Substance Misuse Services in Wales

Our review looked at whether people are receiving the care, treatment and support that they need.

What we did

We considered the following questions:

• Is the treatment on offer right for people?
• Can people access the treatment they need?
• Do people receive joined up and person-centred care from services?
• How are people, their families and those around them safeguarded
• What happens after people finish treatment?
• How well are services led and managed?

To answer these questions, we carried out national surveys and focus groups across Wales for people using substance misuse services and service staff. In total, we involved over 850 people and staff in the review. We also looked at the seven Area Planning Boards in Wales who are responsible for the planning, commissioning and delivery of substance misuse services.

Our national surveys were developed based on surveys used by Care Inspectorate Scotland in their review of Alcohol and Drug Partnerships in 2016-17. They were also converted into easy read format and piloted with a small group of people using substance misuse services to ensure the questions were appropriate.

To help us with our review, we worked closely with Peer Reviewers who are mental health professionals with relevant experience working in or closely with substance misuse services. We used Peer Reviewer’s knowledge and skills to ensure our work was based on current practice and experience, so that good practice was highlighted or areas of concerns were identified. 

What we found 

Overall, HIW and CIW found people get good care by passionate and caring staff, but access for services across Wales is inconsistent and limited in rural areas. Specifically, people found it difficult to get the treatment they needed from substitute prescribing (e.g. methadone), detox, rehab and counselling services, because of long waiting times and a lack of capacity in services.

Positive findings:

• People were positive about the care they received from services
• Staff are clearly hard working and passionate about providing high quality person centred care
• People were generally positive about ongoing support and the benefits of recovery and aftercare programmes
• Examples of good practice are seen in regions but there is a need for consistency and further collaboration across Wales.

Key areas for improvement:

• More joint working is needed between substance misuse services, secondary care, primary care, social services and, in particular, mental health services so people have their needs met holistically. People often said they found it difficult to get help with their mental health problems because of their substance misuse and described being bounced around between substance misuse and mental health services
• A review of waiting times and care pathways is needed to ensure people can quickly get access to the treatment they need in substitute prescribing, detox, rehab and counselling services
• Greater flexibility of services and outreach into communities is needed, with support out of hours and at weekends to enable people to get the help they need in times of crisis when they may be at a greater risk of relapse and overdose
• Across Wales there needs to be greater awareness about substance misuse amongst the public and professionals to:
  • Improve knowledge about the support available so people know where they can get help
  • Reduce stigma people experience in their interactions with professionals and increase understanding.

The report also identifies weaknesses in oversight and regulation around the quality and safety of services. Governance around safeguarding and drug poisonings also needs to be strengthened to ensure Area Planning Boards can quickly identify, monitor and act on emerging themes and issues across all services in order to protect people’s safety. 

Many of the issues identified in this report are similar to those HIW identified in its previous substance misuse report in 2012. 

We have made 34 recommendations for Area Planning Boards and/or Welsh Government to consider as result of our findings. Further information on our findings and our recommendations is available in the report below.