MEDWAY SUBSTANCE MISUSE TIER 4 PANEL: TERMS OF REFERENCE

Version control Version: 1.3 Date: 07/05/2013 Status: Working Draft Author: Matthew Scott (TONIC Consultants) & Medway T4 working group

Contents
1. Purpose........................................................................................................................2 2. Principles......................................................................................................................2 3. Functions......................................................................................................................2 4. Governance..................................................................................................................3
4.1 Membership .................................................................................................................................... 3 4.2 Quorum ........................................................................................................................................... 3 4.3 Decision-Making Process................................................................................................................. 3 4.3.1 Standard Process ...................................................................................................................... 3 4.3.2 Fast Track Detox Process.......................................................................................................... 4 4.3.3 Extensions to Current Placements ............................................................................................. 4 4.4. Clinical Governance........................................................................................................................ 4 4.5 Record Keeping & Reporting Requirements ................................................................................... 4 4.6 Eligibility Criteria (See Annex A) ...................................................................................................... 5 4.7 Appeals Against Decisions ................................................................................................................ 4.8 Safeguarding & Risk Management .................................................................................................. 5 4.9 Administration ................................................................................................................................. 5 4.10 Information Sharing ....................................................................................................................... 5 4.11 Exit & Early Exit Plans .................................................................................................................... 5 5.1 Budget Management ...................................................................................................................... 6 5.2 T4 Placement Providers ................................................................................................................... 6 5.3 Contracting...................................................................................................................................... 6

5. Commissioning/Purchasing Arrangements ..................................................................6

ANNEX A. ELIGIBILITY CRITERIA ....................................................................................7 ANNEX B. T4 PLACEMENT PROVIDER LIST ................................................................13 ANNEX C. STANDARD PACKAGES OF CARE...............................................................16 ANNEX D. MEDWAY T4 PATHWAY.............................................................................17 ANNEX E. TIER 4 PANEL EXAMPLE AGENDA .............................................................18 ANNEX F. Suggested Text for a Service User Leaflet...................................................19

1. Purpose
To ensure the delivery of the vision for: A clear, safe, fair, transparent & effective pathway for appropriate access into and out of Residential Rehabilitation and Inpatient Detoxification for substance misusers in Medway to aid recovery and improve outcomes.

2. Principles
The following principles underpin the actions of the panel: We will work together in a partnership approach We will aim to continuously improve the system to increase the level of effective outcomes and value for money The service user must be at the heart of the process The process must be open, transparent, integrated with other service provision, simple to follow, and consistently applied Criteria and decisions must be clear, fair and based on evidence Communication will be open and all decisions recorded

3. Functions
The Panel will: Make decisions on funding applications for access to inpatient detoxification and residential rehabilitation for substance misusers in Medway Be responsible for managing the Substance Misuse Tier 4 budget Regularly review all cases currently in placement (minimum every 4 weeks) and those that have recently left placement Enact after placement & unplanned exit plans Report to the Medway Drug & Alcohol Action Team (MDAAT) Follow locally-agreed processes for all serious incidents, deaths and high-risk cases involving service users currently on, or recently closed to, the Tier 4 pathway, inc: o Kent & Medway Dual Diagnosis Protocol http://bit.ly/10cOTEj (2013 update) o Kent & Medway Serious Incidents (SI) and Drug & Alcohol Related Deaths (DARD) Process o Kent and Medway Multi Agency Risk Assessment Conference (MARAC) http://bit.ly/WTlosj o Medway MAPPA http://bit.ly/YE0c3U o Medway Safeguarding Adults processes http://bit.ly/ZroEIW o Medway Safeguarding Children processes http://www.mscb.org.uk/ Share learning and good practice through papers to the DAAT Board including audits of the cases presented to the Panel, a summary of outcomes, key points for practice and views on the effectiveness of various T4 Placement providers Keep the Tier 4 pathway, eligibility criteria, T4 provider list and Panel Terms of Reference under review, revising as required, with a formal review at 9 months (Dec 2013).
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4. Governance
The following governance arrangements are in place to ensure the process is robust, fair and fully accountable, with clear roles and responsibilities.

4.1 Membership
Medway Community Substance Misuse Service providers: KCA (UK), KMPT, & CRI Medway Council: Substance Misuse Social Workers Medway Public Health: Drug & Alcohol Action Team (no voting rights) Others: Co-opted members can be brought onto the Panel for specific client cases where their involvement is required. These co-opted members are expected to include the lead worker making the application, Probation, Social Care, Mental Health services, Prison services, Tier 4 providers, other community agencies. NOTE: Co-opted members will not have voting rights and will not be considered to be full members of the T4 Panel

4.2 Quorum
For a Panel meeting to go ahead, and its decisions to be considered valid, there must be a minimum of 2 substance misuse service providers and 1 representative from Substance Misuse Social Workers present. It is possible for members unable to attend the meeting in person to contribute via email or phone to meet this requirement. This will ensure that required skills, knowledge and quality assurance are in place when making decisions.

4.3 Decision-Making Process

4.3.1 Standard Process
The Panel will meet every 2 weeks (unless there are no applications and no reviews scheduled) with at least quorum membership. Applications & reviews should be emailed via secure email to Julie Collins (julie.collins@medway.gov.uk.cjsm.net), the Public Health DAAT Administrator, by midday on the Monday before Panel meeting or the presenting agency should bring 5 paper copies of relevant forms to the meeting for Panel members. Meetings will be arranged by DAAT, with the chairing rotated amongst Panel members. The role of Panel Chair will rotate amongst Panel members after 3 months. The Chair will: o Ensure that all new applications are heard o Ensure the Panel decision for all applications is recorded on the T4 Tool o Ensure all open cases are reviewed every 4 weeks as a minimum The decision on whether to approve an application will be made by those Panel members present, with absent members able to contribute by email via DAAT for inclusion in discussions. The decision will be based on the available budget and reviewing the application against the eligibility criteria. Members of the Panel present will then vote to: o Approve the application, or approve the application with amendments; o Request that the practitioner making the application provides further information or the client conducts more work in the community before resubmitting the application to the Panel; or o Refuse the application.
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 The majority vote carries the decision. If the vote is equal with no majority, then the Panel will discuss the decision until they can reach a majority vote. If a majority cannot be achieved through this process, then the Chair will have the deciding vote. If the application is approved, the Panel will make a decision on which T4 provider(s), from the T4 Placement provider list, to use for the placement. This decision will be based on the available budget, and the stated preferences of the client and their lead worker unless there is good reason to decide on another provider. All detox applications must be supported in writing by an appropriately qualified member of the medical or nursing staff from KCA or KMPT (as part of the T4 Tool). All rehab applications must have involved the Substance Misuse Social Workers and community substance misuse service providers in the process. Approved placements should normally be started within 14 days for detox and 1 month for rehab of the decision being taken by the T4 Panel.

4.3.2 Fast Track Detox Process

In the event that a Fast Track detox is required, the application must be supported in writing by an appropriately qualified member of the medical or nursing staff from KCA or KMPT (as part of the T4 Tool). Provided this is in place, the placement will be funded for a period of up to 14 days. The choice of inpatient detox provider will still be made from the provider list at Annex B and will need to be justified. All Fast Track applications must be emailed to the DAAT T4 Panel administrator. The application and decision will be discussed at the next Panel meeting. The Fast Track process will be kept under review to ensure this mechanism is appropriate.

4.3.3

Extensions to Current Placements

In the event that a client already on a placement requires an extension to their placements agreed duration, this will be brought back to the next Panel meeting to make a decision on. The exception to this is where a client on a detox requires an extension and the Panel will not meet again in time for this decision to be made to allow for continuous care. In these circumstances, the decision making process will follow the Fast Track Detox process set out in point 4.3.2.

4.4. Clinical Governance

Responsibility for clinical governance lies with each of the Panel members organisations, and must be in accordance with their Medway Council contract and service level agreement and nationally recognised standards.

4.5 Record Keeping & Reporting Requirements

The following information must be recorded centrally by DAAT for all applications to the T4 Panel (inc. Fast Track Detox), and a summary reported quarterly to DAAT Board: The clients name and relevant demographic details The name & organisation of the lead worker making the application Dates of application, Panel decision, reviews, placement start & exit (waiting times) The outcome of their application (i.e. the decision) & the rationale for the decision The cost, duration of their placement & which provider(s)
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 The outcome of their placement (e.g. completed, early exit - planned or unplanned) Current status (with brief update at review) & subsequently the reason for exit of client from the Tier 4 pathway

4.6 Eligibility Criteria (See Annex A)

The T4 Panel are responsible for keeping the eligibility criteria fit for purpose, and for ensuring the criteria are published and made available to clients, their families, specialist substance misuse services and partner agencies.

4.7 Appeals Against Decisions

If a client or practitioner wishes to appeal against a Panel decision, they may resubmit their application to the Panel with further information addressing the reasons given for refusing their application. If they are still unsatisfied, they can make an official complaint to Medway Council - h t t p : / / b i t . l y / Y D j j f p .

4.8 Safeguarding & Risk Management

Each member of the panel will work to their organisational policies for safeguarding and risk management as well as the protocols and policies regarding high-risk cases, SI, DARD, and dual diagnosis (outlined in Point 3 of this document).

4.9 Administration
A member of the Drug & Alcohol Action Team will provide administration of the T4 Panel. They will be responsible for: Maintaining a central record & prepare quarterly reports for DAAT Board (point 4.5) Managing & administering the T4 budget (e.g. paying invoices, keeping up to date budget record and forecast) Arranging & attending the fortnightly Panel meetings, circulating required papers Ensuring that a spot purchasing contract is in place with all T4 placement providers

4.10 Information Sharing

T4 Panel members will be governed by the Kent & Medway Information Sharing Agreement http://bit.ly/145QC1n.

4.11 Exit & Early Exit Plans

A suitable and robust exit plan must be in place prior to the application being submitted to the Panel. Given the likelihood of early or unplanned exit from T4 placements, there must also be suitable early exit plan in place prior to Panel application. The Panel will review these arrangements and ensure they are enacted on the clients exit from placement.

5. Commissioning/Purchasing Arrangements
5.1 Budget Management
The specific annual budget for funding residential rehabilitation and inpatient detoxification for substance misusers in Medway will be set annually, and be managed by the DAAT. To accompany this a list of examples of standard packages of care are described at Annex C.

5.2 T4 Placement Providers

The T4 Placement providers list is attached as Annex B. This is based on a list from Kent DAAT who undertook a consultation and tendering process to compile this list. The T4 Panel will be responsible for keeping this list up to date and fit for purpose, ensuring that provision is safe, appropriate and offers value for money, by: Ensuring all providers are CQC registered and compliant Ensuring all providers are registered with and reporting to NDTMS Capturing client feedback on placements Looking at outcomes from placements Ensuring that there are a range of different approaches / types of placement available to offer a choice to clients Ensuring there is variety of placements on offer to meet need to include priority and vulnerable groups such as pregnant women, mothers with babies or young children, those with mental health problems, those with speech or language issues or who may require a translator Reviewing the Potential provider list in line with CQC expectations http://bit.ly/WHukjn

5.3 Contracting
The DAAT T4 Administrator will be responsible for ensuring that there are spot purchasing contracts, conforming to Medway Council standards, in place with all T4 providers on the list (Annex B). The spot purchasing contract will set out the Tier 4 Panels expectations from a Tier 4 provider in terms of quality, value for money, minimum standards and practical arrangements.

ANNEX A.

ELIGIBILITY CRITERIA

PURPOSE To act as a guide to decision-making on eligibility for access to residential rehabilitation and inpatient detoxification1 (Tier 4) for people with substance misuse problems (drugs and/or alcohol) in Medway. The Medway T4 Panel makes final decisions on funding access to Tier 4 provision. ELIGIBILITY CRITERIA 1. Substance misuse issues have critical or substantial impact on the client3 2. A resident of Medway (unless placed out of area by Medway Council) 3. Aged 18 years old or above 4. Treatment in the community (or prison) is the first option and should be fully explored before an application for a Tier 4 placement. Only in exceptional circumstances will residential treatment be the first choice (e.g. an urgent detox, or where alcohol dependency prevents access to other treatment) 5. Before applications will be accepted by the T4 Panel: The client (or family/carer if required) must give their consent to the application A comprehensive assessment2 must be undertaken to enable an accurate rating of key areas against Medway Fair Access to Care Services criteria3 As part of this, clients who require inpatient detoxification must be assessed by a suitable medical or nursing practitioner from KMPT and/or KCA (UK) Robust Exit and Early Exit Plans must be in place The application must contain a statement by the clients lead worker (inc. where they do not support the application) The application must contain a statement of the perceived risks for the client if the Tier 4 application is not approved EXCLUSION CRITERIA Applications for Tier 4 services will not normally be considered within 12 weeks of a previous residential or inpatient treatment episode being funded - apart from in exceptional cases, in which case the T4 Panel will consider the circumstances of the particular case and make its decision. This does not prevent applications for the extension of current Tier 4 placements. PRIORITY GROUPS Pregnant women are a priority group for access to Tier 4 provision. FAST TRACK DETOX Where it is dangerous for the clients health or safety to wait until the next Panel meeting to discuss an application, it may be necessary for an inpatient detox to commence very quickly. Fast Track Detox applications must be supported by a suitably qualified member of KCA or KMPTs medical or nursing staff.
1
2

For definitions of detox and rehab, please see Annex A5 See the Medway Tier 4 Tool 3 See annexes A1 & A2 for examples and definitions of Medways Fair Access to Care Services

ANNEX A1. DETERMINING ELIGIBILITY CRITERIA FOR ADULT SOCIAL CARE (DH, 2010)

The eligibility framework is graded into four bands, which describe the seriousness of the risk to independence and well-being or other consequences if needs are not addressed. The four bands are as follows: Critical When life is, or will be, threatened; &/or Significant health problems have developed or will develop; &/or There is, or will be, little or no choice and control over vital aspects of the immediate environment; &/or Serious abuse or neglect has occurred or will occur; &/or There is, or will be, an inability to carry out vital personal care or domestic routines; &/or Vital involvement in work, education or learning cannot or will not be sustained; &/or Vital social support systems and relationships cannot or will not be sustained; &/or Vital family and other social roles and responsibilities cannot or will not be undertaken. Substantial When there is, or will be, only partial choice and control over the immediate environment; &/or Abuse or neglect has occurred or will occur; &/or There is, or will be, an inability to carry out the majority of personal care or domestic routines; &/or Involvement in many aspects of work, education or learning cannot or will not be sustained; &/or The majority of social support systems and relationships cannot or will not be sustained; &/or The majority of family and other social roles and responsibilities cannot or will not be undertaken. Moderate When there is, or will be, an inability to carry out several personal care or domestic routines; &/or Involvement in several aspects of work, education or learning cannot or will not be sustained; &/or Several social support systems and relationships cannot or will not be sustained; and/or Several family and other social roles and responsibilities cannot or will not be undertaken. Low When there is, or will be, an inability to carry out one or two personal care or domestic routines; &/or Involvement in one or two aspects of work, education or learning cannot or will not be sustained; &/or One or two social support systems and relationships cannot or will not sustained; &/or One or two family and other social roles and responsibilities cannot or will not be undertaken.
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Annex A2. MEDWAY COUNCIL ELIGIBILITY CRITERIA - EXAMPLES OF DEFINITIONS

Physical Health

Critical imminently life threatening, e.g. liver failure, cancer (no remission), significant diagnosed heart problem where substance use places additional pressure on heart, AIDS. Substantial history of fits, serious liver damage, DVT, open abscesses, endocarditis, serious gastro problems, HIV+, Hep C+, groin and neck injecting, collapsed veins. Moderate some liver scarring/liver disease, gastro-intestinal problems, vein damage from injecting Low - no damage yet but if continues life style will go up scale.

Mental Health

Critical detained under the Mental Health Act or very serious suicide attempt in the last 3 months requiring hospital treatment. Substantial subject to CPA, regular suicide attempts with most recent being within last six months. Moderate mental health managed by primary care, e.g. depression, anxiety. Low says feels depressed but not receiving any treatment for it.

Social Functioning
Critical no contact with anyone, may be referred in via mental health services, even if critical at point of referral probably not by the time ready for rehab, imminent loss of job as a result of substance misuse. Substantial totally enmeshed in a drug or alcohol social culture with no contact with non-users either in or outside of home, going through disciplinary at work or high level of sickness due to substance misuse, substantial debts, significant involvement in criminal justice system due to substance misuse. Moderate - limited contact with non-substance users, anyone in structured work where substance is having an impact on their job. Low high level of contact with non-substance users, occasional sick days from work due to substance use.

Child Care (children aged 17 and under)

Critical childcare proceedings, or pregnancy. Substantial Safeguarding Children issue. Moderate Children In Need. Low have children in their care. N/A Dont have children, dont have children in their care, or their children are over 18.

Housing

Critical street homeless, eviction proceedings/repossession, living in a crack house, living in a car, have to leave house due to dealers threats (police involvement). Substantial - hidden homeless, i.e. homeless but somewhere to sleep (sofa surfing, etc.), serious neighbour problems, targeted by drug dealers, serious rent arrears. Moderate inadequate housing, i.e. damp/not large enough to house everyone. Low housing adequate but want a transfer. N/A housing adequate, no desire for transfer/move.

Impact on Carer

Critical domestic violence (perpetrator or victim) physical and verbal at a significant level, person has significant physical or mental health needs and carer is unwilling to provide care. Substantial person has care needs and carer isnt willing or able to meet all of these a significant part of the time, relationship breakdown. Moderate carer isnt willing or able to meet all of these care needs all of the time. Low - any carer. / N/A no carer.

Annex A3.

INPATIENT DETOXIFICATION NICE CRITERIA

The criteria for inpatient detoxification includes: Physical dependence on one or more substance that require concurrent detoxification Co-morbid physical or mental health problems (but not acute severe mental illness) Women who are pregnant Client choice where there is a preference to be away from their home environment Individuals who are unlikely to cope with outpatient/home detoxification due to significant personal isolation, homelessness or lack of support from family or friends Clients who have experienced previous withdrawal complications e.g. seizures Individuals who need stabilisation due to their chaotic drug use and/or lifestyle acute withdrawal symptoms that are life threatening.
NICE, 2011, 2008a; Department of Health (England) and the devolved administrations 2007

Annex A4.

RESIDENTIAL REHABILITATION NICE CRITERIA

The criteria for residential rehabilitation may include: Individuals who fail to achieve and maintain abstinence in a community setting Those who express a desire to maintain abstinence and express a preference for admission to rehabilitation programmes Client agreement and commitment to enter this type of programme Those who are likely to have substantial problems maintaining abstinence due to the severity of their substance dependence Those requiring a programme of support and rehabilitation that is most suitably delivered in a residential environment Those who are living in an environment characterised by social deprivation, including housing problems or instability, which represents a threat to relapse Those who lack social support Those whose social environment contains people (e.g. partners, friends) who are misusing substances and who are likely to hinder resolve or ability to maintain abstinence.
NICE, 2011; Department of Health (England) and the devolved administrations, 2007

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Annex A5. DEFINITIONS Tier 4 treatment is defined by the National Treatment Agency for Substance Misuse in Models Of Care for Treatment of Adult Drug Misusers: Update 2006 (pages 45 and 46) as follows: Inpatient Detoxification Inpatient drug treatment interventions usually involve short episodes of hospital-based (or equivalent) drug and alcohol medical treatment. This normally includes 24-hour medical cover and multidisciplinary team support for treatment such as:

Medically supervised assessment Stabilisation on substitute medication Detoxification/assisted withdrawal from illegal and substitute drugs and alcohol in the case of poly-dependence Specialist inpatient treatments for stimulant users Emergency medical care for drug users in drug- related crisis.

The multidisciplinary team can include psychologists, nurses, pharmacists, occupational therapists, social workers, and other activity and support staff. Inpatient drug treatment should be provided within a care plan with an identified keyworker. The care plan should address drug and alcohol misuse, health needs, offending behaviour and social functioning. Care-planned inpatient treatment programmes may also include a range of additional provisions such as:

Preparing the client for planned admission to inpatient treatment (if this is not carried out by a suitably competent community worker as part of the agreed care plan leading to admission) Psychosocial interventions, including relapse prevention work Interventions to tackle excessive levels of drinking Appropriate tests or vaccination (if appropriate) for hepatitis B, C and HIV Other harm reduction interventions Educational work Physical and mental health screening Linking inpatient treatment to post-discharge care, which may involve preparation for referral to residential rehabilitation or community treatment, aftercare or other support required by the client.

Inpatient drug treatment is an important intervention for enabling adequate assessment of complex needs and for supporting progression to abstinence. It is very important to have effective discharge care planning, and to ensure appropriate referrals to mainstream medical services (e.g. liver clinic and psychiatric services) or social and community services (e.g. housing, legal advice, social services), as well as harm reduction and relapse prevention advice as required.

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Residential Rehabilitation Drug residential rehabilitation consists of a range of treatment delivery models or programmes to address drug and alcohol misuse, including abstinence orientated drug interventions within the context of residential accommodation. Residential rehabilitation programmes should include care planning with regular keyworking with an identified keyworker. The care plan should address drug and alcohol misuse, health needs, offending behaviour and social functioning. There is a range of residential rehabilitation services, which include: Drug and alcohol residential rehabilitation services whose programmes to suit the needs of different service users. These programmes follow a number of broad approaches including therapeutic communities, 12-Step programmes and faith-based (usually Christian) programmes Residential drug and alcohol crisis intervention services (in larger urban areas) Inpatient detoxification directly attached to residential rehabilitation programmes Residential treatment programmes for specific client groups (e.g. for drug-using pregnant women, drug users with liver problems, drugs users with severe and enduring mental illness). Interventions may require joint initiatives between specialised drug services (Tier 3 or 4, depending on local arrangements) and other specialist inpatient units: Some drug-specific therapeutic communities and 12-Step programmes in prisons Second stage rehabilitation in drug-free supported accommodation where a client often moves after completing an episode of care in a residential rehabilitation unit, and where they continue to have a care plan, and receive keywork and a range of drug and non-drug- related support Other supported accommodation, with the rehabilitation interventions (therapeutic drug- related and non-drug-related interventions) provided at a different nearby site(s). Residential rehabilitation programmes normally combine a mixture of group work, psychosocial interventions and practical and vocational activities. These components are also used in specialist residential programmes for particular client groups (e.g. parent and child programmes).

Clients usually begin residential rehabilitation after completing inpatient detoxification. Sometimes the detoxification will take place on the same site as the rehabilitation programme, to enhance continuity of care. Prior to starting the rehabilitation programme, the client should be supported by their keyworker (or other substance misuse professional) to prepare for admission, so as to minimise disengagement and maximise benefit, but there may also be preparation input from the rehabilitation service.

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ANNEX B. T4 PLACEMENT PROVIDER LIST

[See accompanying Spreadsheet]

The following list must be used in the interim as a tendering process for preferred providers has not yet been conducted. Workers should use the Rehab & Detox Directory Excel spreadsheet to determine the most appropriate choices of placement for their individual clients needs using the additional fields regarding type & duration of programme offered. The list below contains all T4 placements that are CQC registered, are NDTMS compliant and report on that system to have had more than 5 placements in the first 6 months of 2012-13. Organisation
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Address
Old Court House, Chapel Street, Duckinfield SK16 4DT Fulstone House, 130 Mile End Lane, Stockport SK2 6BY Agar Road, Truro, Cornwall TR1 1JU 20 Landport Terrace, Portsmouth PO1 2RG Fleming House, Waterworks Rd, Farlington, Portsmouth PO6 1NJ 15 Valley Road, Scarborough YO11 2LY 126 Station Street, Burton upon Trent, Staffs DE14 1BX 35 Clayton Road, Newcastle- under-Lyme, Staffs ST5 3AF St James Hospital, Locksway Rd, Portsmouth, Hants PO4 8LD 69 Bosence Road, Townshend, Hayle, Cornwall TR27 6AN Bridge House, Bow Arrow Lane, Dartford DA2 6PQ 128 Holderness Road, Hull HU9 1JP 465 Tavistock Road, Plymouth PL6 7HE Totterdown Lane, Weston- super-Mare BS24 9NN 36 Chandos Road, Redland, Bristol BS6 6PF 31 Mile End Road, Tower Hamlets E1 4TD Longcause, Plymouth PL7 1JB East Knoyle, Wiltshire SP3 6BE 352-358 City Roads, London EC1V 2PY 136 West Hill, London SW15 2UE 30 Russell Hill, Purley, Croydon CR8 2JA 23 Ripon Road, Harrogate HG1 2JL Imperial Buildings, Bevan St East Lowestoft, Suffolk NR32 2AA 3 Mitcham Park, Surrey CR4 4EN 82 Risbygate Street, Bury St Edmunds, Suffolk IP33 3AQ 14 Pattenden Road, Catford, London SE6 4NQ Risdon Farm, Okehampton, Devon EX20 3AJ Gloucester House, Highworth, Swindon SN6 7AG 20 Garford Street, London E14 8JG Mill Bridge, Mill Lane, Gisburn, Lancashire BB7 4LP 52 Rectory Grove, London SW4 0EB

Website & Email

www.acorntreatment.org lynnbarker@acorntreatment.org www.acorntreatment.org lynnbarker@acorntreatment.org www.addaction.org.uk/chy r.dunstan@addaction.org.uk www.arcproject.org.uk info@arcproject.org.uk www.anatreatmentcentres.com info@anatreatmentcentres.com www.arkhouse2005.com ark.house@virgin.net www.bacandoconnor.co.uk enquiries@bacandoconnor.co.uk www.bacandoconnor.co.uk enquiries@bacandoconnor.co.uk karen.morris@solent.nhs.uk www.bosencefarm.com info@bosencefarm.com www.kmpt.nhs.uk/bridgehouse bridgehouse@kmpt.nhs.uk www.rapt-thebridges.org.uk phil.hindle@rapt-hull.org.uk www.broadreach-house.org.uk tom@broadreach-house.org.uk www.broadwaylodge.org.uk mailbox@broadwaylodge.org.uk www.chandoshouse.org info@chandoshouse.org www.charislondon.org charis@towerhamletsmission.org www.broadreach-house.org.uk tom@broadreach-house.org.uk www.actiononaddiction.org.uk cloudshouse@actiononaddiction.org.uk www.cranstoun.org admissions@cranstoun.org.uk www.cranstoun.org referrals@cranstoun.org.uk www.cranstoun.org referrals@cranstoun.org.uk www.detox5.co.uk info@detox5.co.uk www.eastcoastrecovery.co.uk daniel.farnham@eastcoastrecovery.com www.equinoxcare.org.uk Mitchampark@esms.equinoxcare.org.uk www.focus12.co.uk info@focus12.co.uk www.freedomrecoverycentre.co.uk enquiries@freedomrecoverycentre.co.uk www.gilead.org.uk admin@gilead.org.uk www.gloucesterhouse.org.uk denise.garside@salvationarmy.org.uk greig.house@salvationarmy.org.uk www.holgatehouse.org.uk holgatehouseltd@aol.com www.actiononaddiction.org.uk hopehouse@actiononaddiction.org.uk

Acorn Recovery Acorn Treatment and Housing Addaction (Chy Colom) Addiction Recovery Centre ANA Treatment Centres Ltd Ark House Rehab Ltd Bac OConnor Centre Bac OConnor Centre (Newcastle-under-Lyme) Baytrees Detox unit Bosence and Boswyns Treatment Services Bridge House (KMPT) Bridges at Abbey Street, The (RAPt) Broadreach House Broadway Lodge Chandos House Charis Alcohol and Drug Treatment Closereach (Broadreach House) Clouds House Cranstoun City Roads Cranstoun Oak Lodge Cranstoun Trelawn House Detox 5 East Coast Recovery Equinox Substance Misuse Services Focus 12 Freedom Recovery Centre Gilead Foundations Charity Gloucester House (Salvation Army) Grieg House Addiction Services (Salvation Army) Holgate House Hope House

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32 33 34 35 36 37 38 39 40 41 42 43 44 45

Kairos Community Trust Kenward Trust, Naomi Project Kenward Trust, Kenward Barn Kenward Trust, Kenward House Keystone House Ley Community, The Littledale Hall Therapeutic Community Longreach (Broadreach House) Max Glatt Unit (CNWL) Nelson Trust Newroads Park House Park View Project Perry Clayman Project (PCP Chelmsford) Phoenix Futures Hampshire Residential Service Phoenix Futures National Specialist Family Service Phoenix Futures Sheffield Residential Service Phoenix Futures Wirral Residential Service Pierpoint Primary Treatment Centre Priory Group Providence Projects Quinton House Ravenscourt Recovery Project (BHT), The St Thomas Fund Salvation Army Bridge Programme Sefton Park Somewhere House Ltd Street Scene (Allington House) Street Scene (Francis House) T.H.O.M.A.S (Those on the margins of a society) Trevi House TTP Bradford Inpatient Detox TTP Chorley (Withnell House) Inpatient Detox TTP Chorley (Withnell House) Therapeutic Community TTP Coventry Community Rehab

59 Bethwin Road, London SE5 0XT Highgate Hall, Rye Road, Hawkhurst, Kent TN18 4EY Kenward Road, Yalding, Kent ME18 6AH Kenward Road, Yalding, Kent ME18 6AH 9 Akabusi Close, Croydon CR0 6YL Sandy Croft, Sandy Lane, Yarnton, Oxfordshire OX5 1PB Littledale, Nr Brookhouse, Lancaster, Lancashire LA2 9EY 7 Hartley Road, Plymouth PL3 5LW South Kensington and Chelsea Centre for Mental Health, SW10 Nelson House, Brimscombe Hill, Stroud, Gloucs GL15 2QP The Old Manse, Chapel Hill, Wrington BS40 5NJ Park House, 15 Park Rd South, Hockley, Birmingham B18 5QL 30-34 Kremlin Drive, Liverpool L13 7BY Unit 1 & 2, 45 Broomsfield Rd, Chelmsford CM1 1SY

www.kairoscommunity.org.uk kairos.bethwin@kairoscommunity.org.uk www.kenwardtrust.org.uk admissions@kenwardtrust.org.uk kenwardtrust.org.uk admissions@kenwardtrust.org.uk www.kenwardtrust.org.uk admissions@kenwardtrust.org.uk www.slymca.org.uk brett.seath@slymca.org.uk www.leycommunity.co.uk sara.lewis@ley.co.uk www.littledalehalltc.co.uk lhtcadmissions@btconnect.com www.broadreach-house.org.uk tom@broadreach-house.org.uk www.cnwl.nhs.uk/max-glatt mgu.cnwl@nhs.net www.nelsontrust.com admissions@nelsontrust.com www.newroadsrehabservices.co.uk newroadsrehabservices@hotmail.co.uk www.phoenix-futures.org.uk www.parkviewproject.co.uk tommccully@parkviewproject.co.uk www.rehabtoday.com info@pcpluton.com www.phoenix-futures.org.uk hampshire.residential@phoenixfutures.org.uk www.phoenix-futures.org.uk sheffield.family@phoenix-futures.org.uk www.phoenix-futures.org.uk sheffield.residential@phoenixfutures.org.uk www.phoenix-futures.org.uk wirral.residential@phoenixfutures.org.uk www.pierpoint.co.uk admissions@pierpoint.co.uk www.priorygroup.com bristol@priorygroup.com www.providenceproject.org info@providenceproject.org www.quinton-house.co.uk arlenequinton@uwclub.net www.ravenscourt.org.uk admin@ravenscourt.org.uk www.bht.org.uk recovery@bht.org.uk www.cri.org.uk abi.mcminnies@cri.org.uk www.salvationarmy.org.uk phillip.roberts@salvationarmy.org.uk www.sefton-park.com enquiries@seftonpark.com www.somewherehouse.com info@somewherehouse.com www.streetscene.org.uk info@streetscene.org.uk www.streetscene.org.uk info@streetscene.org.uk www.thomasonline.org.uk rachel.walker@thomasonline.org.uk www.treviproject.org office@trevihouse.org www.rehab.org steven.scorah@ttpcc.org www.rehab.org steven.scorah@ttpcc.org www.rehab.org andy.tutte@ttpcc.org www.rehab.org dawn.moore@ttpcc.org

46 47

Wickham Road, Droxford, Hampshire SO32 3PD 29-31 Collegiate Crescent, Sheffield S10 2BJ

48

229 Graham Road, Sheffield S10 3GS

49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67

Upton Road, Wirral Merseyside CH43 7QF 385 Clifton Drive North, St Annes on Sea, Lancs FY8 2NW Heath House Lane, Bristol BS16 1EQ 17 Carysfort Road, Bournemouth BH1 4EJ 12-14 Campbell Road, Bournemouth BH1 4EP 15 Ellasdale Rd, Bognor Regis, West Sussex PO21 2SG 10 Ditchling Rise, Brighton BN1 4QL 58 Cromwell Road, Hove, Sussex BN3 3ES Wade Street, Bristol BS2 9EL 10 Royal Cr, Weston-super- Mare, Somerset BS23 2AX 68 Berrow Road, Burnham on Sea, Somerset TA8 2EZ 46 Dean Park Road, Bournemouth BH1 1QA 2 Hulse Road, Southampton SO15 2WG Whitton Bank, Spring Lane, Blackburn BB2 2PW 2-6 Endsleigh Gardens, Plymouth, Devon PL4 6DR 21a Bolling Road, Bradford BD4 7BG Withnell House, Bury Lane, Chorley PR6 8BH Withnell House, Bury Lane, Chorley PR6 8BH 4 The Quadrant, Coventry, CV1 2EL

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69 70 71 72 73 74

TTP Kingston (Thames Clinic) Inpatient Detox TTP Lancaster, Recovery Academy Therapeutic Community TTP Luton Community Rehab TTP Warrington Community Rehab Turning Point (Smithfield Detoxification) WDP Passmores House Western Counselling Service Willowdene Farm Drug Rehabilitation Centre (Willowdene Farm Ltd) Worcester House (Weymouth Aftercare Centre) Yeldall Manor (1st Stage Rehabilitation)

28-33 Cromwell Road, Kingston Upon Thames, Surrey KT2 6RN Walter Lyon House, Quernmore Rd, Lancaster, Lancashire LA1 3J Telford place, 1 Telford Way, Luton LU1 1H Holly House, 73 Sankey Street, Warrington Cheshire WA1 1SL Thompson Street, Collyhurst, Greater Manchester M4 5FY Third Avenue, Harlow CM18 6YL 18 White Cross Road, Weston- super-Mare BS23 1EW

www.rehab.org dawn.moore@ttpcc.org

www.rehab.org andy.tutte@ttpcc.org www.rehab.org dawn.moore@ttpcc.org www.rehab.org andy.tutte@ttpcc.org www.turning-point.co.uk recovery@turning-point.co.uk www.stabilisationservices.org enquiries@stabilisationservices.org www.westerncounselling.com enquiries@westerncounselling.com www.willowdenefarm.org.uk info@willowdenefarm.org.uk Carlton9@tiscali.co.uk www.yeldall.org.uk admissions@yeldall.org.uk

75 76 77

Chorley, Bridgenorth, Shropshire WV16 6PP 39 Lennox Street, Weymouth, Dorset DT4 7HD Blakes Lane, Hare Hatch Reading RG10 9XR

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ANNEX C.

STANDARD PACKAGES OF CARE

For the purposes of establishing what a standard package of care might look like for Tier 4 substance misuse provision, below are set out examples based on research evidence about effective practice and national average costs for detox and rehab placements. This is intended as a rough guide only, and it is acknowledged that individual placements must be tailored to fit each clients circumstances and needs.

Inpatient Detox A typical inpatient detox (from alcohol or opiates) will last 10 14 days at a potential cost of 2,320 - 3,248.4 This is likely to be longer for pregnant women and some poly-substance misuse combinations, and may be shorter for people reducing from a lower amount of substance use. Residential Rehab A typical residential rehabilitation placement will be expected to last a minimum of 12 weeks5 at an average cost of 7,7766.

Expected Outcomes The national picture7 with regards to outcomes for those commencing a Tier 4 placement (detox or rehab) can be summarised as: (approx) 50% of those who start detox or rehab have an unplanned early exit or are transferred to another provider (approx) 50% will have a successful exit, with around half of these (25% of all entrants to Tier 4) needing no further support & the other half needing further support from community treatment services Therefore, around 73% of rehab or detox starters will need further community treatment after exiting their placement 40% of unplanned exits happen in the first 2 weeks, with another 23% in weeks 2-4

Based on a 232 per night cost in 2012-13 from the local inpatient detox provider Bridge House (KMPT) 12 weeks is considered to be the minimum duration for an effective residential rehab treatment episode 6 Based on an average weekly cost of 600 published by NTA in 200x, with an increase added in line with inflation to bring it up to a 2013 cost estimate 7 Based on NTA data
5

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ANNEX D.

MEDWAY T4 PATHWAY

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ANNEX E.

TIER 4 PANEL EXAMPLE AGENDA

An example agenda will follow this sequence. The timings may need to be adapted depending on how many new applications received and their complexity. If there is not sufficient time to conduct the review section, then any non-urgent reviews can be rolled forward into the next meeting.

9.30am

Welcome & introductions of any new members/presenting workers (Chair) Budget update (DAAT) New Applications (Chair) Review of open cases (Chair) Agenda for next meeting: Expected applications & Reviews due to be heard (Applications: All / Reviews: DAAT) Close of Meeting

9.35am

9.40am

10.10am

10.25am

10.30am

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ANNEX F. Suggested Text for a Service User Leaflet

Medway Tier 4 Panel A Service User Guide to Residential Rehab Inpatient Detox (Tier 4) What is the Tier 4 Panel? The Tier 4 panel is responsible for ensuring access to Residential and Inpatient treatment for all eligible substance misuse service users in Medway. The group meets on a fortnightly basis to review applications for residential rehab and inpatient detox placements. Each application is discussed and the panel makes a decision whether or not to fund the requested placement. The panel will take into account the following when making a decision: o Your physical and mental health o Your social situation (including housing, relationships & employment) o Your current/past engagement with treatment services o The reasons why you want to change now o Your current drug/alcohol use o What you are doing to help yourself o Any other relevant information The Panel is made up senior representatives from all the adult drug and alcohol treatment services in Medway and Medway Council Adult Social Care. What can be funded? Residential Detox Standard 10 - 14 days, but can be extended if there is a clinical need. If you are also applying for rehab, we will try to ensure that this placement starts straight after the detox. Residential Rehab Rehab is one component of a care plan. An effective rehab placement has to meet your needs and commitment to continued work on discharge. Primary rehab: is a short-stay rehab programme or the initial stage of a long-stay programme, focusing on intensive therapeutic interventions and the immediate responses to becoming drug free: typically 12 weeks. Secondary rehab: is a later stage of a long-stay rehab programme, focusing on the development of life skills that are required to sustain a drug-free lifestyle while still receiving intensive support, e.g. education, training or employment: typically 12 weeks. This may be considered for funding by the Panel Third stage treatment: is not funded through the panel.
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Who can access it? You will need to meet the following criteria to be able to access Tier 4 services: o A Medway resident o 18 years and over o Treatment in the community (or prison) is the first option and should be fully explored before an application for a Tier 4 placement. Only in exceptional circumstances will residential treatment be the first choice (e.g. an urgent detox, or where alcohol dependency prevents access to other treatment) o Before applications will be accepted by the T4 Panel: The client (or family/carer if required) must give their consent to the application A comprehensive assessment8 must be undertaken to enable an accurate rating of key areas against Medway Fair Access to Care Services criteria9 As part of this, clients who require inpatient detoxification must be assessed by a suitable medical or nursing practitioner from KMPT and/or KCA (UK) Robust Exit and Early Exit Plans must be in place The application must contain a statement by the clients lead worker (inc. where they do not support the application) The application must contain a statement of the perceived risks for the client if the Tier 4 application is not approved Exclusion criteria Applications for Tier 4 services will not normally be considered within 12 weeks of a previous residential or inpatient treatment episode being funded - apart from in exceptional cases, in which case the T4 Panel will consider the circumstances of the particular case and make its decision. This does not prevent applications for the extension of current Tier 4 placements. How do I apply for a Tier 4 placement? Good preparation is essential and helps to make a Tier 4 placement successful. There are preparation groups run by KCA and KMPT that your key-worker can tell you about. Speak to your key-worker and they will discuss options available to you and whether you meet the funding criteria. If you do, you will work together to make an application that will be reviewed by the panel. If you don't, alternative community treatment options will be offered. Your application must specify the need for residential treatment with review dates and proposed arrangements for aftercare, housing and long-term plans when you leave your residential placement. Matching your 'need' to suitable residential services is essential. Your choice will be respected in the search for a suitable placement.

8 9

See the Medway Tier 4 Tool See annexes A1 & A2 for examples and definitions of Medways Fair Access to Care Services

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You may be currently required to contribute financially and will undergo a financial assessment by Medway Council. What happens next? If you and your key-worker decide that a Tier 4 placement would be suitable, your keyworker will complete the application form and submit it to the Panel. When will I find out the outcome of my application? If successful, confirmation will be sent to your key-worker. If unsuccessful, your key-worker will advise you as to the reasons why and the further options available to you. You have the opportunity to appeal the decision or raise a complaint. Complaints procedure Complaints regarding the conduct or processes of the funding panel should be made to Medway Council through their complaints procedure. Complaints regarding the conduct or provision of drug and alcohol treatment services will be dealt with by the relevant agencies. If you have any further questions that are not covered within this leaflet, please contact your key-worker.

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