North Yorkshire Horizons

Updated 7 February 2019

North Yorkshire Horizons provides community substance misuse support for adults in North Yorkshire. Their services include substitute medication and support with detoxification from alcohol and/or drugs in the community, support to reduce the harm of drugs and/or alcohol and achieve a balanced approach to life. The service also provides structured group therapy, support to families, health and wellbeing checks, health screenings, blood testing and vaccinations. North Yorkshire Horizons also supported clients going through the criminal justice system.

The local council had commissioned an integrated substance misuse service, combining services between four organisations. A non-profit organisation held the contract for care coordination within North Yorkshire Horizons and provided psychosocial interventions, the clinical elements of the service had been subcontracted to Spectrum Community Health Community Interest Company. A health and social care charity provided recovery support and mentoring and had subcontracted elements of recovery to another non-profit organisation. North Yorkshire Horizons was the overall name for the partnership between these organisations.

This inspection only observed the Spectrum element of the service, and the rating applied is specific to the clinical care they provide for North Yorkshire Horizons.

North Yorkshire Horizons was registered for diagnostic and screening procedures and treatment of disease, disorder or injury. There was a registered manager for this service.

North Yorkshire Horizons operates from five main hubs across North Yorkshire, covering 3,600 square miles, these are: Northallerton, Harrogate, Skipton, Selby and Scarborough. The service also runs outreach clinics in rural areas including Malton, Whitby, Tadcaster, Sherburn, Thirsk, Great Ayton and Catterick.

The service was previously inspected in February 2016, the Care Quality Commission did not rate substance misuse services at that time, the service did not have any regulatory breaches at the last inspection.

Updated 7 February 2019

We rated North Yorkshire Horizons as outstanding because:

• Clients were protected by a comprehensive safety system with a proactive approach to anticipating and managing client risk. Risk management was discussed as a multidisciplinary team between the partner organisations and utilised the support of external agencies where applicable. Staff used technology to ensure prompt information sharing and support integrated care. Clients were supported to manage their risks at home. Staff maintained effective clinical audits. They introduced batch prescribing to avoid delays in clients’ receiving medicine. Lone-working protocols were embedded to safeguard staff. The team had a focus on openness, transparency and learning when things go wrong.
• Outcomes for clients were better than expected when compared with other similar services. Staff worked with partner organisations and external services to provide holistic care. All staff had associated specialisms, such as sexual health. Staff exhibited excellent knowledge of associated national guidance. They had submitted treatment outcomes that were above the average listed by national benchmarking services. They were identified as engaging increasing numbers of detoxification clients, which contrasts the national trend. Harrogate was trialling new urine drug tests. Staff planned discharge in advance to ease care transfer. Staff monitored client’s physical health, encouraged healthy lifestyle choices and offered tests and vaccinations for blood borne viruses. Staff would transport clients to appointments external to the service if required.
• Clients were truly respected and valued and empowered as partners in their care, practically and emotionally, by an exceptional service. Staff developed respectful relationships with clients, treating them with kindness and dignity. Clients felt staff “genuinely care”. Staff went above and beyond to support clients’ and carers’ emotional and social needs. Staff introduced links with communities and local support networks. Staff offered flexible support to meet clients’ needs. Clients informed treatment choices and their feedback informed services changes.
• Services were tailored to individual’s needs and delivered in a way that ensured flexibility, choice and continuity of care. They delivered person-centred pathways to clients with complex needs, through relationship development. Staff were active in re-engaging clients and overcoming barriers to clients accessing care. Staff ran clinics in isolated, rural locations or attended clients’ homes to encourage engagement. Staff kept short appointments free to stay responsive to service need. Staff were proactive in understanding and responding to the needs of clients with protected characteristics. Information was available in different formats according to communication needs.
• Leadership, governance and culture were used to drive and improve the delivery of high-quality, person-centred care. Leaders at all levels were compassionate, inclusive and highly experienced. Staff morale was very high, they were proud of the service provided and felt valued. Managers acknowledged staff strengths and supported their development. Managers supported staff work-life balance. Leaders understood the challenges and priorities of the service. There was a focus on service improvement and reflective practice. Staff could contribute to service development. Governance structures adhered to best practice.

Updated 7 February 2019