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 and fair culture.

At our last comprehensive assessment, we rated this key question good. At this assessment, the rating changed to requires improvement.

We found areas for improvement as follows:

Staff said that they would like more opportunities to contribute to discussions about the future of the service where they worked, particularly where changes were being proposed or implemented.

Staff across Eileen Skellern 1 ward, Warton ward, and Clare ward told us that their morale was low, they felt unsafe due to the high acuity of violence and aggression they experienced at work. This was an issue at the last inspection and remains an area to address.

Staff said that while they understood the arrangements for speaking up, many did not feel able to speak up or that their concerns would be heard and addressed.

Whilst there were governance systems in place to provide assurance, the breaches in the safe domain reflect that these are not working consistently well.

There was evidence of good practice. Ward managers and matrons were visible in the service and approachable to both staff and patients. They had a good understanding of the wards and patients’ individual needs, risks and circumstances. There was a PICU forum held monthly to connect the PICU units across the trust. This promoted peer support and sharing of best practice and learning. Quality improvement approaches were being used across the services and there were examples of positive results.

This service scored 57 (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 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 knew and understood the provider’s vision and values and how they applied to the work of their team.

Staff reported that senior managers visited the wards. Senior managers conduct routine walkarounds, complemented by bi-monthly joint walkarounds with quality and operations, integrated support services, and estates and facilities teams, with the aim to enable real-time escalation and resolution of operational issues. Staff said that they had some opportunity to contribute to discussions about the strategy for their service. However, they felt they needed more opportunities to contribute to discussions about the service’s strategy, particularly where changes were being implemented at the frontline level.

Most staff said they felt respected, supported and valued by immediate colleagues. Staff said the trust provided opportunities for development and career progression. Staff spoke with pride about the service and goals to deliver safe, high-quality care.

We found that staff across the trust demonstrated a strong commitment to patient care despite the challenges of working on high-intensity wards.
 

The evidence showed some shortfalls.

Staff knew who senior leaders from their directorate were and these leaders visited the wards. We found that most senior leaders had the skills, knowledge, and experience required for their roles.

Staff told us that ward managers had a good understanding of the services they managed. We observed that ward managers and matrons were visible in the service and approachable to both staff and patients. They had a good understanding of the wards and patients’ individual needs, risks and circumstances.

Staff said safety concerns that they raised were not always recognised or addressed sufficiently. Staff across Eileen Skellern 1 ward, Warton ward, and Clare ward told us that their morale was low, they felt unsafe due to the high acuity of violence and aggression they experienced at work This was an area for improvement at the previous inspection. Although they had raised this and supervision and reflective practice was offered, their experience had not changed.

Managers recognised and managed poor performance, including working to understanding reasons for this.

The evidence showed some shortfalls. Staff did not always feel they could speak up and that their voice would be heard.

Information about the Freedom to Speak Up Guardian (FTSUG) was displayed on the wards and staff said knew about their role and how to contact them. However, staff told us they did not access speak up initiatives as they felt it would not be effective, and no changes would be made. The trust should strengthen Freedom to Speak Up processes to ensure staff feel confident that raising concerns will lead to meaningful change.

Staff we spoke with said they felt able to raise concerns at a local level with managers.

Patients had opportunities to give feedback on the service they received, for example, through community meetings, during their one-to-one session with staff, and through patient feedback surveys.

The trust had developed an Anti-Racism Action Plan with involvement from staff, service users and carers. One part of this was focussed on workforce, with an aim to achieve an equitable and supportive environment where all staff, especially those from Ethically and Culturally Diverse backgrounds felt empowered, respected and valued. This included delivering anti-racism training, strengthening existing staff networks, inclusive recruitment and supportive career development. Whilst this plan was in place, staff told us that they did not always feel it was put into practice. Some staff said they still experienced racism and did not always feel that recruitment was carried out with equality of opportunity. The trust recognised that these were areas that needed improving. The trust’s Workforce Race Equality Standard data for 2023/2024 showed a slight improvement of 0.24% (47.66% to 47.04) in ethnic minority staff believing the trust provides equal opportunities for career progression or promotion.

Most staff said they were happy with their local ward management. Staff had access to support for their own physical and emotional health needs through an occupational health service.

Staff were able to apply for flexible working arrangements, and managers made reasonable adjustments to support staff in conducting their roles. Examples demonstrated that the service supported positive work–life balance, contributing to workforce equality, diversity, and inclusion, and ensured adjustments were made to maintain service delivery.

The trust had four staff networks available. These were the Black and Minority Ethnic Staff Network, the Diverse – ability (disability) Staff Network, LGBT Staff Network and the Lived Experience Network. The trust were a Stonewall Diversity Champion and a disability confident employer.
 

We found evidence of several areas of good practice, although there were some shortfalls around the effectiveness of audit processes.

Although staff undertook clinical audits and other assurance checks, these were not always effective in identifying shortfalls. Despite regular audits of seclusion and patients’ NEWS charts, the audit systems in place failed to detect the issues we identified during our inspection. This demonstrated a lack of effective oversight. This was a breach of regulation 17 Good governance.

However, we also found several areas of good practice.

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.

The trust had a framework of what must be discussed at a ward, team or directorate level meetings. This ensured that essential information, such as learning from incidents and complaints, was shared and discussed.Where staff could not attend the meetings, the information would be made available to them.

There were daily clinical care meetings, safety huddles, and regular governance, business meetings and least restrictive practice meetings on the wards.

Ward managers met together weekly, and they described good support from their matrons. There was a PICU forum held monthly to connect the PICU units across the trust. This promoted peer support and sharing of best practice and learning.

The trust had a clinical risk management process in place, including risk registers for the wards. Staff were able to contribute risks to the risk register. Risk registers were reviewed each month by the divisional management boards. Risks were escalated to the board meeting, where appropriate.

The trust collected feedback from patients about their experience through the patient experience audits carried out throughout the year.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership with others. They shared information and learning with partners and collaborated to drive improvement.

Community care coordinators were invited to all ward rounds, either in person or via video conferencing facilities. Senior managers engaged with external stakeholders, such as commissioners and Healthwatch.

There were various Quality Improvement (QI) and ongoing projects in collaboration with external partners across the trust. For example, joint initiatives with local authorities and community organisations supported patient discharge planning and continuity of care. These partnerships supported innovation and service improvement and helped enhance the quality and effectiveness of patient care.

The trust engaged with various community teams, such as theThe Croydon Crisis Plus project, an Anticipatory Management Plan (AMP). This supports high-intensity users (HIUs) of mental health services who experience frequent cycles of crisis from admission to discharge, who have had more than three inpatient admissions in twelve months.
In addition, the trust highlighted its strong partnership with the South East London Suicide Bereavement Service, which provides support to anyone affected by suicide, including staff. This service is delivered in collaboration with a third-party organisation and is based in Bethlem.
 

The evidence showed a good standard. The service maintained a focus on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to creating safer, more effective practice and ongoing research.

The Trust Staff Awards ceremony was held on 5 March 2025 to celebrate staff and their hard work, dedication, and achievements.

Staff told us that Lucas Ward was recently recognised with the ’Clinician of the Year Award’ and is currently ranked among the top three wards across the trust in terms of performance and patient outcomes. The work on Lucas Ward was part of a research trial, providing intensive psychological support to patients.

Staff were committed to continually learning and improving services. Staff used quality improvement (QI) methods to make improvements in care and the quality of services provided. Quality improvement projects included improving the daily ward planning meeting, ensuring patients had a written record to take to their ward round as a prompt, welcome packs for new patients and a new weekly film night. Lucas Ward had a quality improvement board on which all staff could submit suggestions for improvements. On Jim Birley Unit, there were quality improvement projects to improve the completion of daily tasks and to generate more feedback from patients. On Eileen Skellern 1, there was a quality improvement project to have more reflective and effective staff handovers.