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Provider: East London NHS Foundation Trust Outstanding

Reports


Inspection carried out on 20 March to 18 April 2018

During a routine inspection

Our rating of the trust stayed the same. We rated it as outstanding because:

  • Since the last inspection in 2016, the trust has continued to make improvements. We inspected three services and carried out a well-led review. In all areas further progress had taken place and in forensic services the rating had improved from good to outstanding.
  • We rated safe and effective as good; caring, responsive and well-led as outstanding. Following this inspection, five of the trust’s fourteen core services were rated as outstanding and nine as good.
  • We rated well-led for the trust overall as outstanding.
  • The trust had addressed most of the areas where improvements were needed from the last inspection. In the inpatient and community services for people with a learning disability staff had received training in positive behaviour support, patients had individualised behaviour support plans and staff were supporting patients who had challenging behaviours appropriately. In the forensic service, the use of restrictive practices, including electronic monitoring for patients leaving the hospital was based on individual needs and not a blanket approach. Where work was still in progress, the trust had clear action plans and was monitoring progress closely.
  • The trust recognised that even though it had a rating of outstanding, that did not mean that all patients, carers or staff had an outstanding experience of care or of working for the trust. They had created a culture where people could share their experiences and concerns and where there was a genuine commitment to learning and making improvements. An example of this was found in the investigation of serious incidents and sharing of learning.
  • The trust has made further progress in the use of a quality improvement methodology. We saw that this methodology gave genuine opportunities for staff and patients in wards and teams to identify areas for improvement and make changes. The use of quality improvement was widespread throughout the trust. The methodology had been extended further to address strategic priorities such as improving care pathways and enhancing staff engagement.
  • The trust board was visionary and confident in performing its role. Board members reflected the diverse communities served by the trust. The chair and non-executive directors were committed to ensuring that patients received the best care possible and used their wide range of skills and experience to challenge the executive directors to deliver high quality services.
  • The trust has continued to grow, and shortly prior to the inspection had taken on the provision of community services in Bedfordshire. The trust worked collaboratively in innovative partnerships with other providers to deliver services in Tower Hamlets and Bedfordshire. The trust recognised the value of partnership working and when other providers could enhance the services delivered to patients.
  • The involvement of patients and carers remained central to the work of the trust. Patients were supported to express their wishes and to be active participants in meetings where their care was discussed. The involvement of patients and carers in the wider work of the trust had developed further since the last inspection. This included access to a range of opportunities to contribute to the trust strategy, support operational aspects of the work of the trust and monitor the services delivered by the trust.
  • The trust had strong governance systems supported by high quality performance information. This meant that at all levels of the organisation staff and members of the board had access to useful information that enabled them to gain assurance and make improvements where needed. This enabled the trust to achieve a balance between assurance and improvement work.

However:

  • We identified a number of areas where the trust can make further improvements.


CQC inspections of services

Service reports published 26 June 2018
Inspection carried out on 20 March to 18 April 2018 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 395.53 KB (opens in a new tab)Download report PDF | 851.05 KB (opens in a new tab)Download report PDF | 362.32 KB (opens in a new tab)Download report PDF | 514.55 KB (opens in a new tab)
See more service reports published 26 June 2018
Service reports published 7 February 2018
Inspection carried out on 8 - 9 November 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 327.17 KB (opens in a new tab)
Service reports published 1 September 2016
Inspection carried out on 13 – 26 June 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 606.54 KB (opens in a new tab)
Inspection carried out on 14-16 June 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 444.16 KB (opens in a new tab)
Inspection carried out on 14 - 16 June During an inspection of Community health services for adults Download report PDF | 296.14 KB (opens in a new tab)
Inspection carried out on 13 - 24 June 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 398.08 KB (opens in a new tab)
Inspection carried out on 13 –17 June 2016 & 20 – 24 June 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 356.21 KB (opens in a new tab)
Inspection carried out on 8-9 June 2016 During an inspection of Community health inpatient services Download report PDF | 306.68 KB (opens in a new tab)
Inspection carried out on 13 - 24 June 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 379.57 KB (opens in a new tab)
Inspection carried out on 13-14 June 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 336.27 KB (opens in a new tab)
Inspection carried out on 22 June 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 283.38 KB (opens in a new tab)
Inspection carried out on 14 - 16 June and 21- 23 June 2016 During an inspection of Community-based mental health services for older people Download report PDF | 361.8 KB (opens in a new tab)
Inspection carried out on 21 June 2016 During an inspection of Wards for people with a learning disability or autism Download report PDF | 300.46 KB (opens in a new tab)
Inspection carried out on 13-17 June 2016 During an inspection of Community health services for children, young people and families Download report PDF | 362.11 KB (opens in a new tab)
Inspection carried out on 14-17 June and 7 July 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 460.15 KB (opens in a new tab)
Inspection carried out on 14 June 2016 During an inspection of Child and adolescent mental health wards Download report PDF | 326.23 KB (opens in a new tab)
See more service reports published 1 September 2016
Inspection carried out on 13 June 2016

During a routine inspection

We have given an overall rating to East London NHS Foundation Trust of outstanding because:

  • We have rated four of the fourteen core services that we inspected as outstanding and ten as good.

  • The trust is well led with a visionary board and senior leadership team who have created an open culture that welcomes innovation. There are hard working and enthusiastic staff throughout the organisation who enjoy their work and are committed to improving services. Sitting alongside this are clear systems of assurance that enable the trust to get things right.

  • The trust has invested over the previous two years in a wide scale quality improvement programme. This has been embraced by staff working in the trust. The methodology has successfully encouraged innovation and improvement which we were able to see throughout the inspection. There was a genuine passion to ensure that the services provided are the best possible.

  • Staff worked with patients and their carers to ensure they were partners in their care. Patients were supported to express their wishes. They were active participants in all the meetings where their care was discussed. But more than this, patients were actively involved in the running of the trust. Opportunities were in place throughout the organisation to promote this participation. Examples included patients helping to recruit and train staff. Also patients developed and helped with audits and other quality checks.

  • The trust was mindful of the need to provide the safest care possible. This included making the buildings where care was delivered as safe as possible, providing enough appropriately trained staff, ensuring equipment is in good condition and ensuring all staff considered potential risks for people receiving care.

  • Staff were genuinely engaged in the work of the trust. Many staff had worked at the trust for a number of years and said they would not want to work anywhere else. They knew the senior staff in the organisation, feel it was non-hierachical and said they could raise concerns or ideas in the knowledge that they would be taken seriously.

  • Staff had access to a wide range of opportunities for learning and development, especially leadership training, which had helped many staff to make progress with their career whilst also improving the care they delivered to people using the services. Staff from East London had helped manage the changes in Luton and Bedfordshire which had provided them with opportunities to develop their leadership skills.

  • The trust staff understood the importance of supporting patients with their physical as well as their mental health. In Newham this was made easier as the trust provided mental health and community services. There was positive work taking place to facilitate close working with GPs. Innovative work was taking place to promote good physical healthcare for patients, for example arranging health screenings for female patients.

  • The trust staff worked well with commissioners and other statutory and third sector providers to make sure the best services were provided and to support patients to access all the services they need.

  • The trust recognised and celebrated the diversity of the patients and staff and worked to meet the needs of people using the services. There were a lot of exciting initiatives to meet the needs of people using the trust’s services. The trust also had an active department of spiritual, religious and cultural care.

    However:

  • Although we have rated the trust outstanding overall, our inspection has identified a number of areas in core services rated good or outstanding where further improvement can be made. We expect the trust to continue its journey of continuous improvement and  we will work with the trust to agree an action plan based on the findings of our inspection.            

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.