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 good. At this assessment the rating has remained good.

Leaders demonstrated the skills, knowledge, and experience required to perform their roles effectively. They provided clear direction and oversight, ensuring that the service delivered care that was safe, effective, and responsive to young people’s needs. Staff told us they understood the provider’s vision and values, and how these were reflected in their daily practice.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Quality Statement Score: 3.

The evidence showed a good standard.

The service had a clear direction and a positive culture.

Leaders described a clear framework underpinning service delivery, based on four key pillars:

• Community-oriented care – recognising that young people should remain closely connected to their home environments and communities, with strong partnership working to support this
• Co-production – working collaboratively with young people and families, including their involvement in ward rounds and Care Programme Approach (CPA) meetings
• Leadership at all levels – encouraging staff to show initiative and contribute to service development
• One team approach – fostering a shared sense of purpose and collaboration across inpatient and community services, with staff supporting one another and building strong working relationships.

We found the service demonstrated a positive and inclusive culture. Staff showed a commitment and passion for their work despite system challenges. Opportunities for collaboration and mutual support were evident, contributing to effective team functioning. Staff consistently reported feeling respected, supported, and valued by leaders and their colleagues. Staff felt able to raise concerns, share ideas, and contribute to service development.

Quality Statement Score: 3.

The evidence showed a good standard.

The service had inclusive leaders at all levels who demonstrated a strong understanding of the context in which they delivered care, treatment, and support. Leaders embodied the values and culture of the organisation, promoting a compassionate, open, and person-centered approach. They showed integrity, honesty, and transparency in their leadership, and staff spoke positively about their support and approachability.

Leaders demonstrated a good understanding of the services they managed and were able to clearly explain how teams worked together to deliver high-quality care. They maintained oversight of performance and ensured that staff were aligned with service priorities. Leaders described their oversight across both London and Luton services, demonstrating an understanding of risks, performance and operational pressures across geographically distinct sites. This supported coordinated leadership and consistency in service delivery.

Leaders were visible within the service and approachable to both staff and young people. This visibility supported strong relationships, open communication, and a positive culture where staff and young people felt able to raise concerns or share feedback. This was reflected in feedback from young people, who told us they felt safe and confident approaching their care manager, nursing staff, or consultants to raise concerns or discuss issues. This indicated a culture of openness, trust, and psychological safety.

Quality Statement Score: 3.

The evidence showed a good standard.

The service demonstrated a strong commitment to openness, inclusion, and continuous improvement, ensuring that the voices of staff were valued and acted upon.

The trust had Freedom to Speak Up (FTSU) processes in place. FTSU information was clearly displayed. Staff were aware of the whistleblowing policy and freedom to speak up guardian and said they were encouraged by them to raise concerns. Staff were confident to raise concerns, should they need to.

Quality Statement Score:3.

The evidence showed a good standard.

The service demonstrated a commitment to valuing diversity within its workforce and promoting an inclusive and fair culture, working towards improving equality and equity for staff.

Staff told us they felt well supported within an inclusive and open environment, with access to Equality, Diversity and Inclusion (EDI) initiatives. These included regular EDI forums, equality and diversity champion roles, and discussions on areas such as race equality, which supported staff to share experiences and contribute to a more inclusive workplace.

Staff also had access to union representation and support for workers’ rights and reported feeling able to raise concerns without fear of reprisal. We saw evidence that staff were able to apply for flexible working arrangements, which helped them to balance professional and personal responsibilities, including caring roles and health needs.

Managers made appropriate reasonable adjustments to support staff in their roles, demonstrating a responsive and person-centered approach to workforce management. The provider also undertook equality monitoring, helping to ensure the workforce was representative and that any disparities could be identified and addressed.

Staff feedback was positive. A new member of staff told us they felt supported, valued, and heard, and were encouraged to introduce new ideas and ways of working, which increased their confidence in practice. They described feeling impressed and reassured by the team, and spoke highly of the leadership, particularly the matron, stating they felt well supported in their role.

Quality Statement Score: 3

The evidence showed a good standard.

The service had clear governance structures, roles, responsibilities, and systems of accountability in place to support the delivery of high-quality, sustainable care. Leaders used information about risk, performance, and outcomes to inform decision-making and ensure safe and effective service delivery.

There was a clear framework outlining what should be discussed at ward, team, and directorate meetings, ensuring that essential information, such as learning from incidents, complaints, and safeguarding concerns were routinely shared and reviewed across different levels of the service.

Leaders provided joint oversight across both the Coborn Centre (London) and Evergreen Unit (Luton) through a shared senior leadership structure, including a lead nurse, deputy lead nurse and clinical director with responsibility across both sites. This arrangement supported consistency in clinical practice, governance processes and decision-making across geographically separate services, alongside clear escalation routes for risk, incidents and performance concerns.

At ward level, regular staff meetings took place and followed structured agendas with rotating topics. These included ligature management and safety, fire safety, observation policy, seclusion practice, physical health monitoring, patient search procedures, restrictive practice and learning from incidents, safeguarding reviews and complaints. Staff demonstrated that they implemented recommendations from incidents, complaints and safeguarding reviews, supporting continuous improvement at service level.

Governance systems operated across ward, site and directorate levels, supported by a range of forums that enabled oversight of safety, quality and operational performance. Weekly Operational Leadership Forum meetings functioned as operational forums within CAMHS inpatient services, focusing on current patient risk, incidents and safeguarding, staffing levels and pressures, observations, therapeutic engagement and daily ward functioning. These meetings were well established at the Coborn Centre and where being introduced at the Evergreen Unit, supporting alignment across sites. All staff were able to attend these meetings, promoting transparency and shared ownership.

Daily Senior Management Group meetings provided senior-level oversight of risk and performance, including high-risk cases, incidents and staffing pressures, with authority to escalate concerns and allocate resources. Directorate-level governance meetings further strengthened oversight, ensuring that issues identified at ward level were escalated appropriately, recorded and tracked through formal governance systems, including the risk register where necessary.

Leaders used a range of governance mechanisms to monitor service delivery, including the systematic review of incident data, safeguarding concerns, restrictive interventions, staffing levels and patient flow. Leader said the integration of the Coborn Centre and Evergreen Unit supported shared learning and alignment of governance processes, strengthening organisational oversight. There was evidence that learning from incidents was shared across both sites.

Staff also took part in scheduled audits and benchmarking to support oversight and improvement. Managers ensured staff carried out a range of audits, including care plans, risk assessments and escalation of physical health observations, to check adherence to good practice guidance. Audit findings were discussed within meetings and away days, and used to drive improvements, with identified areas for development addressed through reminders, training and supervision.

The service maintained effective systems for the management of risk, issues, and performance. Staff had access to a risk register at ward and directorate level and were able to escalate concerns appropriately. The risk register reflected a range of operational, clinical and environmental risks relevant to the CAMHS inpatient setting. These included staffing pressures, environmental risks such as fire safety and ligature risks, and challenges relating to patient flow and discharge. Risks had defined controls, mitigating actions and identified gaps. Staff and leaders were aware of these risks, and concerns raised during inspection were consistent with those recorded Concerns raised by staff were consistent with those recorded on the risk register, indicating transparency and shared awareness of risks. Leaders were open about areas for improvement and described actions being taken to address them. Risks were monitored through established governance structures, with actions tracked to reduce risk and support the delivery of safe care.

Quality Statement Score: 3

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.

Staff told us that young people were often admitted from different boroughs, and the service worked to support their return to their home communities on discharge. However, staff highlighted challenges with inter-agency working across boroughs, which could impact timely discharge planning. Staff described challenges with discharge planning, including limited clarity and availability within community teams and delays in brokerage processes when arranging placements or packages of care. As a result, some young people were clinically ready for discharge but remained on the ward due to a lack of suitable placements or step-down options.

At the time of inspection, staff told us there were instances where 5 young people were ready for discharge but remained in the service due to delays in identifying appropriate placements. This highlighted system-wide challenges beyond the direct control of the service. Despite these challenges, the service continued to work proactively with partners, maintaining communication and attending multi-agency meetings to progress discharge planning and advocate for young people’s needs. Staff demonstrated persistence in coordinating with external agencies, even where pathways were complex.

Quality Statement Score:4

The evidence showed an exceptional standard.

The service demonstrated a strong focus to continuous learning, innovation, and improvement, both within the organisation and across the wider system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

We saw evidence of meaningful co-production, where staff and young people worked together to influence service development. For example, following a series of collaborative workshops, two wards at the Coborn Centre were renamed in January 2026. Young people contributed ideas to the renaming of the wards which reflected their experiences of care, recovery, and belonging. The names “Nova” and “Pluto” were chosen to represent hope, new beginnings, calmness, and reflection, demonstrating a commitment to creating a positive, recovery-focused environment.

Staff were supported to engage in quality improvement (QI) initiatives and had opportunities to contribute ideas for service enhancement. They demonstrated an understanding of quality improvement methods and applied these in practice to drive change. There were several QI projects within CAMHS services focusing on areas such as improving engagement, reducing restrictive practices, and addressing inequalities in access and experience. For example, a 2025 quality improvement project on Coborn CAMHS acute inpatient ward aimed to reduce the use of intermittent and enhanced observations while increasing meaningful therapeutic engagement. The team identified key drivers including unclear rationale for observations and limited weekend activity, and tested changes such as structured activity programmes and daily MDT prompts to review observation levels. As a result, the ward achieved an approximate 40% reduction in enhanced observations, alongside improved patient engagement, demonstrating how targeted QI methodology can support less restrictive, more therapeutic care environments within inpatient CAMHS settings.

The service had also undertaken quality improvement work to improve the experience of young people requiring nasogastric (NG) feeding. This included a co-production approach, where staff worked with young people to better understand the factors that contributed to distress during NG feeding interventions. As a result, the service introduced more personalised and supportive approaches, including adapting the physical environment during feeding including the use of more supportive positioning, such as soft seating, where appropriate, to improve comfort and reduce anxiety. Staff described how this work had led to a more compassionate and individualised approach to care. Learning from this improvement work had also been shared more widely, including with local acute hospital teams, to support consistency in practice and improve experiences for young people across different care settings.

Staff also participated in research and national audits, and the service engaged with external quality assurance frameworks, including membership of the Quality Network for Inpatient CAMHS (QNIC). The service at the Evergreen unit had undergone peer review, with overall feedback described as very positive, and was progressing through an accreditation process.