Reset Treatment and Recovery Support Service - Tower Hamlets

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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.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

People received care and treatment that reflected current evidence and supported their recovery. They told us staff listened, helped them understand their goals, and offered flexible assessments tailored to individual needs. Staff used structured first-contact processes that explored substance use, mental health, physical health and social context, and offered home visits or phone assessments to reduce barriers. Risk was identified and escalated promptly, and multidisciplinary forums supported timely safety planning. Care plans were generally up to date, and people described interventions such as trauma workshops, acupuncture and motivational interviewing that helped improve wellbeing. Staff worked with external partners, including GPs, housing agencies and mental health services, and people said these arrangements helped them feel supported and connected to care. Staff delivered evidence-based care and followed structured protocols for prescribing, including methadone and buprenorphine, and policies were reviewed regularly.

Clinical risks were identified and escalated appropriately, and staff described examples of assertive engagement leading to sustained recovery. People were supported to live healthier lives through tailored interventions and reasonable adjustments, including women’s clinics and outreach to hostels. Staff promoted harm reduction and health improvement, and partnerships were used to deliver targeted interventions for groups such as the Bengali community and people experiencing homelessness. The service monitored outcomes and acted on what it learned, using performance data and feedback to inform improvement plans. Leaders tracked retention and completion rates and compared them with benchmarks, and governance records showed actions to address gaps. People told us they were given clear explanations about their care and treatment and that consent was sought before any intervention. Staff described a strong focus on collaborative working and informed decision-making, and training compliance for the Mental Capacity Act and Deprivation of Liberty Safeguards was high.

However, the service was consistently performing below its own benchmark for ‘successful completions’ and the national average. The service was using performance data to understand the reasons for this and to refine its pathways and improve outcomes. Some people reported miscommunication about group sessions and said calendar information was not always shared, which suggests internal coordination could be improved to support consistency in care. Staff described challenges in partnership working, particularly with mental health services, where substance misuse was sometimes used as a reason to decline support.

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.

People experienced assessments that were collaborative, flexible and tailored to their needs. They told us staff listened, helped them understand their recovery, and supported them to manage triggers. Groups were adapted to individual circumstances, such as women-only sessions. People were signposted to relevant services including psychological therapies and memory clinics, and carers described receiving practical support such as housing advice. This helped people feel heard and connected to care that reflected their goals.

Staff described a structured first-contact process that explored substance use, mental health, physical health and social context. People were offered home visits, phone assessments and choice of venue and time. This reduced barriers to disclosure and supported safer, more complete assessments. Staff prioritised contact based on need and used activity reports to monitor whether people had been reached within expected timeframes, particularly those awaiting Tier 4 admissions.

Risk was identified and escalated promptly. In one case, a person disclosed suicidal behaviour; staff updated the record immediately, discussed the case with appropriate colleagues and shared crisis information and brought it to the next team debrief. Staff used multidisciplinary forums to share emerging risks and plan re-engagement for people who had not attended. This ensured assessments translated into timely safety planning.

Care and treatment records included blood-borne virus assessments, supporting safe harm reduction. Staff described using motivational interviewing, International Treatment Effectiveness Project mapping (ITEP) and Treatment Outcome Profiles (TOP), and the electronic records system flagged review dates.

Monthly activity reports flagged overdue reviews, and alerts in the electronic system helped prioritise follow-up. Supervision, case management and quality assurance meetings considered who had not been seen and why. Staff liaised with pharmacies and GPs to coordinate care.

Assessments reflected multi-agency working and attention to carers. Staff worked with adult social care, drug intervention programmes and risk panels. They coordinated with GPs and planned aftercare ahead of treatment endings. People and carers were signposted to appropriate services and received practical support. This helped ensure assessments were informed and inclusive.

Staff considered diverse needs. They offered women-only groups and adapted assessments to access needs. Leaders identified gaps in representation and initiated outreach and training. These actions supported safer disclosure and more relevant assessments for under-represented groups.

People received care and treatment that reflected current evidence and supported their recovery. They described attending structured interventions such as trauma workshops, de-stress courses and acupuncture, which helped them manage their wellbeing. Events like coffee mornings contributed to a sense of community and reduced isolation. People said staff were professional and understanding, and that the service had made a positive impact on their lives.

Staff followed structured protocols when initiating treatment, including for new patients, those in hospital and on prison release. Prescribing decisions were guided by internal policies and clinical judgement, with buprenorphine or methadone offered based on individual need. Policies were reviewed monthly in team meetings, ensuring practice remained consistent and up to date.

Clinical risks were identified and escalated appropriately. Staff explained how irregular ECG results were detected and shared with prescribers, GPs and the person affected. In one case, a person with deteriorating health and a long history of substance use was supported through motivational interviewing and assertive engagement into residential rehab. They later resettled and gained employment in the same service. This demonstrated how evidence-based approaches could lead to sustained recovery.

Managers told us the provider had delivered structured sessions to staff, including workshops on end-of-life care and microaggressions. These supported a trauma-informed and inclusive approach to care. The provider engaged with system-wide improvement work. We observed that information from the local Substance Misuse System Improvement Group was shared with staff, and milestones from the 2025–2026 Drug and Alcohol Treatment and Recovery Improvement Grant (DATRIG) plan were being implemented. This included the roll-out of the Common Assessment Framework and motivational interviewing training. These actions supported consistent delivery of evidence-based care across the local system.

People experienced a service that was generally responsive and supportive. They described regular check-ups with doctors or prescribers and said staff worked together to meet their needs.

Staff described a range of multidisciplinary working arrangements. Weekly alcohol MDTs were held separately from other substance use MDTs, allowing focused discussion and decision-making for people with clinical alcohol dependence. Staff said all team members could contribute to case discussions and ask questions, which supported shared learning and collaborative planning. Escalated MDTs had been piloted to improve responsiveness for complex cases, and adjustments were made to meeting structures to avoid clashes with service opening times.

There was evidence of joint working with external professionals. Staff described liaising with GPs following reviews to share updates on treatment and physical health concerns, and checking with pharmacies about medication adherence. Referrals were made to adult social care, housing agencies, and employment support, and staff worked with care navigators and external colleagues to support people with CVs and access to education, training and employment. Legal services and smoking cessation teams attended the service regularly, and staff made referrals to mental health services and talking therapies.

Staff gave examples of coordinated care for people with complex needs. In one case, a person with a brain injury and limited English was supported through a home visit involving a nurse and use of a family member for translation, following consent. In another, a criminal justice client was supported into detox and rehab through multi-agency meetings, shared planning and regular communication between professionals. Staff also described escalating concerns when partnership working was ineffective, and learning was shared with the wider team.

The provider had formal arrangements in place to support joint working. We saw evidence of a joint working protocol with the local NHS trust for people with co-existing mental health and substance misuse needs, and a service level agreement with Providence Row aimed at reducing drug-related deaths among the street homeless population. Meeting minutes showed the provider attended interface meetings with the local NHS trust, where shared learning and case escalation were standing agenda items. Internal learning and development meetings included continuity of care, treatment pathways and presentations as regular topics.

Staff described challenges in partnership working, particularly with mental health services. They said substance misuse was sometimes used as a reason to decline mental health support, and that planned detox pathways were not adequate for people needing urgent admission. Staff maintained contact with clients but reported high levels of pushback from other services. Despite this, they continued to advocate for people and escalate concerns where needed.

The provider was part of a system improvement group involving multiple agencies and monitored referrals to support joint working. A Partnerships Lead had been appointed through supplementary grant funding to strengthen collaboration, and staff were encouraged to include external professionals in MDT meetings. Referrals were made to specialist services such as the Respiratory Virtual Ward for people with Chronic obstructive pulmonary disease (COPD), and staff liaised with MARAC where safeguarding concerns were present.

However, some people reported miscommunication around group sessions and said calendar information was not always shared, suggesting that internal coordination could be improved to support consistency in care.

People were supported to improve their physical and emotional wellbeing through tailored interventions and reasonable adjustments. They described volunteering and mentoring opportunities that gave them purpose, and said the service supported creativity, with one person sharing they had started writing again. Group activities such as Acceptance and Commitment Therapy (ACT), delivered by psychologists, were valued. People suggested abstinence groups should be offered as rolling programmes and said trips outside the service, such as theatre visits and lunch dates, would support recovery.

Staff made adjustments to meet people’s physical health needs. For example one person with sight impairment received weekly home visits, pre-measured methadone bottles and pharmacy support, which improved medication adherence and supported independence. These adjustments helped people manage their health safely and maintain engagement.

Staff said psychosocial treatment was prioritised alongside medical care, with a focus on understanding the reasons behind substance use. Women’s evening clinics were introduced in response to feedback, offering medical reviews and sexual health checks in a safer, more comfortable setting. Staff described using motivational interviewing and escalating concerns where needed, including referrals to GPs, A&E and housing teams. They also supported people with learning disabilities and financial issues, including helping one person complete a PIP application to access benefits.

Partnerships were used to tailor health promotion to different groups. Staff worked with hostels to deliver recovery-focused groups, adapting content to the needs of each setting, such as sexual health and domestic violence in female-only hostels, and cannabis and opiate use in mixed hostels. Acupuncture was delivered across four hostels, with plans to expand. Staff also worked with GamCare to address gambling-related harm, particularly in the Bengali community, using local authority data to inform interventions. Mental health supported accommodation services received training on the impact of cannabis use on recovery.

We saw evidence of health promotion across the service. Posters advertised sexual health information, gardening for wellbeing, gentle exercise, LGBT/SMART groups and drama drop-ins. Staff had completed training in basic life support and anaphylaxis, and meeting minutes showed discussion of the sexual health pathway. Couples counselling and psychology input were available, and the service had made improvements to Hepatitis C testing through staff champions and partnership with the Hep C Trust, resulting in increased uptake.

The provider submitted annual impact and equality assessments for contract monitoring and had a flexible approach to reviews, asking people whether they preferred quarterly or six-monthly contact. This supported personalised care and helped ensure health needs were revisited at appropriate intervals.

The service monitored outcomes and acted on what it learned. In seven care records we reviewed, staff assessed motivation to change and gave harm reduction advice in every case. These steps help people engage safely and reduce immediate risks. However, the service was consistently performing below its own benchmark for ‘successful completions’ and the national average. The service was using performance data to understand the reasons for this and to refine its pathways and improve outcomes.

Leaders strengthened oversight by starting a clinical practice group in July 2025 and using assurance meetings to review performance. The improvement plan focused on measurable outcomes. Actions included improving access to and recording of smoking cessation interventions, linking with the local adult autism service to build staff skills, and increasing access for women in criminal justice pathways. These actions matter because recording and breaking down data by group, allows leaders to check if changes improve outcomes.

Performance data showed the service tracked retention and completions over time and compared them with benchmarks. For April 2024 to March 2025, retention for 12 weeks or more started at about 86%, dropped to 74–75% by May 2025, and rose slightly to 78.79% in June 2025. Alcohol-only clients had the highest retention (30.64%), while people using crack without opiates had the lowest (4.38%). This breakdown helped identify groups that need targeted support. Other services reported retention rates in the low-to-mid 90s, so comparing results helps leaders decide if gaps relate to case mix or pathway design.

The successful completions dashboard showed similar monitoring. In June 2025, the service recorded 307 successful completions from 2,389 people in treatment. The completion rate was 12.85%, below its internal benchmark of 20.03% and below the lowest national rate shown (21.35%). The trend line showed a peak of about 16.7% in late 2022, then a fall to around 11.5% by March 2023, staying below the national average through March 2025. Leaders also tracked monthly caseloads, which ranged from 2,333 in July 2024 to 2,448 in early 2025 before falling to 2,389 in June 2025. Tracking both rate and volume matters because changes in caseload can hide real shifts in performance.

Governance records showed leaders used this data to review pathway effectiveness. They focused on unplanned exits and successful completions and questioned whether the enhanced brief intervention pathway met the needs of people using crack or cocaine. This links to retention data, which showed the lowest outcomes for this group. Using data to direct changes helps target improvements where they will have the most impact.

Feedback from people using the service added another source of outcomes intelligence. A survey of 221 responses highlighted delays in assessments, missed follow-up, and unclear detox and rehab pathways. These issues match gaps seen in care records around goals and reviews. Leaders can use this feedback to test if better planning and follow-up reduce unplanned exits and improve completions.

People told us they were given clear explanations about their care and treatment and that consent was sought before any intervention. All ten service users we spoke with said staff explained consent processes and involved them in decisions about their treatment. Four carers confirmed they were included in discussions and that consent was checked, except in one case where the service user had not given consent for information to be shared with their carer. This showed staff respected people’s choices and upheld confidentiality, which is important because it helps people feel in control and confident that their wishes will be followed.

Staff described a strong focus on collaborative working and informed decision-making. They told us they emphasised that service users were “in the driving seat” and that they routinely checked consent and capacity. Leaders told us consent was obtained at the start of treatment and that staff were confident in applying the principles of the Mental Capacity Act (MCA). They also confirmed that staff liaised with other professionals only when consent was in place. This matters because it ensures people’s rights are protected and that care reflects what they want, reducing the risk of decisions being made without their agreement.

The provider had embedded MCA guidance within its safeguarding adults policy, which included links to the MCA Code of Practice and outlined the five statutory principles. This supports staff to access relevant guidance when needed, reducing the risk of unlawful decisions. Training compliance for MCA and Deprivation of Liberty Safeguards was between 98% and 100%, which means staff had the knowledge to apply legal requirements in practice. High training completion helps ensure people are supported to make informed choices and that decisions about their care are made lawfully and in line with their wishes.