We carried out a review of the data available to us about Turning Point Oxfordshire on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Turning Point Oxfordshire, you can give feedback on this service.
We rated Turning Point Oxfordshire as outstanding because:
We do not currently rate independent standalone substance misuse services.
We found the following areas of good practice:
The hub environments were clean, tidy and well lit. All appropriate health and safety records were present and in order.
The service had adequate medical cover. There was minimal delay between referral, assessment and start of treatment. Assessments, prescription starts and medical reviews took place within 24 hours. The service responded promptly to people released from prison, offering initial assessment and bridging prescriptions as needed. A bridging prescription in this context is a prescription of methadone that is given whilst a person’s care is being transferred between two services i.e. prison and a community-based service.
Each client had an initial risk assessment and most also had a risk management plan.
Clients received a comprehensive assessment of their individual needs and a care plan jointly formulated by them and their recovery worker. Care plans were recovery focussed, with individually formulated goals. Most care plans showed evidence of client involvement in the care planning process. Clients told us that staff had asked if they wanted family or friends involved in their treatment program.
A full multi-disciplinary team complemented the teams of hub-based recovery workers and support workers. The provider had a dedicated safeguarding worker, based at the multi-agency safeguarding hub at Cowley Police Station. Clients had access to extensive levels of specialist employment, housing and benefits support from staff and partner agencies.
The provider had undertaken a program of supplying Naloxone kits to clients and training them in their use, in case of methadone overdose. Naloxone is a medication administered when a patient overdoses to temporarily counteract the effect of the opiate, pending the arrival of paramedics.
Staff followed National Institute for Health and Care Excellence (NICE) guidance when prescribing medication.
Clients had access to a range of psychological therapies, including Cognitive Behavioural Therapy (CBT), International Treatment Effectiveness Project (ITEP) psychosocial interventions and Model of Psychosocial Interventions (MOPSI) group therapy.
New staff completed an induction program and were then assessed for their level of competence. Specialist staff training was provided on a rolling program. Examples of courses offered were drug awareness; assessment and recovery planning (including the use of ITEP psychosocial interventions); delivering MOPSI groups; harm reduction; Blood Borne Virus (BBV) testing; and, needle exchange.
The service had been proactive in building solid working relationships with partner agencies. A new dual diagnosis pathway had been developed to enhance the relationship with mental health services, in response to a recent serious incident.
Staff consistently treated clients in an appropriate, respectful and supportive manner. Staff demonstrated an excellent attitude towards clients when interacting directly with them, and when talking about them with colleagues. Clients had universal praise for the caring, compassionate, helpful, non-judgemental, supportive, understanding and responsive service they receive.
Clients were encouraged to provide positive and negative feedback about the service. A newsletter written by and for clients provided them with the opportunity to impact upon service delivery.
The service operated a comprehensive system for contacting and re-engaging clients who fail to attend appointments, and provided a “prescription collection from service hub” arrangement for clients with a history of being poor attenders.
The service responded well to the specific needs of its clients, such as provision of specialist support for people experiencing homelessness in Oxford city centre and specific interventions for victims of domestic abuse. Also, the service operated regular satellite clinics and mobile engagement programs (as an adjunct to the four main hub offices), and offered evening and weekend services at the hub sites.
Staff had a clear understanding of the organisation’s visions and values and these were embedded into the day-to-day operation of the service.
Staff displayed a high level of motivation for their work and a genuine passion for helping their clients. There was great positivity about the degree of progress made within the first year of the provider’s contractual term.
The service participated in a yearly review into drug related deaths. The clinical lead in public health conducted a quarterly review into deaths connected with the service.
The service operates a peer mentor scheme and a social enterprise café to provide work-based experience for former clients.
However, we also found areas that the service provider could improve:
There were a number of issues with the clinic room at Oxford hub: there was no record of when (or from where) stocks of Naloxone pens had been received; there were no oxygen cylinders, although a standard oxygen sign was on the door of one clinic room; resuscitation equipment was stored in a green oxygen equipment bag and there was no check list of contents or evidence that the contents had been checked; calibration of the heart rate, blood pressure and oxygen saturation monitor in the Oxford clinic room was overdue; and the ambient temperature of the clinic rooms was not monitored.
Staff acknowledged a need to develop more support for people from black and minority ethnic backgrounds and the lesbian, gay, bisexual and transgender community.
The needle exchange worker did not liaise with the prescriber in cases where a client was continuing to use illicit drugs to supplement their prescription.
There was conflicting evidence on the quality of physical healthcare, assessment and monitoring. Physical examinations were not routinely carried out prior to prescribing or at medical reviews. None of the care records we examined contained evidence of a full physical health examination or assessment upon admission, or evidence of ongoing physical care monitoring. However, a nurse we spoke with, told us that staff obtain a medical history from the GP, as part of the care planning process.
Staff experience of supervision frequency was variable. Some individuals were supervised only once every six months, whilst others were supervised more than once a month. No members of staff we spoke with had received an appraisal, within the ten months that the provider had operated the service.
One hub had two pregnant clients whose risk assessment had not been updated since they told staff they were pregnant.
Staff knew how to report incidents, but told us that they did not receive feedback on investigations. Feedback from incidents was not a standing item on the agenda for team meetings.
Approximately half of the 14 risk assessments we examined had been reviewed within the provider’s target of 12 weeks.