East London NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question good. At this inspection the rating has remained good.

Good: This meant people were supported and treated with dignity and respect; and involved as partners in their care.

Staff treated people who used services and patients with compassion and kindness. They respected people’s privacy and dignity. They understood the individual needs of people and supported them to understand and manage their care, treatment or condition. Staff involved people in care planning and risk assessment and actively sought their feedback on the quality of care provided.

However, the service did not consistently promote the welfare of staff who were required to work alone.

This service scored 70 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff treated people with kindness, empathy and compassion and respected their privacy and dignity.

We observed care and treatment in health-based places of safety (HBPoS), on home visits and during telephone and face to face assessments. We saw respectful, kind and responsive attitudes and behaviours from staff towards people during our observations. Staff did not rush people during conversations and gave them time to ask questions and voice any concerns.

Staff provided people with help, emotional support and advice at the time they needed it. We saw staff maintained the confidentiality of information about people in visits we observed, asking consent to share appropriate information or make referrals to other services.

In daily handover meetings we attended during our inspection, we saw staff knew the people they were working with well and were caring and respectful when talking about them.

We spoke to 13 people who used services. People mostly said staff treated them with kindness, using words such as polite, gentle and caring to describe interactions with staff. However, 2 people told us some staff had been rude and condescending towards them. Two people told us they had not found staff attitudes when calling 111 option 2 helpful.

The service provided examples of feedback given by people who used services via the patient reported experience measure between November 2024 and October 2025. People who used services mainly said they felt listened to and understood by staff involved in their care and treatment.

The service treated people as individuals and made sure people’s care, support and treatment met their needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff received training in recognising and responding to autistic people and people with a learning disability. The service did not provide information on compliance with this training. However, staff we spoke to during our inspection confirmed they had completed this training. Following our inspection, the trust told us though clinical staff were required to complete recognising and responding to autistic people and people with a learning disability, this was not included in mandatory training compliance reports due to difficulties accessing the appropriate training at Integrated Care Board (ICB) level. They told us they were working with local partners and the ICB to find a sustainable model for the delivery of the training and reviewing future reporting requirements. They provided information that showed compliance varied between 66% and 100% for the online element of the training.

Managers ensured that staff and people who used services had access to interpreters and/or signers. Staff gave examples of using interpreters on calls and at face to-face meetings and said the service was easy to access and responsive.

Staff ensured that people who used services had access to appropriate spiritual support. At Newham Home Treatment Team (HTT), a staff member also worked within the chaplaincy service and supported colleagues to ensure people’s spiritual needs were considered.

In the health-based places of safety (HBPoS), patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

During our inspection, we saw examples of staff promoting independence during initial contact with the service. For example, staff in the City and Hackney Crisis Assessment Team (CAT) signposted people to resources and activities in their local community by facilitating assessment visits with community connectors. Community connectors worked with organisations in the local voluntary, community and social enterprise sector to identify resources for people to access.

During home visits, we saw staff used strengths-based approaches, focusing on current skills and capabilities, including support networks and discussing future plans and goals.

Staff at Newham Home Treatment Team (HTT) ran group sessions such as art, music and sensory sessions aimed at promoting recovery. Support workers from Newham HTT ran a Saturday drop-in session, co-facilitated by a peer support worker which promoted independence as through this people using services were supported to sell items made in craft sessions at local fairs and events. They used money from this to fund additional group activities in the community such as lunches and cinema trips. Staff told us people could access this support after discharge on an individual basis. However, some people accessed the drop-in session for lengthy periods following discharge from the service.

Some crisis teams, such as those in Bedfordshire and Luton, had Occupational Therapists (OT). OT staff supported people with activities of daily living to promote independence and recovery. They linked people with resources in their community such as local leisure centres.

HTTs facilitated clozapine titration in the community for people, to avoid the need for admission to hospital. Clozapine titration is a gradual increase of clozapine medicine to minimise the risk of sedation, hypotension and seizures. It requires close physical health monitoring which the HTTs provided in the community.

The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were aware of and dealt with specific risk issues and these were reflected in risk assessments. We saw risk assessments were updated in response to any changes in people’s presentation, risk or levels of distress.

We saw staff took people’s wishes and views into account during appointments. For example, we saw staff offering to signpost someone for benefits advice but did not pursue this when the person declined.

Staff showed an awareness of how to use least restrictive options to minimise people’s discomfort and distress. For example, staff in HBPoS told us about getting doctors to authorise temporary leave for a person who was distressed and agitated, so they could be escorted to have a break from the unit and not call on the rapid response team to manage the situation.

The service mostly cared about and promoted the wellbeing of their staff, though lone working safety measures were inconsistent across teams. The service mostly supported and enabled staff to deliver person-centred care.

Staff spoke positively about the teams they worked in and support from their peers and managers within the team. They told us they had regular away days to discuss how to improve services and to build team relationships. In Newham Home Treatment Team (HTT), the team had shared lunches to celebrate the different cultural backgrounds of people working in the team.

Staff told us they were well supported by the service and their managers following any involvement in incidents. They gave examples of support offered through debriefs and with psychology colleagues following events staff found distressing.

Though data provided by the service showed not all staff received regular supervision, staff we spoke to during our inspection told us they did receive supervision and found it valuable and helpful. Staff told us they did not have to wait for supervision to raise issues or concerns but could do this directly with immediate managers.

Staff received specialist training for their roles. For example, staff working in the 111 option 2 telephone line at Tower Hamlets had completed training provided by a suicide prevention helpline, on how to handle calls from people who were expressing suicidal thoughts and intent. Managers had developed a bespoke training and induction programme for 111 option 2 staff which included simulation training.

However, throughout our inspection we saw an inconsistent approach to promoting the welfare of staff required to work alone. The trust provided staff with lone working and personal protection devices. However, these were not used consistently by staff and there was inconsistency in local monitoring of their use. For example, at Newham Home Treatment Team (HTT) some staff told us they did not always use these and there was no system for checking people had returned from community visits safely. In Tower Hamlets HTT, staff told us they had a phone application they could use in an emergency but no personal alarm. They used a spreadsheet to know where people were and what time they were expected back but there was no system to check in and out of appointments or visits. Most staff told us they felt safe lone working but some did say they felt unsafe in some environments they needed to visit. Staff did conduct visits in pairs where they felt there was a known risk. Following our inspection, the trust carried out a trust-wide review of device use, with fortnightly reporting to the trust health and safety and quality committees. They told us each HTT operated local check-in and escalation procedures which would be standardised by July 2026 and a new lone worker policy in place by 31 July 2026.