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Models of care for treatment of adult drug misusers: Update 2006


Quality criteria and improvement reviews

Drug treatment should be seen as integral to the NHS and other social care and criminal justice provision. Realising links to other quality initiatives is important, as the majority of drug misuse treatment will be commissioned by local mechanisms for commissioning healthcare. Primary care trust commissioning structures and local joint commissioning structures and partnerships are crucial to drug treatment.


The Department of Health’s Standards for Better Health

Drug treatment should be provided in line with the Department of Health’s Standards for Better Health (2004). The purpose of the standards is to provide a common set of requirements applying across all healthcare organisations, to ensure that health services are safe and of an acceptable quality and provide a framework for continuous improvement.

There are two sets of standards:

  • Core standards describe a level of service that is acceptable and must be universal. Meeting the core standards is mandatory. Healthcare organisations must comply with them from the date of publication

  • Developmental standards are designed for a world in which patients’ expectations are increasing. Progress is expected to be made against the developmental standards across much of the NHS as a result of the NHS Improvement Plan and the extra investment in the period to 2008. The Healthcare Commission will, through its criteria for review, assess progress by healthcare organisations towards achieving the developmental standards.

These standards cover seven domains – safety, clinical and cost- effectiveness, governance, patient focus, accessible and responsive care, care environment and amenities and public health. The Healthcare Commission will focus assessments around these performance areas to measure outcomes, outputs and process quality.

Models of Care: Update 2006 specifically supports service development towards development standard D2.

Standard D2: Patients receive effective treatment and care that:

  • Conforms to nationally agreed best practice, particularly as defined in the national service frameworks, NICE guidance, national plans and agreed national guidance on service delivery


  • Takes into account their individual requirements and meets their physical, cultural, spiritual and psychological needs and preferences

  • Is well co-ordinated to provide a seamless service across all organisations that need to be involved, especially social care organisations

  • Is delivered by healthcare professionals who make clinical decisions based on evidence-based practice.


NTA and Healthcare Commission Improvement Reviews

The NTA works in partnership with the Healthcare Commission, developing detailed criteria for reviewing drug and alcohol treatment services, and carrying out these reviews. These criteria are developed during the process of each themed annual Improvement Review of drug treatment systems. Improvement Reviews will review local providers and commissioning functions against these criteria and against Standards for Better Health (2004).

The reviews for 2005/06 were piloted and developed in consultation with the drugs field. Detailed criteria have been developed for reviewing care planning and co-ordination and community prescribing, and were published in 2005. They are available on the NTA website at www.nta.nhs.uk. Criteria for future reviews will also be available from the NTA website.

Upcoming themes are:

  • 2006/07: systems management (across the key elements of risk management, patient choice, diversity and effective partnerships) and harm reduction provision

  • 2007/08: Tier 4 treatment and diversity (to be confirmed).

There are two parts to an Improvement Review. In the first part, the performance of all organisations taking part in the review is assessed. Using a standard framework, an initial assessment is made of the performance of each DAT and participating healthcare organisation. Wherever possible, this is done using nationally held data to reduce the burden on treatment providers. In the second part, the minority of organisations or treatment systems (approximately ten per cent) that have the weakest assessments are helped in developing an action plan to improve their performance.

The assessments are focused on a small number of key outcomes and quality measures, which matter most to patients and the public, and on the key features of services that are necessary to achieve good outcomes and quality for patients and the public.

More detailed information on the review process can be found on the NTA website at www.nta.nhs.uk and the Healthcare Commission website at www.healthcarecommission.org.uk.

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