Chapter 2: Aim, Scope and Nature of Inspection
2 Pilot multi-agency inspection of substance misuse services in Grampian
2.1 Background
The Scottish Executive's Drug Treatment and Rehabilitation Review, published on 27 October 2004, recommended an external audit of drug and alcohol services to provide an independent overview of service quality, service delivery and integration of the range of local providers. In order to fulfil this commitment, the Ministers for Justice and for Health and Community Care asked SWIA, in partnership with others, to develop a multi-agency inspection framework in order to inspect services for people who misuse drugs and people with alcohol problems. This would cover services provided by local authorities, health and the voluntary sector and would be informed by the findings of the Care Commission.
2.2 Working group
In order to progress this inspection, SWIA convened a working group to develop the inspection framework and methodology for a pilot inspection in 2006. In addition to our partner inspectorates and quality assurance bodies, the working group included representation from health, local authorities, Scottish Executive policy interests and voluntary sector organisations representing service users and Drug and Alcohol Action Teams. The involvement of service users was central to this inspection.
2.3 Purpose of inspection
The overall purpose of the inspection was to establish to what extent substance misuse services were helping the people who use them to make positive changes in their lives.
Scope and unit of inspection
SWIA and its partners inspected services for adults with drug or alcohol problems. We addressed harm reduction, abstinence, recovery and routes out. We also looked at the links between these services and the welfare of dependent children, offending behaviour and mental health. The inspection covered a range of services provided by local authorities and health, and services commissioned or purchased from the voluntary sector.
It was agreed that the unit for inspection would be the Action Team area.
2.4 Identification of pilot area
In identifying a pilot area for this inspection, we wanted to achieve an urban/rural mix and significant prevalence. In addition, we tried as far as possible to take account of other inspection activity taking place at the same time. We chose Grampian and approached the Action Teams for their consent. We were delighted that the Grampian Action Teams responded so positively. This was a pilot inspection and we will be actively seeking feedback about the process.
2.5 Inspection partners
SWIA's key partners in this inspection were NHSQIS, the Care Commission and HMIe. We made full use of information and intelligence held by our partners, in particular, inspection findings from the HMIe inspections of services to protect children and the Care Commission's inspections of relevant care homes and support services.
The inspection team consisted of inspectors from SWIA, the Care Commission, Her Majesty's Inspectorate of Constabulary, inspectors with social work and health backgrounds, including two GPs, one senior nurse, one consultant psychiatrist, one pharmacist, people who used services and a carer.
2.6 Inspection model
The inspection model focused on the outcomes for people who use services and their families and the overall approach was one of continuous improvement. The model is based around six key questions and is similar to the SWIA performance inspection model, but was adapted for multi-agency use and the particular issues relating to substance misuse services. It also takes account of the Scottish Executive's quality standards for substance misuse services. Appendix 2 sets out the model.
2.7 Inspection process and timeline
The inspection process began with formal notification to senior officers. It then fell into three main phases.
Phase One
This phase involved the collection of a large amount of information from a variety of sources including:
- a range of existing information provided by the DAATs about substance misuse services in Grampian (such as strategic and business plans, partnership arrangements, guidance and protocols, range of services, performance information, etc.);
- the Action Teams' own self-evaluation of substance misuse services in Grampian, which was provided through the Self Evaluation Questionnaire;
- peer research into the views of people who use substance misuse services in Grampian;
- questionnaires to staff, carers and stakeholders; and
- analysis of a sample of case files across sectors.
Phase Two
The information collected during phase one was analysed and was used to inform the fieldwork phase of the inspection. The inspection team spent two weeks in Grampian meeting with services users and carers, staff at all levels, elected members and stakeholders as well as visiting services and observing practice.
Phase Three
All of the evidence was collated into a published inspection report. Performance against each of the key questions in the inspection model was graded using a six-point scale.
The inspection of substance misuse services in the Grampian area, given its complexity, posed some problems.
Because the focus for this inspection was Action Team areas, we have evaluated each Action Team area, in Chapters 3, 4 and 5, according to our Performance Improvement Model ( PIM). We have placed as much information as possible into each Action Team area to give as full a picture as possible. We have not reported on Grampian-wide issues using this model and have therefore not evaluated Chapter 7.
We were not able to break down the health file reading or health staff survey into Action Team areas. We have therefore reported on them in Chapter 7 in the section on NHS Grampian. The peer survey was conducted as a Grampian-wide survey, and is reported on in the chapter on Grampian-wide issues, but we were able to disaggregate some data into Action Team areas, and these data are reported in section 2 of each of the Action Team chapters.