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

On this page

• 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-centered care; supported learning and innovation; and promoted an open, fair culture.

This key question has been rated good.

This meant the service was well managed and leaders promoted a positive culture that supported safe, effective and person-centred care.

Leaders promoted a positive, inclusive and recovery-focused culture. Staff described leaders as visible, approachable and supportive, and governance systems provided effective oversight of quality, safety, performance and risk. 

Outstanding practice was evident in the service's highly developed partnership approach and commitment to learning and innovation. The service delivered outreach across 32 community satellite locations, specialist chemsex interventions with NHS partners, coordinated support through domestic abuse and perinatal partnerships, and contributed to wider system learning through safeguarding, harm reduction and offender management forums. Learning and innovation were embedded throughout the organisation through a comprehensive Motivational Interviewing programme, ongoing pathway development, evidence-based service improvement and a flexible innovation fund that helped people overcome practical barriers to recovery, education, employment and social inclusion.
 

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.

The evidence showed a good standard. The service had a shared vision, values and culture which promoted equality, inclusion, recovery and person-centred care.

Staff described a supportive and values-driven culture focused on improving outcomes for people using the service. Staff told us teams worked collaboratively and shared a strong commitment to recovery and harm reduction approaches.

Equality, diversity and inclusion were actively embraced and reflected within the staff group. Staff felt confident raising concerns and contributing ideas through a range of forums, including daily morning meetings, multidisciplinary team discussions, and direct engagement with team managers. They consistently described an open, transparent, and inclusive culture with both peers and leadership. Staff felt this positive culture had contributed to improved staff retention, staff satisfaction and workforce stability.

The service demonstrated a commitment to developing practice and supporting staff. For example, staff had access to motivational interviewing development programmes and there were opportunities for staff to contribute to improvement initiatives and service development.

The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders demonstrated a good understanding of the service and its priorities and were able to clearly describe how teams were working to deliver safe and effective care. Staff spoke positively about local managers and described them as visible, approachable and supportive.

The service promoted staff engagement and development through staff forums, supervision, leadership opportunities and professional development programmes. Staff described clear opportunities for career progression and told us they were supported to develop new skills and knowledge.

Induction processes were tailored to individual roles and experience levels. New staff were supported through shadowing opportunities, supervision and regular review meetings to help them develop confidence within their roles.

Staff reported that leaders promoted a supportive culture where wellbeing and professional development were valued. Regular reflective practice sessions and supervision arrangements helped staff discuss challenges, identify learning opportunities and improve practice.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had policies and processes to support speaking up and whistleblowing. Staff knew how to raise concerns and described a range of routes available to escalate issues, including supervision, team meetings and direct discussions with managers.

Staff told us leaders were approachable and responsive when concerns were raised. Staff felt their views were listened to and described a culture that encouraged openness and constructive challenge.

Regular supervision, reflective practice and staff forums provided opportunities for staff to raise concerns, discuss challenges and contribute ideas about service development and improvement.

Leaders used feedback from staff to inform improvements to service delivery and operational processes. Staff felt this demonstrated a strong commitment to listening and responding to their concerns.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service had a range of arrangements to support equality, diversity and inclusion. This included equality champions, staff forums and access to specialist training in areas such as autism awareness and Oliver McGowan training.

Staff described a positive and inclusive culture where diversity was respected and valued. Staff told us they felt able to be themselves at work and believed managers promoted fairness and inclusion.

Managers supported flexible working arrangements and reasonable adjustments where required. Staff told us these arrangements helped them balance personal circumstances and work commitments.

The service monitored workforce equality information and worked to ensure services reflected the needs of the diverse communities they served. For example, specialist engagement roles had been developed to strengthen relationships with diverse local communities and help address inequalities in access and engagement.

The evidence showed a good standard. The service had effective governance systems that supported oversight, accountability and continuous improvement.

The service maintained a structured governance framework that included clinical governance meetings, mortality and morbidity reviews, service development meetings and operational governance forums. These meetings reviewed incidents, complaints, safeguarding concerns, audits and performance information to support oversight and improvement.

Leaders used governance systems to monitor quality, safety and risk. Learning from incidents, complaints and reviews was shared through governance meetings, multidisciplinary discussions and supervision arrangements to support improvements in practice.

The service maintained a programme of audits covering areas including prescribing, safeguarding, clinical records and quality assurance. Audit findings were reviewed and actions monitored through governance structures to ensure improvements were implemented.

The service maintained key risk management documents including the Service Delivery Plan, Business Continuity Plan and health and safety assessments. Performance information, including safeguarding activity, blood-borne virus testing and engagement data, was reviewed regularly to identify risks and development areas.

Leaders recognised areas requiring further improvement. For example, plans were in place to improve safeguarding training compliance and address workforce vacancies. These issues were being monitored through governance processes and action plans.

The evidence showed an outstanding standard. The service worked collaboratively with partners and local communities to support coordinated care and improved outcomes.

The service demonstrated a highly developed partnership approach which was integral to how care and support were delivered. Staff worked closely with hospitals, primary care services, probation services, mental health providers, housing organisations, public health teams and third-sector partners to support coordinated care and continuity of treatment. These arrangements extended beyond traditional referral pathways and included outreach clinics across 32 community satellite locations, regular street outreach activity and joint working with organisations supporting people experiencing homelessness.

The service worked proactively with partners to engage groups who may be less likely to access traditional treatment services. For example, staff attended a local sexual health clinic three times each week to provide specialist chemsex interventions alongside NHS colleagues. Leaders reported this had supported engagement with a high-risk and marginalised cohort and contributed to increased access amongst LGBT+ people.

Partnership working also supported coordinated responses for people experiencing multiple vulnerabilities. Staff worked closely with domestic abuse services through weekly co-location arrangements and facilitated a dedicated perinatal multi-disciplinary team forum where safeguarding concerns had been identified. These arrangements supported information sharing, joint risk management and coordinated support.

Leaders actively contributed to wider system learning and local strategic priorities. Staff participated in drug-related death reviews, harm reduction groups, safeguarding partnerships, Multi-Agency Risk Assessment Conference meetings and offender management forums. They also delivered naloxone training to external partners and contributed to local harm reduction initiatives.
 

The evidence showed an outstanding standard. The service promoted learning, improvement and innovation to improve outcomes for people using the service.

The evidence demonstrated an outstanding standard. The service had a fully embedded and systematic approach to learning, improvement and innovation. Continuous improvement was an integral part of how care was delivered, monitored and developed, with leaders and staff consistently using learning, evidence and innovation to improve outcomes for people using the service.

Staff described a culture where learning was actively encouraged and supported through supervision, reflective practice, governance meetings and quality improvement activity. Staff were empowered to identify opportunities for improvement and contribute to service development. Leaders routinely reviewed incidents, deaths, safeguarding concerns, complaints, audit findings and performance data to identify learning, improve service delivery and drive sustainable change. Learning was shared across the organisation and translated into tangible improvements in practice.

The service demonstrated a particularly strong commitment to workforce development through its comprehensive Motivational Interviewing (MI) programme. Leaders had invested significantly in developing MI capability across the workforce, with a large number of staff receiving advanced training and a high number qualifying as MI trainers through a recognised Train the Trainer programme. Staff described how MI principles informed day-to-day practice, engagement with people accessing support and risk management discussions. This investment in workforce development helped create a culture where learning, reflective practice and continuous professional development were embedded within day-to-day service delivery.

The service demonstrated a proactive approach to reviewing, evaluating and refining care pathways in response to feedback, outcomes and emerging needs. Leaders reviewed outcomes from alcohol and community detoxification pathways and used findings to strengthen assessment processes, improve preparation for treatment and enhance ongoing recovery support. The service also developed specialist pathways, including community-based opiate detoxification arrangements, harm reduction initiatives and long-acting injectable buprenorphine pathways, using learning from implementation to inform future service development.

A comprehensive programme of clinical and quality audits provided effective oversight and supported continuous improvement. Audit findings, performance information and feedback were routinely analysed to identify trends, monitor quality and prioritise improvement activity. This ensured changes were evidence-based and focused on improving outcomes for people using the service. Leaders used outcome information, benchmarking data and feedback from people using the service to inform decision-making and service development.

Safe innovation was actively encouraged throughout the organisation. Leaders maintained an innovation fund of up to £20,000 per year to provide personalised recovery support tailored to individual needs. Staff used this funding creatively to overcome barriers to recovery and social inclusion, including helping people furnish new homes, access education and vocational opportunities, purchase laptops and digital technology to address digital poverty and support reintegration into employment. This flexible approach enabled staff to provide practical, wraparound recovery support beyond routine treatment interventions and helped people achieve wider social, educational and recovery goals.

Innovation was not limited to individual projects but was embedded within service delivery. The service sought opportunities to respond to emerging needs, improve engagement and strengthen outcomes through new approaches. Examples included harm reduction initiatives, innovative prescribing pathways, contingency management approaches and the continued development of recovery and peer-support pathways. Leaders were able to demonstrate how learning from these initiatives had been incorporated into ongoing service improvement and future service planning.

Overall, learning, improvement and innovation were embedded throughout the organisation. Leaders promoted a culture in which staff were encouraged to develop new ideas, evaluate their impact and use learning to continuously improve care. This approach supported the delivery of evidence-based, recovery-focused services and contributed to improved outcomes for people using the service.