North East London NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. We did not re-rate the service as a result of this inspection. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

• Systems to keep young people safe while they waited for treatment required improvement as they did not always work effectively. Systems to identify, manage and mitigate risks for children and young people who were receiving treatment also needed improving.

• As a result of high demand for services, children and young people experienced delays from when they were referred to starting their treatment. There was a group of young people on the waiting list who were about to turn 18, or had turned 18, and had not yet had an initial assessment, affecting their transition to adult services.

However,

• The service had a system to record, investigate and monitor incidents. Staff we spoke with could describe what incidents they should report and knew how to report them on the provider’s electronic system.

• The service had made a number of improvements based on learning from past incidents. Some parents/carers we spoke with told us they knew what to do in a crisis and were provided with information on crisis services.

• The service had designated clinical rooms with appropriate equipment for physical examinations.

• The service had made progress with recruiting permanent staff to vacant posts. Compliance rates for mandatory training, supervision and appraisal were relatively high.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had made a number of improvements to based on learning from past incidents. All children and young people referred to the service were now assessed in person. Each part of the assessment and treatment process was provided by staff employed by the trust. There were no longer any third-party contractors involved in delivering services. The medical team was better staffed, with permanent appointments made to posts that had been vacant and previously covered by locum staff.

The service had a system to record, investigate and monitor incidents. Staff we spoke with could describe what incidents they should report and knew how to report them on the provider’s electronic system. Staff told us that incidents and lessons learnt were discussed in a number of forums, for example MDT meetings.

We reviewed 3 incident records. These were reported appropriately on the provider’s electronic system and reviewed by managers, with actions documented. There was one serious incident during the 6 months preceding our inspection, which was being reviewed in line with the trust’s patient safety incident reporting framework.

As a result of high demand for services, children and young people experienced delays from when they were referred to starting their treatment. There was a group of young people on the waiting list who were about to turn 18, or had turned 18, and had not yet had an initial assessment. The service was looking at additional ways of mitigating the risks to this group during transition to adult mental health services, for example offering weekend appointments.

The service operated a single point of access for all incoming referrals. Staff risk-assessed referrals and aimed to prioritise those they identified as more urgent. There was now a psychiatrist working as part of the triage team. Some staff we spoke with felt the referral screening process could be improved so they could signpost young people to the relevant services earlier.

We observed a meeting where the multidisciplinary team discussed new referrals. Staff shared essential information about the patients to determine if their needs could be met appropriately. Staff discussed the involvement of other agencies where appropriate, for example school and social services.

Feedback from partner organisations indicated that the service made appropriate referrals to them. One stakeholder said the service could improve its communication in providing more consistent updates on the outcome of referrals and waiting times and more information on the support available.

The service had established a process to ensure that every patient was discharged safely. This included a multidisciplinary panel discussion prior to any discharge taking place. Staff we spoke with said this process was robust.

Systems to keep young people safe while they waited for treatment required improvement as they did not always work effectively. The service had introduced a clinical harm review (CHR), a telephone check-in with the parents/carers of young people who had been waiting for treatment a year or more. We viewed 2 records of young people eligible for a CHR. For both a telephone call was attempted but not answered by the parent/carer. Staff told us this was because these calls were not pre-arranged. The service carried out a monthly audit of compliance with CHR. We reviewed this audit for the 3 months preceding our inspection and found that CHR were not completed consistently. In February 2025, 36% of eligible young people did not have a CHR. This meant the service was not aware of any changes in risk or need for these young people whilst they waited. However, the service risk-assessed referrals and aimed to prioritise those whose needs were identified as more urgent. The service worked well with the crisis, home treatment and inpatient service teams and was effective at meeting the 5-day follow up targets.

Systems to identify, manage and mitigate risks for children and young people who were receiving treatment also needed improving. Whilst systems were in place, these did not always operate effectively. Not every young person had a risk assessment completed and documented in line with the services standard operating procedure. A monthly audit of 10 care and treatment records to ensure appropriate risk assessment were in place had been introduced. However, when we reviewed this audit for the 12 months preceding our inspection we found the service had not audited the minimum required sample of cases. During most months, 8 cases were audited, and in March 2025, this dropped to 4 cases. Of the sample that were audited, 16% of risk assessments had not been completed. Whilst audits identified gaps in risk assessment completion, they did not outline what actions should be taken to address these.

We reviewed 10 care and treatment records. In most of these staff assessed and documented risk to patients well. Staff involved parents/carers and relevant services where appropriate. The majority of risk assessments were updated following incidents and risk management plans were in place. However, one young person’s risk assessment had not been updated since their initial assessment and it was not clear whether any changes had been considered. In another record, there was a gap of more than 1 year between the initial risk assessment and its review.

The service recognised national guidance advising against the use of risk stratification tools, recommending instead the use of risk formulation as part of comprehensive assessment. At the time of our inspection a risk stratification tool using low medium and high risk was in use at the service. Whilst the trust had developed and started to roll out risk stratification guidance, tools and training this had yet to be implemented across community CAMHS. Two young people whose records we reviewed included past incidents of self-harm. Their risk had been assessed as low overall, and it was not clear what the rationale was for this. We escalated this information for review by the service during our inspection.

Some parents/carers we spoke with told us they knew what to do in a crisis and were provided with information on crisis services.

Staff discussed risks to patients in a range of forums, with input from multidisciplinary team representatives.

Staff carried out regular risk assessments of the care environment. Staff completed fire safety and other relevant checks and kept these records up to date.

Parents/carers’ feedback about the care environment was positive. They described it as visibly clean and well-managed.

Attendance at the service was by appointment and access to the building was monitored, with the safety of children and young people in mind. Access to staff-only areas was secure and all visitors were accompanied by staff. Staff had access to panic alarms. The service had procedures in place to ensure staff safety whilst conducting community visits.

Staff had assessed the potential ligature anchor points within the service. The ligature risk assessment was completed in September 2024 and included appropriate management and mitigation plans.

The service had designated clinical rooms with appropriate equipment for physical examinations. The equipment was well-maintained and calibration records were up-to-date.

Staff had easy access to first aid supplies and biohazard kits, the contents of which were in date. Trained staff had access to resuscitation equipment. The service had implemented a procedure to ensure that staff checked the resuscitation equipment daily and audited it monthly.

However, staff we spoke with shared concerns about limited room availability which impacted on patient appointments. This included not having access to appropriate space to meet individual patients’ needs. Leaders told us they were exploring options to address these concerns.

The service had a multidisciplinary team which was 86% established. Although the service had made progress with recruitment over the past months there were still vacancies within medical, nursing, psychology and psychotherapy teams, equating to approximately 9 FTE in total. The largest number of vacancies was in the psychology department, with 5 vacancies of different grades. Some vacant posts were filled by agency staff. Leaders told us that recruitment was ongoing and they were looking at other ways of increasing service capacity, for example extending the service hours.

In the 6 months prior to our inspection, the average sickness absence rate was 5% for all staff. The staff turnover rate was low, with 1 leaver during the same period.

Staff participated in training, appraisal and supervision and leaders monitored the compliance rates for these. Ninety-four percent of all staff were up-to-date with their mandatory training, 83% with appraisal and 78% with supervision. Staff told us about other training available to them to better meet the needs of patients using the service, for example specialist prescribing training and professional conferences. New starters received an induction and had the opportunity to shadow colleagues. Staff told us they received regular supervision, however some said they did not have enough time for reflective practice due to the workload.