Written - The commencement of the First Review of Substance Misuse Services in Wales by Healthcare Inspectorate Wales

‘Working Together to Reduce Harm’, the Welsh Assembly Government’s new 10 year strategy to tackle and reduce the harm associated with substance misuse was launched on 1st October 2008 . The strategy aims to address the full range and changing patterns of substance misuse and seeks to improve the quality of treatment services and related support and supports evidence based decision making.

One of the objectives of the Strategy is to secure further improvements in the quality and consistency of treatment services across Wales. We have introduced a programme of external thematic reviews to be carried out by Healthcare Inspectorate Wales. The external thematic review programme is an essential component of the Performance Management Framework for substance misuse services. It seeks to measure and secure improvements in the quality, availability and access of treatment services to achieve a comprehensive and consistent range of services throughout Wales. This will be the first time that substance misuse services in Wales have had such a comprehensive thematic review.

Following the piloting and testing of the methodology, the first review has recently commenced and is focusing on the planning, commissioning and delivery of substitute prescribing treatment and will evaluate how well treatment that involves the prescribing of opiate substitute drugs within substance misuse services is commissioned and provided.

HIW take a holistic approach covering three strands that are essential markers of quality:

• Service User Experience;
• Clinical Outcomes;
• Governance Arrangements.

This approach will include measuring waiting times, an evaluation of referral pathways for prescribing treatment and the experiences of service users. The review will be of a sufficient depth to provide a comprehensive, qualitative and comparative measure between organisations, identifying areas of best practice and aspects that require improvement and/or further central guidance.

All organisations will receive individual feed-back from HIW and a national report will be published in March 2009.

The future programme of reviews will be informed by the findings of this first review and finalised in partnership with stakeholders from across Wales to identify and prioritise the high-risk issues associated with substance misuse services.

Integrated governance systems, commissioning processes and service user involvement will be an integral element of the whole review programme and a as a minimum all reviews will encompass:

• Commissioners and service providers within the statutory and non-statutory sectors to consider the effectiveness of multi-agency/multi-disciplinary working;
• The experiences of service users; and,
• The measurement of service quality and delivery against existing standards and guidance.