East London NHS Foundation Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Good

Our view of the service

With an annual income of £744 million, East London NHS Foundation Trust (ELFT) provided care and treatment for a population in excess of 2 million people. They employed around 7,700 staff who worked across 120 community and inpatient sites. The trust managed 900 inpatient beds. 

ELFT provided a range of mental health, community, primary care and inpatient services to children, young people, adults of working age and older adults to the City of London, Hackney, Newham, Tower Hamlets, Bedfordshire and Luton. The trust provided community health services in Newham, Tower Hamlets and Bedfordshire. The trust also provided some specialist mental health services, including forensic and perinatal services to a wider catchment area in North East London and the surrounding area. 

Specialist GP inclusion services were provided by the trust for homeless people across 3 East London centres in Tower Hamlets, Hackney and Newham. In addition, the trust delivered talking therapy services in Newham, Tower Hamlets and Bedfordshire. They also provided drug and alcohol support services in Bedfordshire. 

We had previously carried out a well led review of East London NHS Foundation Trust in 2021. At that time, we had rated the trust overall as outstanding and well led as outstanding. 

The Care Quality Commission has updated its approach to regulating NHS trusts, moving away from single word ratings at organisational level. Trust-level assessments now focus primarily on a well led rating. As a result of this assessment, we rated the trust as good for well led. We did not identify any breaches in regulations, although we did find some areas for improvement. The trust were sighted on this but there was more to do. 

We undertook this trust level (well-led) assessment, which included an onsite visit, on the 30 June and 1 July 2026. We also held 14 staff focus groups on site and remotely and observed board and several other committee and operational meetings between March and June 2026. We requested information from the trust to inform our understanding of the organisation. 

We carried out this assessment for the following reasons:

• Our previous inspection made some recommendations for improvements and the CQC wanted to see if these had been implemented.
• Since the last inspection there had been significant changes to the board leadership – both executive and non-executive and the CQC wanted to assess the impact of these changes.
• This inspection took place at a time of significant pressures for healthcare services – especially those associated with crisis and acute mental health pathways. The CQC wanted to see how the trust was managing these pressures and working with system partners to support access to services.
• The CQC monitor serious incidents and wanted to understand how the trust was addressing and learning from these incidents. 

Prior to the well led review we had inspected 5 core services: 

• acute wards for adults of working age and psychiatric intensive care units (PICU)
• community health services for adults
• specialist inpatient mental health services for children and young people
• mental health crisis services and health-based places of safety
• community-based mental health services for adults of working age

We used what we found during those inspections and visits to inform the well led review and the findings. 

We recognised that our well led assessment had taken place at a time where the trust had taken steps to meet efficiency requirements and improve financial control which had impacted staff across the organisation. This had happened at the same time as a significant increase in demand from the communities served by the trust. 

Despite these challenges we found areas of positive practice of which the trust can be rightly proud. This included examples of further progress since the last well led inspection: 

• Focus on people who use services. Staff told us that they felt proud to work for the trust and we heard many examples of how they put the people who use services at the centre of their work. We observed staff supporting people who use services in a kind and caring manner, getting to know them and recognising what was important to them. 

• Leadership. It was positive to find that significant changes to the board had gone well and provided an opportunity to introduce people with the skills and experience needed to support the strategic direction of the trust.

• People participation. This had become more embedded since the last inspection and was hard wired into how business was done at the trust. We heard of many examples where co-production was taking place and making a real difference to the experiences of people using services. People who use services were actively involved in key committees across the trust; were integral to the work on population health, collaboratively working to develop services to meet the needs of people in communities; were active participants in quality improvement initiatives in corporate services and in local services. This was in addition to the people participation work which had continued since the previous inspection including 63 peer support workers; 47 active befrienders supporting 177 people and the ongoing service user led accreditation scheme. 

• Quality improvement. This had continued to be embedded and developed further across all areas of the trust. People working for and associated with the trust talked about how the approach was widely used. We heard how this approach had supported some trust wide improvements. This had included improving the flow of mental health patients across the trust and reducing out of area care; improving waiting lists for services for example in musculoskeletal services. We also observed how a large scale quality improvement project was reducing the use of intermittent observations and improving therapeutic engagement on inpatient wards. 

• Trust strategy. The refreshed strategy had been launched and was developed through extensive internal and external consultation with a wide range of stakeholders. The strategy on 2 pages was clear and accessible. It provided a focus for the work being done by the trust to meet the needs of local populations. At this inspection we also noted that the current strategy incorporated a strategy delivery framework to support a more disciplined approach to implementation, prioritisation, co-ordination and learning across the organisation. 

• Partnership working. This work had developed further since the last inspection with the focus on population health. We heard about the continued active participation and leadership roles by members of the trust leadership team in the 2 care systems where most trust services were located. The trust had many examples of where it was working in boroughs and neighbourhoods to meet the needs of communities. For example, in Tower Hamlets, the trust had opened Barnsley Street, a pilot site offering a 24/7 open access neighbourhood mental health centre. Another example was the healthier, wealthier families initiative in Newham and Luton helping homeless people open bank accounts, supporting people to receive specialist immigration advice and providing learning for young people to improve their financial awareness. This was being implemented in partnership with local councils, Citizens Advice and banks. 

• Staff engagement. We heard from many staff about how senior leaders connected with staff across the wide geography. This included the monthly chief executive breakfasts, monthly chief executive discussion group sessions with members of the executive leadership team, and the programme of executive and non-executive walkarounds. These were well received and aligned with the non-hierarchical culture of the trust where people felt able to speak openly to senior leaders. We also heard positive feedback about the staff networks and the support they received from senior leaders. Since the last inspection, the networks were working together to address issues of intersectionality. 

The inspection found there were some areas where work had taken place but there was more to do:

• Governance. The trust governance arrangements were largely robust but would benefit from some additional strengthening. The directorates had autonomy within a framework to support them to meet the needs of local populations. However, our inspections of services found some unwarranted variation both between and within directorates, where trust policies and procedures were not always applied and embedded to the same standard. We also found areas of good practice which would benefit from being shared across services and directorates to improve the care being delivered to patients. 

• Learning from serious incidents. At the last well led inspection we identified recurring themes linked to serious incidents and recommended the progression of the work to achieve sustained improvements across all the services. At this inspection we found that arrangements were in place for staff to learn from incidents including safety alerts, learning events and discussing learning at team meetings. We also heard about the large-scale quality improvement work on therapeutic engagement. Our inspections of inpatient mental health wards found this was understood and being applied by staff, although this needed to be consistently embedded. At this inspection we found that the themes from serious patient safety events were reported through to the quality assurance committee. We also heard about actions being taken to improve safety and a range of quality improvement projects to support this work. Whilst work was taking place to explicitly state patient safety priorities and measures to monitor them, this was not yet embedded. This meant there was a potential risk that measures to address known recurring patient safety risks, such as the undertaking of risk formulation were not being implemented at pace across directorates and services. 

• Staff wellbeing. The trust recognised the importance of staff having a positive working experience and were implementing a staff experience programme to address areas for improvement. Many staff told us they enjoyed working for the trust. However, they also described the pressures they were experiencing and the impact of this on their ability to deliver high quality care. This was reflected in the results of the staff survey 2025. This had lower than average results across the majority of people promise themes. The trust recognised that staff were experiencing burnout and had made this a theme for their staff experience programme which needed to be fully implemented and for staff to feel the improvements. 

• Estates. The trust had an estates strategy and had made improvements to the arrangements to maintain the estates. Despite this work the condition of some estates was impacting on the quality of experience for people using services and for staff working in those services. This had been an area for improvement at the last well led inspection. The inpatient mental health estates in Hackney and Tower Hamlets were presenting ongoing challenges for staff to deliver therapeutic care. The trust was considering options for refurbishment and potential reprovision, but this had not concluded. In Bedfordshire there were plans to replace the inpatient facilities but funding shortfalls needed to be overcome. A programme of refurbishment of the forensic inpatient facilities was commencing shortly after our assessment. 

People's experience of this service

The 2024 NHS community mental health survey showed the trust performed 

about the same as other trusts in all 12 areas. The survey found service user experience of the trust was best in feeling they had enough privacy to talk comfortably during therapy. The trusts lowest score related to people being asked to give feedback on the service they received. 

During our inspection of acute wards for adults of working age and psychiatric intensive care units, community health services for adults, specialist inpatient mental health services for children and young people, mental health crisis services and health-based places of safety and community-based mental health services for adults of working age we spoke with:

• 130 people using the service
• 73 relatives or carers
• We also observed 4 people participation forums and held 1 people participation focus group where we also had the opportunity to speak with people who use services or their carers’. 

They told us:

• Feedback from young people receiving care and treatment on adolescent mental health wards indicated that the service was caring and supportive, with staff generally viewed as engaged and responsive to young people’s needs. Young people felt able to ask staff questions and said staff responded quickly when support was needed. 

   

• Patients and carers consistently spoke positively about community health service teams. Many people told us staff went above and beyond. People said they trusted staff and felt more confident in their mobility and treatment plans because of the support they received. Staff responded quickly and efficiently to people’s needs, particularly when they were in pain or distress.

• On the acute and PICU wards people’s views about the service varied considerably. Patients’ feedback about staff was mixed. Whilst the majority described most staff as kind, helpful and respectful, others were not happy with the way staff treated them. 

• People we spoke with who had used the health-based place of safety spoke very positively about staff. Feedback from people using mental health crisis services was mixed with some people commenting positively about the support they received and others commenting negatively on the attitude of some staff. Some people told us they felt the crisis team had supported them to stay safe. 

• Feedback from people using community mental health services was also mixed. Overall, people told us that the service met their individual needs, and staff were compassionate and supportive. However, some people told us that appointments and any changes were not always communicated well.

The trust gathered feedback from people who used their service through a friends and family test. Between 1 April 2024 and 31 March 2025, 19,632 people responded. The percentage of people who responded positively to question ‘overall, how was your experience of our service?’ was 80%.