We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Clients were mostly positive about the service they received and the staff who provided. They felt safe within the service and knew how to raise concerns or make a complaint. A service user satisfaction survey was completed every two years. The most recent survey was carried out in December 2016, and the findings were mostly positive. Peer mentors and volunteers received training and support to work in the service.
• Clients had their physical health care needs assessed, and this information was used to inform their treatment, or shared with GPs and other agencies when necessary. A registered nurse was based at each site. They provided health promotion such as blood borne virus screening and hepatitis B vaccinations. There was a needle exchange service at each of the three sites.
• Treatment was provided in accordance with Department of Health and National Institute for Health and Care Excellence guidelines. Clients had their needs assessed, and risk management and recovery plans implemented. They were offered psychosocial interventions, such as mindfulness and recovery groups. When necessary, clients were assessed for their suitability for an appropriate and safe detoxification programme.
• The service was nearing the end of the second stage of a three stage reconfiguration programme that changed the focus of the service from maintenance to recovery. Staff had received training to give them the skills to implement this new way of working.
• Staff received regular supervision, and most staff had completed their mandatory training.
• Staff had received safeguarding training, and knew what action to take if there was a safeguarding concern. Staff liaised with local authority safeguarding teams and other statutory agencies regarding child protection and domestic violence concerns.
• There was a young persons’ team, which provided services to children and young people in local facilities such as schools and GP surgeries. A rural worker led clinics outside the three main sites, to promote access to clients who lived in remote areas.
• Incidents and complaints were reported, investigated, reviewed and followed up on appropriately.
• Prescriptions and medication were securely stored and managed.
• Turning Point had a framework and manual for the monitoring of quality and performance in substance misuse services. This had been effectively implemented at Turning Point Cheshire West and Chester. Key performance indicators were used to monitor the service, report to commissioners and benchmark the service against other substance misuse services.

However, we also found the following issues that the service provider needs to improve:

• Over 60% of the service’s clients with long-standing opiate dependency had been in treatment for over six years. This cohort of clients had an average length of treatment of over seven years, compared with the national average for this cohort of 4.9 years. The service was looking at new ways of working with this client group.

• Risk assessments and recovery plans were not always been completed as required.
• The service recorded clients’ ‘walk-in’ visits, but did not monitor how this was implemented, or if the process delayed or deterred clients from accessing the service.
• Staff morale was uncertain, though many of the staff we spoke with were cautiously positive about the changes.