East London NHS Foundation Trust

On this page

• 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 outstanding. At this inspection the rating has changed to requires improvement.

We found 1 breach of regulations 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.

Staff made adjustments based on individuals’ accessibility requirements and needs. For example, staff told us they were able to access British Sign Language interpreters, when requested. They had arranged additional psychology sessions with BSL interpreters alongside written assessments to respond to individual needs and Occupational Therapy support to ensure comprehensive psychology assessments could be completed.

During visits and appointments, we saw staff empowering people to make decisions about their care and treatment. For example, we observed a discussion to agree the frequency and venues for visits by the home treatment team based on the person’s preferences. We saw staff discussing medicines and potential side effects with people so they could make informed choices.

People could access support from independent advocacy services, when needed. We saw information on advocacy services displayed in bases we visited.

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

Managers in City and Hackney locality attended monthly health-based place of safety (HBPoS) meetings with system partners. We reviewed the minutes of the last 3 meetings and saw in the HBPoS and 111 option 2 services across the patch was discussed as well as an overview of detentions under Section 136 of the Mental Health Act. Partners discussed key interface issues and shared concerns.

Where people using services were supported by more than one service or provider, there was continuity in people’s care and treatment because staff worked in a collaborative way. For example, staff in Home Treatment Teams (HTT) worked with voluntary sector staff to support people who were in ‘step down’ beds. HTT staff provided clinical support to people who stayed in these beds to facilitate discharge from hospital. We saw examples of joint visits with community mental health teams to facilitate assessments and discharge from the service.

When appropriate, staff ensured that people had access to education and work opportunities. Staff at Newham HTT told us about supporting people to access education courses at the trust Recovery College. In multidisciplinary team meetings and appointments, staff demonstrated an awareness of the importance of enabling people to maintain education and employment.

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

The service made sure information leaflets and posters were available in languages spoken by people using services. People could access the trust website in other languages from a drop down on the home page with the flag displayed next to the language. Posters were displayed in the reception area of Bedford Crisis Resolution Home Treatment (CRHT) team in difference languages to suit the needs of the local population.

Staff ensured that people who used services could obtain information on multiple topics such as treatments and local services that were available. We saw posters and leaflets to inform people about a variety of topics including mental health conditions, being a victim of sexual exploitation, healthier living, local food banks and menopause information.

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 most information could be easily accessed by making it larger or changing colours and fonts. Information on how to access crisis services was easily available by using a red ‘I need help now’ button the on the trust website home page.

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.

People we spoke to knew how to complain or raise a concern. Posters were displayed in the reception area of Bedford Crisis Resolution Home Treatment (CRHT) team to inform people how to make a complaint. There was a "you said, we did" board in the waiting area which told people about changes made in response to feedback.

The service provided information showing 254 formal complaints were made between November 2024 and October 2025. However, this data included complaints for community-based mental health services for adults of working age, so it was not clear how many related specifically to crisis services. 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 crisis services. 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 954 responses, with the majority, 81%, being good or very good responses. Each team had a PREM champion to support locally with the collection and sharing of learning from PREM responses.

The trust held a monthly carer peer support group to provide carers with an opportunity to raise issues. Issues discussed in the meeting fed into the appropriate management forum.

City and Hackney produced a People Participation newsletter which gave details of how people using services and their carers could get involved in the community transformation programme. In Bedfordshire and Luton, the action plan to deliver the carers strategy included actions to ensure a clear pathway for carer’s assessment and support when a person was in crisis.

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 always make sure that people could access the care, support and treatment they needed when they needed it.

In City and Hackney health-based place of safety (HBPoS) patients were frequently admitted to ‘swing beds’ under section 2 of the Mental Health Act (MHA). Swing beds were used to prevent unlawful detention for patients requiring admission under the MHA once the period allowed by a section 136 expired. The use of HBPoS as a ‘swing’ bed, meant that patients often stayed longer than 36 hours in the HBPoS. The service provided information that showed between November 2024 and October 2025, 30% of patients admitted to City and Hackney HBPoS had stayed longer than 72 hours. The service told us this was patients who were no longer detained under a section 136 but were admitted to a swing bed. The average length of stay in City and Hackney HBPoS over the last 12 months was 70 hours while the median length of stay was 40 hours.

We asked the service how many times in the last 12 months the HBPoS at City and Hackney was not available. The service told us they did not have this information. They explained decisions to take people to an HBPoS were decided under the NHS England pan-London all-age Section 136 pathway and coordinated by the Mental Health Crisis Assesment Line not the trust. Managers from City and Hackney HBPoS attended the twice daily ‘pan London Hub’ meetings where HBPoS capacity across London was discussed and spaces allocated.

The service provided information showing the percentage of people taken to an emergency department (ED) compared to City and Hackney HBPoS under section 136 of the MHA had varied between 27% and 53% between September 2025 and May 2026. In September 2025, 53% of people were taken to an ED in May 2026 this was 41%. Though psychiatric liaison services remained involved with people in ED it was not a therapeutic environment for people in mental health crisis. Remaining for prolonged periods in ED meant that treatment may be delayed and the service recognised this in the risk register for Bedfordshire and Luton, which included risks related to acute hospitals being an unsuitable environment for people with mental illness.

There was a risk that people taken to an ED because the HBPoS was not available would not receive timely assessment and care. The service did not meet targets for assessing people presenting in ED within 1 hour and there were incidents of people leaving ED before assessment. Data provided by the service showed between March 2026 and April 2026 the trust did not meet their target of 95% of patients being seen within 1 hour by psychiatric liaison. However, performance varied across the localities, with Newham achieving 94% against the 1-hour standard over this period, Bedfordshire Luton was 86%, City and Hackney 82% and Tower Hamlets 77%. Data provided by the trust also showed in October 2025, 24 patients spent more than 72 hours in an emergency department (3%). This is not in line with the NHS England standard and was a slight increase from the previous month. Between November 2024 and October 2025, 239 people spent more than 72 hours in an emergency department across the service. However, following our inspection the service provided updates information showing between December 2026 and March 2026, only 7 people spent more than 72 hours in ED. There was a risk people would leave the emergency department before receiving care and treatment and we saw 4 incidents reported of people leaving ED in the 12 months prior to our assessment.

The service told us the biggest factor impacting the number of people waiting in the ED and HBPoS was inpatient bed capacity and discharge. Data about the number of people waiting for inpatient beds showed average delays of 157 hours in Luton and 149 hours in Bedford. The service monitored 1-hour performance by locality and had improvement plans in place including ED escalation and short-stay admission capacity. The position was monitored at 2 urgent and emergency care boards the trust attended and reported to the trust's quality assurance committee. In Tower Hamlets managers were meeting with the local ED to develop pathways and standards to try and address some of these challenges.

The service provided information that showed between October 2024 and October 2025, 19% of calls to the crisis line (111 option 2) were abandoned, an average of 467 calls. This was higher in Tower Hamlets 111 option 2 service where 25% of calls were unanswered or abandoned. We spoke to staff who told us there was no process to follow up unanswered calls as they did not have the number of the person calling. A recorded message played whilst people were waiting for a call to be answered signposting them to alternative options in case they abandoned the call. Following our inspection, the service provided data showing the number of abandoned calls had decreased to 16% in January 2026, 15% in February 2026 and 11% in March and April 2026.

However, the service provided data that showed between October 2024 and October 2025, the service carried out 81% of urgent assessments within 4 hours. The national standard for very urgent assessments is 4 hours and for urgent 24 hours. The same data showed average crisis response times for the same period were 13.1 hours.

The service had a trust Waiting Times and Access policy which set out the approach staff should take to manage access to services, waiting lists, and non-attendance.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. However, patient safety incident investigation (PSII) reports we reviewed did not include information on, or exploration of, people’s protected characteristics.

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 actively anti-racist organisations by ensuring that 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.

In Bedfordshire and Luton, we were told about a quality improvement project to implement PCREF across the crisis pathway. The team included a person with lived experience and was looking at referrals using consensus data and to see if the people being referred to crisis services were reflective of the local population. They found that though 37% of the population of Luton were from an Asian background, 21% of people referred to crisis services were from an Asian background. They were using this data to focus on people within the Asian community and look at what barriers there might be to accessing crisis services and identify any disparity.

Staff were trained in equality, diversity and human rights. Compliance with equality, diversity and human rights training was above 86% in all teams except the Luton psychology team which was 67% but this was due to 1 out of 3 staff needing to complete it.

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. Additionally, some teams included staff who spoke other languages, which helped meet local community needs and supported people in understanding their medicines.

However, patient safety incident investigation (PSII) reports we reviewed did not include information on or exploration of people’s protected characteristics. We reviewed 1 PSII report, where the person’s ethnicity may have been an important factor to consider. The investigations did not explore how health inequalities faced by people using services may have contributed to aspects within the incidents.Following our inspection, the service told us all safety reviewers completed mandatory equality and diversity training. The trust was working to strengthen the use of equity-focused questions in the investigation process and add equity considerations to the trust Patient Safety Incident Response Framework (PSIRF) plan by the end of September 2026.

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

People using services were supported to make informed choices and plan their future care while they had the capacity to do so. We saw a person’s capacity was considered at initial assessment and throughout their time under the care of the team and was recorded in most care records we reviewed.

Staff supported people to make decisions about their care and treatment and their future. We observed in appointments and home visits staff supported people to plan what to do if their condition deteriorated and ensured they had contact details to use if this happened.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. For example, in Newham locality there was an early discharge lead nurse who facilitated early discharge from inpatient wards by ensuring the Home Treatment Team (HTT) worked with GPs, community teams and specialist services such as substance misuse services to ensure the right support was in place.