South London and Maudsley 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

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 inspection we rated this key question good. At this inspection the rating has remained good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff we spoke with understood the trust’s vision and values and how they were applied in their work. These were part of induction for all new starters and awaydays for staff. Staff and leaders were acutely aware of the multiple challenges faced by their patients and spoke passionately about their role in supporting them. This was echoed by the feedback that some carers shared with us. For example, one carer told us: “Having this service is a real anchor. It’s been amazing”. Another said: “There are restrictions on what staff can do, but they have been really good and made a huge difference”.

Staff were positive about the initiatives promoting diversity, patient and carer involvement and supporting staff wellbeing. Staff followed the trust’s equality, diversity and inclusion (EDI) policy, and 99% had completed the Equality, Diversity and Human Rights training. Staff and leaders shared examples of how equality and diversity was actively promoted within the service. The service was one of the early adopters of the Patient and Carer Race Equality Framework (PCREF), the NHS framework aimed at reducing racial inequalities in services. The service shared an EDI event calendar and newsletter.

Staff had access to equality networks, and regularly organised events for staff and patients to promote diversity and inclusion. For example, we attended a PCREF event held at River House, where peer support workers spoke about the role of lived experience in the forensic pathway. Staff, patients and carers recently organised an event aimed at reducing stigma in forensic services. One carer told us: “I come away from these sessions feeling so proud.”

Staff and patients had the opportunity to contribute to discussions about the strategy and development for their service. There was a Patient and Public Involvement Lead overseeing this work within the service. Patients had participated in policy development, research, quality improvement and tendering process. Forums for staff included reflective practice sessions, team meetings, staff forum, access to Freedom to Speak Up, quality improvement projects and surveys. Staff described a positive and supportive listening culture where learning was shared.

Staff could explain how they were working to deliver high quality care within the budgets available. Ward managers had oversight of budgets and financial reports for their wards.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The service had a well-established leadership team with the skills, knowledge and experience to perform their roles effectively. Leaders had a good understanding of the services they managed. They fostered a culture of safe, compassionate and inclusive care and least restrictive practices.

Leaders were knowledgeable and open about the priorities, risks and challenges for the service. For example, they had started action plans around staff development and wellbeing, service development and restorative justice. Leaders were monitoring the progress and completion of these.

Leaders were visible in the service and approachable for patients and staff. Most staff we spoke with reported a good morale and said they felt respected and valued. Majority described the leaders as approachable, hands-on, supportive and responsive.

Staff had access to training and development to support their career progression. Several managers we spoke with previously worked for the trust in other roles before progressing to their current positions. Staff spoke positively about development opportunities available for colleagues from underrepresented groups. The service had established programmes to support professional development for staff from Black and ethnically and culturally diverse backgrounds, for example dedicated programmes for Band 5 Nurses and Occupational Therapy (OT) support staff.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had Freedom to Speak Up (FTSU) processes in place. FTSU information was clearly displayed and there were FTSU champions within the service. 100% of managers and FTSU champions had completed the relevant training. Staff we spoke with told us that the ward FTSU champions encouraged them to raise concerns or could do so on their behalf. Staff said they were confident to raise concerns, should they need to.

Patients and carers had opportunities to give feedback on the service they received. This included community meetings, meetings with staff, patient representative meetings, questionnaires and surveys. During our site visit, we saw that patients were confident to raise issues that concerned them and complain.

Patients and carers were involved in decision-making about changes to the service and could meet with the senior leadership team. For example, the Service User and Carer Advisory Group consulted on service developments.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The trust had an equality, diversity and inclusion policy and 99% of staff had completed the Equality, Diversity and Human Rights training. The service had ongoing initiatives around equality, diversity and inclusion. These included Diverse Ability passports for staff, staff network celebration events and support with career development for Black and Ethnic Minority (BME) staff. There were equality and diversity champions within the service, for example Diversity in Recruitment Champions.

The service undertook equality monitoring of staff within the service to ensure it was diverse and representative of the patient group. A number of projects were ongoing as part of Patient and Carer Race Equality Framework (PCREF). For example, the PCREF team had proposed to employ Black and Mixed Black peer support workers to help improve the experiences and outcomes for Black service users.

There were anti-discriminatory processes in place. Staff told us that after incidents of racist abuse directed at them, managers spoke to patients involved in the incidents to explain this was not acceptable.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The service had a clear framework of what must be discussed in meetings at a ward, team or directorate level to ensure that essential information was shared. Lessons learnt and performance were on the agenda of staff meetings. Staff had implemented recommendations from reviews of deaths, incidents and safeguarding alerts at the service level.

Staff understood the arrangements for working with other teams, both internal and external, to meet the needs of the patients. The service submitted notifications to the relevant external bodies. Staff involved other services when necessary, including primary and specialist care, criminal justice and community teams. The service actively involved patients in reducing restrictive practices in use.

Governance and performance monitoring arrangements in place supported the quality and safety of service provision and identified risks. Staff undertook local audits and participated in the trust’s audit programme. The provider’s central teams carried out additional audits. The audits provided assurance and staff acted on the results when needed. Leaders responded promptly to our feedback throughout this inspection and shared action plans for the areas of improvement identified.

The service had a risk register which detailed an appropriate range of risks specific to the service and mitigations for these. Staff and patient concerns matched those on the risk register, for example the shortages of ward-based occupational therapy and activity practitioner staff. Leaders we spoke with were open about these areas for improvement and demonstrated that they had been proactive in trying to address them. The service had robust plans for each ward to ensure business activities could continue in the event of emergency, such as adverse weather or loss of utilities.

Staff had access to appropriate equipment and information technology that supported their work. The information technology infrastructure, including the electronic records system, worked well. Systems used to collect data were not over-burdensome for staff.

Information governance systems included confidentiality of personal records. Managers had access to information to support them with their role. Data on bed management, staffing and performance was integrated into the provider’s electronic dashboards. The information system allowed timely and accurate oversight and identified areas for improvement.

Staff understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Staff and leaders worked effectively with external stakeholders, including commissioners, service delivery partners, local authorities, education and training providers, police, prisons, sports organisations, community and voluntary services, and local businesses. The service had worked jointly with these on initiatives that supported patients’ mental and physical wellbeing and re-integration into the community. The service held quarterly learning events with Ministry of Justice (MoJ) teams that benefitted both teams’ and patients’ understanding of the MoJ procedures. The care records we reviewed demonstrated a multi-agency approach to managing safe transition of patients into the community.

Patients had the opportunity to showcase their artwork to the public at the gallery located on the hospital grounds, and could participate in the annual national awards celebrating the creative work of individuals in the criminal justice system.

The service was part of the South London Partnership (SLP), an innovative model of commissioning care based on collaboration of the 3 neighbouring mental health trusts. Staff described this as a positive factor in providing joined-up local care and facilitating patients’ contact with family, friends and communities.

We sought feedback from partner organisations who regularly worked with the service. The stakeholders’ feedback was positive. They described staff as supportive, accommodating and consistent.

Patients and carers were involved in decision-making within the service and could meet with the senior leadership team. The Service User and Carer Advisory Group was a structured group who consulted on service developments. Patients contributed to policy development, research, quality improvement and tendering process.

Numerous innovation and improvement activities were taking place within the service. Staff were given the time and support to consider opportunities for research, improvements and innovation. For example, staff on Spring Ward had created a sensory room for patients as a quality improvement project, and staff on Brook Ward a spirituality room. The service had led on changes to the Historical Clinical Risk Management-20 (HCR-20), a structured tool used to assess risk factors for violence, which meant that neurodiverse needs were considered as part of risk formulation. Staff had access to the trust’s charity funding for quality improvement projects. The charity-funded projects were designed to improve patient experience, for example cycling proficiency training, audiobooks and clothes upcycling. Additionally, 10 patients at the service were recently trained in quality improvement, so they could participate in and lead projects. A patient on Spring Ward recently won a national competition to design a safety pod, which had been developed and was in use on the ward. Staff could present their proposals for approval by the local committees and the South London Partnership. A number of projects were aimed at reducing the inequalities for the forensic patient group. These included restorative justice, physical health, culturally competent interventions, and reducing restrictive practices and the length of stay. Several projects focused on improving the outcomes for Black and Muslim people, because staff knew these groups were overrepresented within the patient group and faced multiple challenges. For example, the service hosted academic research into advance statements for Black African and Caribbean people, and was recently awarded funding for a Patient Voice Project to meet the spiritual needs of Muslim patients better. The service had created a restorative justice practitioner post, dedicated to promoting restorative justice approaches. Restorative approaches were used both to support patients and staff after incidents, as well as to help patients repair relationships in their local communities. Staff participated in national audits relevant to the service and learned from them. A new quality improvement project was approved recently to enhance the quality of audits. Wards participated in trust-wide and local accreditation schemes relevant to the service and learned from them. For example, the service was working towards achieving the National Autistic Society accreditation. Patient involvement and peer support work enabled the launch of the White Ribbon Initiative at River House, an initiative to end male violence against women. It had contributed to the accreditation of the trust as a White Ribbon organisation.