Turning Point - City of London and Hackney Integrated Drug & Alcohol Service

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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 key question has been rated good. 

This meant people's outcomes were consistently good, and people received effective care and treatment that reflected their individual needs and preferences.

Staff completed comprehensive assessments, developed personalised care plans and reviewed these regularly. Care and treatment were delivered in line with national guidance and evidence-based practice. Staff worked collaboratively within multidisciplinary teams and with partner organisations to support coordinated care. The service monitored treatment outcomes, used performance information to improve practice and supported people to improve both their physical health and long-term recovery outcomes.

We found outstanding practice in how the service monitored and improved outcomes. The service used recognised outcome measures, national data and benchmarking to evaluate treatment effectiveness. It achieved top-quartile national performance for successful treatment outcomes across all four substance categories and achieved hepatitis C micro-elimination in September 2025. Data also showed improvement in outcomes from residential rehabilitation and inpatient detoxification pathways. Leaders used this information to strengthen treatment pathways and reduce the risk of people dropping out of treatment.
 

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 evidence showed a good standard. The service assessed and reviewed people's health, care, wellbeing and communication needs and used this information to plan effective care and treatment.

We reviewed 8 care records during the assessment. Records demonstrated staff completed comprehensive assessments that considered substance misuse history, physical and mental health needs, recovery goals, strengths, support networks and wider social circumstances. Assessments were person-centred and informed the development of individualised care plans.

Care plans were tailored to individual needs and recovery goals and clearly identified the allocated key worker. Staff regularly reviewed care plans and updated them when people's needs or circumstances changed. We saw evidence that people were involved in developing and reviewing their care plans, supporting shared decision-making and ownership of recovery.

The service provided a comprehensive programme of psychosocial interventions to meet a wide range of needs. For example, clients could access programmes including Introduction to Change, Managing Alcohol Programme, Recovery Skills, Moving Forwards, Reclaim, Crisis Survival Skills and Mindfulness-Based Relapse Prevention. Specialist provision included services for people using crack cocaine and emotional wellbeing groups delivered in partnership with MIND.

The evidence showed an outstanding standard. The service planned and delivered care and treatment in line with legislation, evidence-based guidance and recognised standards. A particular strength was its well-established peer mentoring programme, which supported people with lived experience to gain nationally recognised qualifications and progress into volunteering, mentoring and employment opportunities, delivering positive and sustained recovery outcomes.

Staff delivered care and treatment in line with National Institute for Health and Care Excellence (NICE) guidance and recognised substance misuse treatment models. Clients had access to a range of interventions including medically assisted treatment, psychosocial support, structured recovery programmes, rehabilitation activities and wellbeing interventions.

The service-maintained access to specialist clinical support and physical healthcare interventions, including blood-borne virus testing, vaccinations and specialist medical reviews where required.

Staff participated in a range of clinical audits and compliance checks. For example, audits reviewed medicines optimisation, ECG monitoring, alcohol assessments, medical reviews and compliance with NICE guidance. Findings were reviewed through governance structures to support service improvement.

The service demonstrated a commitment to developing staff skills and maintaining professional standards. Staff received training in areas including motivational interviewing, trauma-informed care, smoking cessation, autism awareness, fibroscan assessment and long-acting injectable therapies.

The service demonstrated innovation and continuous service development through a range of specialist pathways. These included blood-borne virus pathways, family and friends support, ambulatory detoxification, and re-engagement pathways for clients who had previously disengaged. A standard operating procedure (SOP) was developed for community-based opiate detoxification to ensure safe and consistent practice.

The service also implemented a provider-wide, evidence-based contingency management scheme, designed in collaboration with clients, to encourage engagement with treatment and improve outcomes. This included incentivising attendance for vaccinations and other health interventions.

The service was an early adopter and pilot site for long-acting injectable buprenorphine (Buvidal), initially targeting high-risk groups such as individuals experiencing homelessness and multiple disadvantage. Following positive outcomes, the service secured funding to expand its use. Staff reported this approach supported treatment engagement and stability for some of the most vulnerable people using the service.

A particular strength of the service was its well-established peer mentoring programme, which formed an integral part of the recovery pathway. The programme enabled people with lived experience to complete a nationally recognised Level 2 Peer Mentoring qualification and progress into structured volunteering and mentoring roles that provided practical and emotional support to people accessing treatment. At the time of the assessment, four peer mentors were active, four individuals were onboarding and 12 people had completed the qualification, with eight progressing into peer mentor placements. The service could also demonstrate strong longer-term outcomes, with two former peer mentors successfully securing permanent paid roles within the organisation. Staff described the programme as making a significant contribution to recovery by promoting engagement, confidence, social connection and purpose, while providing a clear progression pathway into employment and helping to reduce the risk of relapse beyond formal treatment.
 

The evidence showed a good standard. Staff, teams and partner organisations worked together effectively to support coordinated care and treatment.

Multidisciplinary working was well established throughout the service. Staff held regular multidisciplinary meetings to review treatment progress, care plans and risk. These included alcohol and opiate MDT meetings and joint meetings with NHS mental health services where people had co-existing mental health and substance misuse needs.

Staff shared information appropriately through daily meetings, MDT discussions and case reviews. These arrangements supported continuity of care and helped staff respond to emerging risks and changes in need.

The service worked collaboratively with a wide range of partner organisations. For example, staff worked with the local mental health NHS trust, social care services, safeguarding teams, probation services, housing providers, criminal justice agencies and specialist voluntary sector organisations. This enabled people to access coordinated support across health, social care and community services.

The service teams also worked to support families affected by substance misuse through dedicated family support services. This helped to improve outcomes for both people using the service and those close to them.

The evidence showed a good standard. 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, reduce their future needs for care and support.

Clients told us staff supported them to improve their physical health and wellbeing and helped them access other healthcare services when required. People described receiving advice about healthier lifestyles, including diet, exercise and smoking cessation.

Staff supported people to access primary care, mental health services and specialist healthcare provision where appropriate. For example, one client described being supported to access their GP and a mental health nurse following concerns relating to physical health and wellbeing.

The service promoted harm reduction and healthier lifestyles through a range of interventions, including smoking cessation support and access to a vape support service. These interventions helped people reduce health-related risks and improve overall wellbeing.

The evidence showed outstanding standard. The service monitored care, treatment and outcomes and used this information to improve the quality and effectiveness of care.

The service collected and reviewed performance and outcome information to understand how effectively people were progressing through treatment. Staff used performance dashboards and reporting systems to maintain oversight of key indicators including caseloads, treatment engagement, treatment completions and naloxone provision.

The service routinely used the Treatment Outcomes Profile (TOP) tool to monitor progress and treatment outcomes. Information was reviewed regularly and used during multidisciplinary discussions to support care planning and identify opportunities for improvement.

The service submitted data to the National Drug Treatment Monitoring System (NDTMS) and used benchmarking information to review performance and outcomes.

Outcomes for people using the service were consistently positive. The service achieved top quartile performance nationally for successful treatment outcomes across all four substance categories: opiates, non-opiates, alcohol, and alcohol and non-opiates. This is a significant achievement and demonstrated sustained effectiveness across the whole treatment system.

The service demonstrated positive outcomes across several areas. For example, it achieved Hepatitis C micro-elimination in September 2025, becoming the first inner London borough to achieve this.  Leaders told us the service's work had attracted wider national and international attention, including sharing learning and best practice with external healthcare organisations.

The service demonstrated a strong commitment to improving outcomes for people accessing treatment. Data showed successful completion rates for residential rehabilitation and inpatient detoxification pathways had increased significantly, from 41% to 81% over a 2 year period. Staff carefully prepared and supported people throughout their treatment journey, helping them achieve recovery goals and sustain abstinence. Leaders used outcome data to develop and strengthen Tier 4 treatment pathways, Increased peer mentoring opportunities contributed to reduced treatment drop-out rates and helping to ensure people continued to receive effective care and treatment.
 

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 demonstrated a good understanding of consent and the Mental Capacity Act (MCA). Staff understood how to assess capacity where appropriate and described how they would seek advice and support when required.
 

Care records showed that consent to treatment was clearly documented. Staff recorded people's preferences regarding information sharing and ensured consent processes were completed and reviewed appropriately.

Where people had children or where safeguarding concerns were identified, staff ensured appropriate information was recorded and shared in line with consent requirements and safeguarding responsibilities. Evidence showed these issues were discussed within MDT meetings and managed collaboratively with partner agencies when necessary.

Staff had completed Mental Capacity Act training and demonstrated an understanding of how to support people to make decisions about their treatment and recovery wherever possible.