Inspiring evidence-led approach in Derby reduces service users’ risk of accidental overdose.


The NHS SMPA exists to develop the collaboration between service users, carers and organisations, enabling services to provide the best quality care. As part of this, we want to share stories inspiring stories of great practice, such as this Health Improvement Team initiative in Derby.

Derby Healthcare Foundation NHS Trust has looked at their care delivery in an effort to meet the deficit that diminishing resources can have. They have devised a ‘red flag system’ to identify those service users most at risk of accidental overdose.

This was achieved by reviewing 6 years of local mortality data and identifying red flags. The common themes that correlate this risk of accidental overdose are largely expected, for example:

  • Continued intravenous use of illicit drugs
  • Erratic engagement with services
  • Poor physical and/or mental health

However, less considered is Hep C status and a correlation for those living in isolation. Other risk factors considered were:

  • Having a hospital admission in the last 12 months,
  • Having a physical health condition such as chronic obstructive pulmonary disease or a deep vein thrombosis.  
  • Being prescribed additional medication with a sedating effect by their GP.

Collecting and analysing this data identifying who was at risk led to the creation of a Health Improvement Team (HIT) in Derbyshire. This approach was incorporated into a tender for Derbyshire treatment services at the beginning of 2017, and the new service went live in April 2017.

The Health Improvement Team do not carry a caseload, instead supporting key workers with their higher-risk service users. The team’s sole focus is on improving service users’ physical and mental health and preventing drug related deaths. Those with chronic and deteriorating physical health have greater priority placed on managing these conditions, and support is integrated with their substance misuse treatment. Physical health assessments and advice are provided by the HIT nurses, such as blood borne virus testing and vaccinations alongside ECG.

The establishment of the HIT Team has had a significant impact on reducing the numbers of drug-related deaths locally, and shows the value (both qualitatively and financially) of innovative, joined-up, evidence-based approaches to substance misuse services.