North East 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

Well-led

Well-led – 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.

At our last assessment we rated this key question good. At this assessment the rating remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Managers had a good understanding of the services they managed. Teamwork was strongly embedded in each of services we visited. Team managers were aware of the importance of creating a culture where staff felt safe to raise concerns about patient care, safety, or workplace issues, without fear. Staff knew how to use the whistle-blowing process and about the role of the Freedom to Speak Up Guardian (FTSUG).

The trust valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The teams we visited reflected the cultural make up and diversity of the communities they served. The service engaged well with patients, staff, the public and local organisations to plan and manage services.

Governance processes operated effectively at team level and performance and risk were managed well. There were robust structures, processes, and systems of accountability in place to monitor the performance of the service. Staff were committed to continually learning and improving services. Staff used quality improvement (QI) methods to make improvements in care and the quality of services provided.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The trust had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The senior leadership team had successfully communicated the trust’s vision and values to staff. Staff were able to tell us what the trust values were and how they applied them in their day-to-day practise. Teamwork was strongly embedded in each of services we visited.

Managers had a good understanding of the services they managed. They could explain clearly how their teams were working to provide high quality care.

The trust 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.

The majority of teams felt listened to by leaders at all levels within the trust. Overall, teams said that leaders understood what was working well and where the challenges lay. We fed back to the trust that one particular team did not feel listened to. The trust subsequently put a range of measures in place to address this.

The trust fostered a positive culture where people felt they could speak up and their voice would be heard.

Team managers were aware of the importance of creating a culture where staff felt safe to raise concerns about patient care, safety, or workplace issues, without fear of negative consequences.

Staff knew how to use the whistle-blowing process and about the role of the Freedom to Speak Up Guardian (FTSUG). Staff were able to tell us how to access the trust’s FTSUG. Some teams had invited the FTSUG to team meetings or away days to raise awareness.

The Cranbrook and Loxford district nursing team set up a listening panel in December 2024 including an executive member of the board, FTSUG, community nursing consultant, associate director of nursing and senior people manager to hear feedback from staff.

The trust valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The teams we visited reflected the cultural make up and diversity of the communities they served. A range of staff networks were in place to support staff with a range of protected characteristics. Trust, directorate and team plans to address workforce race equality and workforce disability standards were in place. Managers and staff were able to describe how a range of reasonable adjustments had been explored to support individual staff to carry out their role or balance their work and home lives.

A range of cultural and religious festivals were recognised and celebrated across teams. The trust recognised the valuable contribution of its internationally recruited workforce and planned to host an event to celebrate international nurses’ day.

The trust launched its anti-racist strategy shortly after our on-site visits concluded.

The trust had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Governance processes operated effectively at team level and performance and risk were managed well. There were robust structures, processes, and systems of accountability in place to monitor the performance of the service. Staff at all levels were clear about their roles and accountabilities. There was a clear framework of what must be discussed at team and service level to ensure essential information was shared and discussed. Staff attended regular staff meetings with a standard agenda that included complaints, audits, incidents, and training.

The service managers attended clinical governance meetings and senior management meetings. Managers fed information from these meetings back to their teams regularly.

Staff implemented recommendations from reviews of deaths, incidents, pressure care incidents, complaints, and safeguarding alerts within their teams. Staff participated in clinical audits. The audits provided assurance and staff acted on the results when needed.

Staff understood arrangements for working with other teams, both within the provider and externally, to meet the needs of the patients. Challenges in the timely provision of services by external contractors, including hospital transport and equipment provision had been recognised and were being appropriately addressed, both with the team and through escalation to senior leaders.

The trust understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service engaged well with patients, staff, the public and local organisations to plan and manage services. Staff had access to the trust intranet that contained up-to-date information on the trust and its services. Patients and carers had access to up-to-date information about the service being provided and opportunities to give feedback on the service they received. Staff collaborated with partner organisations to help improve services for patients within the trust.

Teams were able to access up to date feedback from ‘friends and family’ tests each month to understand what they were doing well and what needed further development.

Teams were able to access support from a trust-wide carers lead and carers assessments were carried out where appropriate. Carers events were also organised by the trust.

Staff were committed to continually learning and improving services. Staff used quality improvement (QI) methods to make improvements in care and the quality of services provided.

QI projects in operation at the time of our visit included:

• District nursing teams piloting the delegation of insulin administration
• Re-designing existing pathways of Pulmonary Rehabilitation (PR) delivery in the Redbridge respiratory service
• Havering north locality team had a project to reduce the referral to treatment time (RTT) to a maximum of 2 weeks, for patients in nursing homes referred to the intermediate therapy team (ITT).
• Basildon and Brentwood respiratory Service was reviewing digital platforms to improve the consistency of wound care assessment and management.

The pharmacist teams worked jointly with community health services to facilitate improvements. These included the Redbridge directorate undertaking a caseload review of all patients who were receiving insulin to review current care plans and ensure these were reflective of the dose administered and explore options for utilising robotic process automation (RPA) technology to link allergy information within shared records directly onto the care records system.