Medication Assisted Treatment (MAT) standards: access, choice, support

What do the standards mean for people who use and provide services and support?

What do the standards mean for people who are using services?

• People can get a prescription or other treatment support they request on the day they present to any part of the service. People have the right to involve others, such as a family member or nominated person(s) to support them in their journey throughout their care. Staff will help people to do this if they choose this form of support.
• People are informed of independent advocacy services that are available and feel able to use them to discuss the issues that matter to them.
• People are aware that treatment is not conditional on abstinence from substances or uptake of other interventions.
• People who have stopped accessing MAT or who have undergone detox are supported to easily come back into services for the care they need.
• If people miss appointments, services do not discharge them and actively get in touch to find out what people need to continue in treatment.
• People are made aware that abstinence is offered as a choice along with other treatment options.
• People will be given information and advice on recovery opportunities within their community.
• People can expect support from community pharmacists, dentists and GPs as part of their care plan, including being able to ask to move their drug treatment to their GP when appropriate.
• People are clear about what choices are available to them throughout their journey through services and are aware of their right to make their own decisions about their care plan.
• People feel listened to and involved in all decisions. They understand the different medication options available, including appropriate dose options.
• People feel able to talk about and review the choices they have made with their worker at any time. They have support if they choose from advocacy or a family member or nominated person(s) and are encouraged to do so.
• People feel able to provide feedback, including complaints, to the service on the way they have been treated, through formal or informal channels.
• People can expect a service that is welcoming and treats them with dignity and respect, working with them to improve their health and wellbeing.
• People can get treatment and care for as long as they want to.
• People can expect that different organisations will work together to meet their needs and that information about them will be shared and stored appropriately.
• People feel involved in the design, delivery and evaluation of MAT services.

What do the standards mean for families or nominated person(s)?

• The service will ensure people are aware of their right to have someone, such as a family member or nominated person(s), to support them while they are in MAT and staff will actively assist and support people who choose this option.
• Family members or nominated person(s) are welcomed at visits and treated with dignity and respect. Their own experiences and points of view are acknowledged and valued when people request that they attend.
• Family members or nominated person(s) feel involved in choices about care plans and are encouraged to support the person in following their treatment plan.
• Family member or nominated person(s) are confident that if they contact a service with immediate concerns for the safety of their loved ones, or themselves, or of those around them, including children, they will receive appropriate and timely support.
• There are clear pathways that enable family members or nominated person(s) to use independent advocacy to raise concerns if, for example, they feel they have not been fully informed in decisions about the persons care.
• Family members or nominated person(s) have a named worker as a main point of contact with services and are confident that services are working together and sharing information appropriately.
• Family members or nominated person(s) feel involved in the design, delivery and evaluation of MAT services.
• Family members or nominated person(s) feel able to provide feedback, including complaints, to the service on care planning and treatment, through informal or formal channels.

What do the standards mean for staff across all services?

• Staff can feel confident and supported to discuss and offer all treatment and care options for MAT on the first day a person presents. Where the staff member is not trained to do this they should be able to use a clear pathway to refer a person on the same day to colleagues who can.
• Staff can feel confident that there are governance structures and guidance in place to enable prescribing as part of MAT, from the first day a person presents to the service.
• Staff members who are prescribing medication as part of MAT, receive regular supervision and training to remain updated on prescribing guidelines and are confident their competencies and development needs are addressed through training and support.
• Staff are clear on their responsibility to provide accessible, accurate information on medication choice and dose, conduct care plan reviews and proactively promote independent advocacy.
• Staff are clear on their responsibility to proactively identify risk and initiate appropriate action for individuals, especially those who have recently left or stopped attending the service or who are at risk of overdose due to reduced tolerance.
• Staff have clear guidance on multi-agency and multi-professional working, including clear pathways of referral and communication between partners such as community pharmacy, GPs, third sector agencies and social care.
• Staff feel confident that mechanisms are in place to maximise their wellbeing to reduce the risk of secondary traumatisation, burnout and compassion fatigue.
• Staff actively (routinely and repeatedly) encourage and help people using services to consider nominating a named person(s) or family member to support their treatment and wider recovery.
• Staff should be aware of the needs of peoples family or others they live with and, if needed seek support for them.

Leadership and governance

Effective leadership and governance are critical to ensuring safe, person-centred and equitable services. Individuals accessing drug treatment and support should have confidence that the care they receive is of the highest quality. The table below outlines requirements for governance and leadership to implement the standards.

What do the standards mean for organisations?

• Organisations have governance, policies, resources and staff in place to establish the roles, responsibilities and lines of accountability required to deliver the standards safely. Arrangements should ensure that people accessing services benefit from partnership working at local, regional and national level.
• Multi-agency partnerships support effective information sharing in line with Caldicott principles. In particular the duty to share information can be as important as the duty to protect confidentiality.
• Clinical governance groups and multiagency partnerships support effective planning and continuous quality improvement through collation, analysis and review of data. This should include local and national epidemiological and improvement data.
• Organisations demonstrate a commitment to effective planning and continuous quality assurance through:
  • effective data collection and analysis including data on quality improvement and inequalities;
  • local and national benchmarking against agreed outcomes and standards;
  • clear alignment of strategic policy objectives and support for implementation.
• Below is a list (not exhaustive) of key policies and processes that should be in place for all the MAT standards of care:
  • co-ordinated, person centred pathways of care with input from third sector, health and social care partnerships (HSCP), those with lived and living experience and family members;
  • information sharing agreements that enable multiagency partnerships to deliver timely, high-quality and equitable care. These should allow for shared record keeping between the multiagency team providing care including social care, housing, community pharmacy, GPs, Police Scotland, Scottish Ambulance Service (SAS), primary and secondary care and third sector providers;
  • systems that record feedback from the person and family member or nominated person and inform quality improvement work;
  • mechanisms that enable people with lived and living experience of drug use and treatment, family members or nominated person(s) and staff to provide feedback, including complaints, to the service on care planning and treatment. And, that can demonstrate where this feedback has resulted in change;
  • policies and procedures that demonstrate a commitment to family inclusive practice, and ensure that staff are supported to encourage and help people using services to consider nominating a family member or nominated person(s) to support their recovery;
  • policies and procedures to ensure people are informed of independent advocacy services that empower them to access their rights and enable informed decision making;
  • systems and resources to provide evidence to demonstrate success in implementation of the standards.

The criteria set out against each standard provide further specific organsational requirements.