Turning Point Drug and Alcohol Wellbeing Service - City of Westminster and RBKC

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is our first inspection for this service. We rated this key question as good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 8 care and treatment records. Staff had completed comprehensive assessments of clients’ physical and mental health. Where indicated, staff used recognised tools such as AUDIT-C, SADQ, COWS, ReQol and GAD-7, and completed alcohol and drug screening. Staff developed care plans that met the needs identified during the assessment and updated these regularly. Care plans were personalised, holistic and recovery-oriented, with input from the multidisciplinary team including doctors, nurses and social workers. Care plans were linked to individual goals and risks. For example, for one client this focused on managing the risks of alcohol use, and for another on achieving abstinence from cannabis use.

Clients and carers we spoke with said they were involved in reviewing their care and treatment. All felt that staff understood and supported their individual needs. Client voice was clearly evident in the care plans we viewed. Staff we spoke with demonstrated understanding of individuals’ needs and a person-centred approach to assessing these.

Staff offered clients access to a paper or electronic copy of their care plan. Most clients and carers told us they had been offered a copy. In most of the care records we reviewed, staff documented that clients had been offered and declined a copy.

Staff offered all clients a routine screening for blood borne viruses (BBV) and was working towards micro-elimination of Hepatitis C. Specialist nurses provided Hepatitis B vaccinations and treatments for BBV.

Staff were flexible in arranging medical reviews at home or in the community for some clients, for example those with mobility or housing needs. Staff liaised with the primary care regularly to update clients’ GPs on commencement of treatment and any changes to it.

Staff planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service offered a comprehensive range of care and treatment interventions in line with the guidance from the National Institute for Health and Care Excellence (NICE). These included medically assisted treatment, trauma-informed psychological therapies, social and wellbeing activities, training and work opportunities to help people achieve better outcomes in recovery. The psychological offer included low intensity interventions, cognitive behaviour therapy and mental health focus groups. Staff told us that clients who otherwise may find it challenging to access mental health services particularly benefited from these. The lead clinical psychologist worked with a small caseload of clients with more complex needs.

In the records we reviewed,staff had ensured that clients had access to physical healthcare, including specialist care when indicated.

Staff participated in the provider’s clinical audits and other national benchmarking. The provider’s annual programme of audits included medicines optimisation, compliance with NICE guidelines, electrocardiograms (ECGs), alcohol assessments and medical reviews. The service submitted its treatment data to the National Drug Treatment Monitoring System (NDTMS) and the clients’ treatment outcomes were benchmarked against other drug and alcohol treatment providers in England.

The staff team included a full range of specialists to meet the needs of clients. The team comprised doctors and nurses, clinical psychologists, mental health support workers, social workers, pharmacists, peer support workers and peer mentors. Staff regularly met as a team.

Staff had the right skills, knowledge and experience to meet the needs of the client group. In addition, we heard that around a third of staff had lived experience. New staff received comprehensive induction, and all staff received regular supervision and appraisal of their work performance.

Staff had access to reflective practice sessions led by a clinical psychologist and debriefs following deaths and incidents. Staff could bring challenging cases for discussion at multiagency forums.

Managers ensured that staff received the necessary specialist training for their roles. Competency assessments for clinical staff were signed off annually. Specialist trainers delivered clinical training in areas such as electrocardiograms (ECGs), fibroscan (liver scan) and Buvidal (prolonged release buprenorphine depot injection).

Staff worked well across teams and services to support people. They shared assessments of people’s needs when they moved between different services.

Staff held regular multidisciplinary meetings at each hub. We observed 2 daily meetings, where staff shared information effectively.

The local team had effective working relationships with other relevant teams within the organisation. The staff had also developed strong relationships across the organisational boundaries. For example, the service employed 2 social workers who were co-located within the local authorities. We heard that this arrangement enabled more women to access support. The Turning Point teams worked closely with the local police, Jobcentre, local mental health trusts, hostels, housing and criminal justice teams to support people to refer to and transition between services smoothly.

The provider had enabled its clinical staff to access clients’ NHS summary care record securely. This meant staff had the necessary clinical information available to start treatment. Staff liaised with primary care regularly to update clients’ GPs on their treatment progress.

Staff always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff actively supported clients to live healthier lives. This included harm reduction, smoking cessation, needle exchange, sexual health, testing, vaccination and treatment for blood borne viruses. The service offered clients electrocardiograms (ECGs) and fibroscans (liver scans for people whose liver may have been damaged by alcohol use).

Clients we spoke with told us the staff encouraged them to lead a healthy lifestyle, eat healthily and get involved in physical exercise. One client said the staff had put them in touch with a dietician. The service hosted breakfast clubs and Sunday lunches for clients, with healthy food options available. Carers also told us that staff supported them with advice on self-care and exercise.

The service offered sessions throughout the week to promote mental and physical wellbeing. The service had developed its own outdoor fitness programme, ‘Get Connected’, run 7 days a week in the local parks by a trained sports coach. Clients we spoke with described the exercise programme as “great”. Clients could also become involved by training as peer mentors and completing fitness qualifications. For example, a peer mentor told us they were training to become a personal trainer. Another peer mentor said: “It’s amazing. I wouldn’t exercise otherwise. We get encouragement, we are all in recovery”. Clients could access football, organised hikes, swimming, tennis, boxing, yoga and mindfulness. Staff were working jointly with a local professional football club to develop the offer further. In 2024 ‘Get Connected’ was recognised by an award in the Westminster borough. Staff were proud of the programme and told us the uptake was growing.

Staff routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We reviewed 8 care and treatment records. Staff used recognised rating scales where indicated (for example, AUDIT-C, SADQ and COWS). Staff completed treatment outcome profiles (TOPs) with clients to measure progress throughout their treatment. Staff discussed and agreed achievable and holistic goals with clients. Clients we spoke with told us they could request changes to their treatment, for example to increase or reduce their medication dose.

Staff completed regular reviews of clients’ risk assessments, care plans and medically assisted treatment to ensure they reflected their evolving needs. These reviews took place every 3 months or sooner if needed. Staff used outcome measures, such as ReQol, GAD-7 and Dialog+, pre- and post-interventions to measure their effectiveness. Some clients found it helpful to keep substance misuse diaries to track their own progress.

The service participated in the National Drug Treatment Monitoring System (NDTMS) data collection. This meant the treatment outcomes of its clients were continuously benchmarked against other drug and alcohol treatment providers in England.

Staff used technology to support care effectively. For example, clinical staff could access the clients’ NHS summary care record securely through the provider’s electronic system.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff followed the provider’s policy on consent to treatment and took all practical steps to enable clients to make their own decisions. Clients we spoke with told us that staff discussed consent in every meeting and before sharing information with their GP. Staff recorded clients’ consent to involve other people in their care, or whether they wished to decline this. Consent and information sharing was explained clearly in the service admission pack.

Compliance with Mental Capacity Act training was 98%. Staff assessed and recorded clients’ capacity to consent appropriately. They did this on a decision-specific basis about significant decisions. For example, in one care record we reviewed the staff were awaiting the outcome of assessment of the client’s capacity to consent to treatment and information sharing.