North East 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

Effective – 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. At our last assessment we rated this key question good. At this assessment the rating remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff provided a range of care and treatment suitable for the patients in the service and it was consistent with national guidance on best practice. Psychologists provided assessments and therapy for patients and occupational therapists provided a timetable of activities and support with activities of daily living. However, staff on some of the female wards, told us that they thought more psychology support was needed for patients with a diagnosis of emotionally unstable personality disorder.

Staff ensured that patients had access to physical healthcare and supported them to live healthier lives. There were regular audits to check the quality of record keeping, for example care plans, risk assessment and physical health although these had not resulted in the care plans and risk assessments for patients’ physical health being at a consistently high standard.

We saw good use of mutual help meetings across the wards and observed effective staff handover and safety huddle meetings. Whilst managers made sure they had staff with the range of skills needed to provide high quality care, some staff felt more occupational therapy and psychology input would be beneficial.

Some patients felt that there were not enough activities available to them on the wards, although wards had been allocating an additional member of staff as an activity coordinator, who would specifically work to support the activity timetable.

New staff had a trust induction before starting work on their ward. Managers supported staff with appraisals, supervision and opportunities to further develop their skills. Supervision for clinical staff was mostly provided monthly. However, there was some variability between wards in the rates of staff supervision with strongest compliance on Monet, Rodney and Kahlo wards over the last 6 months, whilst lower rates of compliance on Picasso, Ogura, and Titian wards.

Managers made sure staff attended regular team meetings or gave information to those that could not attend. Ward meetings had a standard agenda including safeguarding, incidents and risks. They recognised and managed poor performance, understanding reasons for this, including ensuring that staff did not work excessive hours.

Staff supported patients to make decisions on their care for themselves. They understood the trust policy on the Mental Capacity Act (MCA) 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.However, we found some gaps in recording of patients’ consent for use of physical healthcare monitoring by camera in their rooms.

Staff kept up to date with training on the MHA, and its Code of Practice and knew how to contact the MHA administrators for support. Patients had access to information about independent mental health advocacy, however this service only visited the ward when requested by individual patients rather than on a regular basis.

Section 17 leave (permission to leave the hospital) was agreed with the Responsible Clinician as appropriate. Patients told us that they were not always able to take escorted leave if staff were not available to escort them. However, staff said that whilst escorted leave might be delayed, it would almost always still take place on the same day.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans with patients which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans generally reflected patients’ assessed needs, were personalised, holistic and recovery oriented. We did find that some patients did not have care plans in place to guide staff on how to manage their physical healthcare conditions. We found the care plans we sampled on Kahlo ward to be particularly holistic.

Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. When patients were admitted they were reviewed by a doctor for an initial assessment, as well as a nurse who completed base line physical health observations and oriented the patient to the ward. Patients’ physical health was reviewed regularly during their time on the ward. This included blood tests and electrocardiograms where needed.

Staff provided a range of care and treatment suitable for the patients in the service and it was consistent with national guidance on best practice. Treatments were delivered in line with guidance from the National Institute for Health and Care Excellence. Doctors prescribed medicines appropriately with input from clinical pharmacists to ensure that national guidance was followed. Psychologists provided assessments and therapy for patients and occupational therapists provided a timetable of activities and support with activities of daily living. However, staff on some of the female wards, told us that they thought more psychology support was needed for patients with a diagnosis of emotionally unstable personality disorder.

Staff ensured that patients had good access to physical healthcare and supported them to live healthier lives. They participated in clinical audit and used Dialogue as a tool to assess and record severity and outcomes. Across the service there were regular audits to check the quality of record keeping, for example care plans, risk assessment and physical health. The results and actions were shared with the ward managers and matron, who in turn shared the findings with staff in team meetings or individual supervision.

We saw good use of mutual help meetings across the wards and observed effective staff handover and safety huddle meetings. However, on some wards the number of meetings impacted on the amount of time staff had to spend with patients.

Some patients felt that there were not enough activities available to them on the wards, although wards had been allocating an additional member of staff as an activity coordinator, who would specifically work to support the activity timetable.

The ward teams had access to a range of specialists required to meet the needs of patients including doctors, nurses, psychologists, and occupational therapists. Whilst managers made sure they had staff with the range of skills needed to provide high quality care, some staff felt more occupational therapy and psychology input would be beneficial.

Managers gave each new member of staff a full induction to the service before they started work. New staff had a trust induction before starting work on their ward. Once on the wards they had a local induction and were supernumerary for two weeks to allow them to shadow other staff members. The wards also operated a buddy system where new staff worked closely with experienced staff to support their learning.

Managers supported staff with appraisals, supervision and opportunities to update and further develop their skills. Supervision for clinical staff was mostly provided monthly. There was some variability in rates of staff supervision between wards, with strongest compliance on Monet, Rodney and Kahlo wards over the last 6 months, whilst lower rates of compliance on Picasso, Ogura, and Titian wards. Supervision in October 2024 was highest on Monet ward at 96%, and lowest on Knight ward at 54%. The average overall compliance for the last 6 months was 78%.

Similarly, there were variations in staff appraisals at the time of the inspection ranging from 100% on Monet ward to 48% on Picasso ward. In May 2024 appraisals were lowest on Ogura ward at 50%, and in September 2024 appraisals were lowest on Picasso ward at 40%.

Managers made sure staff attended regular team meetings or gave information to those that could not attend. Ward meetings had a standard agenda including safeguarding, incidents and risks. They recognised and managed poor performance, understanding reasons for this, including ensuring that staff did not work excessive hours.

Staff ensured that patients had good access to physical healthcare and supported them to live healthier lives. Staff made sure patients had access to physical health care, including specialists as required. The wards had access to a physical health specialist and a substance misuse team that visited when needed.

Staff helped patients live healthier lives by supporting them to take part in programmes for giving advice. Smoking cessation service leaflets were available on the wards, as well as access to nicotine replacement therapy.

Staff participated in clinical audit and used Dialogue as a tool to assess and record severity and outcomes.

Staff took part in clinical audits across the service, to check the quality of record keeping, for example care plans, risk assessment and physical health. The results were shared with the ward managers and matrons, who shared the findings and necessary action with staff in team meetings or individual supervision.

Staff supported patients to make decisions on their care for themselves. They understood the trust policy on the Mental Capacity Act (MCA) 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

Staff training in the Mental Capacity Act ranged from 92% on Knight and Picasso wards to 100% on several wards. Most staff we spoke with had a good understanding of the principles of the Act.

Staff knew who to speak with for advice on the MCA and deprivation of liberty safeguards. Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. Staff gave patients appropriate support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. When staff assessed patients as not having capacity, they made decisions in the best interest of patients. However, we found some gaps in recording of patients’ consent for use of physical healthcare monitoring by camera in their rooms. On Rodney ward we saw that patients who did not consent had this switched off in their rooms, however, it was unclear if this was the case on the other wards.

Training in the Mental Health Act (MHA) ranged from 88% on Titian ward, and 89% on Kahlo ward to 100% on Rodney ward. Staff kept up to date with training on the MHA, and its Code of Practice and knew how to contact the MHA administrators for support. Patients had access to information about independent mental health advocacy, however this service only visited the ward when requested by individual patients rather than on a regular basis.

Staff explained to patients their rights under the MHA in a way that they could understand, repeated as necessary and recorded it in the patient’s notes. However, there were no notices for informal patients informing them of their rights to leave on Ogura and Rodney ward exit doors. Staff told us that these notices had been removed by patients, and informal patients would need to see the doctor if they wished to leave.

Section 17 leave (permission to leave the hospital) was agreed with the Responsible Clinician as appropriate. When patients needed a member of staff to escort them on leave, plans for allocating a member of staff were agreed at the morning mutual help meetings. Patients told us that they were not always able to take escorted leave if staff were not available to escort them. However, staff said that whilst escorted leave might be delayed, it would almost always still take place on the same day. There were no audits in place to confirm that this was the case.