East London NHS Trust’s mental health services downgraded to ‘Requires Improvement’ by CQC

Emergency mental health support services across City & Hackney, Newham and Tower Hamlets were deemed in need of improvement in all but one category

An East London hospital trust’s mental health services have been downgraded by the Care Quality Commission (CQC) after an inspection exposed multiple failures around staffing, training and safety.

Following a routine CQC inspection in November 2025, the East London NHS Foundation Trust was moved down on July 28 from ‘Good’ to ‘Requires Improvement’ for its emergency mental health support, after inspectors found multiple regulation breaches including patients not being given enough direct access to fresh air. The trust provides services across the City of London and Hackney, as well as Newham and Tower Hamlets

NHS trusts provide two tracks of mental health support: rapid, 24/7 urgent ‘crisis’ services and emergency clinical detention units, also known as health-based places of safety (HBPoS), where individuals in acute mental health crises can be assessed for up to 24 hours.

The trust has retained its overall CQC rating of Outstanding, but must now present the regulator with its action plan for addressing the deficiencies found in its mental health services across all but one of the commission’s five ‘core quality’ questions: Safe, Effective, Caring, Responsive and Well-led.

In City and Hackney, the regulator found far too little supervision of staff who were dealing with patients in acute psychiatric crises, with more than two-thirds (68%) missing mandatory supervision sessions – one to one sessions designed to support staff and allow them to discuss concerns.

Though this was similar in other boroughs, here the CQC found compliance did not improve post-inspection at City and Hackney’s HBPoS. Inspectors also discovered one room at this setting had a CCTV bathroom blind spot staff claimed had not been solved for two years.

Patients at City and Hackney also more commonly faced physical or chemical restrictions compared to the other services in the trust, with roughly half of all seclusions, holding restraints and rapid tranquilisations occurring at the HBPoS.

To stop patients being unlawfully detained beyond the 24-hour legal limit under the Mental Health Act, City and Hackney staff had used a loophole in admitting patients to so-called “swing beds” – temporary settings where they can be detained. As a result, around a third (30%) of patients remained in this emergency suite longer than 72 hours – with 70 hours being the average.

Safety training was also found to be deficient across the board. Only half of staff were found compliant with adult basic life support skills, placing both clinicians and vulnerable patients at risk. Although a systemic issue for the health service, staffing levels were dangerously low, with more than one in 10 temporary shifts left unfilled.

However, on ‘Caring’ these services maintained their ‘Good’ rating, scoring 70 out of 100. Inspectors noted that staff were respectful and did not hurry or rush patients. Clinical staff showed “kindness, empathy and compassion” and used the “least restrictive options” to help calm those in distress, preventing the need for physical or chemical restraint.

But the score was capped because of inconsistent safety and monitoring measures for staff working alone in the community.

The trust also recorded that suicides under mental health care fall significantly below the national average.

Supervision and understaffing issues were commonplace within the wider trust, which is spread across Bedfordshire & Luton, City & Hackney, Newham and Tower Hamlets, the latter three belonging to the most deprived local authorities in the capital.

At Luton’s HBPoS, 29 patients who were 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, meanwhile, has seen its services hit by a severe staffing crisis due to sickness absences rising far beyond other localities, peaking at 15.1% for its specialist home treatment workers.

In a statement to the Local Democracy Reporting Service (LDRS), Chief Nurse and Lead for Peer Support and Allied Health Professionals (AHPs), Claire McKenna, said many of the report’s themes were “not new” and reflected the reality of delivering high-quality care in an increasingly complex environment.

“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.”

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