East London NHS Foundation Trust

On this page

• 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 assessment we rated this key question outstanding. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

We spoke with 65 patients and 13 carers across the wards. People’s views about staff were mixed. Fifteen patients and 2 carers were not happy with how staff treated them. Some patients felt that staff avoided them, could be rude, dismissive or undermining of them. Four patients told us that they had felt pressured by staff as they thought their fresh air access might be limited or withdrawn if they did not agree to take their medicines. Seven patients and 1 carer shared with us concerns in relation to attitudes they had experienced from staff working night shifts on Ash, Bevan, Coral, Townsend, Jade and Crystal Wards.

Patients on Emerald Ward and a carer on Crystal Ward told us that staff spoke in other languages in front of them. This was supported by our own observation when we visited Emerald Ward. On Rosebank Ward, the garden was overlooked by the male ward balcony. We observed male patients harassing female patients and shouting down to them, with staff not intervening.

Carers’ feedback about staff was mostly positive. Twenty-three patients described staff as kind, patient, helpful and respectful. Most of the time, we observed staff engaging with patients in a relaxed, respectful and caring manner. Staff provided patients with help, emotional support and advice when they needed it. The meetings we attended were conducted in a respectful and appropriate manner. Staff we spoke with discussed patients with kindness and compassion. In the meetings we attended, staff used patients’ first names and demonstrated they knew them well. Staff spoke kindly and respectfully about transgender patients, using their preferred pronouns.

Whilst welcome packs had been developed and were available, 5 patients across Ash, Coral and Ruby wards reported not receiving them and felt inadequately orientated to the ward.

Improvements were needed to ensure staff consistently maintained confidentiality of information about patients. On Emerald Ward, physical health observations were completed in communal areas, compromising privacy and dignity. On Conolly Ward, patients’ personal details on the board within the nursing office were visible from the communal lounge, which we raised with the managers.

Following our inspection, the trust updated us on actions taken to complete physical health observation in line with patient preference, to address ward cultures and to ensure privacy and dignity of patients on Rosebank Ward.

The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The wards were step-free and staff made reasonable adjustments for patients, for example people with mobility issues. However, a patient on Ash Ward said the toilets were too small for people using walking aids.

There was information displayed on the wards to make diverse groups of people welcome and included, for example, LGBTQ+, minoritised groups and carers. Carer support was limited. None of the carers we spoke with had been invited to family support groups.

Staff did not always meet patients’ cultural, social, religious, dietary, or other personal needs. Thirteen patients and 4 carers told us that their or their relatives’ individual needs had not been met. Two carers said staff had not helped their relative with personal grooming. Feedback about the food, drink and snacks on offer was mostly negative. Twenty patients and 3 carers reported not always having the choice of food to meet dietary needs, intolerances or preferences. Patients on Townsend and Coral wards said there were not enough lactose-free options. At the same time, staff on City and Hackney wards told us about their close links with the local Jewish community, and a local charity delivered kosher food for patients.

Staff ensured that patients had access to spiritual support. Spiritual leaders visited the wards and patients could access prayer and multi-faith rooms which were located on the ward or within the unit. Staff and patients celebrated religious festivals together.

Staff knew about communication needs of people with protected characteristics under the Equality Act 2010. Staff completed Oliver McGowan training on learning disabilities and autism. A dedicated team within the trust provided additional support for autistic patients and those with learning disabilities. Sensory provision was available on 5 of the wards we visited. Staff we spoke with shared examples of making individual adjustments, such as using personalised distraction techniques and sensory aids. Staff on Coral and Bevan wards thought the loud and busy ward environment was not the best for autistic patients. To help mitigate this, work was in progress to adapt 4 bedrooms on Coral Ward for the needs of neurodivergent patients.

Since our inspection, the trust shared its plans to improve carer engagement and support.

The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Although we saw evidence of patient involvement in most care and treatment records we viewed, feedback from the patients we spoke with indicated there was further work to do. Fifteen patients and 9 carers said they were not satisfied with their level of involvement or access to the care plan. Thirteen patients and 6 carers did not have information about independent advocacy or did not know what this was. Most carers said that staff had not explained consent, confidentiality or how they shared their relative’s information. Nine carers shared concerns about poor communication and lack of information about their relative’s care. Nine carers were not happy about the discharge planning for their relatives. They shared examples of how they felt staff had not listened to their views or concerns in this process or had not kept them informed.

Peer support was working well on Brett, Ivory, Ruby and Crystal wards. Patients were keen for peer support workers to be rolled out over other wards. Staff on Townsend Ward had created an informal buddy system for new patients on admission, promoting peer support and patient empowerment. A patient on Joshua Ward told us about running weekly group sessions on breathing and meditation for peers on the ward.

The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff were aware of patient-specific risk issues and planned for these accordingly. Staff discussed risks in daily huddles and handovers.

We saw staff always present in the communal areas, engaging with patients and responding to their requests promptly on most wards. However, some patients told us that staff sometimes took longer to respond and that some staff were more helpful than others. One patient said they felt like they were burdening staff with requests. We attended a community meeting on Coral Ward where patients raised a concern about not having drinking water available. Managers provided water only following our request after the meeting concluded. A carer said their relative on Crystal Ward needed more water due to the side effects of their medicine, but staff did not always provide it, and night staff would not warm up their food. A patient on Joshua Ward said they asked for socks and a towel on admission, but it took a while for staff to provide these. Five of 7 carers reported difficulties in contacting staff.

The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to deliver person-centred care.

Staff we spoke with felt respected, supported and valued by their peers and managers. They were positive about working for the trust and their team. They spoke with compassion about the patient group they supported.

Staff had access to support for their own physical and emotional health needs through the trust’s wellbeing service. Staff told us about accessing occupational health, counselling, psychology support and physiotherapy. Although verbal and physical aggression, including racist abuse, was a common type of incident, staff said they were supported by managers and confirmed they received debriefs and reflective practice.

The trust recognised staff success within the service, for example through annual staff awards. On Townsend Ward, managers had additionally introduced weekly awards to celebrate staff and patient achievement. Some PICU staff thought there was not enough awareness and recognition of their work from colleagues on acute wards.

Staff supervision and appraisal records included conversations about wellbeing and development goals. Staff told us they found managers supportive and there were good opportunities for training and development.

Staff on Jade and Joshua wards told us about the recently created staff rooms, which helped support their wellbeing at work. However, the ongoing environmental issues across the London wards impacted staff morale and wellbeing. Approximately half of staff thought that staffing challenges could on occasion put pressure on their workload or working hours. Staff on Ash Ward shared concerns about the recent decision to rapidly switch the adjacent male and female wards to accommodate demand and bed pressures, with one describing it as “out of the blue”. Some were concerned about their skillset and training needs not being considered in this.