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Serious concerns uncovered in residential detox clinics

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Many independent clinics that provide residential detoxification in England are not providing “safe or good quality care”, according to a warning from the health and social care regulator.

As a result, people undergoing medically-supervised withdrawal from drugs or alcohol in residential settings are being put at risk of harm, said the Care Quality Commission in a briefing today.

“Detoxification can be a difficult, unpleasant and sometimes, risky experience”

Paul Lelliott

The CQC’s report was based on inspections over the last two years of the 68 services in the independent sector that have been identified as providing residential detoxification.

In it, the regulator said it had “uncovered multiple concerns”, with many of the clinics found not to be assessing the risks to the safety of the people within their care prior to their admission.

Also, they were not always following recognised national clinical guidance on how to treat people who are withdrawing from alcohol or drugs, highlighted the regulator in its damning report – titled Substance misuse services: The quality and safety of residential detoxification.

In addition, clinics were not storing, dispensing and handling medicines appropriately and were not carrying out full employment checks or sufficiently training their staff.

“It’s crucial these services are in line with best practice”

Rosanna O’Connor

The CQC said it found 72% of the providers that it had inspected had been failing in at least one of the fundamental standards of care that anyone should have a right receive.

The regulation on safe care and treatment was where CQC found the most breaches, with 63% of providers not meeting this particular standard at the time of their first inspection.

Examples of what inspectors found included staff administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.

Staff were also observed giving paracetamol to people within their care more frequently than every four hours, despite them being at a greater risk of having liver damage due to heavy alcohol use.

In addition, staff did not always have planned how they would manage a person’s epileptic fits during their withdrawal, despite knowing from their history that they were at risk of having seizures.

Staff also lacked appropriate training in basic life support, consent and mental capacity and safeguarding, added the CQC.

“People undergoing detoxification are being exposed to unnecessary risks”

Colin Drummond

Four of the services that were inspected were no longer operating following the concerns raised by the CQC, it said.

It also noted that, from spring 2018, the CQC expected to begin to rate substance misuse services in the way the other services as either outstanding, good, requires improvement or inadequate.

Dr Paul Lelliott, deputy chief inspector of hospitals and lead for mental health at the CQC, said: “We are deeply concerned about how people undergoing residential-based medical detoxification from alcohol or drugs are being cared for in many independent clinics across the country.

“While we have found some services that are providing good care and we are beginning to see improvements, all providers need to review their practice so that we can be assured that they are delivering safe and effective care,” he said.

Care Quality Commission

Dr Paul Lelliott

Paul Lelliott

He noted that detoxification can be a “difficult, unpleasant and sometimes, risky experience”, and it was vital that providers got it right to support people’s onward rehabilitation and recovery.

Rosanna O’Connor, director of drugs, alcohol and tobacco at Public Health England, said: “While residential detox makes up a small part of the overall treatment system, seeing about 1% of all in treatment, they do have a vital role.

“It’s crucial these services are in line with best practice, as the clinical guidelines on drug treatment clearly sets out,” she said. “This helps ensure not only safety but gives some of the most vulnerable and disadvantaged people the best chance of getting their recovery on track.”

Professor Colin Drummond, chair of the addictions faculty at the Royal College of Psychiatrists, said the CQC report made for “sobering reading” on the scale of the problems with quality and safety.

“It shows systemic failings in the way these services are provided and that people undergoing detoxification are being exposed to unnecessary risks,” he said.

“It raises serious concerns around basic safety and fundamental standards of service”

Izzi Seccombe

He said: “Detoxification from drugs and alcohol is not a trivial undertaking and carries risks even in well-resourced services with adequately trained clinical staff.

“Potential risks include severe alcohol withdrawal including epileptic fits and hallucinations, suicide risk, and risk of prescription opiate drug overdose,” said Professor Drummond

“Therefore, it is essential that staff looking after these patients are properly trained, follow national clinical guidelines, and have appropriate 24-hour medical cover,” he added.

Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, said: “While the findings of this latest CQC report relate to a very small proportion of people in treatment, it raises serious concerns around basic safety and fundamental standards of service.

“Councils want to see providers have rigorous safeguarding procedures in place and ensure high quality training of staff, and it is right to inspect and regulate the market in this way,” she said.

Izzi Seccombe

Izzi Seccombe

Izzi Seccombe

“This report should be a wake-up call to those providers who are not meeting the required safety standards and to deliver urgent improvements,” she added.

In 2015-16, 2,622 people received medical detoxification from a residential rehabilitation service in England – this is around 1% of the 288,843 people in drug and alcohol treatment as a whole.

The services are commissioned mainly by local authorities with people also able to pay privately – as “self-funders” – for treatment too.

Successful medical detoxification, which can take around five to 10 days, often then leads to further rehabilitation and recovery support, such as through psychosocial interventions.

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