East London NHS Foundation Trust

On this page

• 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 good. 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 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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff knew and understood the trust’s vision and values. 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 working with people from disadvantaged groups such as those who were homeless, and making reasonable adjustments so they could access care and treatment.

Staff had the opportunity to contribute to discussions about the future of their service. For example, staff in Bedford and Mid-Bedfordshire Crisis Resolution Home Treatment (CRHT) team attended an away day where they met with local partners and internal teams and agreed ways to work together and referral processes.

Staff could explain how they were working to deliver high quality care within the budgets available. For example, a manager described how they had used money from a nursing vacancy to recruit a pharmacist to provide vital support to the team.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Local leaders were visible in the service and approachable for staff. Staff were aware of senior trust leaders and told us they visited regularly. They spoke highly of their local leaders and managers, saying they were open and supportive.

Leaders and managers we spoke with had a good understanding of the services they managed. They could clearly describe challenges the service faced and the actions they were taking action to address them. For example, leaders for the London localities talked about the challenges people in mental health crisis faced waiting in emergency departments. They told us they were developing new escalation processes to see if people could be moved more quickly from emergency departments using step up beds.

Leadership development opportunities were available, including opportunities for staff. Staff told us they were supported to grow and develop into management and leadership roles. One staff member told us about being supported to complete a level 5 coaching qualification to develop their leadership skills.

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. We observed positive challenge and discussion in multidisciplinary meetings we attended.

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 how to contact them. A FTSU guardian works alongside the trust’s senior leadership team to ensure staff have the capability to speak up effectively and are supported. Information provided by the service showed there were 6 FTSU concerns raised across the service between November 2024 and October 2025. The main themes related to processes and inappropriate attitudes or behaviours.

Staff gave examples of concerns that had been escalated to the trust FTSU guardian and were able to describe the actions taken and outcomes from these. The FTSU guardian provided an annual report to the quality committee, which ensured trust leaders had oversight of the themes and trends of concerns raised and there was a FTSU improvement plan in place.

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.

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.

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.

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. For example, in the 111 option 2 service at Newham locality staff were able to access support form external coaches when returning from long-term sickness absence to support them to readjust to being in work. 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 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 Employer is 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 clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes.

There was a lack of consistency in processes, systems, models and team structure across the service. In Bedfordshire and Luton, the work of crisis resolution home treatment (CRHT) teams was aligned across the 2 teams but not with any London-based teams. In London, each borough had a different model and team structure. Inconsistency in team structure meant pharmacy support to teams was different in London to Luton and Bedfordshire. The home treatment team (HTT) in Tower Hamlets did not have the full range of roles and disciplines in the multidisciplinary team, as other boroughs did.

The service did not always report and learn from incidents. The quarterly integrated safety report sent to the quality assurance committee did not break down incidents by service type and analysed trends across the trust rather than at service level.

Though managers undertook some local audits, they were not sufficient to provide assurance. For example, the service did not 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.

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 incidents and 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. In Newham locality, the service told us teams did not have specific local governance meetings but there were 2 trust governance meetings monthly that covered aspects of crisis services. These meetings were not minuted, but actions were recorded and tracked.

This meant there were potentially missed opportunities for sharing learning and positive practice across the service. Where we saw examples of positive practice, such as the use of the decider skills application in Bedfordshire and Luton, we did not always see this replicated across the trust. Decider skills are evidence-based mental health strategies designed to help individuals monitor and manage their emotions.

Following our inspection, 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 Bedfordshire and Luton included risks related to acute hospitals being an unsuitable environment for people with mental illness and delays to detention under the Mental Health Act. The register included controls in place, any gaps, actions to mitigate risk and a risk owner.

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 crisis network. Managers and senior leaders attended monthly meetings which included providers and stakeholders across the crisis pathway. Managers of the 111 option 2 service in Tower Hamlets met monthly with the police and local acute NHS trust as part of the joint committee.

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 incident 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).

Directorate leaders and managers engaged with external stakeholders. For example, managers at the 111 option 2 service were part of a task and finish group with other local services and trusts including the ambulance service to look at alternatives to emergency departments for people experiencing mental distress. This included making a video for paramedics with advice and guidance on criteria for crisis services.

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.

Some teams participated in accreditation schemes and related national and local networks. For example, City and Hackney Home Treatment Team was part of the Quality Network for Crisis Resolution and Home Treatment Teams facilitated by the College Centre for Quality Improvement (CCQI) of the Royal College of Psychiatrists (RCPsych). This is a national CCQI quality assurance programme supporting continuous improvement within CRHT services and sharing learning through networking events.

The HTT at Tower Hamlets was members of the RCPsych Home Treatment Accreditation Scheme. They told us they had been visited by services in other European countries so they could learn from their model.

Four teams, City and Hackney Crisis Assessment Team (CAT), City and Hackney Health-based Place of Safety (HBPoS), Luton and Bedfordshire Liaison and Diversion and Reconnect service, and Newham psychiatric liaison service were accredited by the trust’s internal ‘Raising the Standards, Service User Led Accreditation’ programme. The programme measured services against standards coproduced by people who use services based on what matters most to them and is carried out by people who use services who visit the service, review evidence and interview people, carers and staff.

Staff had carried out a number of quality improvement projects in the last 12 months. This included a project in Luton and Bedfordshire to improve the timeliness and quality of 72-hour reports, these were reports following a patient safety incident categorised as severe harm or death that provided an initial review to understand facts and identify any immediate learning. The project led to faster completion of these reports. City and Hackney psychotherapy service used quality improvement methods to address the number of people missing their appointments. This meant the proportion of missed appointments fell from 16% to 9% through 2024 and 2025.

In Bedfordshire and Luton, staff were piloting the use of a ‘decider skills’ phone application with people using services. Decider skills are a set of evidence-based, cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT) techniques designed to help people monitor and manage their emotions, mental health, and impulsive behaviours.