CQC rates leadership and services run by South London and Maudsley NHS Foundation Trust

The Care Quality Commission (CQC) has published reports on leadership, and four services at South London and Maudsley NHS Foundation Trust (SLaM), following inspections carried out between June and October 2025.

The trust provides community and inpatient mental health services for children and adults to a population of around 1.3 million people across the London Boroughs of Croydon, Lambeth, Lewisham and Southwark. It also delivers a number of national services. The trust employs approximately 6,635 staff working across 240 bases, providing services to more than 40,000 people in the community and 712 beds across 48 inpatient wards. The main sites are Maudsley Hospital, Bethlem Royal Hospital, Lambeth Hospital and the Ladywell Unit in Lewisham.

Following the four service inspections:

• Forensic inpatient or secure wards at Bethlem Royal Hospital remain rated as good overall.
• Acute wards for adults of working age and psychiatric intensive care units have dropped from good to requires improvement overall.
• Mental health crisis services and health-based places of safety have dropped from good to requires improvement overall.
• Community-based mental health services for adults of working age remain rated as requires improvement overall.

CQC inspected four services ahead of the well-led review to ensure a thorough understanding of leadership across the trust. The inspections of community-based mental health services for adults of working age and mental health crisis services and health-based places of safety were completed as part of CQC's adult community mental health programme, which contributes to CQC's commitment to inspect the standard of care in community mental health services across the country.

CQC rated how well-led the trust is as requires improvement. CQC currently gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at that level. CQC consulted on this approach and will use the feedback gathered to consider whether this well-led key question at NHS trust level is appropriate for the new innovative, complex and integrated models of care being created.

Across leadership:

• Many staff described a disconnect between front line staff and senior leaders and said they didn't feel their experiences were heard or that their work was always appreciated. Staff told inspectors that they no longer felt that they wanted to provide feedback through the staff survey or other means as they didn't believe this would make a difference. This was reflected in the low completion rate of 39% for the 2024 NHS staff survey.
• Leaders didn’t always have effective working relationships with the staff networks. Work was needed to ensure all networks feel valued and that issues of race, racism and disability are understood and appropriately addressed.
• Staff were aware of the Freedom to Speak Up Guardian role, but feedback about speaking up was mixed. While some staff felt able to raise safety concerns with local managers, many did not feel confident that wider concerns were taken seriously or acted on, particularly when escalated to senior management. More work was needed to ensure speak up arrangements were working well, rebuild trust and ensure staff feel confident to raise concerns across the organisation.
• The clinical leadership at a trust and directorate level was not always working well with some leaders not feeling that they contributed appropriately to decisions. At a directorate level, members of the multi-professional team did not always feel able to adequately contribute to decision making. There was a need to ensure clinical leadership was reviewed, considering roles and accountability to allow all leaders to contribute effectively.
• Staff were committed, compassionate and strived to provide high quality care and treatment to people using the services. The trust had strong partnership working at both a local and system level. This was demonstrated through various projects and work such as the new community mental health model in Lewisham.

Inspectors found:

Forensic inpatient or secure wards at Bethlem Royal Hospital:

• People and carers said staff were kind, caring and understood their needs. The ward environment was well-maintained, calm, light and spacious.
• Managers had created an open and supportive team culture where learning was shared. Staff were positive about working for the service and the support they received from managers.
• Staff completed the Seni Lewis training, developed by the trust to build skills in preventing and using the least restrictive approaches to managing behaviours that may challenge, including violence and aggression, in mental health settings.
• The service was implementing an opt-out system for independent advocacy, so every person would automatically receive advocate support unless they chose to decline.

Acute wards for adults of working age and psychiatric intensive care units:

• Staff didn't always keep accurate records of therapeutic observations or carry these out in line with trust requirements. Records often lacked required detail, such as the time of observation or information about people's wellbeing.
• Staff across several wards told inspectors that their morale was low and they felt unsafe due to the high levels of violence and aggression they experienced at work.
• Staff said that while they understood the arrangements for speaking up, many didn't feel able to speak up or that their concerns would be heard and addressed.
• Staff reduced the use of restraint across the wards. The trust collected and analysed data about physical interventions to drive improvement, with most months recording fewer than 200 restraints trust-wide.
• Staff involved external organisations such as physical healthcare services and social care services to provide a continuity of care with the service and post-discharge. Staff also worked in partnership with external organisations to support people to engage in activities within the community.

Mental health crisis services and health-based places of safety:

• Staff in the home treatment teams didn't all have access to working alarms to obtain support in an emergency.
• The service kept most people in the health-based place of safety for more than 24 hours which was not in line with the Mental Health Act code of practice. Approximately 40% of people were from outside of the trust’s geographical boundary which contributed to assessment delays.
• Leaders didn't always make sure staff completed mandatory training, with low completion rates for training on learning disability and autism.
• People who used services said they were often seen by different staff and experienced poor communication, including a lack of regular discussions about their treatment plans. Two people told inspectors they would have appreciated being supported by the home treatment team for longer before being discharged.
• Leaders made sure the home treatment teams were aware of how to raise incidents and staff gave examples of changes made as a result. Staff were aware of safeguarding procedures and were using them appropriately.

Community-based mental health services for adults of working age:

• Leaders didn't ensure clear oversight of risk for people waiting for services. At the time of the inspection, 596 people remained on waiting lists, including 160 urgent referrals, with no formal process in place to monitor or review their clinical needs while waiting.
• Staff didn't consistently complete or update risk assessments and crisis management plans. Staff hadn't completed up-to-date risk assessments in 10 records out of 20 care records inspectors reviewed.
• Leaders didn't ensure care environments were always fit for purpose. In Lewisham, cramped waiting areas and ongoing building work caused dust, heat and noise.
• The service didn't manage caseloads in line with national guidance. In the Lewisham early intervention in psychosis team, practitioners carried an average of 26 to 27 cases, significantly above the NHS England recommended maximum of 15, limiting staff’s ability to deliver recovery-focused care.
• Leaders didn't consistently act on learning from incidents and deaths or addressed recurring themes from mortality reviews, including poor documentation and gaps in basic life support training remained unaddressed.
• However, carers gave positive feedback, with 88% rating their experience as good or very good in the family and friends survey. They praised the service’s communication and said staff listened to them, valued them and provided good support.