CQC voices ‘serious concerns’ over residential detox

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Clients undergoing medically supervised withdrawal in residential settings are being ‘put at risk’ by poor quality care, according to a briefing from the Care Quality Commission (CQC).

The document, which is based on inspections of nearly 70 services over a two-year period, says that the regulator uncovered ‘multiple concerns’ and warns that ‘many independent clinics in England are not providing safe or good quality care’.

More than 70 per cent of the facilities inspected were deemed to be failing in at least one of the fundamental standards of care that ‘anyone should have a right to receive’, says the commission, with more than 60 per cent not meeting the basic standard of ‘safe care and treatment’. Many providers were not assessing risks to clients’ safety before admission, adequately training their staff or following recognised clinical guidance, it states, and there were also concerns around the appropriate handling, storing and dispensing of medicines.

Examples included staff who hadn’t received appropriate training in basic life support, safeguarding or consent, or who were administering methadone without having been assessed as competent to do so. Others had failed to plan how they would manage a client’s epileptic fits during withdrawal, despite being aware of their medical history.

More than 2,600 people received medical detoxification from a residential service in England in 2015-16, around 1 per cent of the total number in drug and alcohol treatment. Some of the providers had ‘already improved’, the regulator notes, while others will be subject to re-inspection. Four, however, have ceased operating following the concerns raised by inspectors.

‘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,’ said the CQC’s deputy chief inspector of hospitals, Dr Paul Lelliott. ‘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. Detoxification under clinical supervision is often the first stage of a person’s addiction treatment. It can be a difficult, unpleasant and sometimes risky experience. It is vital that providers get this right to support people’s onward rehabilitation and recovery.’

The Royal College of Psychiatrists called the report ‘sobering reading’, while PHE’s director of drugs, alcohol and tobacco, Rosanna O’Connor, said that while residential detox clinics made up a small part of the overall treatment system their ‘vital’ role meant it was crucial that they were in line with best practice as set out by the clinical guidelines. ‘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. PHE has already been working with these services to help them improve and we will continue to provide this support.’

Substance misuse services: the quality and safety of residential detoxification at www.cqc.org.uk