East London NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

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

We found 1 breach of regulation in relation to timely access to appropriate care and treatment. The score of 1 for the quality statement ‘Equity in access’ limits the overall rating for the key question to requires improvement.

Requires improvement: This meant people’s needs were not always met.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

However, the service made sure people were at the centre of their care and treatment. They supported people with activities outside the service such as work, education and family relationships. They made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

This service scored 62 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

All people we spoke to said that staff understood their individual needs including cultural and religious needs. Staff helped people with communication and their social issues, such as homelessness and access to services. Staff recorded in people’s care records their individual needs and preferences, and whether they had any communication or accessibility needs. Staff created communication passports for people with communication or accessibility needs.

Staff discussed people who used their services’ specific needs in daily morning planning meetings. Staff made sure people could access information on treatment, local services, and how to complain.

During our inspection we saw examples of how staff in the service provided person-centred care. Staff responded flexibly to ensure care and treatment was delivered in line with people’s choices. The community mental health and early intervention service teams all had peer support workers as part of the team. Peer support workers would spend one to one time with people who used the service and offered to meet people in a park for a walk. Staff and people who used the services gave positive feedback about the support.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up and flexible.

Staff worked in a collaborative way to provide continuity of care and treatment. Managers and staff told us they had good relationships with the primary care network. GPs could refer directly to the service and were involved in discharge planning for people who used the service. Some teams had link workers that liaised between the community-based mental health services for adults of working age service and primary care. The Tower Hamlets neighbourhood mental health teams had a daily referral meeting with GPs and psychologists to discuss all new referrals from that day.

The community-based mental health services for adults of working age service ensured that families and carers had opportunities to be involved in the care and treatment of the people who used their services, with their consent. Families and carers were usually present during home visits by the team. Staff told us that they knew it was important to involve carers and families as they provided contextual information on a person that would benefit formulating their care plan.

The service was in the process of embedding the Triangle of Care to formulate care plans. The Triangle of Care is an improvement tool based on 6 principles to ensure providers include and support unpaid carers. Staff referred carers to the local authority for a carers assessment. The people participation lead for the trust ran a working together group for carers, and managers from the service would also attend.

Some teams in the community-based mental health services for adults of working age service included occupational therapists. They worked with care co-ordinators to develop joint care plans for people using services. This meant people were supported with goal setting and developing daily living skills.

Staff we spoke with told us it was difficult to access support for neurodiverse people and described long waiting times for assessment services. Staff could refer to an assessment service, and staff from the assessment service came to the teams and provided support on working with neurodiverse people. Some staff felt they did not receive enough training in working with neurodiverse people to meet their needs fully.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff across the community mental health service ensured that people who used services could obtain information on treatments, local services, rights and how to complain. There were notice boards and leaflets in service user areas and people were given information about other services as part of their assessments. The service also had a list of staff who were bilingual and were happy to support people who used their service with their language skills.

Staff communicated with people who used services so that they understood their care and treatment, including finding effective ways to communicate with people with communication difficulties. People we spoke to told us the service made an effort to meet their communication needs.

The service complied with the Accessible Information Standard. The Accessible Information Standard is a legal requirement for organisations providing NHS care to ensure that people with disabilities or sensory losses receive information and communication support in a way they can access and understand. The trust had assessed its website against accessibility standards and found that most information could be easily accessed by people who used services having the ability to make the website larger or by changing colours and fonts.

Information governance systems ensured the confidentiality of care records. Staff accessed electronic patient records securely, using passwords, and logged out when not using them to prevent any unauthorised access.

Staff at the service made notifications to external bodies where relevant. Managers told us that they made all necessary notifications to external bodies, for example, reporting relevant concerns to the CQC.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Most people we spoke to knew how to complain or raise a concern. Staff knew how to respond to complaints and described the escalation process and how learning from complaints was shared in team meetings.

The service provided information which showed 254 formal complaints were made between November 2024 and October 2025. However, this data included complaints for the crisis service, so it was not clear how many related specifically to community-based mental health services for adults of working age. The top 5 themes for complaints, which made up 77% of the complaints, were concerns about assessment, access to services, clinical management, attitude of staff and communication. In the same period, 3 complaints were referred to the Parliamentary and Health Service Ombudsman (PHSO), but it was not clear if they related to community-based mental health services for adults of working age. The PHSO took no further action on 2 cases and 1 was still in progress.

The service used a patient reported experience measure (PREM) to gather feedback from people who used services and their carers. Each team had a unique PREM QR code which people could use to leave feedback. Between November 2024 and October 2025, the service received 3,201 responses, with the majority, 73%, being good or very good.Each team had a PREM champion to support locally with the collection and sharing of learning from PREM responses.

The trust had a ‘Carers, Friends and Families Strategy’ for 2022 to 2026 co-produced with carers and staff. It set out 5 priority areas including improving identification and recognition of carers, staff awareness of carers, clear pathways to access support for carers and help in a crisis, carer voice and involvement and ensuring the right support is in place for young carers. Implementation of the strategy was overseen by a carers strategy implementation group which met bi-monthly and enabled directorates to report any achievements and escalate any challenges.

The service did not make sure that people could access the care, support and treatment they needed when they needed it.

The service did not always provide treatment in a timely way. In the City and Hackney locality non-urgent referrals were not assessed within 28 days.

In the 12 months prior to our inspection, across the community-based mental health services for adults of working age service localities, the average number of days from referral to initial assessment were as follows:

• Bedfordshire – 28 days
• City and Hackney – 65 days
• Luton – 24 days
• Newham – 11 days
• Tower Hamlets – 37 days

At the time of our inspection, across the service there were 2,353 service users waiting to be seen for an assessment. There were 477 in Bedfordshire, 188 in Luton, 789 in City Hackney, 204 in Newham and 695 in Tower Hamlets. In August 2025, there was an increase in the number waiting for an assessment. Senior locality leaders told us this was due to an increase of referrals in the Tower Hamlets locality and the opening of Barnsley Street.

Following our inspection the trust provided information showing an improvement across most localities. As of July 2026 the average number of days from referral to initial assessment were Bedfordshire was now 20 days, City and Hackney were now 62 days, Luton was now 17 days, Newham was now 14 days and Tower Hamlets was now 31 days. The waiting list had also reduced to 1,846. There were 453 people waiting to be seen in Bedfordshire, 265 in Luton, 448 in City Hackney, 159 in Newham and 521 in Tower Hamlets. The service used dashboards to routinely review waiting lists and caseloads to ensure that people were actively managed. Intensive and assertive treatments for people had been identified and flagged on the care records system so all staff could see this. The service had introduced a waiting well process in the last year. All people waiting longer than 28 days were telephoned to check on their well-being and any potential risks. If there was risks identified then an urgent visit or appointment was arranged. All people waiting were reminded of the crisis contact details.

People who used the service and were waiting for assessment were reviewed every week and were prioritised for assessment if the risk increased. Senior leaders told us that in City Hackney the teams were looking at including a specific assessment service to reduce waiting times. We were told this was to start in April 2026. Senior leaders told us the increase in complexity of people who used their service was impacting waiting times. We were told there was an action plan to address any cases where the person had received no contact in the past 6 months, however the trust did not provide details on actions and target dates. Delays within the Tower Hamlets neighbourhood teams were linked to service users not engaging with the teams, with regular reviews in place to assess their ongoing care needs.

The number of people who required a follow up but were not seen in 12 months in Bedfordshire was 173, City and Hackney was 75, Luton was 14, Newham was 2 and Tower Hamlets was 103. In City and Hackney, the number of people not seen in 12 months had reduced from 247 to 75 from July 2025 to November 2025. We were told that over the 12 months prior to our inspection, the number of people who required a follow up but had not been seen in 12 months had reduced, however the trust did not provide details of this reduction for the other localities.

Following our inspection the trust provided information showing an improvement across the localities. The number of people who required a follow up but were not seen in 12 months was now 26 in City and Hackney, in Newham all people had been offered an appointment, and 89 in Tower Hamlets. Across the Bedfordshire and Luton teams 705 people, or 9.5%, were waiting a first appointment, while 292 people, or 3.9%, have not been seen for over 12 months.

The service also had waiting lists for people to access psychological therapies. In the 12 months prior to our inspection, across the localities, the average number of days people were waiting for therapies was as follows:

• Bedfordshire – 48 days
• City and Hackney – 75 days
• Luton – 38 days
• Newham – 35 days
• Tower Hamlets – 62 days

Staff we spoke with told us waiting times for psychology impacted a person’s journey through the service. They told us they kept people on the teams' caseload for longer than necessary whilst they were waiting for psychological input, potentially creating a dependency on the service.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff in the community-based mental health services for adults of working age service were mindful of providing an inclusive service that protected people’s human rights. Staff received training in equality, diversity and human rights and across teams the compliance rate averaged 98%. The teams met the needs of all people who used their service, including those with a protected characteristic. A protected characteristic is one that is protected by law against unfair treatment or discrimination. We spoke to 16 people and those that had protected characteristics felt the services had incorporated these into their care.

The trust had assessed itself against the Patient and Carer Race Equality Framework (PCREF). PCREF is a mandatory framework for trusts to follow to become an actively anti-racist organisation by ensuring they are responsible for co-producing and implementing concrete actions to reduce racial inequalities within their services. They had an action plan for 2025 to 2026 which covered key objectives including consistency of ethnicity recording, developing a tool on the electronic care records system to record carer demographic information, reviewing advocacy services to ensure they were culturally appropriate and developing an advanced choices document.

Staff across the service told us about the diverse needs of their populations. They understood how this could impact people’s experience of care and treatment. For example staff told us that people for whom English was not a primary language were less likely to engage in the service, so staff would ensure there was access to interpreters and information was provided in their language.

The service had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Medicines information leaflets were provided in multiple languages and easy-read formats.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff ensured relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. Teams within the service had regular multidisciplinary (MDT) meetings. We saw multiple examples within the meeting minutes of partnership working to ensure the best outcome for people who used services. People with complex needs were discussed at MDT meetings and relevant plans made.

All staff we spoke to told us about the importance of discharge planning from the first point of assessment. We reviewed 30 care records and saw discharges were discussed, and staff recorded when people were still receiving intensive treatment and were not ready for discharge yet. We saw 24 of the 30 care records had robust crisis and safety plans in place. Most people we spoke to told us staff helped them plan what to do if their condition deteriorated and ensured they had contact details to use if this happened.

Staff supported patients to make decisions about their care and treatment and their future. Staff were able to refer to other teams and services if appropriate, such as autism services.