National standards for professionals working in drug services
A range of quality frameworks are relevant and used by drug treatment services to demonstrate quality or meet national requirements for registration or inspection. These include the following:
7.3.1 NHS Knowledge and Skills Framework
The NHS Knowledge and Skills Framework (NHS KSF)41 defines and describes the knowledge and skills which NHS staff need to apply in their work in order to deliver quality services. It provides a single, consistent, comprehensive and explicit framework on which to base review and development for all staff. The NHS KSF and its associated development review process lie at the heart of the career and pay progression strand of the NHS Agenda for Change. Specific professional registration criteria and qualifications or accreditation programmes exist for groups such as nurses, pharmacists, general practitioners and addiction psychiatrists involved in substance misuse treatment, which relate to differing levels of competence. These involve accreditation by the Nursing and Midwifery Council, the Royal Pharmaceutical Society of Great Britain (RPSGB), the General Medical Council, the Royal College of General Practitioners and the Royal College of Psychiatrists and most recently additional training and accreditation for supplementary non-medical (nurse and pharmacist) prescribers. The Royal College of General Practitioners and the Royal College of Psychiatrists, in conjunction with the NTA, published a set of competences for doctors in 2005.31
7.3.2 Drugs and Alcohol National Occupational Standards
The Drugs and Alcohol National Occupational Standards (DANOS) guidance gives clear descriptions of the standards of performance required of people in the drugs and alcohol field. The guidance also describes the knowledge, understanding and skills workers need in order to perform to those standards. The DANOS standards describe all the functions and activities involved in improving the quality of life for individuals and communities by minimising harm associated with substance misuse. There are three key categories in DANOS: service delivery, management of services and commissioning services. More information on DANOS, and the standards, can be found at www.skillsforhealth.org.uk/danos.
Training providers increasingly provide programmes which are linked to National Occupational Standards, which will assist employers to ensure new workers can be quickly inducted and existing workers can be provided with the knowledge and skills needed to perform their roles competently.
Models of care for treatment of adult drug misusers: Update 2006
7.3.3 National minimum standards for care homes for younger adults
The national minimum standards for care homes for younger adults42 were issued under the Care Standards Act 2000 (CSA). The Commission for Social Care Inspection (CSCI) currently has the remit to inspect and regulate individual establishments, agencies and institutions for which registration as care homes is required. The standards specifically apply to care homes for people with alcohol or substance misuse problems and cover choice of home, individual needs and choices, lifestyle, personal and healthcare support, concerns, complaints and protection, environment, staffing, conduct and management of the home.
They also specify the national occupational standards for staff. In order to meet registration criteria, staff and managers are required to have relevant TOPSS NVQ qualifications, or demonstrate they are working towards them.
7.3.4 Commissioning Standards for Drug and Alcohol Treatment and Care
In 1999, the Substance Misuse Advisory Service (SMAS), on behalf of the Department of Health, developed the Commissioning Standards for Drug and Alcohol Treatment and Care43 document as a tool for commissioners of drug treatment. The document provides guidance on the commissioning of comprehensive and evidence-based alcohol and drug treatment and care systems, and is available on the NTA website at www.nta.nhs.uk.
7.3.5 Quality in Drugs and Alcohol Services (QuADS)
QuADS44 was developed jointly by Alcohol Concern and DrugScope for the DH (1999) and is still widely used by alcohol and drug treatment services throughout England as the set of quality standards for organisations in the sector. Organisations use the standards for self-assessment and also for peer review. QuADS is particularly relevant when considering the management and quality assurance of drug and alcohol treatment services.
7.3.6 Other quality frameworks and standards
Other quality improvement frameworks, standards or accreditation systems are also be relevant to alcohol intervention and treatment systems. These may include clinical governance mechanisms in NHS providers, Investors in People, criminal justice accredited programmes, standards and registration for independent hospital provision, and RPSGB standards as set out in the Medicines, Ethics and Practice guidance.45
Commissioners and providers should be clear about which quality initiatives are required and how other quality initiatives (e.g. Investors in People), can contribute to demonstrating the quality of local provision. Commissioners should minimise duplication of effort for providers in reporting requirements where possible.