This report highlights good practice in commissioning and providing effective Tier 4 services. It is based on interviews with local drug partnerships and treatment services that performed well in the 2007-08 service review on Tier 4, carried out by the NTA and Healthcare Commission.

Good practice: the key points:
Elements for commissioning effective Tier 4 treatment:
• Good partnership working, with close collaboration between drugs partnerships, drugs services, and local social services community care departments at a strategic and operational level
• Established routes into and out of treatment, with clear arrangements for preparing people for treatment, and for aftercare and reintegration
• Regular contract reviews with providers
• Good use of relevant data and other feedback to inform decisions on commissioning services.

Elements for providing effective Tier 4 treatment:
• Clearly established and effective exit strategies for clients when they leave treatment, including links with housing, education, training and other ongoing support
• Ongoing risk assessment and clear policies to keep clients safe following unplanned discharge and to reduce the risk of overdose
• Good structures for managing staff and helping them to deliver treatment, including clear supervision arrangements and meeting their training needs.