North London NHS Foundation Trust

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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 is the first assessment of this newly merged trust. However, these wards were inspected under their previous trusts. At our last comprehensive assessment, we rated this key question good. At this assessment the rating changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

Patients were not always involved in creating their care plans. Care plans were not always updated and did not always include patient views. Many patients told us they did not have access to a copy of their care plan. Staff did not always have regular supervision and appraisals. Team meetings and governance meetings did not always occur monthly. Staff did not always use the trust templates for meetings and minutes were not always clear. Handover notes did not always contain all relevant useful information. Whilst wards carried out audits, these were not always carried out in line with the trust’s audit schedule frequency. There were no clear outcomes and learning from audit results. Staff did not use recognised rating scales to assess and record severity and outcomes.

However, staff completed a comprehensive mental health and physical health assessment of patients in a timely manner. Staff provided a range of care and treatment interventions suitable for the patient group. Staff told us they had been able to access non-mandatory training and development.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We looked at 52 care and treatment records across the Trust.

Staff completed a comprehensive mental health assessment of patients in a timely manner at, or soon after, admission. These initial assessments were detailed, thorough assessments.

Staff assessed patients’ physical health needs in a timely manner after admission. Staff used the national early warning score (NEWS) system to detect and respond to clinical deterioration of physical health. We saw regular reviews of physical health in patient records.

Staff did not always develop care plans that met the needs identified during assessment. Ten records we reviewed did not have specific care plans for identified needs, for example, supportive care plans around self-harming and managing aggression. There was no care plan in place to support a blind patient on the ward. There was also no communication care plan in place for a patient with a learning disability, despite their community team providing a thorough personalised plan to support their patient. The plan from the community team had not been shared with the ward staff. There was no care plan in place to monitor the fluid intake of a patient who was reported to be dehydrated by ambulance staff on admission. We saw examples where allergy information was not included in care plans or risk assessments. However, staff on Amethyst Ward developed holistic, recovery-oriented care plans informed by a comprehensive assessment

Staff did not always involve patients in their care planning. Sixteen patients told us they were not involved in the decisions around their care. Some patients told us they did not feel listened to, were misunderstood and staff made plans for them. Eighteen patients told us they did not have a copy of their care plan.

Staff did not always record patient views on care plans. We saw 12 records where there were no patient views. Many of the views we did see were not written in first person by the patient. For example, we saw a patient view saying ‘patient to stop hearing voices’.

Care plans were not always updated. Nine records we reviewed contained old information, for example, we saw medicine care plans with medicines from a previous admission. We also saw two patient records that only had 72 hour care plans, despite one patient being on the ward for 18 days and the other patient for five days. We saw examples where staff used the same text for multiple patient’s care plans, meaning they were not specifically designed and written with patients.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies, as well as supporting daily living skills. Some carers told us they had been able to access family sessions with a psychologist on the wards.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. We saw examples of patients being referred to podiatry, diabetes nurses and speech and language therapists.

Ward teams included or had access to a range of specialists to meet the needs of patients. This included nurses, healthcare assistants, doctors, pharmacists, psychologists, art therapists, occupational therapists, activity coordinators, gym instructors, and physiotherapists. There was a visible presence of psychologists on the wards and in multidisciplinary team meetings. Psychologists gave input to risk assessments and care plans on many wards.

Where the trust had identified specific areas of learning needed, they had put together face to face scenario, skills-based simulation training to deliver to specific staff groups. For example, there were ongoing sessions on getting to know the contents of the emergency grab bags.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction. Staff told us they had a two week induction, as well as a corporate induction. Their induction included time to shadow staff on the ward. However, not all managers were able to provide assurances that staff had completed inductions.

Staff told us they received regular supervision, however there were low compliance figures for some wards over the last 6 months. For example, in January 2025, 50% of staff on Daisy Ward, 44% on Sapphire Ward and 64% on Opal Ward had recorded supervision. Managers were not always able to access supervision records to confirm these meetings took place. For example, the supervision tracker said 15 staff members received supervision in one day on a single ward, but the manager was unable to provide any written minutes of these meetings.

Appraisal completion also varied across the wards. In January 2025, 13.6% of staff on Thames Ward, 30% of staff on Trent Ward and 20% of staff on Daisy Ward had completed their appraisals. There were no appraisal records for Sussex Ward or Amethyst Ward.

Staff told us they had access to reflective practice, led by a psychologist. However, the frequency of these sessions varied across hospital sites. Staff at Highgate West Mental Health Centre had reflective practice weekly, staff at Chase Farm Hospital had reflective practice monthly, but some staff on Thames Ward told us they had not had any sessions for many months.

Most wards had team meetings; however, these were not always happening monthly. Staff reported wards had been busy and there was a lack of administrative support which impacted how regularly these meetings occurred. Where managers were unable to have monthly meetings, they told us they met with staff for safety briefings when necessary to share any concerns or learning.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff told us they had been able to access nursing apprenticeships and phlebotomy training through the trust. Managers told us they were able to access leadership training.

Managers dealt with poor staff performance promptly and effectively. Ward managers and matrons gave examples of recognising and managing poor performance, in line with their trust’s policy.

Wards participated in clinical audit, benchmarking and quality improvement initiatives. However, audits were not always carried out in line with the trust’s audit schedule frequency. For example, Sapphire Ward last completed the monthly infection prevention and control audit in August 2024, and Tulip Ward last completed the monthly physical health audit in December 2024.

Wards carried out audits looking at physical health monitoring. Some wards showed low compliance with the trust’s policy, with low audit scores. Five wards were under 60% compliant, with Diamond Wards showing 33% compliance with policy.

Wards also completed audits looking at care plans and risk assessments. Most wards showed over 70% compliance to trust policy. However, Topaz Ward showed a 56% compliance.

It was unclear if any action plans had been created following these audits to improve practice.Senior leaders were however aware of the concerns around the physical health audit. As a result, senior leaders planned to retrain staff on how to use the audit tool, and carried out immediate physical health audits across all inpatient units.

Staff held regular and effective multidisciplinary meetings, safety huddles, and formulation meetings. We observed 10 staff meetings across the trust. These were generally run well, however at a meeting on Sunflower Ward there was some confusion regarding patient’s Mental Health Act status and who had tested positive for drug use.

Staff shared key information to keep patients safe when handing over their care to others. Handover meetings occurred at the beginning of nursing shifts, as well as on weekday mornings for the multidisciplinary team. However, we found key areas, such as risk, medicines and Section 17 leave were often blank on handover documentation on all 3 wards at the Dennis Scott Unit.

The wards had effective working relationships with teams outside the organisation. For example, we saw notifications being sent to GPs and community teams invited to ward rounds. We also saw ward staff communicating with housing and care homes to support patient discharges. The division’s safeguarding lead had regular meetings with the local authority.

Staff supported patients to live healthier lives. For example, through participation in smoking cessation schemes, healthy eating advice and supporting issues relating to substance misuse.

Ward activities helped promote a healthy lifestyle for patients, for example walking groups and sports activities. Highgate West Mental Health Centre had links with a local football club who ran a weekly session for the patients. Most sites had access to gym equipment. However, the equipment on Devon Ward was broken. Some patients told us staff were not always able to escort them to use the gym.

Whilst there was a schedule of activities, these did not always take place. There were occasions when we were on the wards during an activity time, however the activity was not happening. Some patients and carers told us there were not enough activities available, and they often felt bored on the wards.

Staff did not use recognised rating scales to assess and record severity and outcomes. Doctors did not use Health of the Nation Outcome Scales (HoNOS) to monitor patient outcomes. On occasion, occupational therapy staff used the Model of Human Occupation Screening Tool(MOHOST), however there was usually only 1 recording. Staff told us due to a patient’s short admission there was often not time to track outcome measures.

There was also inconsistency in the usage of Dialog+ across the Trust to support patient care plans. Staff on some wards told us they had been asked to stop using this tool.

Staff took all practical steps to enable patients to make their own decisions.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history