CGL Waltham Forest Adults Substance Misuse Service

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Leaders promoted a positive and open culture, with staff describing them as approachable, visible and supportive. Staff felt able to raise concerns and challenge decisions, and this culture was reflected in people’s experiences of compassionate and respectful care. Leaders embedded organisational values across the service, creating a shared sense of purpose.

Governance systems were well established, with structured oversight of quality, risk and performance. Learning from incidents, safeguarding and feedback was integrated into practice, and improvements were made in response to identified issues. People experienced care shaped by these systems, including safer referral processes and clearer escalation pathways.

Partnerships with external organisations supported integrated care and improved access, and the service demonstrated commitment to innovation and continuous improvement, including involvement in research and development initiatives.

Staff described feeling valued and supported, and leaders took steps to recognise contributions and maintain morale.

However, staff survey findings indicated variability in experiences relating to communication, feeling listened to and access to resources, which may affect consistency in team functioning and, in turn, people’s experiences of the service.

We have not awarded this service a score for Well-led.

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

Staff and leaders described a shared sense of purpose and a culture aligned to the organisation’s values. Staff told us they approached their work in a bold, open and compassionate way and felt these values were reflected both in the team and in the organisation’s expectations. One staff member said the organisation had shown compassion to them personally, including through flexible arrangements such as being supported to work from home following a health event. Leaders said these values were also embedded in recruitment, where they looked for candidates who demonstrated openness, compassion and a commitment to supporting people who used the service. Observations of staff reinforced these accounts.

The service had a Service Quality Improvement Plan (SQIP) that set out priorities including improving staff engagement and wellbeing and establishing a Lived Experience Recovery Organisation (LERO) to strengthen the voice of lived experience within borough level strategic spaces. The SQIP had been reviewed in December 2025 and recorded as completed, and minutes from the Integrated Governance Team Meeting (IGTM) showed that both the SQIP and LERO development were routinely reviewed as part of governance. The provider also had an audits programme in place that fed into leadership and IGTM meetings, demonstrating an ongoing commitment to improvement and accountability.

Staff told us they felt supported by leaders and described managers as approachable, visible and accessible. Several staff said they had no difficulty contacting leaders through phone or Microsoft Teams, and one staff member said they had met with a director over the Christmas period while providing cover, which reinforced senior leadership presence. Staff said they could raise concerns even when they disagreed with decisions from senior levels and felt confident, they would be listened to. They described local leadership, team leaders, deputy service managers and the registered manager as making up the “bulk” of everyday leadership presence. Staff consistently reported that the registered manager was available, responsive and supportive. There was an established registered manager in post, providing stable leadership for the service.

Leaders’ descriptions of their role aligned with staff accounts. Leaders said they ensured staff had access to support and explained that they aimed to be present and engaged. Staff who had needed additional support said they had access to it and valued leaders’ responsiveness. These accounts demonstrated an inclusive leadership culture where staff felt safe to express concerns and confident in their leaders’ compassion and availability.

Staff described a culture where they felt able to speak up without fear, and examples provided showed how staff challenge was welcomed. Staff reported that managers encouraged open discussion and routinely used feedback from people using the service, carers and staff to inform improvements. Leaders also described strong commitment to acknowledging and valuing frontline staff, highlighting the demanding nature of the work and emphasising their intention to protect staff recognition even in challenging funding contexts. Leaders expressed a desire to further strengthen recognition, for example through introducing an employee of the month initiative, and said they remained focused on supporting staff morale and ensuring their contributions were visible.

Staff told us they believed their colleagues were highly skilled and committed and that this had contributed to the service being one of the “top performing” services within the organisation. Leaders described advocating for staff and ensuring they received praise for their work. These accounts indicated a culture where staff felt heard, valued and empowered to raise concerns or improvement ideas.

Staff did not raise concerns about their own treatment or that of colleagues and said the team was supportive and stable, with many staff having been in place for over 2 years. Staff described situations where they supported colleagues dealing with personal difficulties, which reinforced the impression of a cohesive, mutually supportive team. Leaders said all staff had completed equality and diversity training, ensuring a shared baseline of understanding.

Staff also discussed cultural factors that can influence engagement, noting that substance use can carry taboos in some communities and that seeing staff from the same local community could create barriers for some people seeking treatment. Staff said the service was known widely across the borough and functioned as a “one stop shop,” which supported access but did not include specific outreach work at the time of inspection. Staff survey data from 2024 showed over 60% positive responses across several questions, and 62%–75% positive responses in areas relating to recommending the team as a place to work and feeling supported by colleagues.

However, the survey also showed over 30% negative responses in some areas - particularly relating to communication, feeling listened to and access to resources. A small number of questions showed an almost equal balance between positive and negative ratings. These results suggested that while many staff felt valued and treated fairly, others had different experiences, and improvements to communication and resource consistency could strengthen equity across staff groups.

Leaders described a well-established governance structure with clear roles, responsibilities and accountability. Staff understood their responsibilities and could explain how risks were escalated and managed. Leaders said audit cycles were carried out quarterly and covered areas such as alcohol and benzodiazepine prescribing. Findings were fed into a Governance Lead Forum, chaired by the Quality and Governance Lead, and then escalated to the Senior Leadership Team, which met every 2 weeks. Leaders’ meetings also took place monthly. Named staff had responsibility for health and safety and clinical oversight, and safety reviews were recorded on the electronic system.

Leaders described how changes had been made following learning from a death, including improvements in recording contact and ensuring staff understood the rationale behind revised processes. They explained the re engagement pathway, which included 2 attempted phone calls, a letter, and further contact at set intervals before decisions about discharge.

The service also used an integrated risk register, reviewed by the Quality Governance Lead and manager, with automated notifications prompting updates. A Business Continuity Plan was in place covering fire, flood, loss of IT access, staff shortages and outbreaks. These systems demonstrated structured governance and regular oversight of risk.

Staff described a range of collaborative partnerships that supported access, continuity and integration. Alcoholics Anonymous held sessions on site on Thursdays and Sundays, and SMART Recovery also operated from the service, offering peer led support in the community. Staff said a new fortnightly mental health clinic had been established with the Jane Atkinson Centre, providing face to face access to mental health assessment and strengthening pathways between substance misuse and mental health services. Staff also described involvement in Integrated Offender Management meetings and said their role included enhancing links with NELFT and Goodmayes Hospital to support coordinated care for people with complex needs.

However, plans to establish a presence at Chingford Police Station could not proceed after the station closed, leaving this workstream on hold. Leaders said they were awaiting further information to determine alternative arrangements.

Staff and leaders described how learning from incidents and safeguarding concerns had been embedded into everyday practice. Staff said that following a past incident where safeguarding issues were not identified at referral, the service had introduced a system where every referral was screened by a manager before allocation. Safeguarding risks were now flagged clearly and recorded in the electronic system with instructions for workers to explore these. Leaders also outlined expectations for incident management and staff support, explaining that the Quality Lead reviewed incidents, and that deaths triggered a Loss of Life forum to support staff involved in the case. Leaders said incidents were notified to commissioners within 24 hours, with investigations expected within 28 days.

IGTM minutes showed the service discussed professional curiosity and safeguarding escalation pathways, which led to implementing an escalation document to strengthen communication with social care. Improvement actions were attached to risk register items and reviewed through leadership and team meetings, supporting collective problem solving and oversight. Staff also described proposed innovations, including pod working for lower risk presentations, allowing more than 1 person to be seen in a supportive group format while maintaining 1:1 pathways for higher risk cases.

However, leaders explained that pod working remained at the planning stage and had not yet been implemented, meaning its impact could not yet be evaluated.