Date Published: 5 August 2010

Health and social care services are monitoring controlled drugs more effectively, according to the CQC

The Care Quality Commission (CQC), independent regulator of all health and adult social care in England, has

Health and social care organisations are continuing to develop systems and services to manage controlled drugs more effectively and to share information on concerns and best practice at a local and national level, according to a recent statement from the Care Quality Commission (CQC), independent regulator of all health and adult social care in England.

The findings have been published in the third annual report on progress made in implementing regulations introduced in response to the Shipman Inquiry. The inquiry found ineffective monitoring had allowed Dr Harold Shipman to divert supplies of diamorphine to kill at least 15 and possibly up to 200 patients without detection. The Controlled Drugs (Supervision of Management and Use) Regulations 2006 were then introduced in 2007. Controlled drugs include opioids, such as morphine and diamorphine, which are used for example in relieving severe pain and treating drug dependence. Controlled drugs also include benzodiazepines (tranquillisers and sleeping tablets), anabolic steroids and growth hormones.

Covering the year ended 31 December 2009, the CQC report analyses arrangements for monitoring controlled drugs, the progress on implementing recommendations made last year and makes further recommendations for protecting people who use services. It found the role of the accountable officer, responsible for monitoring controlled drugs, is now embedded in healthcare organisations. But the report warns it is particularly important, considering the current economic cutbacks, that gains such as these are not lost.

Other key findings and trends:

• Prescribing by nurses and pharmacists continued to increase in line with policy to increase people’s access to medicines through the introduction of non-medical prescribers.
• The requisition regulations do not currently allow the collection of a consistent data set to monitor orders by individual practitioners.
• Local intelligence networks (LINs) – comprised of accountable officers from local providers as well as regulators and agencies - have developed an improved understanding of their intelligence-sharing function.

CQC found evidence of good practice including a development to show how LINs are developing reporting arrangements for concerns about the management of controlled drugs. For example, NHS Tees’ LIN has developed an online reporting tool that allows accountable officers to report any concerns directly and permits others in the LIN a view-only access. This allows real time rather than retrospective reporting of concerns.

The report concludes that managing and monitoring systems for controlled drugs will require ongoing activity and vigilance to sustain the developments achieved in the past three years.

It detailed the following recommendations:

1. Chief executives and accountable officers should continue to keep the safe management of controlled drugs a high priority on their organisation’s agenda.
2. The Royal Colleges should develop guidance on appropriate use of opioids and amphetamines for all sectors to ensure best practice.
3. The Department of Health should revisit the regulations for the requisition of controlled drugs to better capture the data identifying individual practitioners in line with original policy intent.

CQC chief executive, Cynthia Bower, said:

“ We’re greatly encouraged by the progress made by provider organisations in improving and embedding the systems and processes necessary to support frontline managers in managing controlled drugs and to pick up concerns. Coupled with the good work done to share intelligence at a local and national level, this shows we are all better equipped to identify inappropriate or unusual prescribing and that patient safety remains top of the agenda for health care organisations.

Despite this progress, we still feel there are improvements to be made and will be asking for improved regulation of controlled drugs to capture data on requisitions and for further guidance on prescribing of opioids and amphetamines across all settings.”

The government handed overarching responsibility for external scrutiny of the new systems to CQC’s predecessor body, the Healthcare Commission. This passed to CQC on 1 April 2009. All health and adult social care services that provide regulated activities, as defined by the Health and Social Care Act 2008, must be registered with CQC. NHS providers were registered in April, and adult social care and independent healthcare providers are due to register between April-October 2010. Dentists and private ambulances will be registered from April 2011, and primary medical services (GP practices) registered from April 2012. To be registered, health and social care organisations must show they meet the essential standards of quality and safety. The essential standard that relates to the safe management of drugs is regulation 13, which is outcome nine. CQC’s Guidance about compliance, published on its website, sets out the expected outcomes that describe quality and safety from the perspective of people who use services.

About the CareQuality Commission: The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. The CareQuality Commission inspects health and adult social care services in England, whether they're provided by the NHS, local authorities, private companies or voluntary organisations. It also protects the interests of people detained under the Mental Health Act. (Until 31 March 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.)

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