Dear Mrs Hashmi INQUEST TOUCHING THE DEATH OF ANTHONY MAURICE HUGGAN, DECEASED We write further to your letter of 27 November 2014 regarding the above named person (deceased) and your request for a response to matters of concern raised in your Report to Prevent Future Deaths (Regulation 28). Before responding to the matters of concern you raise, we would like to provide some contextual information in relation to commissioned substance misuse services in Bury. Following a competitive retendering process One Recovery Bury (ORB) were successful in securing the contract to provide a recovery orientated substance misuse service for adults in Bury. The contract start date was 1 February 2014 and the new model was implemented from 1 April 2014 (following TUPE of staff from the existing service). One Recovery Bury is a collaboration of Addictions Dependency Solutions (ADS), Sodexo Justice Services, Harvey House Social Enterprises and Bury Education Support and Training (Bury EST). The service is commissioned to provide flexible opening hours, including weekend and evening provision, which are responsive to local need. The service is also commissioned to provide satellite services, the operating hours of which are to be based on an assessment of local need. Work is currently ongoing to develop the flexible service in Bury, with plans to be put in place early in 2015. ADS is the lead provider of the consortium. ADS has in place a robust Serious Untoward Incident (SUI) policy and all SUI5 are thoroughly reviewed, actions noted. Operational responsibility for implementation of the action plans rests with the Service Delivery Director through operational service management structures. . We do not accept 1 st Floor, Town Hall, 4r ‘ INVESTORS electronic or Knowsley Street, 4, IN PEOPLE fax service of legal Bury BL9 OSW documents

Bury Prestwjch Radcliffe Ramsbottom I Tottington Whitefield I

Each SUI review is chaired by the Chief Executive Officer of ADS who then reports to the Board of Trustees. Full organisational governance of SUIs rests with the ADS Board of Trustees through the Board led Professional Committee, the Chair of which is a former CQC inspector, and senior local authority social services manager of mental health services. In direct response to matters of concern;
1. Lack of suitable out of hours service resulting in an undue burden being placed on emergency services and the NHS (none of whom are best placed to deal with and support those with drug addiction problems). ADS has for some considerable number of years provided a 24/7 helpline service for criminal justice clients who are taken into custody ‘out of hours’ as these service users were subject to the Drug Intervention Programme (DIP) and this was a requirement of the commissioned service. However, this arrangement is now being reviewed because most ‘new’ services are integrated and prefer a system of on call and cover arrangements to be more localised and based on demand. These arrangements are to be planned and delivered on a local basis and will include cover arrangements for periods of maximum disruption to the service such as Christmas/New year and bank holidays and also includes senior management cover on a Director rota which applies 52 weeks a year. Consideration of Bury’s needs in relation to 24/7 helpline service will be considered early in 2015. In relation to an undue burden being placed upon the emergency services and the NHS, One Recovery Bury is not commissioned as an emergency service: it is commissioned as a recovery orientated treatment services and is resourced and staffed on that basis. However, as part of overdose prevention and education all service users are informed to dial 999 in emergencies such as suspected overdose or other medical emergency. Currently, if a call is made to the service out of hours, callers are given details of opening times and then advised “in the event of a medical emergency please dial 999”. Bury Council has in operation an Emergency Duty Team which is available out of hours (from 16:45 to 08:45; weekends and bank holidays). The service operates a single point of entry and all calls to the service are recorded. Call records for June indicate that no call was received in relation to Mr Huggan.
2. Where the patient takes self-discharge following a life threatening drugs overdose, concerns arise around the timeliness of follow up/welfare checks, given the limitations of the service commissioned by the local authority. Where a patient takes self-discharge following a life threatening drug overdose. One Recovery Bury would arrange to see the client at the earliest opportunity upon receiving the information concerning discharge (currently, One Recovery Bury does not always receive this information).

We aim to see all clients leaving hospital within seven days (as per seven day follow-up). Any client leaving hospital is vulnerable to over dose, as are prison releases, particularly those who may have had a long hospital stay, had medication changes or have refrained from illicit drug use during their hospital stay.