The Care Quality Commission (CQC) has published reports on leadership, and three services at North East London NHS Foundation Trust (NELFT), following inspections carried out between October 2024 and March 2025.
The trust provides community and mental health services to a population of around 4.3 million people across the London Boroughs of Barking & Dagenham, Waltham Forest, Redbridge, Havering, and in the counties of Essex and Kent. The trust employs approximately 7,500 staff working from 210 bases. NELFT is a significant provider of community health services for children and adults, and community and inpatient mental health services for children and adults.
Following the three service inspections:
- Specialist community mental health services for children and young people in Redbridge were not re-rated and remain as requires improvement overall.
- Acute wards for adults of working age and psychiatric intensive care units have dropped from good to requires improvement overall.
- Community health services for adults remain rated as good overall.
CQC inspected these three services ahead of the well-led review to ensure a thorough understanding of leadership of these services, provided by the trust.
CQC has again rated the trust as good for how well-led they are. CQC now gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at a trust level. This simpler, more focused approach to rating NHS trusts reflects the strong correlation CQC has found between the quality of leadership at an organisation and the quality of care being delivered. CQC continues to inspect and rate individual hospital services and locations to capture how people are directly experiencing care at that level.
Across leadership:
- There had been significant changes in trust leadership at executive and board level. Inspectors found senior leaders to be more visible and approachable, with staff speaking positively about the trust’s culture and diversity work. Staff valued having better access to senior leaders, specifically mentioning board service visits and meetings held at different trust sites.
- Inspectors saw strong engagement through the Just and Compassionate programme that promotes fairness and empathy and that the trust designed services with the people using them.
- Leaders were also effectively using quality improvement and digital innovation to drive change.
- However, the trust still needed to strengthen medical leadership, and some medical staff still felt it was hard to contribute to decision-making in their area of work. Whilst a review had started, this was at an early stage.
Inspectors found:
Specialist community mental health services for children and young people:
- Most carers described the staff as kind, caring, respectful and supportive. Most care plans were personalised, holistic and recovery orientated.
- Staff made sure that people and their carers could easily access information on a range of topics, including local services, helplines and safeguarding.
- People using the service, and most carers knew how to complain, and staff handled complaints appropriately.
- Leaders worked hard to improve staff morale and wellbeing. Staff reported a friendly, open and supportive culture between peers and the leadership team.
- However, systems to identify and manage risks to young people and governance processes needed improving.
- Children and young people couldn't access care in a timely way, with over 60% waiting for initial telephone triage, assessment or treatment.
- Children and young people experienced delays from referral to starting treatment. Some young people were nearing or had passed their 18th birthday without an initial assessment, which affected their transition to adult services.
- Caseloads were highest in triage, with some staff holding over 90 cases and one reporting up to 110, which impacted the waiting times for assessment and treatment.
Acute wards for adults of working age and psychiatric intensive care units:
- Staff learnt from incidents and could explain how they had incorporated learning, with action plans in place for all serious incidents.
- Staff understood the trust’s safeguarding procedures to protect people from abuse.
- Staff carried out appropriate environmental checks. The wards were visibly clean, with regular hand washing and infection control audits in place.
- However, staff needed to improve how they recorded a restraint of someone using the service, and subsequent debriefs so it could be appropriately monitored, to identify opportunities for reduction.
- Some people did not have risk assessments and care plans in place for physical health conditions. Improvements were needed in how staff carried out and recorded observations on people, and recorded administration of controlled medicines.
- People on all wards reported they could not access hot drinks and snacks directly and often waited a long time for staff to provide these. The trust was committed to addressing this.
Community health services for adults:
- People felt involved in their care planning, and staff understood their strengths, abilities, aspirations, culture, and protected characteristics.
- Staff understood how to protect people from abuse and worked well with other agencies to do so.
- The trust treated concerns and complaints seriously, investigated them and used them for learning.
- The trust listened to those most likely to experience inequity and aimed to develop services to address this. Staff reflected the diversity of the communities they served.
- People were encouraged to give feedback on services and engage in their development through local and trust-wide engagement networks.
- Some people said communication needed improvement, and a small number reported that an interpreter was not booked when they did not share a language with the person providing care.
Due to a large-scale transformation programme at CQC, the reports for acute wards for adults of working age and psychiatric intensive care units and community health services for adults have not published as soon after the inspection as it should have done. The programme involved changes to the technology CQC uses but resulted in problems with the systems and processes rather than the intended benefits. The amount of time taken to publish these reports falls far short of what people using services and the trust should be able to expect and CQC apologises for this.
While publication of some reports has been delayed, any immediate action that CQC needed to take to protect people using services has not been affected. CQC is taking urgent steps to ensure that inspection reports are published in a much more timely manner.
The reports will be published on CQC’s website in the coming days.