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

Updated 26 June 2023

Turning Point - City of London and Hackney Integrated Drug & Alcohol Service provides advice, support and treatment to adults who misuse drugs and alcohol and live in the City of London and the borough of Hackney. The service had been operated by the provider since October 2020. The provider had experienced challenges in the implementation of the new service during the Covid-19 pandemic but continued to deliver care and treatment to clients.

The service’s main hub is based on Mare Street, London which is used to hold clinics and deliver the group programme. The service had been through a period of transition and teams were being further restructured to align with the service’s delivery model, based around neighbourhoods. The service provided care and treatment to clients in the community where clients would usually visit, such as the GP, community centres and hostels. The service comprised of several teams including a criminal justice team, neighbourhood teams (North and South), rough sleeping team and an assessment team.

The service worked in partnership with MIND, which is an independent mental health charity, and Antidote, a drug and alcohol support service that is run by people who identify as lesbian, gay, bisexual and transgender (LGBT). Both organisations provide specialist support to the staff and clients at the service and enabled them to support hard to reach communities.

The service was registered to provide the following regulated activity: Treatment of disease, disorder or injury. The service was commissioned by the London Borough of Hackney and City of London Corporation Public Health Team. There was a registered manager in place for the service.

The Care Quality Commission last inspected this service in October 2021, with a report published in January 2022. The service was rated as Requires Improvement overall, with ratings of Requires Improvement in Safe, Effective and Well-led, and ratings of Good in Caring and Responsive. Requirement notices issued at this previous inspection were found to have been met during the current inspection.

What people who use the service say

Clients were very positive about the service giving many examples of caring, compassionate practice. Clients said they felt comfortable going into the service and talking about their concerns. They described the reception area as welcoming and relaxing, and the receptionists as friendly, and keeping them updated whilst waiting to be seen.

Two clients described the service as being very quick to arrange medication when needed, compared to other services they had used. Clients singled out certain staff members for particular recognition including doctors and recovery workers, describing them as helpful, knowledgeable, and good at communicating with them.

Most clients we spoke with told us that they felt confident to talk to the staff about their treatment and care. Staff gave clients help, emotional support and advice when they needed it and supported clients to understand and manage their own care and treatment or condition.

One client had raised an issue with the service regarding staff support, and this was addressed appropriately. The most frequently raised issue of concern by clients was frequent changes in their recovery workers, as a result of staff leaving.

Clients described their initial assessments as very thorough, with everything explained to them clearly. For example, staff explained the difference and health impact between cutting down on their alcohol intake and suddenly stopping altogether. They said that they received regular reminder emails for appointments to stay engaged with the service. They described the service listening to them, providing strong advice, and a positive influence, but empowering them to make their own decisions.

Clients said that staff were compassionate, and had a person-centred approach, tailoring the support to them individually. Clients spoke of working in partnership with staff. Several clients said that they had recommended the service to others.

One client spoke gratefully about how a member of staff had messaged them at a time when they knew the client might be struggling to keep their recovery on track, and that this had made a huge difference. Clients told us that staff had been particularly supportive, and that they could not have made the progress they had, without them.

Updated 26 June 2023

Our rating of this location improved. We rated it as good because:

• The service provided safe care. The premises where clients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice.
• Staff engaged in clinical audit to evaluate the quality of care they provided. There was an improvement in the monitoring of the physical health care of clients on prescribed medicines.
• The teams had or were recruiting to a full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Managers had improved induction training and provided baseline training for all staff to ensure consistent ways of working. They had also developed further opportunities for career progression within the service. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff treated clients with compassion and kindness, and understood the individual needs of clients. They actively involved clients in decisions and care planning.
• The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet. The service continued to use a public health van to take health services to rough sleepers.
• The service had more consistent and effective governance processes to ensure that its procedures ran smoothly. Managers had implemented significant improvements since the previous inspection in 2021.

However:

• Although most staff felt well supported, a significant proportion of recovery workers were unhappy with management support to cover their high caseloads. There had been issues with staff retention over the last year, with a third of staff leaving, and this had resulted in some staff morale issues, and had an impact on clients as they described frequent changes of key worker.
• Newer staff wanted to have more training in the service’s electronic record keeping system.
• The alcohol detox community pathway had been paused for several months due to insufficient staff with the required competence to conduct this safely.
• Health and safety risk assessments for the service had not been reviewed recently. The environment of the service had been improved particularly in the reception area, but other areas of the service used by clients were still in need of refurbishment and redecoration.
• At the time of the inspection, there were no groups available to provide support or therapy for clients on Fridays. The service was not commissioned to provide any support for clients at weekends.
• The service did not have easily accessible information leaflets translated into locally used languages, at the time of the inspection.

Updated 14 January 2022

See overall summary above.

Updated 26 June 2023

Our rating of this service improved. We rated it as good

See summary above for details