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 assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 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.

The senior leadership teams had successfully communicated the trust’s vision and values to staff. Staff we spoke with knew and understood what those were. They were committed to delivering high quality care in line with the trust’s values.

The majority of staff were positive about the teamwork and morale on their ward. Of the staff we spoke with, a minority shared concerns in relation to morale, burnout or less positive team dynamics.

Staff had the opportunity to contribute to discussions about the strategy and development for the service. Forums for staff included ward awaydays, reflective practice, access to Freedom to Speak Up, listening events and surveys. Most staff described a positive and supportive listening culture where learning was shared. Some staff commented that reflective practice was limited to quarterly ward awaydays. Some suggested that unit-wide awaydays would also be helpful. Although the trust had a People Participation group that patients and carers could become involved in, we saw limited evidence of how this was being used on the wards we visited.

Staff and managers could explain how they were working to deliver quality care within the budgets available.

The evidence showed a good standard. 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.

Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed. Many of the managers we spoke with had worked for the trust since qualifying and had progressed to their current roles.

Staff were positive about the managers, describing them as supportive, visible and approachable. Some told us about managers stepping in to help on the wards during periods of higher acuity or short staffing. Managers on Townsend Ward were planning a quality improvement project to improve staff experience.

Staff spoke positively about the training and development opportunities available, including for staff from minoritised backgrounds.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had appropriate ‘Freedom to Speak Up’ and whistleblowing processes in place. Staff we spoke with said they were confident to raise concerns with managers, should they need to.

The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff received training in equality and diversity and 95% had completed it. Staff we spoke with were confident that the service culture was open and inclusive for patients and staff. Some staff told us about accessing the trust’s equality networks and anti-racism working groups.

Staff told us that they received support from managers after incidents of racist abuse directed at them.

Staff were able to apply to work flexibly. They said managers were understanding and some shared examples of managers accommodating their caring responsibilities or study leave, or creating a personalised induction plan. No staff shared concerns about discrimination.

The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. Leaders did not always act on the best information about risk, performance and outcomes.

Whilst governance arrangements were in place that supported the delivery of the service, our findings across the key questions indicated areas needing further refinement and embedding to promote the consistent safety of the environment, and staff support of patients. For example, governance processes had failed to identify that post-rapid tranquilisation (RT) records had not been completed correctly. Physical health monitoring for patients prescribed high-risk medicines was inconsistent. Risk assessments for prescribed medicines with known side effects were not consistently completed. Legal documentation was not completed correctly, resulting in medicines being administered unlawfully.

Not all premises where care and treatment was delivered were fit for purpose, properly maintained and free from offensive odours. Adequate toilets and bathrooms were not available to people using the service. There were sometimes delays in maintenance work taking place. Some potential ligature anchor points had not been included in risk assessment and management plans. Whilst risks relating to the environment were known, appropriate plans to address them were not in place.

Managers had not ensured that all staff completed mandatory training and received regular clinical and managerial supervision and appraisal.

There was however, a clear framework of what must be discussed in meetings at a ward, team or directorate level to ensure that essential information was shared. Lessons learnt and performance were on the agenda of team meetings. We saw evidence that staff had implemented recommendations from reviews of deaths, incidents and safeguarding alerts at the service level.

Staff participated in local clinical audits. The range of audits was appropriate to provide assurance and staff acted on the results when needed. We saw evidence of improvements made as a result of audits.

Staff maintained ward-based risk registers. We reviewed risk registers on the wards we visited and saw evidence those largely matched concerns shared by staff. These included environmental issues, bed pressures, physical health concerns and violence and aggression.

Information governance systems included confidentiality of patient records and 89% of staff had completed training in data security awareness. Staff had access to the equipment and information technology needed to do their work. However, these systems did not work well at all locations. At Tower Hamlets, wi-fi coverage was poor and access to the electronic record system was slow. At City and Hackney, staff experienced severe IT issues, with only 1 of 4 computers functional and a broken laptop during our visit.

Managers had access to information to support them with their role. Data on key performance indicators such as bed management, risk and staffing was integrated into the trust’s digital dashboards.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Senior leaders engaged with external stakeholders, such as regulatory bodies, commissioners and system partners. This included ongoing work to manage patient flow and reduce the length of inpatient stay.

Staff could meet with members of the trust’s senior leadership team through awaydays and listening events. The trust had a people participation group that patients and carers could join.

The evidence showed a good standard. 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 contribute to safe, effective practice and research.

Staff had opportunities to engage in quality improvement (QI) initiatives. The trust had a central QI team and staff were trained in QI methods, for example one staff member we spoke with was a QI coach.

Approximately half of staff we spoke with said they had either participated in QI projects, or were aware of QI work on their wards. A number of QI projects were in various stages of planning, testing and implementation across the wards. For example, these included transitioning from observations to improved therapeutic engagement, improving pharmacy counselling on discharge, culture of care, physical health and patient flow. Whilst therapeutic hours were implemented to improve positive engagement between patients and staff, on Conolly Ward this had resulted in patients’ garden access reducing from twice to once a day.

Wards participated in accreditation schemes relevant to the service. For example, Ash, Coral, Crystal and Willow wards were members of the Quality Network for Inpatient Working Age Mental Health Services (QNWA). Onyx Ward was accredited by the network until November 2027. QNWA is established by the Royal College of Psychiatrists to involve wards in a process of quality improvement through a supportive network and peer-review process.

The trust had developed a service user-led accreditation scheme which set out standards of patient experience for wards to be assessed against. The wards had participated in this scheme, with levels of accreditation from bronze to platinum awarded to them.