Activity is aligned with priorities across health and care and the recovery-oriented system of care.

• Connected to local public health work programmes, other standards/guidance and other areas of improvement.
• Considered impacts on other areas of the health and care system (e.g. primary care, community-level support, third sector commissioning).
• Incorporation of Ethical Commissioning principles into the planning and commissioning of mental health and substance use services.

Leadership is focussed on learning and enabling people delivering services to make changes and adapt to improve.

• ‘it’s everyone’s job’ - commissioners and providers demonstrate they are fulfilling their joint duties to meet the needs of individuals with co-occurring conditions.
• change programmes across the wider system actively collaborate and join up services.
• an enabling culture amongst staff, empowering them to make informed decisions and develop in their roles.

The workforce is well equipped and supported to manage co-occurring conditions and to provide the right support at the right time.

• The workforce, including third sector, is clearly defined.
• Workforce development enables staff to be trained and supported to assess and manage co-occurring conditions.
• Staff and inter-service relationship building approaches are part of business-as-usual activities. 

Policies and procedures enable more joined up approaches to ensure seamless care.

• Processes for common assessment for co-occurring conditions, and agreed onward pathways that includes an explicit role for third sector services.
• Understanding of roles and responsibilities across the ‘Four Quadrants’, including where collaboration is required and pathways where needs change.
• Information sharing systems that enable timely and joined up care; and support responses when people disengage with services.
• Communication with individuals, their carers and families.

There is a Quality Management System that is people-led and focused on learning, which allows for the maintenance, improvement and planning of quality through collaboration.

• Data and measurement is used for learning, with variations from quality standards used to identify areas where things could be done differently.
• Services adapt based on intelligence that informs quality planning, quality control, and quality improvement.
• Experiential data from people delivering and receiving services informs decision making. 

Key principles are embedded within service delivery for people with co-occurring mental health and substance use conditions.

Strong leadership supports culture change, with a focus on workforce development and relationships across services to create the conditions for effective implementation.