SERVICE SPECIFICATION
Service / Tier 4a Inpatient Alcohol & Drug DetoxificationProcurement Lead / Kylie Thornton Senior Contract Executive
Provider Lead / N/A – spot purchase within a framework agreement
Period / 1 April 2017 – 31 March 2020
1. Purpose
1.1 Aims and objectives of the Service
The aim of the Service is to provide short episodes of Tier 4a alcohol and/or drug specialist treatment interventions in an inpatient setting, including assessment, stabilisation and assisted withdrawal/detoxification, where it is not possible or safe to provide these interventions in the community. The service exists to provide both stabilisation and crisis management, depending on the individual needs of the Service User.
The objectives of the service are:
· to provide a period of alcohol/drug-free recovery as appropriate
· to reduce the use of illicit or non-prescribed and other drugs and/or alcohol
· to provide effective psychological interventions, such as cognitive behavioural therapy and relapse prevention therapy
· to facilitate, support and maximise the opportunities for abstinence from alcohol and drugs
· To improve overall personal, social and family functioning
1.2 Definition of services to be provided
Inpatient alcohol & drug treatment interventions usually involve short episodes of hospital based (or equivalent) drug and/or alcohol medical treatment. This normally includes 24-hour medical cover and multidisciplinary team support.
The framework agreement for Tier 4a inpatient alcohol & drug detoxification seeks to ensure a range of provision to allow choice in placements, and to maximise treatment outcomes for each service user. Procurer’s are seeking to recruit providers to the framework that can offer either or both:
1.2.1 Medically managed treatment. This is characterised by:
· Care for Service Users whose severe and complex medical and/or psychiatric needs require supervision in a controlled medical environment
· A planned programme of medically supervised evaluation, care, and treatment of mental and substance-related disorders, delivered in an acute care inpatient setting by clinicians (including psychiatrist(s)) with appropriate substance misuse qualifications
· 24-hour clinical cover for medically supervised evaluation and withdrawal management
· Care for clients whose severe and complex medical and/or psychiatric needs require supervision in a controlled medical environment
· Meeting the standards and criteria detailed in guidance from the Specialist Clinical Addictions Network (SCAN, 2006).
1.2.2 Medically monitored treatment: This is characterised by:
· Care planned assessment, stabilisation and assisted withdrawal/detoxification delivered in non-acute residential settings, under clinically-approved and monitored policies, procedures and protocols
· May include 24-hour nursing cover for more complex cases with greater needs
· Care for clients with lower levels of dependence, without severe medical and/or psychiatric problems
1.3 Policy Context
The Provider must comply with all of the relevant best practice standards and NICE guidance, and must keep up to date with changes in guidelines Key national guidance documents include:
1.3.1 Alcohol & Drugs
NICE quality standards -
· QS 11 Alcohol dependence and harmful alcohol use (2011)
· QS 23 Drug use disorders in adults
NICE clinical guidelines –
· CG 51 Drug misuse: psychosocial interventions (July 2007)
· CG 52 Drug misuse in over 16s: opiod detoxification (July 2007)
· CG 100 Alcohol-use disorders: diagnosis and management of physical complications (2010)
· CG 115 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (2011)
Other –
· Abulrahim D & Bowden-Jones O, on behalf of the NEPTUNE Expert Group. Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances. Novel Psychoactive Treatment UK Network (NEPTUNE.) London (2015)
· Care Quality Commission (CQC), Brief guide: substance misuse services – detoxification or withdrawal from drugs or alcohol, February 2016
· Department of Health (England) and devolved administrations (2007), Drug Misuse and Dependence: UK Guidelines on Clinical Management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive. Otherwise known as ‘the orange book.’ An updated version is due in 2016.
· Home Office, Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery, Supporting people to live a drug free life (2010)
· Home Office, The National Alcohol Strategy (2012)
· Public Health England, Public Health Outcomes Framework (www.phoutcomes.info) (2015)
· Public Health England, Quality governance guidance for local authority Procurers of alcohol and drug services (2015)
1.4 Legislation
The provider will comply with all of the relevant legislation, regulations, and statutory circulars insofar as they are applicable to the service. These include but are not limited to the following (including any pending reforms and related regulations):
· Rehabilitation of Offenders Act, 1974
· Data Protection Act, 1998
· Freedom of Information Act, 2000
· Employment Act, 2002
· Health & Safety at Work Act, 1974 (and subsequent regulations)
· Food Safety Act, 1980
· Food Hygiene Regulations, 2006
· Environment Protection Act, 1990
· Health & Social Care Act, 2012
· AIDS (Control) Act, 1987
· Children Act, 2004
· NHS and Community Care Act, 1990
· Mental Health Act, 1983 (amended in 2007)
· Carers (Recognition and Services) Act, 1995
· Carers and Disabled Children Act, 2000
· Carers (Equal Opportunities) Act, 2004
· Work and Families Act, 2006
· Equality Act, 2010
· Care Act, 2014
· Police Reform and Social Responsibility Act, 2011
1.5 Expected Outcomes
The Service will contribute to positive performance on the Public Health Outcome Framework (PHOF) which includes the successful completion of drug treatment performance indicator.
The Service is expected to deliver the following outcome:
· Successful completion of treatment (alcohol or drug free) or
· Successful completion of treatment (reduction in use of substances)
The provider will comply with NDTMS reporting.
2. Scope
2.1 Service Scope
The Service is provided as part of the Tameside approved provider list for Inpatient Detoxification services.
The Procurer would like a range of inpatient detoxification programmes to be accessible to their residents that will offer flexible treatment packages suitable for the differing level of Service User need and complexity. There is a clear differentiation in the needs of those who require inpatient detoxification for:
· Those who have complex needs and require 24 hour specialist support.
· Those who do not have complex needs but who are unsuitable for community detoxification because of unsuitable accommodation and/or lack of family or social support.
Inpatient detoxification is part of a broader treatment package to enable recovery of the Service User. Providers of inpatient detoxification services will work in close partnership with the community services to ensure integrated treatment pathways.
The Procurer is seeking proposals from providers who are able to provide inpatient detoxification programmes.
2.1.1 Service description
The Service will provide:
· Medically supervised assessment;
· Stabilisation on substitute medication (drugs);
· Detoxification and managed safe withdrawal from:
o Dependence on illegal drugs as defined by the Misuse of Drugs Act 1971
o Dependence on substitute medication including prescribed medication as part of a poly substance misuse pattern
o Dependence on alcohol
o Poly substance dependency
o Prescribed medication as part of a poly substance misuse pattern
o Problematic use of new psychoactive substances (NPS);
o Dependence on other drugs (including prescribed and non-prescribed medication.)
· Specialist inpatient treatment for stimulant users;
· Support to Service Users to understand the role of substance misuse in their lives and the effect on themselves and their carers, families and friends
· Building coping skills and defence mechanisms
· Psychosocial interventions, including but not limited to motivational and treatment engagement tools to reduce substance misuse, relapse prevention and coping with cravings;
· Understanding the key factors in maintaining change;
· Appropriate evidence-based alternative therapies;
· Lifestyle/well-being services;
· Emergency admission where indicated to protect the health of an unborn child, or where the effects of drugs are so severe and unpredictable that a Service User’s life is in imminent danger;
· Other potential emergency admissions where delay could lead to further serious deterioration in physical or mental health;
· Interventions to address any excessive levels of drinking for Service Users admitted primarily for detoxification from drugs;
· Appropriate tests and immunisation, for hepatitis B and C, and HIV;
· Access to parenteral and oral thiamine for service users admitted for treatment of alcohol dependence and meet NICE CG115 criteria;
· Other harm reduction interventions;
· Educational work;
· Physical and mental health screening;
· Building on the resources and skills that Service Users will need to enable them to start and sustain recovery (‘recovery capital’);
· Plans for post discharge care as confirmed by the Referrer;
· Advice and information to carers and families members who will offer support and help post discharge;
· Advice and information about Mutual Aid, and support that facilitates access to Mutual Aid meetings.
On checking first with the referrer, the provider will encourage carers and families to be involved in treatment and will recognise the positive role that they can play in recovery.
The provider must work in-line with the Service User’s individual Recovery Plan during admission and throughout the Service User’s period of stay (see 2.5.)
Services delivering planned medically assisted withdrawals using prescribed medication will do so in accordance with NICE Clinical Guidelines stated above including CG115 and CG100 (alcohol) and CG 51 and 52 (drugs).
2.2 Definition of service user group
2.2.1 Accessibility/acceptability
· Admissions within this contract will be voluntary admissions.
· Service Users must be 18 years and over on admission.
· Service users must be physically and/or psychologically dependant on one or more substances with physical or psychiatric complications or co-morbidity and not able to complete a detoxification in the community.
· Service Users with a history of severe and enduring mental illness will be accepted only if the presenting mental illness is stabilised prior to admission * or if the Tier 4 provider is confident that the Service User’s symptoms are manageable within the Tier 4 setting. (* However, alcohol referrers may refer Service Users who are not stabilised to determine the level of mental illness when alcohol free)
· Service Users who have a serious physical co-morbidity where continued substance misuse consistently exacerbates the illness or undermines its effective clinical management.
· Service Users must be a Greater Manchester resident and must be receiving drug or alcohol treatment by a service commissioned by one of the local authorities named on the Framework Agreement.
For complex needs (such as acute and serious physical or mental co-morbidity), there should not be an automatic exclusion (see 2.2.2). Providers will assess each individual referral based on the following criteria:
· The Service User is mentally and physically able to participate in the treatment and demonstrates a clear understanding of what the treatment entails. The referrer will be required to demonstrate that a comprehensive health and social needs & risk assessment has taken place prior to admission.
· Where a Service User has a history of presenting a risk of harm to others, the decision as to whether to accept a referral will rest with the inpatient detoxification provider. In making the decision, they will consider capacity to manage presenting risk and implications for others engaged with the service.
2.2.2 Exclusion
· Where there have been 2 previous admissions in the last 12 month period for concurrent episodes of treatment and the Service User has not engaged/not successfully completed treatment. This will be dependant on clinical need and may preclude further admissions until the client has accessed further motivational interventions.
· Where a Service User requires treatment for acute medical emergencies such as delirium tremens, Wernicke’s encephalopathy, septicaemia etc.
· Where a Service User needs treatment for acute psychiatric emergencies that preclude proper assessment. This may include Service Users who are detained under the Mental Health Act 1983 (amended in 2007) or who are liable to be detained due to risk to self or others at the time of planned admission.
· Where a Service User requires medium or high secure conditions of treatment.
· Where the primary purpose of admission is not the assessment and treatment of a severe substance use disorder.
2.3 Equality of access
The service provider should ensure that programmes are inclusive and can meet the treatment needs of Greater Manchester's diverse populations. The needs of a Service User in relation to specific ethnic, religious, gender, sexual orientation, health, literacy or cultural requirements must be identified in the care plan. This should include, but is not limited to, the following:
· arranging for the services of an interpreter at initial assessments and other meetings for Service Users whose English is not sufficient to understand what is being said
· arrangements for contact with an appropriate representative of the Service User's choice
· identification in care plans of Service Users' needs in relation to gender and sexual orientation and how these will be met appropriately and sensitively
· understanding of religious and cultural preferences in relation to food, dress and worship
· arrangements for access for service users with a disability
The Provider is expected to take positive action to combat discrimination on any grounds, and will be expected to apply requirements and good practice in line with the Equality Act 2010.
2.4 Responsibilities of Referrers
· Undertaking a holistic health and social needs and risk assessment that addresses the appropriateness of inpatient treatment for substance misuse. This assessment must be sent as part of the referral to activate the referral process.
· Clearly stating in writing which type of placement they wish to purchase (medically managed or medically monitored.)
· Ensuring that an overall Recovery Plan is in place and that this is being delivered and coordinated effectively. The Recovery Plan must be sent as part of the referral to activate the referral process.
· Supporting the provider in gathering Service User feedback following discharge.
· Appropriate arrangements to transport the Service User to and from the Service where the Service does not provide this.
· Ensuring that the Service User arrives for any pre-admission assessment.
· Informing the provider of any relevant changes in the Service User’s circumstances including, but not limited to, the Service User’s availability for admission.