North London NHS Foundation Trust

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

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 has changed to requires improvement.

This meant the service management and leadership was inconsistent. The culture they created did not always support the delivery of high-quality, person-centred care.

Wards did not always have monthly team meetings in line with trust guidance. Managers did not always use the trust’s team meeting agendas and minutes were not always clear to read.

Some staff told us they had IT issues following the merger, especially for internet-based files and documents from their emails. This adversely impacted the ability of staff to carry out their work in a timely manner.

The multiple areas of non-compliance identified in this inspection mean that governance processes are not always working effectively. Senior leaders cannot be assured that patients are receiving safe and effective care and treatment.

However, all staff told us managers were visible in the service and approachable. They reported managers were supportive when approached. The trust had a robust freedom to speak up policy and system in place. Daisy Ward, Tulip Ward and Sunflower Ward were accredited by the Quality Network for Inpatient Working Age Mental Health Services (QNWA) until July 2026. A further 9 wards were members of the network.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with knew and understood the trust’s vision and values and how they were applied in the work of their team. However, there were differences in staff’s experience within the trust based on the previous trust they worked in. For example, staff at Highgate West Mental Health Centre told us they had a more difficult time with the merge of the trusts due to the IT difficulties.

Following the merger of the two trusts in November 2024, hospitals were often still working with their previous trust’s paperwork and agendas, meaning there was not always a single shared direction and culture across the whole trust. The trust had a 3 year plan in place to review policies and procedures, to ensure consistency across the trust. Senior leaders told us they had reviewed meeting agendas to ensure they all covered the necessary areas.

Staff had the opportunity to contribute to discussions about changes within the service. However, a staff member told us they felt their voice was not heard, and that their manager favoured the opinion of long-standing staff compared to newer team members.

The trust had a cultural development programme in place, called The North London Way. This programme was started in October 2024. Staff were informed of the programme through news bulletins, posters, webinars, and a short booklet sent to all staff introducing the programme. The programme aimed to ensure all staff showed the trust values and delivered high quality care.

The trust had an executive link and buddy system. This involved executive staff members visiting clinical sites. Feedback and learning from these visits was shared in The North London Way Change Team meeting, chaired by the trust’s deputy chief executive.

Managers had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed. Many of the managers we spoke with had worked within the trust for many years. Some had started with the trust as newly qualified nurses.

All staff told us managers were visible in the service and approachable. They reported managers were supportive when approached.

Managers told us they spent time on the wards and supported staff when they were short staffed. Some managers told us they worked later or came in earlier to be able to meet with the staff working the night shifts. At Highgate West Mental Health Centre, a matron was working later shifts to support staff in the evenings.

Leadership development opportunities were available, including opportunities for staff. However, some staff told us they had not heard back from managers regarding starting a course or had been told there was not enough funding for them to complete their non-mandatory courses.

Staff we spoke with stated that they felt able to raise concerns and were aware of the whistleblowing policy.

The trust had a freedom to speak up policy and system in place. Staff had access to information on the freedom to speak up guardian through their intranet and posters with up-to-date information. All new starters to the trust attended an induction programme, which included a session with the freedom to speak up guardian. All trust colleagues were invited to a webinar related to speaking up, and all staff received a bulletin raising awareness of the trust’s policy. Whilst staff were often not able to say who the freedom to speak up guardian was, they felt able to find this information if needed.

We found senior leaders at Highgate West Mental Health Centre and the Dennis Scott Unit took action to address concerns when raised.

The trust valued diversity in the workforce and had several initiatives to promote an inclusive and fair culture for their staff. Staff were able to access several staff networks. These included, a carers network, disabilities network, LGBTQ+ network, race equality and cultural heritage (REACH) network, multifaith network and a women’s network.

Staff were able to apply to work flexibly, such as, flexible working agreements. Managers put reasonable adjustments in place for staff members to help them carry out their role. For example, a staff member told us they had changed shifts to work nights due to a change in personal circumstances.

Our findings from the other key questions demonstrated that localised governance processes were not always effective in identifying issues or driving improvement.

The trust had a framework of what must be discussed at a ward, team or directorate level in team meetings and governance meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. However, ward teams were not always using the trust’s templates. For example, we saw 3 separate forms being used for meetings on the 3 wards at the Dennis Scott Unit.

Wards did not always have monthly meetings in line with trust guidance. Managers told us wards had been busy; staff had been away from work and some wards lacked administrative support. They told us this had affected how often they were able to carry out meetings.

Wards were meant to have separate team meetings and governance meetings. Each meeting had a separate agenda, covering different areas. However, we saw some wards only had one meeting. On some occasions, we saw governance meetings taking place with 3 to 4 staff members, and they were for all senior staff.

Managers were not always able to find where the meeting minutes were stored. Some managers reported this was due to issues following the merger. Meeting minutes were not always easy to follow, with spelling and grammar mistakes.

Whilst staff completed audits, it was not always clear what the actions were to improve practice. Audits also did not occur in line with the scheduled frequency. Senior leaders were aware of the poor compliance with audits, particularly the physical health audit tool. Senior leaders reported this was likely due to the audit questions being unclear. Following our inspection, leaders reviewed the audit tool and undertook immediate physical health audits across all inpatient units.

At times, staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at ward level. We saw incidents and learning being discussed in meeting minutes. However, learning was not always embedded. For example, we saw staff incorrectly monitoring a patient following an Olanzapine depot. This was learning shared with teams following a death within the trust. We also saw examples of staff carrying out intermittent observations against trust policy, this was despite poor observations being noted in the learning for a number of recent incidents.

The trust ran a programme of scenario-based simulations for emergencies and disruptive events. However, some staff were not able to tell us when these simulations last took place, or if any learning came from them.

Staff knew how to report incidents. Incidents were reported on an internal system; however, the trust was still working with two incident reporting systems following the merger. The trust did however have one team within their governance department who reviewed all incidents across the trust. The trust was in the process of securing a single risk management system, which was due to be implemented from August 2025.

From December 2024, the hospital division was in enhanced mandated support. This was implemented by the trust to provide additional support to the division. At the time of assessment, this support included weekly meetings to discuss areas such as, staffing, the environment and physical health.

Staff had access to the equipment and information technology needed to do their work.Staff had access to support and guidance around this if needed. However, these systems did not always work well. Some staff told us they had limited access to internet-based files following the merger. Staff, particularly those at Highgate West Mental Health Centre, told us they lost important information and data that was attached their email addresses when they were required to change email domains. For example, team meeting minutes and supervision records. Some staff at Highgate West Mental Health Centre told us changing their emails meant they no longer had access to some systems, such as their personal Electronic Staff Record (ESR). Senior leaders informed us staff’s previous email addresses were still needed to access this system.

Managers and senior staff were able to manage performance issues appropriately. Managers and senior staff had access to a range of information about the performance of the service, staffing and patient care. However, some managers told us their access to these systems was temperamental, at times they could not be accessed.

The trust had a clinical risk management process in place, including risk registers for the wards. Staff were able to contribute risks to the risk register. Risk registers were reviewed each month by the divisional management boards. Risks were escalated to the board meeting, where appropriate.

The trust held a clinical safety hazard log which identified potential hazards and risks associated with digital systems. The log contained potential mitigations for these risks.

Some staff told us there had been delays in getting responses from the trust’s human resources team. They also said there had been issues with payroll, including some staff members not being paid their correct wage. Senior leaders were aware of the issues surrounding payroll and had an action plan in place to address this.

Staff took part in the national NHS staff survey for 2024. For Barnet, Enfield and Haringey Mental Health NHS Trust, 47% of staff completed the survey and Camden and Islington NHS Foundation Trust had 44% of staff complete the survey. Overall, 62% of staff at Barnet, Enfield and Haringey Mental Health NHS Trust would recommend the organisation as a place to work. At Camden and Islington NHS Foundation Trust 58% of staff would recommend the organisation as a place to work, compared to 66% in 2020.

Data and notifications were consistently submitted to external organisations as required.

Senior managers engaged with external stakeholders, such as commissioners and Healthwatch.

The trust shared information and learning with partners in order to collaborate on improvement. A senior leader told us an external closed culture review had been commissioned for Highgate West Mental Health Centre. A recent review had been carried out at this hospital by NHS England looking into the support and training given to trainee doctors.

The trust had a positive approach to quality improvement, and we saw that staff were involved in several quality improvement projects across sites. For example, wards at Chase Farm Hospital were involved in the perfect day quality improvement project. This project involved having a more structured routine for patients and staff in terms of times for meetings and discharges. The process of collecting data was ongoing at the time of the inspection, but managers hoped to roll the project out to more hospital sites across the Trust.

Staff used quality improvement methods and knew how to apply them. Staff were given the opportunity to consider improvements, for example, staff implemented a quality improvement project looking at reducing medication errors following an increase in these incidents. However, a staff member told us their improvement ideas were not listened to.

However, training compliance, supervision and appraisals continue to be an area for improvement. Low training compliance was found at the last inspection and the trust was given a requirement notice at that time.

Daisy Ward, Tulip Ward and Sunflower Ward were accredited by the Quality Network for Inpatient Working Age Mental Health Services (QNWA) until July 2026. The network aims to support and engage wards in a process of quality improvement through a supportive network and peer-review process. A further 9 wards were members of the network. Coral Ward was part of the National Association of Psychiatric Intensive Care Units (NAPICU).