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
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
will at a minimum include:
 Established clinical and operational standards in the form of service policies which cover all main asp
 A staffing structure whereby all staff receive advice, support, training, clinical guidance and supervisio
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, a
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 prof
 A documented system of risk assessment and risk management
Clinical governance which specifically pertains to the management of controlled drugs, as defined withi
the service will at a minimum have the following:

Registration with the Care Quality Commission as an Independent Healthcare Provider and meeting
the registration
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2013-16 Service Specification September 6th v9

8.2.2
A lead clinician with suitable training, skills and experience to provide clinical advice, supervision and
o GPs with A Special Interest (GPwSIs) and other medically trained staff employed or contracte
service.
o Supplementary and or non-medical prescribers employed or contracted to work directly with t
o A system of reviewing specific areas of clinical practice and its effectiveness through a clinica
o A process, agreed with the CIOS Lead Pharmacist for reporting errors and incidents concerni
the service.
Safeguarding Children and Hidden Harm
All services (including services specifically for adults) have a duty of care towards children as part of the Childre
Children Act (2004) outlines a ‘duty to co-operate’ amongst key people and bodies to promote the welfare of chi
The provider will appoint a Safeguarding Lead; they will possess the appropriate knowledge and skills to fulfil the
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 se
responsibility and who are in frequent contact with children (under 18). When working with substance misusing p
paramount consideration.
The Provider will agree to work within the bounds of the CIOS Joint Protocol Parental Substance Misusing Pare
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 ma
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 Substa
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
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, w
professional or agency requirement to keep information confidential.
The provider will ensure that workforce development plans incorporate Safeguarding and Child Protection Traini
Further information regarding the Cornwall Safeguarding Children Board including policies, protocols and trainin
www.safechildren_cios.co.uk Guidance on how agencies should work together is set out in Chapter 3 of Workin
Children 2010. All agencies have a duty to comply with the South West Child Protection Procedures (http://www
8.2.3 Safeguarding Adults
A Vulnerable Adult, is defined as anyone who is 18 years or over;
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2013-16 Service Specification September 6th v9
“Who is or may be in need of community care services by reason of mental or other disability, age or illness; and
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-A
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
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 P
The provider will include in their Policy on Abuse that any incidence of alleged or suspected abuse must be repo
Team and commissioners.
The provider will ensure that all members of staff cover Protection from Abuse, Code of Conduct and Profession
whistleblowing in their Induction programme.
The provider will ensure that members of staff involved with Care/Support/education delivery are adequately trai
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
the types of abuse and giving examples of what may constitute abuse, in an appropriate language and format fo
The provider will ensure that all Service Users have an up-to-date Recovery Plan that incorporates their views a
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 a
applicants.
The provider will have procedures for ensuring all those working for the provider including volunteers’ and mento
enhanced CRB check and a POVA register check before taking up a position working with vulnerable people. Th
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
9. Delivering an Inspiring Recovery-oriented Workforce
A shared understanding of recovery oriented treatment is required across the workforce deployed, includ
therapeutic alliance is key. Individual choices, preferences and needs must be reflected in care plans and s
of specialist and non-specialist provision.
All job descriptions; person specifications and recruitment processes will be expressed in line with the Drug
Occupational Standards and other relevant national occupational standards. The service provider will be abl
appropriate level of funding is allocated to the training and development of staff at all grades, including mana
9.1 Minimum Workforce Standards
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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 competenc

All workers and their line-managers have completed, or are undertaking, a training course regard
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
them, in line with the Drug and Alcohol National Occupational Standards (DANOS).Effective interventions requir
must have basic occupational competencies (e.g. DANOS). Front line staff must have competence in motivation
interventions.
https://tools.skillsforhealth.org.uk
Addiction specialists, consultant psychiatrists (or other consultants) and GPs working in addiction should have tr
with both guidance from the Royal College of Psychiatrists (monitored through appraisal and professional revalid
College of General Practitioners (RGCP Management of Substance Misuse Cert 1 and 2 at a minimum) and the
Occupational Standards (DANOS).
The Provider will continually work towards achieving a workforce which is fully competent and able to demonstra
the joint NTA/Home Office Development Plan i.e. that all managers and staff have a recognised competency ass
qualification appropriate to their role and are pursuing relevant continuous development. This will be evidenced
All providers to ensure they have a named workforce development lead who will attend partnership Workfo
working group meetings and report on their agency’s workforce competency and continuous professional develo
10. Service User and Carer Involvement
The provider will nominate a named lead for both Service Users and for Carers within the service. These individ
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 syste
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
organisation within the development of the Service.
The provider will undertake regular service user satisfaction surveys and feedback their findings at quarterly con
The provider will have a process to demonstrate that service user feedback has been heard and changes have b
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2013-16 Service Specification September 6th v9
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 a
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,
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 wi
open-access, as well as scheduled one to one appointments and group activities; additionally they will act as the
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 trea
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 S
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 prov
responsibility of the service provider. The CIOSDAAT/NHS Cornwall & Isles of Scilly will have no responsibility
management of the satellite sites.
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2013-16 Service Specification September 6th v9
12. Minimum Information and Intelligence Standards
The provider will have the capability to create, maintain, store and retain Service User Records. Any such recor
secure location and be compliant with the Data Protection Act, Access to Health Records Act 1990, consent req
Law Duty of Confidentiality.
The provider will also be expected to comply with the NHS Code of Practice on Confidentiality, Protecting and U
Manual for Caldicott Guardians), the NHS Information Governance Toolkit, and the security management standa
The provider will be data controller for the lifetime of the contract in that they are responsible for the processing
pertaining service users in receipt of direct care and information used for reporting purposes. At cessation of the
supply the commissioner with an electronic copy of service user records and performance relevant information t
records to an incoming provider.
Information sharing is needed to assure continuity of care and treatment. It is important to ensure consistency in
information is shared. The provider will collect sensitive and personal data through the assessment process and
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) r
(‘subject access’ requests) in accordance with Section 7 of the Data Protection Act 1998. The request does not
‘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. ‘Infor
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 authorita
information for an individual as they progress through the entirety of their recovery journey, both within and acro
sub-contracting arrangements).
The provider will ensure that the system will also be able to provide a robust mechanism for collecting data and
DIRWEB. The provider must be able to provide datasets to commissioners and to analyse and produce reports
information as determined by the Commissioner. All data and reports must meet NTA/NDTMS and Commission
system must be ‘future-proofed’.
There will be quarterly monitoring meetings of the Service Provider and the Commissioner. Monitoring arrangem
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 m
within the national submission schedule and nationally defined processes This information will be 100% comple
(exceeding the DAMS 100% validation metrics) and it will reliably reflect the actual activity of the treatment syste
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
measuring individual and caseload improvement and outcomes. The provider will ensure that the TOP is integra
have processes to share TOP outcomes reports at all levels within the organisation to continually improve servic
staff. The provider will use the information gathered through the TOP as the basis for reporting relevant outcom
The provider will deploy a suitably robust system to capture comprehensive needle exchange activity data. The
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2013-16 Service Specification September 6th v9
supply the commissioner with quarterly Needle Exchange activity reports for both specialist needle exchange pr
exchange report will include at a minimum, basic demographic profile of clients, number of visits, number of new
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 co
regarding all the protected characteristics and to identify where extra needs arise due to protected characteristic
gathering); in particular referrals, access, service user experience and outcomes (as measured by the Treatmen
The provider will analyse and understand where there is inequality of access and where there is inequality of ou
characteristics. The provider will undertake an annual equality impact assessment which will be supplied to the
Needs Assessment and Treatment Planning processes.
The Commissioners have a duty to monitor contract compliance and standard of the service provided to Service
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 in
progress on meeting the outcomes identified in the specification. The final set of local indicators will be develope
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 v
procedures, written -plans and strategies within the service; staff files and Service User files; complaints log; adv
audits, staff training records; and other relevant matters as specified by the Commissioner. The monitoring visit
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
will own the name.
The Provider shall not in connection with the performance of the Service, use, manufacture, supply or deliver an
thing, the use, manufacture, supply or delivery of which would be an infringement of any Intellectual Property Rig
The Provider must fully indemnify the Commissioner on demand against all losses, action, claims, proceedings,
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 th
with the delivery of the Service, any infringement of any copyright, patent, registered design, design right or trad
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 Agreemen
provision of the Service by the Provider shall belong to the commissioner and the Provider agrees that it shall ex
(by its staff if necessary) all deeds, documents and acts required to vest such intellectual Property Rights in the
The Provider shall keep strictly confidential, and shall ensure that it’s staff keep strictly confidential, any and all i
obtained by the Provider and/or its staff in the provision of the Service and shall enter into a confidentiality agree
this be required by the Council.
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2013-16 Service Specification September 6th v9
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2013-16 Service Specification September 6th v9
14. Performance Requirements
Requirement
Indicator
Threshold
Method of
Measurement
Problem Drug
Users in Effective
treatment
1200 OCUs
Of whom at
least 300 are
new treatment
episodes
NDTMS
600non OCUs
Of whom at
least 100 are
new treatment
episodes
NDTMS
Number and %
PDUs in treatment
in Primary Care
70%
NDTMS
Number and % in
treatment in
Secondary Care
30%
NDTMS
By substance
(OCU, nonOCU and
Alcohol)
Aiming to track
above the national
average
Aiming to track
above the national
average
Problem Drinkers
1200
NAMS
Home & Dry
LES
CHAD LES
Secondary 90
DIP
120 Arrest
referral contacts
(drugs and
alcohol) per
month
Offer
assessments to
100% of referrals
from Prison.
120
NDTMS
NDTMS
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By
locality
Incentive
Payment
2013-16 Service Specification September 6th v9
DI 1 60% of initial
contacts to be
assessed
NDTMS
dirweb
DI 2 85% of
assessments
taken onto
caseload
DI 3 95% taken
onto the
caseload to
engage in
treatment
To provide post
tier 2 services
post DRR
completion
80
commencemen
ts (MAX)
NDTMS
60%
completion
Waiting Times
3 weeks (21 days)
from referral date
to admission
90%
NDTMS
Community
Detoxification
Opiates
Report activity
by substance,
locality, gender,
age and
outcome
NDTMS
Home & Dry
CHAD
Hepatitis B
Vaccination
90%
Hepatitis C testing
90%
DBST
HALO
HALO
NDTMS
DBST
NDTMS
Other
By locality,
service, gender
and age
Hepatitis C
treatment referrals
completing
Data quality
By locality,
service, gender
and age
100%
NDTMS
90%
NDTMS
OUTCOMES
TOP completion
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2013-16 Service Specification September 6th v9
Successful
completions
OCUs
Above average
for cluster
groups
Non OCUs
NDTMS
Opiate abstinence
reliably improved
70%
TOP
No longer injecting
70%
TOP
No reported
housing need
85%
TOP
Reduce drop out
rates
OCUs
Below average
drop out rate for
cluster group
Non OCUs
NDTMS
Drug/Alcohol
related deaths of
people in
treatment or who
have been in
treatment
Numeric
Re-offending rate
Top quartile in
complexity group
TOP
Sustained
employment
Top quartile in
complexity group
TOP
The ability to
access and
sustain suitable
accommodation
Top quartile in
complexity group
TOP
Improved
relationships with
family members
Top quartile in
complexity group
HALO
Improved
capacity to be an
effective caring
parent
Top quartile in
complexity group
HALO
Safeguarding
Children
See Appended
Reporting Sheet
Safeguarding
Adults
See Appended
Reporting Sheet
HALO
HM Coroner
INDICATORS
Referrals by
source
Numeric
2011-12
baseline for self
referral
HALO
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2013-16 Service Specification September 6th v9
Dual Diagnosis
Numeric
With dependent
children
Numeric
Contacts by type
(telephone, face to
face, outreach)
Numeric
HALO
Requests (coded)9
Numeric
HALO
Responses
(coded)
Numeric
HALO
Days/Hours of
operation
Times
Report and
publicity
Overdose
prevention and
Basic Life Support
sessions delivered
Number of
sessions, clients
and localities
HALO
Translation
sessions required
(by number of
clients, sessions,
locations and
languages)
Half Year
Performance
review
Initial
Assessments
Number
Friends. Families,
affected others
Telephone and
drop-in Contacts
HALO
Family Support
Groups – 1 per
locality per week
minimum
Agency records
HALO
Telephone and
drop-in Contacts
HALO
Converting into
structured
treatment rate
HALO
-numbers
attending
Number of CAFs
initiated
Number of CAFS
completed
Other
professionals
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
Brief Interventions
ECMS
HALO
Mutual Aid
Support
Report by activity
HALO
Peer Mentoring
activity and
capacity report
By agency and
locality
Outreach to reengage
Activity
Conversion to
structured
treatment rate
HALO
Pre-detox
groups/Preparatio
n for Change
Groups
Post detox
Support groups
Needle & Syringe
Staff turnover rate
HALO
Activity
NEXMS/HALO
Org records
Org records
Sickness levels
Agency/bank
spend
Org records
Caseload per wte
(to not exceed 45)
Org records
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
attended with reports
report 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
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2013-16 Service Specification September 6th v9
Need)
Initial
Assessment
and
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
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2013-16 Service Specification September 6th v9
Other identify
Child
Protection
Leaflet circulated
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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