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Introduction

People who misuse alcohol or drugs often have a range of needs. To meet those needs, there is a wide range of services across Scotland which provide treatment and support to help people with their dependency problems. That range covers a continuum of services, from those providing intensive support in a residential setting through those of a less formal nature, such as community information centres or needle exchange facilities, and includes those assisting with employability, housing and money management. The statutory, independent and voluntary sectors are all involved in managing and running these services.

To ensure consistency of provision by all services a set of National Quality Standards and underpinning statements have been developed. These standards are the starting point in developing a robust monitoring and evaluation framework which will support providers to evidence, assess, and improve the quality of their service provision. We envisage that through compliance with the standards services can demonstrate the quality of their provision, enabling commissioners to make considered funding decisions.

Developing the National Quality Standards for Substance Misuse Services

Scottish Ministers approved a set of draft standards, developed by a steering group formed from representatives of drug and alcohol services, service commissioners and regulatory bodies. Eleven overarching standards, each with a set of underpinning statements, were formed, building on the principles behind the National Care Standards which were produced by the Scottish Executive upon the passing of the Regulation of Care (Scotland) Act 2001 ¹. As a result, the quality standards have been developed from the point of view of people who use the services. They describe what each individual person can expect from the service provider. They focus on the progress that the person using the service can make during a period of treatment.

Many people responded to a consultation on the draft standards, including people who use services, family and community support groups, area Alcohol and Drug Action Teams ( ADATs), voluntary organisations, health boards, local authorities and individuals. Their comments have resulted in these revised standards and accompanying guidance.

A number of different programmes relevant to quality improvement and underpinning development of the standards are described in Annex 1. In particular, the requirements of child protection and information sharing are central to the formation of the standards. Successful implementation depends on the key actions identified in Hidden Harm - Next Steps² being seen as an essential part of service delivery.

Who should use the standards?

The standards are intended to help all those involved in tackling substance misuse, including service commissioners and planners, statutory, independent and voluntary sector service providers, service users, their families, and the Scottish Executive in terms of policy development and funding. The standards are intended to be relevant not only to treatment and support services dealing directly with issues of dependency but also other services involved with substance misusers, for example those assisting them with employability, housing and money management.

The standards are also intended to be used to inform service users, their families or those empowered to represent them, about what they should expect from the services they wish to access and what will be expected of them.

What will the standards achieve?

The standards seek to achieve a consistent level of service delivery across Scotland. They will form the foundation of a process that is intended to enable services to examine and improve their provision and to provide a benchmark for the level of quality to be reached. In doing so these standards will give services, and staff within them, the reassurance that they are working to nationally recognised criteria.

The standards aim to improve information about what substance misusers should expect from service providers and give a basis for sharing information on best practice and treatment effectiveness.

How should the standards be used?

For services

The standards have been developed to be read in their entirety and you should regularly measure your service against each of the standards and underpinning statements and be able to provide evidence that your service is meeting all those which are relevant. Ideally, you should modify your existing evaluation methods so that they are suitable for measuring your service against the standards.

For each of the standards and underpinning statements you should consider how your own service provision can be improved and develop a plan to address any changes needed. The results of the evaluation and action plan should be recorded and any information that would be useful to service funders, planners or commissioners made available to them.

For service planners and commissioners

The standards can be used as a basis for evaluating service provision and ensuring that local services are of a suitable quality and range. Standards can be incorporated into funding or service level agreements and provisions for monitoring included into existing inspection arrangements. They can assist you in identifying any gaps in local service provision and be used to plan future service development. Areas of good practice can be identified and used to inform local and national strategy for developing more effective services.

For service users and their families or representatives

The standards are intended to improve the quality of care available and can be used as an indication of what should be expected from a service. They can be used to identify the types of treatment and/or support which each service is able to provide and should assist you in making a decision about what service to access.

The standards also set out your role and responsibilities towards your own recovery. They highlight when, with support, you can think about your choices and find ways to avoid future problems.

The principles behind the standards

The standards are based on the same set of principles as the National Care Standards, reflecting the recognised rights which you enjoy as a citizen. They recognise that services must be accessible and suitable for everyone who needs them. They reflect the strong agreement that your experience of receiving services is very important and should be positive, and that you have rights.

The main principles are dignity, privacy, choice, safety, realising potential and equality and diversity.

Dignity

Your right to:

• be treated with dignity and respect at all times; and
• enjoy a full range of social relationships.

Privacy

Your right to:

• have your privacy and property respected; and
• be free from unnecessary intrusion.

Choice

Your right to:

• make informed choices, while recognising the rights of other people to do the same; and
• know about the range of choices.

Safety

Your right to:

• feel safe and secure in all aspects of life, including health and wellbeing;
• enjoy safety but not be over-protected; and
• be free from exploitation and abuse.

Realising potential

Your right to:

• achieve all you can;
• make full use of the resources that are available to you; and
• make the most of your life.

Equality and diversity

Your right to:

• live an independent life, rich in purpose, meaning and personal fulfilment;
• be valued for your ethnic background, language, culture and faith;
• be treated equally and to live in an environment which is free from bullying, harassment and discrimination; and
• be able to complain effectively without fear of victimisation.

Supporting framework

The National Quality Standards for Substance Misuse Services form the first stage of a framework that will be developed to improve the quality and consistency of treatment and support for substance misusers. The longer-term aim is for the National Quality Standards for Substance Misuse Services to be incorporated into, and underpin, planning, commissioning and management activities to support continuous service improvements.

The next stage in the process, building on pilot projects conducted during the consultation on the draft standards, is to develop an evaluation tool which allows services to monitor improvements in their delivery of support and provide evidence of good practice. The three pilot projects explored different ways to test the measurability of the standards. These were using an example checklist of the documents, policies and procedures which can identify evidence of good practice; involvement of service users in interviews and questionnaires; and trying out a sample monitoring tool in several action team areas. All the materials and tools used in the pilot projects, including the types of documentary evidence needed to demonstrate compliance with the standards, are available online in the Draft National Quality Standards for Substance Misuse Services: Report on Pilot Projects. ³

A monitoring framework to support implementation is now being developed. This will not take the form of an additional burden of inspection. We have worked closely with regulatory bodies such as the Care Commission and the Social Work Inspection Agency in the development of these standards. However, in the move towards greater accountability, the standards are primarily intended to help continuous self-evaluation and improvement, with support from local ADATs and service commissioners.

Guidance on the statements contained in the standards and on preparations for monitoring is included in Annex 2 of this document. The guidance is provided in the form of Frequently Asked Questions.

Standard Statement 1

You will be provided with all the information you need to help you decide about using the service.

You, or someone acting on your behalf, will be:

• provided with clear and correct information on all the support available in the area;

• provided with information on getting help from the service - such as contacting and getting to it;

• provided with details of who the service is for, what it offers, and how to end your contact; and

• provided with details of its rules and ways of working, for example confidentiality, sharing information and making a complaint.

Standard Statement 2

You will have all the information you need about arrangements for ending your contact with the service.

• If you have children, the service will not ask you to leave without considering their needs.

• When about to leave the service other agencies may have to be informed, particularly if you have children.

• You will be given information such as how to get further help or cope with risks or setbacks.

• The service will talk to you about the choices and risks faced by you and others.

• Before leaving you will be asked for your views of the service.

• The service will send a report on your progress to appropriate agencies and you will receive a copy of this.

• The service may ask if they can keep in touch to see how you are doing.

Standard Statement 3

You will be able to access safe, quality surroundings when engaging with the service.

• The service and facilities offered will be of a good standard - safe and appropriate.

• The service will employ and train its staff to make sure you are treated with respect and dignity.

• The service will make sure that bullying, harassment or discrimination of any kind is not tolerated.

• The service will respect your religious, spiritual, cultural or other beliefs and needs, and those of others who use the service.

Standard Statement 4

You will be involved in a full assessment which makes sure that decisions about your care and support are based on your needs.

• You will take part in a full assessment of your drug and/or alcohol use and other needs. This assessment will be kept up to date.

• Improving your situation will involve discussing areas in your life such as your family, children, aspirations, health, employment and housing.

• Your views will be listened to and used to develop your personal plan.

• With your agreement, your information will be shared with other services and it will be made clear to you when this might be done without your permission.

Standard Statement 5

You will receive a written personal plan that clearly sets out what the service will provide to meet your needs.

• After assessment you will be involved in developing your personal plan.

• What is expected to be achieved will be clearly stated in your personal plan.

• Who does what and when will be made clear in your personal plan which will be kept up to date.

• Your responsibilities will be made clear in the plan.

• As your situation changes, your personal plan will be reviewed to reflect these changes.

Standard Statement 6

The service will work with you to achieve the jointly agreed actions in your personal plan.

• You will be informed about what the service offers, how it can help and how to take part.

• You will have time to think about your choices.

• You will be offered a supportive working relationship to help meet your needs.

• You will be supported to take action to meet your needs identified in your personal plan.

• You will be supported in finding ways to avoid future problems with drugs and/or alcohol.

• You will be expected to work together with the service to make sure that there is a joint responsibility for meeting your needs.

Standard Statement 7

You will be able to discuss and plan your long-term support with service staff, involving your family, other organisations, services or representatives as appropriate.

• From the start, the service will work with you to support you to achieve your future goals.

• The service will support you with all parts of the plan such as identifying personal strengths and maintaining positive relationships.

• The service will assist you to make helpful contacts before you leave.

Standard Statement 8

You will receive quality support and care.

• If you have needs the service cannot meet, appropriate professional help will be sought.

• The service will meet relevant legal requirements.

• Workers (paid and unpaid) will be appropriately trained and supervised.

• The service will continuously review how it addresses the needs agreed in your personal plan.

Standard Statement 9

The service will work with a wide range of partners, including other services, so that your needs are met.

• Funders and providers will jointly design services that meet local requirements and national plans and will ensure they work together in a co-ordinated way.

• Funders and providers will ensure that evidence-based best practice is used to inform service design and delivery.

• Local services will be able to meet the needs of all those affected by alcohol or drugs.

• Services will consult with other agencies, such as housing and employment, when appropriate, to meet your needs as agreed in your personal plan.

• All drug and alcohol specialist services will have clearly written service specifications.

Standard Statement 10

The service you receive has been designed with you, your family, and the needs of the local community in mind.

• The service will treat everyone fairly in the way they work.

• All services will work together to offer the best help with your changing situation.

• How the local community are involved with the service will be clearly laid out.

• The service will recognise the needs of members of your family and those you live with and, where appropriate, seek support for them.

Standard Statement 11

Your views will be sought in order to constantly monitor the type, delivery and development of services.

• You will be given a list of your rights and responsibilities when using the service.

• To improve this service, at least once a year, you will be asked in confidence for your views and ideas on the service.

• To improve this service, at least once a year, other local organisations will be asked in confidence for their views and ideas on the service.

• If you want to join a group with others using services then you will be given support and training to do so.

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