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

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

This key question has been rated Good.

This meant people were safe and protected from avoidable harm.

The evidence showed a good standard. Staff assessed and managed risks effectively and worked with people to promote safety, recovery and independence. The service had established systems for incident reporting and learning, safe staffing, medicines management, infection prevention and environmental safety. Staff worked with partner agencies to support safe transitions and protect people from abuse and neglect.

We found outstanding practice in safeguarding and in how the service involved people in managing risks. Safeguarding arrangements included specialist competency sessions, a dedicated perinatal multidisciplinary forum and weekly co-location with domestic abuse services. The service also delivered an innovative harm-reduction offer, including confidential postal access to injecting equipment, nitazene and xylazine testing strips, laboratory drug checking through The Loop and extensive naloxone provision. Staff reported that wider naloxone training had contributed to 9 overdose reversals during the previous year.
 

We have not awarded this service a score for Safe.

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

The evidence showed a good standard. The service had a positive culture of safety based on openness, learning and continuous improvement. Staff reported concerns appropriately, incidents were reviewed, and learning was shared to improve practice and reduce risk.

Staff used a structured incident reporting system with clear management oversight and defined escalation processes. Incident reporting, review and sign-off were monitored through governance systems to ensure incidents were appropriately reviewed and actions completed.

The service had established processes for reviewing deaths, including timely notification, review and escalation. Findings were discussed through mortality and morbidity meetings and clinical governance forums to identify learning and maintain organisational oversight.

Between October 2025 and April 2026, the service recorded 186 incidents, including safeguarding concerns, medication incidents, medical emergencies, self-harm incidents and deaths. Records demonstrated incidents were appropriately reviewed, risks managed and actions identified where required.

We saw evidence that learning from incidents led to changes in practice. For example, following medical emergencies the service strengthened physical health risk assessment processes. Learning from medication incidents was used to improve communication with community pharmacies, and safeguarding incidents were reviewed with partner agencies to strengthen multi-agency responses to risk.

Staff discussed incidents, risks and learning through daily meetings, multidisciplinary discussions and governance forums. This supported a culture where staff reflected on practice, shared learning and used this to improve care delivery.

The evidence showed a good standard. The service worked with people and partner organisations to establish and maintain safe systems of care and support continuity of treatment when people moved between services.

The service accepted referrals from a wide range of sources, including self-referrals, hospitals, mental health services, social care services, probation services and criminal justice agencies. Staff demonstrated flexibility in supporting continuity of care. For example, the service accepted some out-of-area referrals where people faced barriers accessing treatment within their home area, including circumstances where legal restrictions prevented access to local services.

The service maintained established pathways for people subject to Alcohol Treatment Requirements (ATR), Drug Rehabilitation Requirements (DRR), and those leaving prison. These pathways helped people remain engaged with treatment during significant transitions. New clients were offered an initial induction, during which staff contacted them to explain the service and discuss available treatment options.

A range of psychosocial and recovery-focused interventions supported people at different stages of treatment and recovery. This included core structured groups such as Introduction to Change, Managing Alcohol Programme, Recovery Skills, Moving Forwards, and Reclaim, alongside therapeutic interventions such as Crisis Survival Skills, Mindfulness-Based Relapse Prevention, and Acceptance and Commitment Therapy. Specialist provision included crack cocaine groups and targeted emotional wellbeing groups delivered in partnership with MIND. The service also offered a strong aftercare programme, including coffee mornings, creative workshops, rehabilitation groups, and dedicated spaces such as the Crack Welcome Space. These supported sustained engagement, peer connection, and continuity of care beyond structured treatment.

The service operated a daily high-risk assessment process to support timely responses to urgent referrals. Staff also maintained effective systems for the prescribing and monitoring of high-risk medicines, including methadone. For example, clients prescribed higher doses, or with additional risk factors, received electrocardiogram (ECG) monitoring in line with clinical guidance.

The evidence showed outstanding safeguarding practice. The service demonstrated a proactive and innovative approach to safeguarding, supported by robust oversight arrangements and highly effective multi-agency working. Leaders used safeguarding information to identify emerging risks, drive continuous improvement and strengthen outcomes for people using the service.

The service had comprehensive safeguarding systems that placed people at the centre of safeguarding and protection from abuse, neglect and discrimination. Safeguarding was embedded throughout the organisation, with leaders promoting a culture where keeping people safe was recognised as everyone’s responsibility. Staff demonstrated a strong understanding of safeguarding responsibilities and were confident in identifying, escalating and responding to concerns involving adults, children and families.

The service invested in developing and recognising high-quality safeguarding practice. Staff received role-specific safeguarding training, regular safeguarding supervision and participated in specialist safeguarding meetings. The service awarded a monthly Safeguarding Award to recognise and celebrate outstanding safeguarding practice, while regular one-to-one safeguarding competency sessions with the safeguarding manager enabled staff to reflect on practice, strengthen professional judgement and develop specialist safeguarding knowledge. These arrangements supported a highly skilled workforce and promoted continual improvement in safeguarding standards.

Leaders had established robust systems to identify, monitor and respond to safeguarding concerns. A bespoke safeguarding dashboard provided real-time oversight of safeguarding activity, enabling managers to identify themes, track concerns and respond proactively to emerging risks. Safeguarding activity was regularly reviewed through governance processes, audits and supervision, with learning used to strengthen practice and improve outcomes.

The service demonstrated a proactive approach to protecting people at increased risk. For example, staff facilitated a dedicated Perinatal Multi-Disciplinary Team forum to coordinate support for pregnant women and families where safeguarding concerns had been identified, promoting early intervention and effective risk management.

Partnership working was a particular strength. The safeguarding lead worked closely with the Multi-Agency Safeguarding Hub (MASH), safeguarding boards and partner agencies to support coordinated safeguarding responses. Staff had also developed highly effective working relationships with domestic abuse services through weekly co-location arrangements, enabling timely information sharing, joint risk management and improved support for people experiencing domestic abuse.
 

Evidence showed an outstanding standard of care. The service worked proactively with people to understand and manage risks. Staff supported people to manage risk safely while promoting independence, recovery and personal choice.

We reviewed 8 risk assessments and found these were comprehensive, regularly reviewed and developed with people using the service. Records demonstrated people were actively involved in identifying risks and agreeing how these would be managed.

Staff used a recovery capital approach to assess risks relating to physical and mental health, substance use, exploitation, safeguarding and risks to children. Risks were reviewed at every key working contact, enabling staff and people using the service to identify changes in circumstances and respond promptly when risks increased, and supported collaborative discussions about safety and wellbeing.

Where risks to children were identified, staff took appropriate action and worked closely with social care partners to ensure safeguarding concerns were addressed and children were protected.

The service demonstrated a proactive and innovative approach to harm reduction. Staff provided practical advice, safer injecting equipment and harm reduction resources. This included access to a free, confidential postal needle and syringe service.  Staff also supplied Nitazene and Xylazine testing strips, supporting people to test substances and better understand risks associated with their drug use.

The service further strengthened its harm reduction offer through a partnership with The Loop, a free and confidential drug checking service hosted monthly within the service. Following laboratory testing, people received tailored harm reduction advice based on the content of submitted substances. At the time of inspection, this approach was unique within London substance misuse services and demonstrated the service's commitment to supporting people to manage their own risks.

Staff took a highly proactive approach to overdose prevention. Naloxone was routinely offered to people at risk of opioid overdose, with 98% of opiate users receiving naloxone during the previous year.  The service also provided overdose awareness and naloxone training to external partners, including police and night-time economy staff. Staff reported this had contributed to nine overdose reversals during the previous year, demonstrating how the service's harm reduction approach contributed to safer outcomes across the wider community.

Overall, the service empowered people to understand and manage risks, and its innovative harm reduction initiatives exceeded those typically seen in comparable services.
 

The evidence showed a good standard. The service maintained safe environments, equipment and facilities that supported the safe delivery of care and treatment.

The premises were clean, tidy, appropriately maintained and suitable for the delivery of substance misuse services. Staff completed regular environmental checks and acted on identified issues.

Fire safety arrangements were appropriately managed. For example, fire alarm systems were tested weekly, and a fire drill involving staff and people using the service had been completed in January 2026. Fire extinguishers were available throughout the premises and were within service dates.

Staff completed environmental risk assessments to identify and mitigate potential hazards. For example, a ligature risk assessment had been completed and control measures included anti-ligature fixtures, ligature cutters, CCTV and window restrictors where required.

Clinical areas were appropriately equipped. Emergency equipment and medicines were subject to regular checks to ensure they were available and ready for use.

The service maintained infection prevention and control audits and action plans, which were reviewed through governance structures to ensure risks were monitored and improvements progressed.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Managers maintained oversight of supervision, appraisal and training compliance. Staff received regular supervision and they described this as supportive and beneficial to their development and wellbeing. Staff also reported access to debriefs following incidents and bereavements. Staff told us these provided valuable emotional and professional support following challenging situations.

Staff had access to mandatory and role-specific training relevant to their responsibilities. For example staff completed training in safeguarding, domestic violence, pregnancy and substance use, naloxone, benzodiazepines, ketamine pathways, blood-borne virus testing, motivational interviewing and crisis-survival and suicide-prevention. Learning needs were identified through supervision and appraisal processes and staff reported good access to professional development opportunities.

Recruitment processes supported safe recruitment practices and included appropriate pre-employment checks.

The service had experienced workforce challenges, including vacancies, sickness absence and leadership changes. Managers took action to maintain safe care delivery. For example, a temporary non-medical prescriber had been recruited to maintain clinical capacity and medical directors provided clinical oversight during the planned absence of the clinical lead. Staff told us these arrangements ensured continued access to senior clinical support and decision-making. Despite these challenges, staff described feeling well supported.

Workforce data demonstrated relatively stable staffing levels and manageable turnover rates. At the time of inspection, average caseloads had reduced to approximately 25 clients per worker, supporting effective workload management and continuity of care.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Clinical and communal areas were clean, well maintained and suitable for use. Staff followed infection prevention and control procedures and ensured equipment was maintained and fit for purpose.

Staff safely managed and disposed of sharps and maintained cleanliness within clinical areas used for physical health interventions, blood-borne virus testing and treatment delivery.

Environmental and equipment audits demonstrated 100% compliance at the time of inspection. Staff received infection prevention and control training and understood their responsibilities in preventing and reducing the spread of infection.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

The service had effective systems to make sure medicines were managed safely and supported people’s needs. There were clear lines of accountability and a well‑staffed multidisciplinary team which included doctors, non‑medical prescribers (NMPs – registered clinicians with prescribing authority) and a pharmacist prescriber. The service had strong clinical governance. Staff discussed complex cases in regular clinical meetings and also used clinical review forums, which supported consistent oversight of higher‑risk prescribing decisions

The service followed recognised treatment approaches for substance misuse and had clear processes for opioid substitution treatment (OST – medicines such as methadone and buprenorphine used to treat opioid dependence). Staff described safe practice for starting, restarting and reviewing OST, including supervised consumption during higher‑risk periods and clear actions for missed doses. This reduced the risk of harm linked to changes in tolerance and supported safer continuity of treatment in the community.

The service worked closely with community pharmacies and had particularly strong practice in how it supported safe supply and monitoring of OST across a large pharmacy network. The pharmacy team used routine checks and proactive contact with pharmacies to identify early concerns (such as non‑attendance) which helped the service to respond quickly and reduce harm. The service also had a robust process for producing, tracking and securely handling controlled drug prescription stationery which aided traceability and reduced risk of loss or misuse.

Medicines were stored securely in clinic rooms with daily temperature monitoring for rooms and fridges, and routine stock checks. Controlled drugs (CDs – medicines subject to additional legal controls) held on site were limited and stock checks completed during the visit were accurate. Emergency equipment was checked frequently.

The service promoted harm reduction through the routine provision of naloxone and overdose prevention education. Staff also linked prescribing to physical health monitoring. For example, clients had access to ECG monitoring and liver assessment pathways where clinically indicated, supporting safe prescribing and ongoing review of treatment.