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 – 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.

Whilst governance arrangements were in place that supported the delivery of the service, our findings across the key questions indicated areas needing further refinement and embedding to promote the consistent safety of the environment, and staff support of patients. This was a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, governance processes had failed to identify that some patients did not have risk assessments and care plans in place for their physical health conditions, and observed inconsistent approaches to patient observations, and insufficiently detailed records of physical restraints. There were also some concerns about oversight of medicines administration.

The risk register for the service included bed demand, ligature risk assessments, the windows on Picasso and Knight wards, and the need for mesh netting on Titian ward. It did not include recent concerns with the ceilings on Ogura and Picasso ward. Although following the inspection the trust advised that work had been carried out to secure the wiring up and the ceilings have been reinforced to prevent access to the wiring.

Staff knew and understood the provider’s vision and values and how they applied to the work of their team. They reported that senior managers visited the wards, and they had some opportunity to contribute to discussions about the strategy for their service. There was room for development in ensuring that patients had an opportunity to shape the service.

Most staff felt respected, supported and valued, and said that the trust promoted equality and diversity in daily work and provided opportunities for development and career progression. A new leadership structure had been introduced at the trust since February 2024 realigning directors with localities and prioritising patient safety, clinical effectiveness, quality and treatment. Ward managers and matrons had a good understanding of the wards and patients’ individual needs, risks and circumstances. There were also matrons working on night shifts offering support to staff out of hours.

Many of the staff in leadership positions had been supported to develop into these posts within the trust. Staff knew about the role of the trust’s Freedom to Speak Up Guardian (FTSUG) and how to contact them. However, 2 staff members said that they did not feel safe to whistle blow.

Following the most recent staff survey from 2023 the trust had an action plan including introducing long service awards and opening a café in the hospital building. Managers had arranged for a dedicated person to meet with staff who experienced aggression in their role and added reflective sessions for staff to use for additional support.

Leaders were proud that the wards were taking part in national collaborative work relating to observations, patient safety and engagement. Staff were involved in several quality improvement projects taking place across the wards. Ward managers advised that wards were working towards accreditation with the Royal College of Psychiatrists.

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 knew and understood the provider’s vision and values and how they applied to the work of their team. Trust values included putting people first, prioritising quality, continuous improvement, and being professional and honest.

Staff reported that senior managers visited the wards. They said that they had some opportunity to contribute to discussions about the strategy for their service, especially where changes were being made. There was room for development in ensuring that patients had an opportunity to shape the service.

Most staff felt respected, supported and valued, and said that the trust promoted equality and diversity in daily work and provided opportunities for development and career progression.

A new leadership structure had been introduced at the trust since February 2024 realigning directors with localities and prioritising patient safety, clinical effectiveness, quality and treatment. We spoke with the integrated care director, assistant director and deputy director of nursing, who managed clinical and operational matrons.

The trust had a small bed base. Leaders described collaborative working between home treatment teams to manage patient access and discharge from beds. They were proud that wards had access to a full multidisciplinary team, and that they had removed blanket restrictive practices within services, moving to a risk-based system.

Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for patients and staff.

Ward managers and matrons were present on the wards. They had a good understanding of the wards and patients’ individual needs, risks and circumstances. There were also matrons working on night shifts offering support to staff out of hours.

Many of the staff in leadership positions had been supported to develop into these posts throughout their time within the trust.

Staff knew about the role of the trust’s Freedom to Speak Up Guardian (FTSUG) and how to contact them. Information about the FTSUG was displayed on the wards. Staff also had access to support for their own physical and emotional health needs through an occupational health service. A psychologist also provided reflective sessions and followed up on staff wellbeing following sick leave.

Between May and November 2024, there were 2 cases referred to the FTSUG about patient safety, 5 about policies, 4 about inappropriate behaviours, and 1 about bullying and harassment.

Most staff we spoke with said they felt able to speak up to managers about their concerns. However, 2 staff members said that they did not feel safe to whistle blow, as they had concerns that there was a culture of blame.

Results of the most recent staff survey from 2023 indicated 48% were thinking about leaving, 79% had experienced discrimination from the public, and 88% had experienced discrimination from a manager or colleague. The trust had an action plan in place to address these issues.

Most staff were happy with their local ward management, but some did not feel valued by senior managers. Two staff said that they did not feel safe to speak up due to concerns about a culture of blame.

In response to the staff survey, to promote recognition of staff, the trust had introduced long service awards. The opening of a café in the hospital building had also been very positive for staff morale. Staff were clear that they wanted a bespoke response to the aggression they were experiencing. Managers had arranged for a dedicated person to meet with staff and added reflective sessions for staff to use for additional support.

Whilst governance arrangements were in place that supported the delivery of the service, our findings across the key questions indicated areas needing further refinement and embedding to promote the consistent safety of the environment, and staff support of patients. This was a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, governance processes had failed to identify that some patients did not have risk assessments and care plans in place for their physical health conditions, and observed inconsistent approaches to patient observations, and insufficiently detailed records of physical restraints. There were also some concerns about oversight of medicines administration.

The risk register for the service included the following risks rated as significant: bed demand; ligature risk assessments; the windows on Picasso and Knight wards; and the need for mesh netting on Titian ward. It did not include recent concerns with the ceilings on Ogura and Picasso ward, although following the inspection, the trust advised that work had been undertaken to address this issue.

The trust’s action plan for reducing restrictive practices was dated 2017-2019. Further work was needed to bring back a focus on reducing restraints and restrictive practices across the service.

We reviewed a selection of trust policies including the trust policy for Deprivation of Liberty Safeguards, Seclusion, and the Enhanced Monitoring and Engagement policy which had been updated shortly after the inspection to include the need to vary observation times.

Staff at all levels told us that they were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. There was a clear framework of what should be discussed at team or directorate level to ensure that essential information, such as learning from incidents and complaint, was shared and discussed. Quality and patient safety meetings occurred monthly with senior staff discussing patients risks and incidents. Matrons from all wards met twice weekly to share information and learning between wards, and ward managers met on a weekly basis.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at service level. The trust had invested in CCTV in communal areas on the wards, and anti-ligature doors on two rooms on each ward.

Community care coordinators were invited to all ward rounds, either in person, or via video conferencing facilities.

Home treatment team coordinators worked across the wards. They attended multidisciplinary team meetings and worked closely with the ward teams, community mental health teams and local authorities to ensure that there were no barriers for when the patient was ready to be discharged.

A local substance misuse service visited the wards to provide support with drug and alcohol addiction. Managers advised that they were in the process of negotiating more support for patients from this service.

Leaders were in the process of expanding the trust’s Integrated Care Assessment Hub, where patients could spend 24 hours giving them opportunity for a cooling off period, and to assess when in-patient care was needed.

Leaders were proud that the wards were taking part in national collaborative work relating to observations, patient safety and engagement. Staff were involved in several quality improvement projects taking place across the wards. These included; improving physical health on Rodney ward; creating a culture of care collaborative on Rodney and Kahlo wards; improving the use of PRN (prescribed as needed) Lorazepam on Kahlo ward; improving the quantity and quality of enhanced therapeutic engagement and supportive observation, and improving documentation on Ogura ward; reducing the number of complaints, and increasing the number of recorded compliments on Knight ward; reducing the incidents of restrictive practice on Monet ward; and reducing the amount of money paid out due to lost property on Picasso ward.

We attended 2 quality improvement meetings on the wards, where progress was discussed involving multidisciplinary staff across different services. Ward managers advised that wards were working towards accreditation with the Royal College of Psychiatrists.