The East London NHS Foundation Trust's mental health crisis services have been downgraded from 'Good' to 'Requires Improvement' by the Care Quality Commission (CQC) following an inspection in November 2025. The downgrade, effective from July 28, affects emergency mental health support across the City of London and Hackney, as well as Newham and Tower Hamlets, and was prompted by multiple regulation breaches, including patients not being given sufficient direct access to fresh air.
Inspection findings and regulatory breaches
The trust provides two types of mental health support: rapid 24/7 urgent crisis services and emergency clinical detention units, known as health-based places of safety (HBPoS), where individuals in acute mental health crises can be assessed for up to 24 hours. The CQC inspection revealed failures in staffing, training, and safety across these services, with the trust now required to present an action plan to the regulator to address deficiencies in all but one of the CQC's five core quality questions: Safe, Effective, Caring, Responsive, and Well-led.
In City and Hackney, inspectors found that more than two-thirds (68%) of staff missed mandatory supervision sessions—one-to-one meetings designed to support staff and allow them to discuss concerns. Compliance did not improve post-inspection at the HBPoS, and inspectors also discovered a CCTV blind spot in a bathroom that staff claimed had not been resolved for two years.
Patient safety concerns and use of restrictions
Patients at City and Hackney more frequently faced physical or chemical restrictions compared to other trust services, with roughly half of all seclusions, holding restraints, and rapid tranquilisations occurring at the HBPoS. To avoid unlawfully detaining patients beyond the 24-hour legal limit under the Mental Health Act, staff used a loophole by admitting patients to 'swing beds'—temporary settings where they could be detained. As a result, around 30% of patients remained in the emergency suite for longer than 72 hours, with an average stay of 70 hours.
Safety training was deficient across the board, with only half of staff compliant in adult basic life support skills, placing both clinicians and vulnerable patients at risk. Staffing levels were dangerously low, with more than one in ten temporary shifts left unfilled.
Positive aspects and trust-wide challenges
Despite these issues, the services maintained a 'Good' rating for 'Caring', scoring 70 out of 100. Inspectors noted that staff were respectful and did not hurry patients, showing 'kindness, empathy and compassion' and using 'least restrictive options' to calm those in distress. However, the score was capped due to inconsistent safety and monitoring measures for staff working alone in the community. The trust also reported that suicides under mental health care fall significantly below the national average.
Supervision and understaffing issues were common across the trust, which operates in Bedfordshire & Luton, City & Hackney, Newham, and Tower Hamlets—the latter three being among the most deprived local authorities in London. At Luton's HBPoS, 29 patients detained under emergency police powers were kept beyond the legal 24-hour limit, with one patient waiting over 72 hours to be released. Tower Hamlets experienced a severe staffing crisis due to sickness absences peaking at 15.1% for specialist home treatment workers.
Trust response and next steps
In a statement to the Local Democracy Reporting Service (LDRS), Chief Nurse and Lead for Peer Support and Allied Health Professionals, Claire McKenna, acknowledged that many of the report's themes were 'not new' and reflected the reality of delivering high-quality care in a complex environment. She said: 'Our colleagues do extraordinary work every day, often supporting people through some of the most challenging moments of their lives. The feedback we received from the CQC report relating to some of our crisis teams recognises the commitment, kindness and expertise of our colleagues. We are committed to making improvements to strengthen the quality, safety and experience of care for all who use our services.'
The trust must now present its action plan to the CQC to address the identified deficiencies, with the goal of improving safety and care across its mental health services.
