East London NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated effective as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 30 care and treatment records across the wards.

Staff completed a comprehensive mental health assessment of patients in a timely manner at, or soon after, admission. Staff assessed patients’ physical health needs in a timely manner after admission. Staff used the national early warning score (NEWS) system to detect and respond to clinical deterioration of physical health. We saw regular reviews of physical health in patient records. Staff discussed patients’ physical health in daily huddles.

In most cases, staff developed care plans that met the needs identified during assessment and updated those when necessary. However, in 6 records the care plans omitted some identified needs, for example around physical health conditions, wound care or medication side effects, and for 2 patients, food or fluid intake monitoring.

Staff were aware of communication needs of people with protected characteristics under the Equality Act 2010. For example, in 2 records communication passports were in place and staff told us about using Makaton with another patient. The trust’s intensive support team provided additional support for autistic patients and those with learning disabilities.

Care plans were personalised, holistic and recovery-oriented. In most, there was evidence of patient and where appropriate, carer involvement. In 4 records staff had not documented that the patient had been offered, or declined, a copy of their care plan.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies, as well as activities aimed at improving daily living skills.

Staff ensured that patients had good access to physical healthcare, including specialists when needed. For example, the trust had a dedicated physical health lead and physical health and diabetic nurses who supported staff on the wards. Staff referred patients to primary and secondary care, dentists, substance misuse services and speech and language therapy (SALT). Staff on City and Hackney wards shared with us challenges around access to SALT and dietitian provision.

Overall, staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. However, on Ash Ward, staff had not referred a patient to a dietitian despite identifying a need around fluid intake. For a patient on Coral Ward, no food or fluid chart had been commenced in line with the assessed need.

The teams included or had access to a range of specialists to meet the patients’ needs. These were doctors and nurses, support workers, occupational therapists (OT), activity coordinators, psychologists, pharmacists and fitness instructors. Staff regularly met as a team. There was clear evidence of multidisciplinary team (MDT) input in care and treatment records and ward rounds.

Staff had access to training to develop their specialist skills and knowledge, for example in trauma informed care, DBT (dialectical behaviour therapy), eating disorders, phlebotomy, self-harm and wound care. On Townsend Ward, managers were planning to train staff from Band 3 in phlebotomy and ECG.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. These covered areas including record keeping, risk assessments, physical health monitoring and medicines. Audit results fed into governance meetings, clinical supervision and improvement action plans. Most staff we spoke with told us about completing audits or knew what audits took place on their ward.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary team (MDT) meetings and daily huddles. Each ward held a regular awayday, although this had been recently reduced from 6-weekly to quarterly due to resource constraints. Across Tower Hamlets wards, there had been recent challenges in ensuring regular team meetings.

Staff shared key information effectively about patients when handing over their care shift to shift. We saw this could be improved on Emerald Ward as we observed that information about patients’ observation levels, sections and risks was not always clearly handed over.

Staff had effective working relationships with other teams within and outside the trust. These included primary and secondary care, substance misuse, care coordinators, community mental health, crisis resolution and home treatment teams. We saw evidence of wider MDT and relevant partner agency involvement in most care records we viewed. Some stakeholders said that better communication about ward rounds or changes to those could support more effective joint working.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives. This included smoking cessation and nicotine replacement therapy, healthy eating advice and support with substance misuse.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales and outcome measures. We saw evidence of these being used in most care and treatment records we reviewed, for example Dialog+ (quality of life and treatment satisfaction scale). Staff we spoke with told us about using MOHOST (Model of Human Occupation Screening Tool), PREM (patient-reported experience measures), GAD-7 (generalised anxiety disorder questionnaire), PHQ-9 (questionnaire to assess symptoms of depression) and other tools. A patient we spoke with said they had been actively involved in completing their Dialog+ assessment.

Staff carried out audits to improve the consistency and quality of outcome monitoring, for example, there were ongoing audits of Dialog+ use. On Ivory Ward, staff were planning a quality improvement project to increase Dialog+ completion.

Staff used technology to support patient care effectively. For example, digital dashboards were displayed in nursing offices, showing at a glance, key information about each patient on the ward including length of stay, physical health and risk assessment.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff completed mandatory training in the Mental Capacity Act (MCA) and overall 83% were up-to-date with it.

Staff recorded patients’ consent to involve other people in their care, or whether they chose to decline this.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests. All the care records we reviewed demonstrated that staff had assessed patients’ mental capacity appropriately.