South London and Maudsley 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

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question as good. At this inspection the rating has changed to requires improvement.

There were low completion rates of staff training to enable them to support people with a learning disability and autism. Staff working in the health-based place of safety had low recorded levels of supervision and appraisals. Some people who used services and carers said that the consistency of staff and communication with the home treatment teams could be improved.

We saw staff from the home treatment teams treating people with compassion and kindness. They understood the individual needs of people and supported them to understand and manage their care, treatment or condition.

This service scored 60 (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 mostly treated people with kindness, empathy and compassion and respected their privacy and dignity. A small number of people who use services and their carers said they would prefer to have greater consistency of staff contact from the home treatment teams and felt the involvement of carers could be improved.

We observed 3 home visits and 1 assessment. Staff were respectful, kind and friendly when interacting with people. They listened to people’s views and supported them to manage their care and treatment.

We observed 6 staff handover or multidisciplinary meetings. When staff spoke about people, they were respectful and empathetic towards them.

We spoke with 13 people who have used home treatment teams (HTTs) and 10 carers or family members. Overall, feedback was positive. People who used the service told us staff were friendly, helpful, caring and compassionate. They were supportive, provided advice and responsive. People said staff treated them well and behaved appropriately towards them.

We also saw patient experience data for the Croydon, Lambeth, Lewisham and Southwark HTTs for April 2024 to June 2025. This showed people’s satisfaction with the service was 94%, 88%, 90% and 58% respectively. Carer feedback satisfaction for Croydon, Lambeth and Lewisham HTTs for the same timeframe was 100%, 100% and 96% respectively.

Staff supported people to understand and manage their care and treatment. Most people told us staff communicated well, they felt listened to and they were involved in decision making. People were kept up to date with medication changes, appointments and who to contact when needed. However, 3 people told us that sometimes there had been a lack of communication, and they would have preferred consistency in seeing the same person at each visit.

The majority of carers and family members told us staff listened to them and their wishes, involved them in decision making, and staff provided helpful information. However, 3 people felt carer involvement could be improved and they did not always feel involved.

People who used the service gave examples of when staff had supported them and directed them to other services such as employment support, substance misuse services and talking therapies.

Staff understood the individual needs of people who used the service. They were flexible with appointment times, and 1 person told us staff had been responsive to their preference for consistent appointments with female staff. We observed handover meetings and saw that staff had an effective understanding of people’s personal, social and cultural needs.

Staff maintained the confidentiality of information about patients. We observed staff gaining consent from people to speak with their family members. This was also recorded within their care record.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They mostly took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. The training compliance to support staff to work with people with a learning disabilities and autism fell well below the trust target although the managers were taking steps to improve the numbers of staff completing the training.

We reviewed 17 care records. Staff recorded any protected characteristics within the care record, and what adaptions were required, such as when an interpreter was required at visits or assessments. Staff could access a language line when an interpreter was unavailable to attend. Staff had made referrals to specialist services when required; we saw this recorded for a person with a visual impairment.

The health-based place of safety (HBPoS) was accessible for people with a disability and was on the ground floor. Staff said people had a choice of food to meet the dietary requirements of religious and ethnic groups or for allergies and intolerances. They gave us examples of the food types they could provide to meet this. Staff provided a welcome pack with toiletries and had facilities so people could charge their mobile phones.

In Croydon and Lewisham compliance with level 1 training in working with people with learning disabilities and autism did not meet the trust target at 77% and 75% respectively. Compliance with level 2 training was 31% in Croydon, 40% in Lambeth, 32% in Lewisham and 21% in Southwark. The service told us this was due to limited availability of level 2 training, and they overbooked places to allow for potential cancellations that may occur on the day or shortly beforehand. They had set up a waiting list for each training date, so if any cancellations happened, staff were automatically enrolled.

Staff from the HTTs provided information on the service they offered. People we spoke with who used the service said they would feel comfortable to speak to staff about an issue or complaint. Two people told us staff had dealt quickly and efficiently with their complaints.

The home treatment teams promoted people’s independence, so people had choice and control over their own care, treatment and wellbeing.

The HTTs promoted people’s independence and ensured people had control over their own care and treatment. The aim of the service was to ensure people were treated and cared for in the community as much as possible, and staff would adjust the level of care

Staff, people who used the service and carers said care was delivered in line with people’s choice. Overall, people who used the service said communication was good which enabled them to make informed decisions and choices about their care. The teams had access to a range of health care professionals such as occupational therapists, psychologists, nurses and doctors and they could be seen by a variety of staff, dependent on their individual needs.

People said staff provided information about medicines, and these were reviewed on each visit, including any potential side effects and benefits. This meant people were able to make informed decisions about their medicines.

The home treatment teams listened to and understood people’s needs, views and wishes. Staff responded to people’s needs.

We observed handover, zoning and multidisciplinary meetings for the home treatment teams. Staff identified and responded to the changing needs of people on the caseload. The HTTs had processes in place to ensure people were reviewed and discussed at least once daily and were responsive when they had to change treatment plans. They liaised with other teams when required and could increase the level of visits, provide a medical review or review medicines prescribed and provided.

Staff across all locations received appraisals. Staff gave examples of learning and development to develop their skills and support their career development. Staff had access to reflective practice from the psychology team. However not all staff in the health-based place of safety received clinical supervision.

The staff sickness absence rates for the health-based place of safety were mostly similar to the average for the trust which was 4.3% for the last 12 months. The sickness absence rate for home treatment teams was mostly below the trust target of 3.5%.

There was a trust-wide supervision policy to ensure staff received monthly line management supervision. This policy was under review at the time of our inspection.

Minutes for the health-based place of safety (HBPoS) team meeting for April 2025 stated compliance with staff supervision was being monitored due to low levels of compliance. HBPoS meeting notes from May and June 2025 stated 27% of staff had received supervision. However, most staff we spoke with told us they received regular supervision.

Staff felt supported, respected and valued. They gave examples of support given during periods of sickness absence and of reasonable adjustments made at work. They had access to support through an occupational health service. Staff could access flexible working arrangements to support their individual circumstances.

Staff in the health-based place of safety (HBPoS) and HTTs received an annual appraisal, which was completed between April and July each year. The service provided information which showed in June 2025 compliance was 100% for Croydon HTT, 100% for the HBPoS, 96% for Lewisham HTT, 87% for Southwark HTT and 79% for Lambeth HTT. Staff could access reflective practice, offered by the psychology team.

The trust had a corporate staff induction and substantive and temporary staff received a local induction. The trust was developing a standardised digital induction pathway.

Staff gave examples of additional role specific training they received such as leadership training or dialectic behavioural therapy training. They gave examples of being supported to develop to higher grades and leadership roles. However, a few staff expressed concern that they were not able to access additional training or opportunities to develop in their role.