North East London NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the trust involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating changed to requires improvement. We found some concerns about the systems and processes in place to protect the dignity and protected characteristics of patients across the wards, in breach of Regulation 10 Dignity and respect of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Patients on all the wards said that they did not have direct access to hot drinks and snacks. We observed, and patients reported having to wait a long time for staff to provide these. Patients requesting Halal, vegetarian or vegan food said they were often not receiving these meals as they were being taken by other patients.

We received mixed feedback from patients across the wards. Some patients and carers/relatives spoke very highly of the support and kindness from staff. However, others reported that some staff attitudes could be unhelpful and sometimes staff could be rude to them. Several patients and carers felt that there were not enough staff available to support patients.

Some carers were unhappy with the facilities for visiting patients and said they could not meet patients in private each time. Carers told us that although some staff were incredibly kind and helpful, communication with ward staff was sometimes difficult. There were problems getting through by telephone especially at night, and last-minute changes to meetings. Most carers/relatives on all wards reported that it was very difficult to get through by telephone to staff on the ward, and when they left messages for staff, they were not always passed on.

Patients and some relatives/carers told us that some patients had been assaulted by other patients and had possessions going missing. Many patients felt that there were not enough activities for them to be involved in, and they were often bored. Patients and carers/relatives on Kahlo ward, were very happy with staff support but said that the ward could be very loud. Patients gave a mixed picture of being involved in their individual care plans.

Welcome packs included information such as what to expect from the team, search and mobile phone policies, complaints and compliments processes, and advocacy services. However, not all patients we spoke with remembered receiving a welcome pack. Multidisciplinary staff met with patients weekly to discuss their support and treatment. On some care records it was clear that patients’ views were included in their care plans using their own words. Many patients told us that they did not feel involved in their care and treatment, and did not have copies of their care plans.

There were no current carer groups to support families and carers, although some wards talked about plans for restarting these groups. Patients could give feedback on the service and their treatment, and staff supported them to do this. There were suggestion boxes and weekly community meetings were held on all wards where patient met with staff to discuss ward updates and provide feedback. Mutual help meetings occurred on the wards each morning, providing a space for patients to discuss ways in which staff could support them.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from patients across the wards. Some patients and carers/relatives spoke very highly of the support and kindness from staff, describing them as ‘amazing,’ ‘accommodating,’ ‘sensitive’ and ‘kind,’ going ‘out of their way to support them’. However, some patients and carers reported that some staff attitudes could be unhelpful and sometimes staff could be rude to them. Several patients and carers felt that there were not enough staff available to support patients.

Some carers were unhappy with the facilities for visiting patients and said they could not meet patients in private each time. Rooms were not always available, and they had to use communal areas which did not provide privacy. This was in breach of Regulation 10(2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Carers told us that although some staff were incredibly kind and helpful, communication with ward staff was sometimes difficult. There were problems getting through by telephone especially at night, and insufficient notice and last-minute changes to meetings. Most carers/relatives on all wards reported that it was very difficult to get through by telephone to staff on the ward, and when they left messages for staff, they were not always passed on, and they rarely received a call back. At night they reported being unable to get through to the wards at all. This was in breach of Regulation 10(2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Patients and some relatives/carers told us that some patients had been assaulted by other patients and had possessions going missing. Many patients felt that there were not enough activities for them to be involved in, and they were often bored. Patients and carers/relatives on Kahlo ward, were very happy with staff support but said that the ward could be very loud.

Staff said that they involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. However, patients gave a mixed picture of being involved in their individual care plans.

Staff introduced patients to the wards and said that they provided welcome packs to patients on admission. Welcome packs included information such as what to expect from the team, search and mobile phone policies, complaints and compliments processes, and advocacy services. However, not all patients we spoke with remembered receiving a welcome pack.

Staff made sure patient understood their care and treatment. Multidisciplinary staff met with patients weekly to discuss their support and treatment. Staff were able to access easy read care plans and documents, and translations into other languages, for those who needed it.

On some care records it was clear that patients’ views were included in their care plans using their own words. Care plans enabled patients to describe themselves and their thoughts. However, this was not always the case. Many patients told us that they did not feel involved in their care and treatment, and did not have copies of their care plans.

Relatives and carers were invited to attend ward rounds and discharge planning meetings where patients had given consent for them to attend. They could do so in person or using video-conferencing facilities. However, some family members said that meetings were often changed at short notice, without them being informed, leading them to be unable to attend. This was in breach of Regulation 10(2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some relatives described the difficulty in finding support to meet particular needs of patients who found themselves in repeating patterns of mental health illness and improvement, frustrated that they were not able to break this cycle.

There were no current carer groups to support families and carers, although some wards talked about plans for restarting these groups.

Patients could give feedback on the service and their treatment, and staff supported them to do this. There were suggestion boxes and weekly community meetings were held on all wards where patient met with staff to discuss ward updates and provide feedback. Meeting minutes were displayed for patients to review on the ward notice boards. Actions taken following meetings on were displayed on the wards. For example, on Monet ward, staff took action to ensure patients knew who their named nurses were and could access their care plans. At the time of the inspection, patients on most wards visited said they were not clear about the content of their care plans.

Mutual help meetings occurred on the wards each morning, providing a space for patients to discuss ways in which staff could support them. Staff involved patient in decisions about the service, when appropriate, for example changes to the ward layouts.

There were plans in place to improve patient involvement in the running of the service, although there was still more work to do on this. Trust patient surveys had been completed for all wards except for Titian and Rodney. In 2024, 136 patient surveys were completed and returned, including 33 from Ogura and 28 from Turner wards, but none from Titian or Rodney wards.

Most patients and carers were not clear about how to make a complaint if they were unhappy about the service, although several said that they would know how to find out if needed.

Staff ensured that patients had access to independent advocates, although advocacy services did not visit on a regular basis, but only when requested.

Approximately 50% of carers/relatives we interviewed did not feel as involved as they wanted to be in their relative’s care. In some cases, this was due to their relative not giving consent for their involvement, but in others this was due to poor communication from the staff teams, for example in one case the relative was not given any notice that a patient was to be discharged, so they could not ensure that they had a safe and warm home to return to.

The trust was in the process of fitting call bells in all patient rooms. Patients gave mixed feedback about staff support, indicating that some staff were more helpful than others. They sometimes felt that there were not enough staff on duty to give them meaningful support with their mental health. They often had to wait a long time for a staff member to be free.

Patients on all the wards said that they did not have direct access to hot drinks and snacks. We observed, and patients reported having to wait a long time for staff to provide these. This was in breach of Regulation 10(2)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was a blanket restriction on all wards, due to lack of facilities for patients to make drinks independently, and also a cultural issue in that busy staff did not prioritise meeting patients’ needs/wishes in this area. Following the inspection, senior managers in the trust said that they were taking steps to address this including the introduction of hot drink facilities for patients.

Most staff we spoke with felt well supported by the immediate team and line managers, although not necessarily by the trust itself. In 2023, staff surveys indicated that 61.3% of staff were concerned about the amount of energy they had left for family and friends, 61% of staff were concerned that there were not enough staff available, and 75% of staff were dissatisfied with their pay. Results also indicated that 47% of staff often thought about leaving, 79% experienced discrimination from the public, and 88% experienced discrimination from a manager or colleague.