East London NHS Foundation Trust

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• 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 outstanding. At this inspection the rating has changed to requires improvement. We found 1 breach of regulation in relation to good governance. The score of 1 for the quality statement ‘Governance, management and sustainability’ limits the overall rating for the key question to requires improvement.

Requires improvement: This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

Governance processes did not always operate effectively. Performance and risk were not managed consistently. However, staff knew and understood the provider’s vision and values and how they applied to the work of their team. The service had inclusive leaders at all levels who understood the context in which they delivered care and treatment. Staff felt respected, supported and valued. The service shared information and learning with partners and collaborated for improvement.

This service scored 71 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights and diversity and inclusion. However, not all staff felt they had been involved in developing the vision and values for the service.

The trust’s senior leadership team had successfully communicated the trust’s new vision and values to the frontline staff in the service and staff could describe these and how they applied to their team.

Staff knew and understood the trust’s vision and values and how they were applied in the work of their team. All staff and senior leaders we spoke to had a good understanding of the needs of their patient populations. We saw information on the trust values displayed in team bases we visited. Staff were aware of the trust ‘promise’ which was ‘we care, we respect, we are inclusive’. They were able to describe how this applied in their day-to-day work, for example using outreach teams to provide support and services to marginalised groups to address health inequalities.

Most staff described supportive cultures within their immediate teams that were focussed on delivering high quality care for people who used services.

Staff could explain how they were working to deliver high quality care within the budgets available. Mangers told us this was focused on development of staff and their competencies. Managers and staff gave us multiple examples of staff undertaking further training and development in their roles.

However, some staff described concerns about a lack of support and communication from the wider trust.

The service had inclusive local leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, senior trust leaders were not always visible and approachable in the service for all staff.

Leaders had the skills, knowledge and experience to perform their roles. We spoke with senior leaders in each locality. They showed a good understanding of the services they managed, and their challenges. Team and service managers had held their roles for at least a year, and most had developed into the role within the trust. Leaders spoke with openness about improvements needed in the services they led.

Staff described supportive working relationships with local leaders and managers. Staff told us they felt listened to and supported on a team level. Local leaders told us they were proud of how teams were working to provide high quality care. They described teams that demonstrated strong resilience and compassion. They also highlighted a clear open-door approach within local management and leadership, where staff were encouraged to raise any concerns or issues. Leaders and managers in the service spoke of supportive working relationships with trust leadership. They explained that they could escalate concerns when they believed financial pressures might compromise quality, and that they had the autonomy to develop services within their divisions to meet the needs of their communities.

There were leadership development opportunities available to staff. Most staff told us about a range of personal and professional development opportunities they had access to. For example, a nurse had been able to become trained as a nurse prescriber and another nurse was interested in becoming an Approved Mental Health Practitioner (AMHP) and so their manager encouraged them to apply for this. An AMHP is a trained professional authorised to assess and coordinate care for individuals experiencing mental health crises, often working alongside psychiatrists and social services. Some managers spoke positively about the opportunities they had been given from the service.

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

Staff described a positive culture in their teams, with open communication and an ability to have open and honest reflection with each other. Leaders encouraged staff to raise concerns and staff felt comfortable to do so, without fear of retribution. They were confident in speaking up if they had concerns about people’s safety. Staff were aware of the role of the Freedom To Speak Up (FTSU) Guardian and knew who to contact to raise concerns. A FTSU Guardian works alongside the trust’s senior leadership team to ensure staff have the capability to speak up effectively and are supported appropriately if they have concerns regarding patient care. We saw posters showing staff how to the contact the guardian in bases we visited. Staff completed FTSU training as part of their mandatory training requirements.

Information provided by the service showed there were 12 FTSU concerns raised across the service between November 2024 and October 2025. The main themes related to trust internal processes and inappropriate attitudes or behaviours by staff.

The trust’s Freedom to Speak Up - Raising Concerns and Whistleblowing Policy was being reviewed at the time of our inspection. We reviewed the policy to be submitted for approval. It gave staff information about different ways they could raise concerns and explained the steps involved in raising concerns through the Freedom to Speak Up process, including what staff could expect as a response. There had been 1 whistleblowing raised in the service November 2024 and October 2025. This was around management of workload in a team.

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.

Staff were able to apply to work flexibly and the service supported them to return to work taking account of personal circumstances such as health issues. Staff and leaders gave us examples of flexible working arrangements that supported people’s personal circumstances such as caring responsibilities and religious commitments. For example, a member of nursing staff within a Community Integrated Mental Health Team was supported with a phased return to work following a period of maternity leave.

Staff gave examples of reasonable adjustments made to the workplace to support them to stay in work. The trust had a Work-Life Balance Policy which guided managers on flexible working arrangements for staff where it was appropriate and explained the process for staff to appeal decisions to not allow flexible working.

The service had ‘lead role champions’ with additional knowledge to support staff across a range of equality and diversity areas including women’s health, men’s health, equity and diversity and older people. Staff could access support from a range of staff networks within the trust including the race and culture equity network, the LGBTQIA+ staff network, the ability staff network for staff with disabilities and long-term health conditions, a women’s network and a men’s network.

The trust had analysed the results reported in the Workforce Disability Equality Standard (WDES) report for 2024 to 2025. WDES data is only available at trust-level rather than service-level. In 2025, 8.4% of the workforce identified as having a disability which was an increase from the previous year, where 7.5% identified as having a disability. The trust had reviewed all actions from 2024 with improving access to reasonable adjustments continuing as a priority. The trust had launched a section on the intranet containing support and guidance regarding workplace adjustments, including a refreshed guidance document, flowchart and process information.

The trust was a Disability Confident level 2 employer and was signed up to the Mindful Employer Charter. Disability Confident is a government scheme designed to encourage employers to recruit and retain disabled people and those with health conditions. Mindful Employeris a national initiative supporting employers to take a positive approach towards mental health at work.

The trust had analysed the results reported in the Workforce Race Equality Standard (WRES) report for 2024 to 2025. WRES data is only available at trust-level rather than service-level. In 2025, 59.2% of the workforce were from an ethnic minority group which was an increase from the previous year, when 57.4% were from ethnic minority groups. The trust had identified 4 priority areas for improvement based on the results, focused on improving recruitment and progression for staff from ethnic minority backgrounds and continuing the trust’s anti-racism programme.

The service did not always have good governance. They did not always act on the best information about risk, performance and outcomes. The service did not have clear and aligned responsibilities, roles and systems of accountability.

The service did not always operate effective systems to assess, monitor and improve the quality of services. We found some areas where monitoring was not completed, and audits were not robust.

Though managers undertook some local audits, they were not sufficient to provide assurance. For example, the service did not provide information that showed they have a consistent process to audit the completion and quality of risk assessments and risk management or safety plans. We saw this impacted on quality and consistency of care records and tools used for risk assessment and care planning. The service also did not monitor people waiting in the service for an inpatient bed. The service did not have a valid ‘did not attend’ policy in place.

There was no consistent framework of what must be discussed at team or locality level in governance meetings to ensure that essential information, such as learning from complaints, was shared and discussed. We requested minutes of governance meetings and found each locality had different systems for who met, how often and how meetings were recorded.

Following our inspection the trust told us they planned to introduce a standardised review of care records audit across all adult community mental health teams. The audit will consider both completion and quality. The audits will be embedded in the incident reporting system, and will be supported by electronic risk assessment and formulation forms. The trust told us variation in how governance processes were applied locally sat within a clear overarching governance framework for the trust. They told us a focused governance review was in progress to the consistency of governance structures and processes

However, staff maintained and had access to the risk register at locality level. Staff concerns matched those on the risk register and issues we found during the inspection were also reflected on the risk register. For example, the risk register for Tower Hamlets included staffing vacancies and high referral rate which led to wait times for people who used the service. The register included controls in place, any gaps, actions to mitigate risk and a risk owner.

The service reported and learnt from incidents. Learning from incidents took place locally and trend analysis and learning from incidents is undertaken at a locality level for each of the community teams in different localities.

The service had plans for emergencies which were particular to each locality and team. They included plans for loss of staff, utilities and information technology and telecommunications and gave staff clear processes to follow in such an event. The business continuity plans were reviewed and updated regularly.

Staff mostly had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care. However, not all staff had access to lone working devices or telephone applications to keep them safe whilst working alone in the community.

The service 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.

The trust had close working relationships with other trusts and organisations that were part of the North East London network. Locality leaders and managers engaged with external stakeholders. For example, in City and Hackney a dual diagnosis team had been established with local authority funding, to support the teams in this service. Community connectors from voluntary sector organisations were integrated into teams to support diverse populations, and formal agreements existed with charities to manage complex referrals.

In Tower Hamlets, there was the Tower Hamlets Alliance, which included primary care, drug and alcohol services, and the voluntary sector. The Barnsley Street Neighbourhood Mental Health Centre pilot was being used to model and transfer successful practices across teams.

In Newham a partnership board had been developed to connect directly with teams, and to stabilise funding for local third sector organisations.

In Bedfordshire there were strong relationships with voluntary sector partners. There were ongoing efforts to build relationships with three distinct local authorities.

Managers and senior leaders attended meetings regarding the mental health transformation for their relevant borough. The senior leadership team would meet with commissioners, which included providers and stakeholders across the mental health community pathway.

The service shared information appropriately with external partners and stakeholders. Where the service worked jointly with external services to provide support to people, they had third party access agreements to enable the use of care records systems and information sharing. These agreements outlined the purpose for accessing trust systems, how the data would be used, who required access and any circumstances where it might be shared. The service also had a number of information sharing agreements with external partners and providers.

The service shared information about patient safety incidents categorised as severe harm or death with key system partners across the Integrated Care System (ICS). We saw incident reports and decisions on incident grading were shared with the Integrated Care Board (ICB).

The service focused 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 contributed to safe, effective practice and research.

Teams participated in accreditation schemes and related national and local networks. For example, the Stepney Wapping neighbourhood mental health team and the Tower Hamlets early intervention service had received a platinum award in the trust’s unique service user-led accreditation programme. The trust in conjunction with service users and carers had developed a pioneering programme to recognise excellence, support improvement in patient experience and develop key markers of quality that matter most to people who used the services.

Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes. Managers and staff told us about current quality improvement initiatives taking place across the service. For example, in Tower Hamlets the teams in this locality were involved in a quality improvement forum. This included staff, people who used services and carers. The forum was chaired by a former service user.

Staff told us there was a good supportive culture, with a weekly teaching program for all staff. Speakers from outside the organisation were invited to deliver sessions on specialist topics.