Background: The COVID-19 pandemic presents challenges to substance misuse services. Patients face a higher risk of infection and transmission to others. Services were required to reconfigure quickly in response to the government lockdown. These changes had to be completed before national guidance was published. Method: To examine the strategy and operational delivery of two London boroughs and measure how convergent they were with national guidelines. Referral data were analyzed and compared to a similar time frame pre-COVID-19. Results: Both services adopted similar strategies and pace of change. Longer supplies of opiate substitution therapy (OST) were prescribed, with less restrictive arrangements for collection. There was an increase in opiate assessments and a reduction in alcohol assessments. There was no overall increase in mortality. There was minor deviation from national guidance when it was initially published. Conclusions: The services were well equipped to respond to the rapid changes demanded during early lockdown. Reduced restrictions in OST may not be associated with negative service or patient outcomes. The move to remote consultations and home working are likely to have value in substance misuse services after the pandemic. The long-term impact of lockdown presents uncertainties in terms of clinical safety and requires evaluation.

AimsAims included to explore how, within a London trust, staff at the interface between patients, relatives and access to services view their understanding of confidentiality, and to determine ways to improve knowledge if needed.BackgroundConfidentiality is essential to the trust and development of clinician-patient relationships. National policies set guidance on how confidential information should be recorded, secured and shared. However, confidentiality breaches are reportedly common within health professions. Working with adolescent patient groups brings additional issues regarding confidentiality. Care-givers who contact services, often desiring containment, may experience a sense of uncertainty when confidentiality policy prevents details being shared about a young person's clinical experience.MethodStakeholders were identified from the multidisciplinary team, with a collaborative rather than ‘top-down’ approach. Administrators in patient-facing roles were surveyed to ascertain current understanding and frequency of involvement in confidentiality issues. Based on feedback, a flowchart prompt was designed, ensuring it reflected best practice. Qualitative and quantitive data were collected before and after a two month implementation period.ResultAll respondents (n = 10) dealt with confidentiality issues at work, with 50% experiencing issues daily. 33% respondents did not feel confident dealing with confidentiality queries at work. The majority (60%) had received confidentiality training, but all respondents thought extra information would be useful. Of possible interventions, 70% supported a flowchart. Following an implementation period, 100% respondents re-surveyed agreed they felt confident dealing with issues related to confidentiality at work. The majority of respondents had used the flowchart and found it useful (83%). Qualitative data gathered suggested rolling-out the project elsewhere.ConclusionA lack of confidence surrounding issues with confidentiality, including information sharing, was identified. This can negatively impact patient engagement and delivery of care. The introduction of the confidentiality flowchart demonstrated improved understanding of, and confidence in, patient confidentiality issues. The small sample size means there are limitations in extrapolating findings to wider contexts. However, it is likely that more confidentiality training and practical information for NHS staff at the interface between patients, clinicians and services would reduce the risk of confidentiality breaches and reinforce positive relationships with services.