Addicts at risk of death in detox clinics as majority fail to meet basic standards of care, reveals report

Drug addicts and alcoholics are being put at risk of death in detox clinics as the majority fail to meet basic standards of care, a damning report has revealed.

Residential services for people withdrawing from drugs or alcohol are breaching government regulations by employing untrained staff and failing to prescribe addicts’ medication correctly, with potentially fatal outcomes, according to findings by the Care Quality Commission (CQC).

In the first ever inspection of independent addiction services, which analysed reports of 68 providers in England, the report finds that nearly three in four (72 per cent) of providers breached regulations of the Health and Social Care Act and failed to meet fundamental standards of care.

The findings have raised concerns that the transfer of responsibility for commissioning substance misuse services from primary care trusts to local authorities in 2013, which occurred under the Health and Social Care Act, has led to independent providers “massively cutting costs” in order to win contracts from councils.

Prior to the changes in 2013, a national network of inpatient units commissioned by the NHS provided the majority of addiction services across England as part of a block contract with mental health. Since then, figures show that English councils have reduced budgets for drug and alcohol support services by £105m, which campaigners say have led to local authorities engaging in “competitive tendering” with providers.

The report states that almost two-thirds of the independent services, which are usually private hospitals or third sector places, were failing to provide safe care and treatment for clients, while four in ten were failing to show good governance and 34 per cent were breaching regulations on staffing.

Of these, the CQC took enforcement action against eight providers (12 per cent) and separately issued a notice to cancel the registration of another provider. Four of the services are no longer operating following the concerns raised in the report.

Inspectors said that in some units, members of staff were administering medication before they had completed their training, which led to failures in following the required procedures for handling medicines. In one service, the registered manager had no records of staff training and was unable to provide the detail of what standard training was expected.

Another provider had made a high number of medication errors, including instances where staff were giving clients doses of paracetamol at intervals of less than four hours, despite the fact that the drug should be given with doses at least four hours apart to prevent liver damage.

The report adds that in some units, staff did not undertake a comprehensive assessment before offering admission to addicts, despite some clients being at high risk of developing serious, and possibly life-threatening, complications.

Staff also failed to follow guidance for prescribing medication and did not always adhere to the recommendations on monitoring the physical wellbeing of people in withdrawal, which can reduce the likelihood of successful withdrawal and cause avoidable harm with potentially fatal outcomes.

“Many of our findings stem from a lack of appropriately trained and competent staff to manage and oversee these services. Too often, the services lacked appropriate clinical leadership and clinical governance,” inspectors wrote.

It comes at a time when drug-related deaths across England and Wales are at a record high. Figures show that 3,744 people were fatally poisoned by drugs in 2016 – 70 more than the previous year and the highest number since comparable statistics began in 1993.

Hospitals are seeing more than one million admissions relating to alcohol each year, with a review published by Public Health England late last year reporting that alcohol is now the “leading risk factor for ill-health, early mortality and disability” among 15- to 49-year-olds.

Professor Colin Drummond, chair of the Addictions Faculty at the Royal College of Psychiatrists, told The Independent the issues stemmed from cuts to local council funding for addiction services, which he said was leading to providers “cutting corners”.

“Local authorities have cut the amount of funding drastically, and the residential sector has been particularly hard hit because that’s the expensive end. Councils are engaging in competitive tendering, so in order to win contracts, independent providers have had to massively cut their costs,” he said.

“They’re cutting corners. They’re employing fewer qualified and specialised staff. Guidelines aren’t being followed correctly because it’s more expensive to do things properly. Addicts are being exposed to clinical risk of having things like fits, hallucinations and brain damage because the care hasn’t been properly delivered and staff aren’t following guidelines. There’s a risk of fatalities in that situation.”

Mr Drummond urged that the NHS should have a bigger role in commissioning and providing these services, saying that unsatisfactory treatment by independent providers is leading to more addicts reaching “crisis point” and subsequently seeing the NHS “pay for it anyway”.

“Addiction is a mental disorder. We don’t see why people with addiction problems don’t deserve the same quality of care as people with mental health problems,” he said.

“Medical detoxification is the bit where clinical expertise is needed. Rehab can be provided by the third sector, but doing the harder clinical work in units that are not equipped to do it is a false economy.

“Because people are finding it harder and harder to access these services, or they’re having unsatisfactory experiences when they use them, they’re actually reaching crisis point and ending up in A&E departments, which we know are already rather full of people. So the NHS is ending up paying for it anyway, but not in a very satisfactory way.”

Dr Paul Lelliott, deputy chief inspector of hospitals at the CQC, said that based on the recent inspections, the commission was “deeply concerned” about how people undergoing residential-based medical detoxification from alcohol or drugs are being cared for in many independent clinics.

“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,” he said.

“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.

“We have been given additional powers to rate independent substance misuse services. This increased transparency will help the public and local commissioners to understand the quality of these clinics more than ever before and to drive up the standards of care they provide. We will launch a public consultation on how we will go about this work next year.”

Councillor Izzi Seccombe, chairman of the Local Government Association’s community wellbeing board, said the findings raised “serious concerns” around basic safety and fundamental standards of service that councils as commissioners and people receiving treatment have a right to expect.

“Councils want to see providers have rigorous safeguarding procedures in place and ensure high quality training of staff, and it is right to inspect and regulate the market in this way,” she added.

“This report should be a wake-up call to those providers who are not meeting the required safety standards and to deliver urgent improvements.”

A Department of Health spokesperson said: “These findings are concerning and highlight exactly why we set up the CQC—to shine a light on poor practice and embed a culture of learning to drive up standards of care.

“It is up to local areas to commission public health services and we expect them to take these findings very seriously. We are providing them with £16 billion over the current spending period to set up public health services and Public Health England provides expert advice on how best to do this.”