South London and Maudsley NHS Foundation Trust

On this page

• 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

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 inspection we rated this key question good. At this inspection the rating has changed to requires improvement. We found 2 breaches of the regulations in relation to person-centred care and compliance with reading people’s rights under section 132 of the Mental Health Act.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service did not always maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them. Care plans were not always present or current and did not always reflect actual needs and preferences. The service did not always assess people’s physical health needs annually.

However, the service planned and delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards. Teams and services worked effectively together to support people who used services and supported them to live healthier lives. Staff sought consent for care and treatment and respected people’s right to consent.

This service scored 50 (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 did not always maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

People who used services were not aware of being involved in their care plans. Care plans were not always personalised, holistic and recovery oriented. People’s voices were not always present, and we found frequent use of generic statements. We spoke to 12 people who used services and 7 carers during our onsite inspection. Twelve told us they were not aware of their care plans or their loved one’s care plan, did not have copies, or did not feel involved in care planning.

Care plans were not always present or current. They did not always reflect actual needs and preferences, placing people at risk of care and treatment that did not meet their needs. We reviewed 26 electronic care records and found 15 records had either no care plan or care plans which were not current. In 5 care plans we saw examples of historical content that had not been updated, although the system recorded them as being recent care plans. In 10 care plans there was little evidence of people’s involvement in care planning or use of their voice.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff provided a range of care and treatment interventions suitable for people who used services. The interventions delivered were in line with guidance from the National Institute for Health and Care Excellence (NICE). For example, people could access psychological treatments and interventions, such as dialectical behaviour therapy, cognitive behavioural therapy and eye movement desensitisation and reprocessing therapy. Staff followed care process models which set out the expected standards for community care and these were supported by psychosis clinical standards.

Staff received training in and had a good understanding of the Mental Health Act. At the time of our onsite inspection, compliance with Mental Health Act training was 85% in Croydon directorate, 82% in Lambeth directorate, 89% in Lewisham directorate and 86% in Southwark directorate.

Staff could access relevant policies and procedures on the Mental Health Act and associated code of practice that reflected the most recent guidance. The service had an up-to-date policy for staff to follow in relation to working with people using services who were under community treatment orders.

Staff explained people’s rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Staff did regular audits to ensure that the Mental Health Act was being applied correctly. However, audits for April 2024 to June 2025 showed though most teams showed compliance above 75%, Walworth Community Mental Health Team (CMHT) and North Short Term Support Team achieved 50% compliance with reading people on community treatment orders rights under section 132 of the Mental Health Act to them. Lambeth early intervention team (LEO) achieved 87% compliance. The same audit showed all teams ensured community treatment orders were reviewed quarterly, with compliance at 100% across all teams.

Staff in Southwark directorate attended reflective practice sessions and structured clinical supervision for working with people with personality disorder. Psychology staff supported monthly multidisciplinary case presentations for assertive outreach and rehabilitation teams, where staff could use a recognised psychological trauma-informed framework to plan next steps for work with people who used services. Psychologists also provided staff training such as attachment theory and endings from a psychodynamic perspective to inform how practitioners worked with people who used services.

Teams within the service included or had access to the range of specialists required to meet the needs of people who used services. This included peer support workers who were collocated in community or early intervention teams. Peer support workers arepeople who use their lived experience of mental health problemsto support others.The peer support worker is identified as a key role in NHS England guidance ‘Implementing the early intervention in psychosis access and waiting time standard’ guidance February 2023.

The service did not always work effectively across teams and services to support people, making sure they only needed to tell their story once by sharing their assessment of needs when they moved between different services.

Staff in the service mostly worked effectively across teams to support people.

The Lewisham Early Intervention in Psychosis team employed a transitions worker who worked jointly with children and adolescents’ mental health services (CAMHS) to provide support to young people age 14 to 18 who were moving from CAMHS to adult services.

The assertive outreach team in Southwark worked closely with community mental health teams (CMHT) to ensure people who used services received appropriate support. They carried out between 2 and 4 joint visits with a practitioner from the referring team when someone was referred to the service. This ensured they had all the relevant information to assess if the service was suitable and provided continuity during transition to another service. They worked closely with CMHT managers when the person was ready to be discharged back to the CMHT. They also worked collaboratively with CMHTs to provide advice and guidance to help the CMHTs support people without the need for a referral to assertive outreach.

Some medical staff told us they attended ward rounds for their patients who were currently in hospital, to ensure early discharge planning and continuity of support.

Staff described positive working relationships between members of the multidisciplinary team and between different professions and grades. Members of the multidisciplinary team met regularly to share information and updates. We observed multidisciplinary team meetings and saw staff worked well together. Staff told us doctors and other professionals worked together well to meet the needs of people who used services. We observed a community visit where the doctor and nurse worked well together to respond to the needs of someone whose mental health was deteriorating.

However, some staff described concerns about effective working with external teams such as social services and housing services to support people to stay well in the community.

The effectiveness of shared care agreements with local GPs differed across the 4 directorates. A shared care agreementisa formal arrangement where a specialist such as a consultant psychiatrist shares responsibility with a GP for a person's ongoing care. This often happens for medicines or treatments started in a specialist setting. For example, in Lewisham service managers each liaised with GPs in a specific neighbourhood, however the approach differed dependent on individual teams and managers. However, shared care arrangements between the service and GPs in the Croydon area were not effective. The Croydon CMHT was often responsible for prescribing a range of physical health medicines. This increased the risk of duplicate prescribing between GPs and the CMHT. We saw 1 care record where the care co-ordinator found both the GP and the CMHT had prescribed the same medicines to someone. Staff also reported spending significant time managing prescriptions, which reduced the time available to provide direct support to people. Despite the clinical and operational risks associated with this, the issue was not recorded on the service's risk register.Following our inspection, the service told us leaders from Croydon attended the Croydon Shared Care Working Group led by the Integrated Care Board (ICB). Prescribing protocols were outlined within the group action plans.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported people who used services to take part in activities which helped them to live healthier lives. For example, in Southwark assertive outreach team staff supported people to take part in walking, gardening and cookery groups.

Staff demonstrated an awareness of external services they could refer people to for help to live healthier lives, for example community dietitian services.

Teams included employment support workers who supported people who used services to gain and maintain paid employment. We saw examples of people supported to find employment that matched their needs and preferences and maximised their independence.

The service did not always monitor people’s care and treatment to continuously improve it and to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We requested audits of outcomes for the last 12 months. The service told us they were currently working to implement outcome measures. In April 2025 the service established a multidisciplinary working group attended by senior clinicians to implement the use of 3 nationally recognised clinical outcome measures in 2025 to 2026.

Though some staff told us the service did not systematically assess or monitor outcomes for people who used services and care and outcomes were based on clinical judgment. We found some teams in the service used a nationally recognised patient led outcomes scale which asked people who used services to rate their satisfaction around quality of life and needs for care. However, this was not used consistently in all teams, we did not see outcomes recorded in all care records we reviewed, and it was not fully integrated into care planning. The trust integrated quality and performance report presented to the board in July 2025 showed compliance with completion of the tool was 46%.

Following our inspection, the service provided evidence to show there was improving compliance with the outcomes scales in some teams such as Lewisham Neighbourhood 1 CMHT which had a completion rate of 79% in July 2025. Lewisham Early Intervention Service had a completion rate of 67% in July 2025.

The early intervention in psychosis teams submitted data to the National Clinical Audit of Psychosis (NCAP) for 2024. This showed the teams in Croydon, Lewisham and Southwark performed well in standards relating to effective treatment. The Lambeth team was in the top performing category for effective treatment. However, recording of outcome measures needed improvement in Lewisham and Southwark and had the greatest need for improvement in Lambeth. This meant in Lambeth less than 25% of people using early intervention in psychosis services had 2 or more outcomes measures recorded using a nationally recognised scale. In Lewisham and Southwark it was greater than 25% but less than 50%.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff received training in the Mental Capacity Act. The percentage of staff who had completed level 1 training in July 2025, was above the trust target of 85%. For level 2 training 2 directorates, Croydon and Lambeth were just below the trust target at 84%.

Staff demonstrated in interviews they had an understanding of the importance of assessing a person’s capacity. They told us this was considered in any discussions about people in zoning meetings.

People who used services had access to information about independent mental health advocacy. Staff knew how to support people to access independent advocacy. We saw referrals to Independent Mental Health Advocates (IMHA) discussed in daily zoning meetings. Audits for April 2024 to June 2025 showed all teams except Lewisham Neighbourhood 1 team achieved 100% compliance with people who used services being made aware of advocacy services. Compliance for Lewisham Neighbourhood 1 Team achieved 75%.

Staff assessed and recorded capacity to consent appropriately and we saw this in care records we reviewed.