Turning Point Leicester City Substance Misuse

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• 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 was the first assessment for this service. This key question has been rated Good.

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

Staff developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment for clients based on national guidance and best practice. The team included or had access to the full range of specialists required to meet the needs of clients. Staff from different disciplines worked together as a team to benefit clients.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

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

Of the 12 care records we reviewed, all had an up-to-date risk assessment, and plan for unexpected exit from treatment. Staff developed care plans that met the needs identified during assessment.

Staff completed comprehensive assessments of clients, including substance use, physical health (including urinary systems if needed), mental wellbeing and treatment goals. If there were concerns identified, this would prompt liaison with other stakeholders such GPs and hepatology.

Clients were referred to the substance misuse mental health team if required (SUMH). This team was introduced in 2021 to integrate more tailored support for clients with co-morbid mental health and substance use needs. The model of delivery had a clear tiered approach to supporting a range of clients with varied needs. The service had a plan in place which directly responded to a CoSUM (co-occuring substance misuse) report which included a focus on trauma informed care and implementing crisis survival skills. This model also included liaison with external agencies where required such as community mental health teams. The recent annual report of the SUMH team (2023-2024) included positive client feedback such as not feeling judged and finding coping mechanisms helpful. Outcomes were measured and positive in nature. For example, a reduction in psychological distress and increase in perceived capacity to tolerate distress for clients receiving support from the SUMH.

There was also evidence that harm reduction was discussed in care records. The service was dedicated to micro elimination of blood borne viruses (BBVs). Nurses screened for BBVs and provided immunisations for Hepatitis B. Daily flash meetings included discussions around BBVs, and there was a designated staff member who liaised with the local hospital to work towards reducing BBVs.

Clients that had undergone an assessment told us they were satisfied with the process. One client told us they were seen at home due to being bed bound and appreciated the flexibility the service offered with appointments.

The service 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.

Staff provided a range of care and treatment interventions suitable for the client group, consistent with best-practice guidance, including NICE guidance and national guidance on clinical management of drug misuse and dependence. The service had a clear and comprehensive ambulatory detox policy that reflected best practice and highlighted the importance of the first 24 hours, as this is the riskiest time during a detox. Harm reduction and needle exchange practices were also in line with guidance.

Staff had the right skills and knowledge to meet the needs of the client group.

Client needs were assessed using recognised evidence-based assessment tools, and treatment outcomes were monitored using standardised measures aligned with public health guidance.

Clients had access to a range of staff to help support them, including nurses, doctors, recovery workers, psychologists and peer mentors. Recovery workers were also divided into various areas such as homelessness, criminal justice and employment.

There were a range of meetings and escalation processes to allow for multi-disciplinary discussions of cases which were of particular concern.

Managers identified areas for learning within post-incident reports completed following a client death. Findings from these were fed back to recovery workers to develop their skills where practice had fallen below expected standards.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings. Daily staff meetings were effective, with full team attendance and thorough discussion of risks and incidents.

The service generally had good working relationships with other stakeholders such as GPs, hospitals and social services. Service led reviews of care following client deaths identified that, on occasion, there were missed opportunities for communication with partner agencies. However, these were acknowledged and addressed with the aim of improving the service for future clients and did not appear to contribute to the deaths. These were usually addressed on an individual basis with recovery workers and then shared via learning bulletins and team meetings. The service provided GPs with fortnightly bulletins that had advice about how to refer potential clients.

We heard how the service had worked with the police to train them in the use of naloxone to reduce risk of opiate overdoses under an initiative titled “A Partnership to Save Lives”. Between 2023 and the time of our assessment, 524 police officers had been trained and had then used naloxone to treat opiate overdoses on 24 different occasions. The service also worked alongside the police to identify hot spots for drug use within the local area as part of this pilot. The service received a National Public Partnership award for this work which recognises excellence in local government across the UK.

There was clear guidance on how to support pregnant clients, including immediate referral to the local vulnerable midwifery team.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reducing their future needs for care and support.

Staff supported clients to live healthier lives. The service operated the “swap to stop” scheme funded by the government to encourage engagement with smoking cessation and offered vapes in-house. The service completed blood borne virus (BBV) testing and offered daily drop ins for BBV testing and there was evidence of BBV testing in all client records. The service operated a needle exchange service from their hub to reduce the transmission of BBVs. This process was observed by our inspection team and was in line with the provider policy. The local area was eligible for online needle exchange services and staff encouraged clients to use this to increase use of needle exchange services without needing to attend the service.

All client records included information about harm reduction and use of naloxone; the service offered a “click and deliver” naloxone provision to increase access and reduce risk of opiate overdose.

One client told us that their recovery worker had helped them access a dentist and doctor. Another client reported that their recovery worker checked in to make sure they were eating well.

Clinical staff also completed ECGs and provided wound care and liver scanning in attempts to detect early-stage liver failure.

Clients who were risk assessed as safe to keep medication at home were given safe storage boxes to maximise independence and maintain safety for other people in their homes.

The service ran groups aimed to reduce harm, empower recovery and improve health and wellbeing. Examples include a women’s group, alcohol change group and a crack use group.

The service 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.

Staff used recognised scales to assess client needs, to monitor client progress and reported to the National Drug Treatment Monitoring System (NDTMS) for Public Health England. Clients also completed Treatment Outcome Profile (TOP) forms with their recovery worker in line with the government expectation at the start of treatment, 3 months into treatment and then 6 months thereafter until exit from treatment.

The service had oversight of client outcomes. A quarterly outcome commentary report was completed by the service in December 2025 to monitor the success of all 637 planned exits from treatment. One hundred percent of crack and opiate users were abstinent from substance misuse at the end of their treatment. Most other drugs were also stopped, improved or unchanged, apart from 1% increase of alcohol and cannabis use.

An NDTMS report compared the performance of Leicester with 32 partnership areas as decided by Public Health England. Leicester was 3rd out of 33 for completion of non-opiate treatment. They were 13th out of 33 for completion of alcohol treatment. They were 14th out of 33 for completion of alcohol and non-opiate treatment. They were 24th out of 33 for completion of opiate treatment.

The service acted on client feedback by redesigning its rooms to be more neurodiverse-friendly. This included fidget toys and sensory lights.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff Mental Capacity Act training compliance was 98%. However, the application of the Mental Capacity Act appeared inconsistent. Five recovery workers were asked about capacity. All 5 could reference that they had received training, but they did not elaborate on the functional test or any of the 5 principles. One person was able to recount that capacity can fluctuate. However, they were able to state that they could escalate any concerns regarding client capacity to a multi-disciplinary team, or the substance misuse mental health team within the organisation. Two prescribing staff we spoke to were able to demonstrate more knowledge in this area.

We reviewed 12 care records. We saw initial capacity assessments, however capacity was not regularly revisited throughout treatment. However, we observed one example of a decision-specific capacity assessment being carried out for a pregnant client receiving medical care. Clients confirmed that consent was discussed with them. Consent was reviewed every 3 months as part of ongoing monitoring of client progress and documented within client records.

We observed that consent was reviewed every 3 months in line with provider policy.

Details about advocacy services were displayed in the waiting room.