CGL Waltham Forest Adults Substance Misuse Service

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

The service was responsive to people’s needs, with flexible approaches that supported engagement. People described being accommodated when late for appointments and valued the accessibility of rapid prescribing clinics, particularly compared to previous services. Staff adapted care to reflect individual preferences, maintaining a person-centred approach.

Partnership working supported continuity across services, including mental health, housing, social care and criminal justice pathways. People benefited from access to a range of additional support, including community resources and on-site services, which addressed wider determinants of health.

People were encouraged to share feedback through multiple channels, and leaders used this information to inform improvements. Feedback highlighted positive experiences of staff compassion, group activities and support for recovery, which were reflected in service developments.

However, some people described unclear communication about appointments, group expectations and treatment pathways, which created uncertainty and affected their ability to engage consistently. Inconsistent application of group rules and communication about changes in keyworkers also left some people feeling destabilised or unsure about their support, which could affect continuity of care.

We have not awarded this service a score for Responsive.

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

Staff worked with people in a person-centred way and adapted their approach to reflect individual needs, preferences and levels of motivation. During observations, staff engaged people respectfully, demonstrating warmth and flexibility, and tailored conversations so that individuals felt listened to. Staff told us they valued meeting people face to face to understand how their circumstances were changing and to support those who were ready to make progress. Care records showed assessments captured protected characteristics, including indicators such as military veteran status, which supported staff to consider diverse needs when planning care. Staff described how twice weekly MDT meetings enabled them to discuss changes in presentation, make joint decisions and keep care responsive to people’s emerging needs. They also monitored daily contacts through an activity report and took action to re engage people where this reduced, which helped maintain continuity.

People were encouraged to express their views and influence how support was delivered. Staff described advocacy focused approaches, including helping people express themselves “in their own voice.” Observation and record review showed that staff offered copies of care plans, even when people chose not to take them, ensuring individuals had the opportunity to remain involved in decisions about their care.

Staff described 1 example where communication about text message preferences was not clear when a person returned after an inpatient detox admission. Staff identified the issue related to misunderstanding which types of messages the person wished to stop. Leaders and staff reviewed this and learned to ask people more explicitly about preferred communication types.

Staff worked collaboratively with a wide range of agencies to support joined up care for people whose needs were often complex. Staff described clear referral pathways to crisis teams when people’s symptoms or distress increased, and to community mental health teams when clinical input was needed. They explained how they discussed the risks and benefits of community and inpatient detox with people, helping them make informed treatment decisions. Staff also communicated prescribing needs directly with mental health teams to maintain continuity across services. Leaders told us staff worked regularly with adult and children’s social care, acute hospitals, housing providers and referrers, and shared relevant information during team meetings and flash meetings to ensure emerging issues were addressed promptly. Records showed family and relatives were noted where relevant, ensuring care planning considered the broader context of people’s lives.

Staff supported people to access wider community resources that promoted wellbeing and stability, including GPs, gyms and housing support. They told us that Release, a community legal and welfare service, ran a satellite clinic on site, providing advice on issues such as housing insecurity, homelessness and debt. Staff described working with people with higher levels of complexity, including those supported through Integrated Offender Management (IOM) arrangements, and said probation colleagues responded promptly to risk related communication. They highlighted that information was shared in advance for people with more complex presentations, enabling staff to prepare appropriately before appointments.

Staff provided people with information that supported them to understand their care and make informed decisions. Several people told us their keyworkers were “brilliant,” and others described how staff adapted information to meet their individual needs, including supporting neurodivergent people to complete forms in accessible formats. Staff said they tried to accommodate everyone’s needs and used interpreting services when required, including Language Line. They described using interpreters for telephone appointments and supporting people to make calls about financial matters where language barriers existed. Leaders told us they planned to introduce tele engagement through a pilot scheme to strengthen access to information. Consent documentation was clear and complete at triage, including confidentiality and onward referral consent. Other consent records, such as permission to view the patient summary record, were appropriately completed and dated.

Staff used comprehensive consent documentation for Buvidal treatment, which included confirmation of understanding of risks, benefits, pregnancy considerations and links to patient information leaflets. The provider had an up to date data protection policy outlining principles, responsibilities and data subject rights. Most staff had completed mandatory data protection and information security training, with 2 new starters yet to complete this.

However, some people described inconsistencies in how information about group expectations was communicated, which left them uncertain about requirements. Others said some group content could be triggering in relation to past trauma and would have benefitted from clearer advance information. A small number of people also described occasions where communication about appointments or changes was not clear, which affected their experience. Where information about group content or expectations is not clear, some people may unexpectedly encounter topics that relate to past trauma. This can affect their sense of safety and may lead them to disengage from groups that would otherwise support recovery.

Staff listened to people and involved them in shaping both their care and the wider service. People told us staff were caring and positive in their approach, and observations showed staff advocated clearly on people’s behalf and took time to understand their priorities. Feedback systems were visible throughout the building, including QR codes in waiting areas, paper forms and a submission box. Although the “you said, we did” board had been temporarily removed due to decorating works, leaders confirmed this display was usually available and used to update people on changes made in response to feedback.

Leaders used a range of mechanisms to gather feedback, including compliments, complaints, suggestion boxes, posters and leaflets encouraging people to write to commissioners or CQC if they wished. They used the provider’s electronic system to manage complaints, and leaders described using data from the National Lived Experience Pulse Survey to understand people’s experiences. The 2025 Pulse Survey received 132 responses and highlighted themes including staff compassion, positive relationships, group structure, meaningful activities and stigma. Leaders used “you said, we did” actions to show how changes had been made. Internal governance minutes showed the Pulse Survey was discussed regularly, including how to improve participation without a last minute “rush” each quarter.

Staff encouraged involvement at an individual level by supporting people to understand consent processes and treatment options. Leaders said staff had completed training on professional optimism, focusing on decisions grounded in facts rather than assumptions. They also supported staff through service user champions, who helped highlight knowledge gaps and inform staff training needs.

However, staff told us some people did not always understand the prescribing pathway, which contributed to concerns about delays, even where rapid options were available. Leaders said they were aware of this and were working to improve how information about pathways was communicated.

The service worked to ensure people from different backgrounds and with varied needs could access treatment. Staff described supporting people who faced barriers to communication by using interpreters, including Language Line, and said they could easily secure face to face or telephone translation when needed. They also described helping people make translated calls about financial matters and said managers carried out assessments in other languages where they were able to do so. These approaches reduced barriers for people whose first language was not English.

Staff incorporated protected characteristic questions into assessment, and care and treatment record reviews showed this information was used to consider the broader context of people’s needs. Staff also described working across adult and children’s social care, mental health services, housing and criminal justice services, supporting people with a wide range of experiences and backgrounds to access coordinated care. This helped ensure care was responsive, reduced barriers, and improved access for people with diverse needs.

However, some people described inconsistent application of group attendance rules, which created uncertainty about whether they would be allowed to participate. When group rules are not applied consistently, people may feel unsure about whether they can attend or what is expected of them. This can lead to unequal experiences across the service and may reduce confidence in group pathways as a reliable part of treatment.

People’s experiences of the service were often positive, and many reported strong relationships with staff. Staff described encouraging advocacy, enabling people to speak in their own voice, and leaders highlighted the use of the Pulse Survey to understand whether experiences differed across groups. Survey themes included strong compassion from staff, meaningful activities and the impact of stigma, and leaders used “you said, we did” actions to respond.

Staff described how they tailored support for people with specific needs, including neurodivergent people who required adapted information formats and people with mobility needs who benefited from pharmacy delivery or home visits. Staff also described multi agency support for people with complex circumstances, including those involved in criminal justice pathways, where probation colleagues provided timely responses. These examples showed efforts to ensure equitable support.

Staff supported people to plan for change and develop goals that reflected what mattered to them. Care and treatment record reviews showed people had personalised goals, including employment aims, fitness ambitions and relapse prevention strategies, and staff supported these through one-to-one sessions and group activities. Leaders and staff described how groups such as the employability workshop, weekend planning sessions and wellbeing activities helped people build structure and independence as part of planning for long term recovery.

Staff told us assessments captured information about people’s social circumstances, strengths and wider needs, which fed into ongoing planning. Leaders described future developments such as piloting tele engagement to widen access and improve communication. They also described ongoing review of training needs, including service user champions highlighting learning gaps and the integration of feedback from the Pulse Survey into future service improvements.