East London 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 remained good.

Good: This meant the effectiveness of people’s care, treatment and support achieved good outcomes and was consistent.

Staff understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and consistently discharged these well. The service told people about their rights under the Mental Health Act.

Staff assessed the physical and mental health of all people who used services on referral and acceptance to the service. Staff provided a range of treatment and care for people based on national guidance and best practice. Staff from different disciplines worked together as a team to benefit patients. However, the service did not complete audits to ensure physical health checks were being carried out.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However, the service did not complete audits to ensure physical health checks were carried out.

Staff carried out comprehensive assessments of people who used their services which incorporated their mental and physical health needs. They were aware of the impact of social issues on patients’ mental health. We reviewed 30 care records during this inspection. Of these, 25 of the 30 care records we reviewed showed staff had completed a comprehensive mental health assessment of each person in a timely manner. Of the 5 other care records, the mental health assessment was not completed in a timely manner, the longest time was 10 months after admission. All new referrals were assessed at a daily referral meeting by doctors and psychologists including from the primary care network. Staff then made an appointment to meet the person for assessment.

Staff assessed people’s physical health needs in a timely manner. Teams had physical health leads within the team. If someone required urgent treatment, staff contacted the emergency services or took the person to hospital. Physical health monitoring for service users prescribed antipsychotic medication is delivered through a shared-care approach involving both the trust and primary care services. That means trust clinicians transfer the responsibility of ongoing monitoring to primary care networks. Trust clinicians are able to access and review this information through shared care records with primary care. However, the service did not complete audits to ensure that appropriate physical health checks were being done.

Following our inspection the trust told us that they planned to standardise the care-record audit process across community mental health services, to check for quality and timeliness. The service will also implement a clear timeframe for completing the initial comprehensive mental health assessment.

Staff mostly developed care plans that met the needs identified during assessments. Once an initial assessment was completed, a key worker would be allocated to the person. Key workers were professional staff registered with a regulatory body. The key worker was responsible for developing, implementing and updating the person’s care plan. They created care plans based on assessments.

Care plans were personalised, holistic and recovery-oriented. They consistently demonstrated the involvement of the person using the service. They included specific details about the person’s social circumstances, support networks and relapse indicators. As well as focusing on the person’s mental health, care plans covered the person’s physical health needs and concerns about substance misuse. Staff updated care plans when necessary.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well

Staff provided a suitable range of care and treatment interventions. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies and activities, training and work opportunities intended to help people acquire living skills. Interventions were based on people’s specific needs. The service offered different pathways for psychosis, bipolar disorder, depression, anxiety disorders and personality disorder. Treatment on the psychosis pathway primarily involved prescribing antipsychotic medication and psychological therapies, along with group work on understanding psychosis. Psychological therapies included cognitive behavioural therapy, dialectical behavioural therapy, cognitive analytical therapy and behavioural family therapy.

Staff ensured that people had good access to physical healthcare, including access to specialists when needed. Most people using the service received regular physical health checks conducted by their GP.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The services used a comprehensive set of outcomes measures that were regularly audited to measure performance and people’s progress. These included the patient reported outcomes measures, goal-based outcomes, recovering quality of life measures, health of the nation outcome scores and clinician rated outcome measures.

The teams included or had access to the full range of specialists required to meet people’s needs. Each service employed nurses, support workers, family workers, employment specialists, per support workers, psychologists and doctors. Community connectors and approved mental health professionals, were employed by the local authority, but were fully embedded within the community mental health teams.

Managers ensured that staff had access to regular team meetings. Each team held a meeting for all staff each month. At this meeting, staff discussed education, training, learning from incidents, staffing, clinical supervision, feedback from people using the service, trust-wide developments, quality assurance and performance.

The service provided some of the additional specialist training for their roles. This included training on psychosis assessment and treatment, training on personality disorders and family therapy training were encouraged for all staff. In Newham the local authority had offered investigating officer training to the staff so the teams could investigate their own safeguarding referrals.

Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. However, not all teams met the trust target of 90% for this. Training compliance was Bedford at 74%, City and Hackney at 83%, Luton at 93%, Newham at 83% and Tower Hamlets at 82%.

Following our inspection, the service provided information showing compliance had improved above the trust target for each locality. Bedfordshire was now at 94%, City and Hackney was now at 96%, Luton was now at 100%, Newham was now at 96% and Tower Hamlets was now at 96%.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

People using the service had easy access to information about independent mental health advocacy from a local advocacy provider.

The number of people subject to Community Treatment Orders (CTOs) varied between the different teams. Each team typically had three or four patients subject to community treatment orders. The trust had implemented a quality improvement project improve their compliance of section 132A of the Mental Health Act. This section places a statutory duty on trusts to provide specific information regarding a persons legal rights to people who are on a CTO. From October 2024 to October 2025, compliance for this had gone from 69% to 100%.

Staff explained to each person their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in patients notes each time. When a person was subject to a CTO, a social worker, responsible clinician or their community psychiatric nurse ensured they were aware of the implications of the CTO and their rights to appeal to a tribunal.

Care plans clearly identified people subject to the Mental Health Act and identified the Section 117 aftercare services they needed. Section 117 aftercare provides free support and services to individuals who have been detained in hospital under specific sections of the Mental Health Act 1983 after they leave. Staff reviewed the arrangements for people receiving aftercare services under Section 117 of the Mental Health Act and ensured that details were included in care plans.

The service worked well across teams and services to support people. The service mostly met targets for seeing people within 72 hours of discharge from a ward.

Staff held regular and effective multidisciplinary meetings (MDT). MDTs were set up with the purpose of ensuring accurate diagnosis, treatment and clinical decisions. Each service held a MDT every week and all staff were invited to these meetings. During the multidisciplinary team meetings staff discussed clinical matters including safeguarding, people requiring a 72-hour or 7-day follow-up, people in hospital, people at risk, new referrals, caseload allocations and any concerns that staff may have had. The Tower Hamlets neighbourhood teams had daily MDT meetings to discuss all new referrals that had come in that day.

The service followed up patients that had been discharged from a ward within 72 hours. At the time of our inspection compliance was 82%. Over the 12 months prior to our inspection the average compliance for this was 81%.

The service had regular audits and case reviews embedded into practice to support identification of overdue follow-ups, to reduce delays in follow-up contact. Over the 12 months prior to our inspection the service had implemented a range of initiatives to improve the rate of compliance including introducing pre-discharge discussions in Newham and Tower Hamlets to explain 72-hour follow-up and piloted a process for wards to schedule follow-up appointments directly in community clinics, giving service users clear timelines for contact.

Staff shared information about people using the service at effective handover meetings within the team. Each team held a daily safety huddle to discuss and plan responses to emerging risks. We spoke to clinical staff across the service, and observed clinical staff discussion about the people who used their service. Staff clearly knew the people using their service well. They were familiar with each person’s individual risks and personal circumstances. The teams worked collaboratively, with staff offering to help and support each other.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. The services worked collaboratively with other teams within the trust to support people. This included the autism assessment service, the crisis resolution and home treatment team and inpatient mental health services. Teams liaised with child adolescent mental health services to manage the transition into the community-based mental health services for adults of working age service.

The teams had effective working relationships with teams outside the organisation. Shared care arrangements were agreed with GPs that included conducting physical health checks for these people.

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

Staff supported people to live healthier lives, for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. Mangers from each team attended health and well being clinics monthly with GPs to discuss people who used their services. Teams had access to health coaches. Some people had riskier lifestyles involving drugs, criminality and alcohol. The service sought to support people by working collaboratively with other agencies such as substance misuse services and children’s services within the local authorities.

The services arranged activities that helped promote a healthy lifestyle for people using the services. This included walking groups, activity groups, swimming groups and gym groups. Staff would suggest meeting people who used the service for a walk or outside.

The service routinely monitored 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.

Managers and staff monitored outcomes for people who used services through regular audits completed using an online tool. Managers used results from audits to make improvements. For example, staff took part in clinical audits of risk assessments and care plans and medicines. The trust provided actions following audits for the localities of Tower Hamlets and Newham, however did not provide these for other localities. In Tower Hamlets duty managers reminded staff at daily huddles to record next of kin details on care records. In Newham staff were focusing on improving the recording of crisis plans in care records, which was to be monitored in supervision.

The trust had implemented a patient rated satisfaction scale to be able to monitor people’s care and treatment. Staff had been trained on this and it was being embedded into the service. At the time of our inspection, approximately a third of the people who used the service had an initial score and a follow up score, which allowed the service to compare the 2 scores.

We saw learning and actions were identified to improve care following audits.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. However not all staff were up to date with Mental Capacity Act training.

Staff assessed and recorded capacity to consent appropriately when it was suspected a patient’s mental capacity was impaired. Capacity to consent was considered at each assessment and recorded in the care records we reviewed. Staff gave examples of when they had enabled people who used services to make their own decisions about their care and treatment and discussed their symptoms and risks with them and related them to their care and safety plans.

For people who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Records showed that staff assessed people’s mental capacity at every appointment when there were concerns about this. When people lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. The service ensured people had access to advocacy services.

Most staff received and kept up to date with training on the Mental Capacity Act and could explain the key principles of the Act. Training on the Mental Capacity Act formed part of the trust’s mandatory training programme. However, not all teams met the trust target of 90% compliance with this training. Teams that were below this target were:

Bedfordshire and Luton

• Bedford DECAR Hub – 50%
• Crombie CMHT (Bedfordshire) - 60%
• Beacon CMHT (Bedfordshire) - 45%
• Early Intervention Service (Bedfordshire) - 71%
• Bedfordshire Recovery Team – 80%
• Spring House CMHT (Bedfordshire) - 45%
• Luton Community Mental Health Hub – South – 60%

City Hackney

• Neighbourhood Recovery Service – 78%
• EQUIP Team (Early Intervention City Hackney) - 73%
• City and Hackney North CMHT – 78%
• City and Hackney South CMHT – 67%

Newham

• Community Integrated Mental Health Team (North) - 77%

Tower Hamlets

• Stepney Wapping Neighbourhood Mental Health Team – 75%
• Bow Poplar Neighbourhood Mental Health Team – 54%

Following our inspection, the service provided information showing compliance had improved overall across the localities, although all localities were still under the trust target. The service told us that the Mental Capacity Act training had been suspended while it was updated following advice from the NHSE in June 2026. This training was reinstated in September 2026.