Better care

Improving the quality of our care is always at the forefront of what we do - and we are pleased to have that reflected by our CQC ‘Good’ rating. Increasing demand and acuity made delivering high quality care even more challenging. A number of tragic local and national cases have led to reviews of practice, which we all must learn from. Our focus is on working in partnership with our communities, focusing on active anti-racism, co-production and improvement, to respond to these challenges and deliver the best care possible to those who use our services, their carers, our staff and stakeholders.

A full report detailing our quality improvement work is available in this year’s Quality Account.

Our response to national independent reviews of mental health services

Nationally we have seen the publication of a number of challenging reports into failings in mental health Trusts across the country. There is important learning for everyone in the NHS from these reports – the cases highlight that while process actions and governance are important, relationships and a positive culture are essential. They also emphasise the need to continue our focus on psychological safety and speaking out.

In August, the Care Quality Commission (CQC) published the second part of its special review into patient safety concerns in mental health services at Nottinghamshire Healthcare NHS Foundation Trust, following the deaths of Ian Coates, Grace O’Malley-Kumar, and Barnaby Webber in 2023. The circumstances that led to this review are tragic. Our hearts go out to the bereaved families and all those who have been affected by this terrible event.

In February, NHS England published a full independent investigation into the care and treatment of Valdo Calocane and the interactions with other agencies involved in his care.

We have undertaken a comprehensive review of the findings from the Nottingham review to consider key areas of learning to enhance our patient care and safety in pursuit of best practice.

Many of the recommendations from the review are being taken forward as part of our Adult Patient Journey work, including improving our early detection of deteriorating patients, strengthening assertive care and treatment, and further embedding our fundamental standards of care in our community services.

Learning from incidents in our care

In addition to national reviews, we know that learning from inquests and other incidents in our care is critical. Each incident is a tragedy for the individuals and families involved, and our staff, and requires us to thoroughly examine what happened, understand what went wrong, and take meaningful action to prevent future harm. We are committed to engaging fully and transparently with the incident review process (Patient Safety Incident Response Framework), listening to and communicating with families (especially Duty of Candour), and embedding the lessons we learn into our care, culture, and systems. It is through this openness and commitment to continuous improvement that we can build a safer, more compassionate service for all.

We invited the HM Senior Coroner for West London to visit. She talked to us about her insights and reflections around the inquest process.  She focused on experiences and the importance of working in collaboration to support both the families of the deceased and the staff through the inquest process.

Quality Governance health check

W e commissioned an external follow-up quality governance health check and internal self-assessment against the CQC Well-Led Framework. This builds on the quality governance review work undertaken in late 2023. The report highlights areas that we have built on and improved since 2023 and makes a number of recommendations to help us further strengthen our quality governance arrangements. Work continues around the plans to establish a comprehensive ‘quality management system’ and we have built on feedback from leaders to help us define the necessary changes. Our Learning and Improvement Group is overseeing progress with the plan.

Focus on Fundamental Standards of Care

Our Fundamental Standards of Care (FSoC) are a set of standards which must be met when we provide care – they are fundamental to the care we provide.

We continue to put the FSoC at the heart of what we do. An associated digital ‘dashboard’ has been created for each of the Fundamental Standards, to measure improvements, and we have seen progress on care planning and record keeping, noted by the CQC.

Supporting innovation, improvement, research, and development

Our Board recommitted to continuous improvement using our Quality Improvement (QII) approach. Our QII Programme is well established and has been active since 2018. Our QII work was focused on our two top priorities, with QII projects supporting reducing long lengths of stay and reducing violence and aggression. Our QII work is being built into our MLBT Development Centre and we have focused on psychological safety through our staff experience work. More detail is in the Great Place to Work section.

Overview of QI

Foundations in QI for Teams	This year, we have delivered the training package 4 times.  The sessions were attended by 44 staff members working on 14 QI projects across the organisation.
Core trainee QI programme	The first cohort created a collaborative focusing on improving the completion of capacity and consent forms on admission. The second cohort agreed to collaborate on 4 projects.
Quality, Service Improvement and Redesign (QSIR)	To date, we have delivered nine programmes, attended by 128 SWLSTG staff members, 54 Oxleas colleagues, and 11 SLaM colleagues. Cohort 10 is currently undertaking the training and is attended by 46 delegates.
Preceptorship	The Nursing Development Team and QII Team members collaborated to design a full day’s training for each cohort of the preceptees programme.  This year, we have supported three cohorts and approximately 107 nurses.

 

The QII team has continued to support teams who have come forward with project ideas. There are currently 30 active projects across the organisation. See examples in the Adult Patient Journey section. 

Some examples of innovation and improvement are outlined below:

·        Perinatal Services: Our Perinatal Service has grown significantly since 2018, it now supports all five boroughs and has seen access increase in access rates amongst Black, Asian and Minority Ethnic families. In 2024 the team successfully launched the Perinatal Trauma and Loss Team, expanding the reach of the service. The new team has committed to supporting fathers and partners via couples initiatives and cross-organisation collaboration. They were also successful at achieving accreditation with the Perinatal Quality Network.

·        Friendly Wards: Our Recovery College, Acute and Urgent Care Service Line staff, and carers, have co-developed a new course called ‘Friendly Wards’. Designed to recognise that having a relative or friend as an inpatient in a psychiatric ward can be an incredibly challenging, the course aims to tackle some of the immediate needs of carers, and is open to anyone caring for an individual who has been admitted onto a ward within the Trust. 

·        Resources to support people affected by an eating disorder: Peer Support Workers within our Adult Eating Disorders Service have created a range of resources to support people affected by an eating disorder, as well as family and friends, external services and GPs.

·        Virtual reality to support patients with psychosis: We partnered with Phase Space Ltd to launch an innovative pilot programme that uses specially designed hypnotherapy-based virtual reality (VR) to support patients with psychosis on their journey to recovery. This cutting-edge approach aims to help individuals experiencing symptoms such as hallucinations, delusions and confused thoughts by offering a calming, immersive experience designed to promote relaxation and wellbeing.

·        Wisteria opens new garden designed by patients: Wisteria ward at Springfield Hospital has a wonderful new garden thanks to the creativity and hard work of the ward’s young patients who designed it.

Research and development: A total of 89 research studies were open and active.  Of these, 33 are new studies that were approved. The number of patients who were recruited during that period to participate in research approved by a research ethics committee is 306. We were awarded £172,000 in grants to support our research activities. A key area of focus was researching health inequalities in underserved communities.  We also focused on establishing multi-disciplinary research teams to improve the diversity of those contributing to research initiatives, with a specific objective of involving more nurses.

What our patients tell us

Our culture of openness, compassion, and respect includes sharing feedback, data, learning, and actions across the Trust to drive continuous improvement in our services.

·        Feedback Live!: Our patient experience platform, Feedback Live!, captured 92,321 responses to questions from 5,961 surveys - this is a significant increase (22%) on last year. 84% of respondents agreed or strongly agreed with the positive statements for all themes.

·        Friends and Family Test (FFT): 30% of people contacted responded to the FFT survey. This is an increase from last year’s 27%. The average positive rating has slightly reduced to 84% (86.5% last year).

·        Compliments: We have received and reviewed 1058 compliments (up from 958 last year), including emails, cards and letters. This number far outweighs the number of complaints received at 476. 

·        Complaints: We received 476 complaints (413 last year). We take complaints very seriously and each is independently investigated, with conversations taking place with patients, their carers (where appropriate), and the members of staff involved. We have worked to ensure even more compassionate complaint responses and that learning from complaints is embedded.

·        Patient Advice and Liaison Service (PALS): There were 2,550 (2,344 previously) concerns or queries received through the PALS inbox or advice line . The majority of queries and concerns were addressed, and only 158 (6.20%) of these concerns went on to be raised as a formal complaint . Our PALS team has also worked to reflect the learnings from the national mental health reviews into their service.

·        CQC Community Mental Health Survey: Those aged 18 and over were eligible to take part in the Community Mental Health Survey if they were receiving specialist care or treatment for a mental health condition. Overall, our 2024 results show improved experiences in comparison to 2023. However, there is distance to travel in a number of areas. Improvements were around dignity, respect, and compassion, asking for feedback, involvement with families, and support for carers. Our biggest deteriorations were care reviews. When compared to others, we are ‘about the same’ in all 13 areas.

Patient survey highlights impact of better environments at South West London and St George’s

We scored 97% in the latest Patient-Led Assessments of the Care Environment (PLACE) survey.

PLACE surveys evaluate various aspects of hospital environments, including cleanliness, privacy, food quality, and overall maintenance. They also look at factors such as how the environment supports patients with disabilities.

The latest results for 2024 are an increase on our already impressive score of 96% in 2023, and 94% in 2019. This marks the highest performance across all Mental Health Trusts in London, showcasing our dedication to creating better environments within our services for our community, service users and colleagues.

Co-production and involvement

Through our Making Life Better Together Programme, we have a focus and commitment to co-production and involvement. They are at the heart of what we do. We have been working to further improve patient and carer voices in our services and in our work. The Co-production and Experience Team have also seen improvements in a number of different areas of involvement.

·        Lived Experience Network: We now have 405 members who have lived experience of accessing Trust services and/or caring for and supporting people who have accessed Trust services, within the last 5 years. We increased the ethnic diversity amongst the network by 5.5 percentage points. The network also includes 49 young people (increased from 29 last year) who support developments within the CAMHS service line.

·        Peer Support and Lived Experience Workforce: We have a long history and positive reputation for employing people with lived experience of accessing mental health services. We have extended peer roles within Eating Disorders, QII, and Restrictive Practice teams, as well as increasing the number of peers working within Acute and Urgent Care. The Peer Support Worker model has now been fully implemented across the 5 Boroughs in collaboration with community partners

·        Volunteers: We have 100 registered volunteers across the breadth of Trust services. The volunteering service contributed approximately 8000 hours annually, valued at £111k. We expanded volunteer induction, reflective practice sessions, and support groups in 2024/25, enhancing volunteer engagement and retention.

‘Culture of Care’: We are undertaking an exciting pilot, implementing a range of initiatives (from the national Royal College of Psychiatrists programme) aimed at improving the culture of inpatient mental health, learning disability and autism wards for patients and staff so that they are safe, therapeutic and equitable places to be cared for, and fulfilling places to work.

 

We built on and strengthened our commitments to reducing health inequalities amongst our local communities and developed an ambitious Health Inequalities Strategic Plan to guide our efforts in reducing disparities in health outcomes, particularly racial inequality. This plan places co-production, lived experience, and meaningful engagement with our communities at its core. We also deepened our commitment to the Patient and Carer Race Equality Framework (PCREF) which exists to eliminate the unacceptable racial disparity in the access, experience and outcomes that Black communities face.

Creating an inclusive and supportive culture is essential to tackling health inequalities and ensuring equitable access and outcomes for all patients. In doing so, we continue to meet our legal obligations under the NHS Act 2006 (as amended by the Health and Social Care Act 2012) and the Equality Act 2010.

Towards the end of the year, the Supreme Court ruled on the definition of a woman under the Equality Act. At the time of writing, we were awaiting further guidance from NHS England about what this might mean for our Policy on Supporting Transgender Service Users. Our priority is ensuring any changes are made in a considered, measured, and respectful manner.

Embedding Peer Debriefers in Response to Use of Force: Building on the peer debriefing pilot, the role of peer debriefers will be formally integrated into future peer support roles. These trained individuals will support service users following incidents involving the use of force, offering empathetic, trauma-informed debriefing from a lived experience perspective. This initiative is designed to reduce the emotional harm often associated with restrictive practices and is a key part of efforts to address and reduce racial disparities in how such practices are applied in mental health settings.

 

Health Inequalities Strategic Plan 2025–2030

In 2024/25, the Trust agreed its first Health Inequalities Strategic Plan 2025–2030, reaffirming our commitment to creating an equitable, anti-racist, and community-centred mental health system. The plan sets out an ambitious roadmap to tackle the persistent and unacceptable disparities experienced by racialised and marginalised communities across South West London.  

This strategy places racial equity at the core of our work, acknowledging that systemic barriers - especially for Black, Asian and minority ethnic communities - have led to poorer access, experience, and outcomes in mental health care. It aligns with national frameworks, including the NHS Long Term Plan, Core20PLUS5, and the Patient and Carer Race Equality Framework (PCREF), and reflects our local leadership within the South West London Integrated Care System.

The strategy was shaped through a comprehensive process involving:

•   Literature review of national and international evidence, best practice, and policy
• Local and Trust-wide data analysis, including insights from Core20PLUS5, the Equality Act 2010, and our Ethnicity and Mental Health Improvement Project (EMHIP). 
• Stakeholder engagement with 78 participants across 12 sessions—including staff, patients, carers, voluntary sector partners, and people with lived experience.

  The plan prioritises:

• Equity in access, experience and outcomes, particularly for racialised and marginalised groups.
• Anti-racism as a guiding principle, driving systemic change across services and workforce.
• Partnership and co-production, embedding the voice of lived experience into every aspect of our work.
• Targeted investment and capacity-building to ensure long-term, sustainable change.

  Health Inequalities Advisory Panel

To ensure meaningful and ongoing accountability against our new plan, we also established a Health Inequalities Advisory Panel, bringing together stakeholders from across the community, including service users, carers, voluntary organisations, local authorities, and public health leads. The panel plays a key role in advising on priorities, shaping our approach, and challenging us to do better, ensuring that lived experience and community voice remain central to our work.

  Reducing health inequalities across our communities

We have supported a number of innovative projects across teams that support our ambition to reduce health inequalities. These projects have used continuing improvement methodology and have been developed in co-production with patients and staff:

•   Wandsworth Early Intervention Service (WEIS)  have conducted research to understand the Black patient experience in their service. They have utilised QII methodology to improve their service and provide culturally enhanced person-centred care. This project has led to a change in care delivery and improved patient literature.
• Trauma-informed care  : As part of the Mental Health Act Quality Improvement Programme (MHA QI), our Trust has been working to enhance patient experiences, particularly for individuals from Black, Asian, and Minority Ethnic backgrounds and those with learning disabilities or autism. A key aspect of this work is ensuring our staff feel supported, confident, and equipped to provide the best possible care. Ruby Ward took a proactive approach by developing bespoke trauma-informed care training for staff. This tailored programme has helped deepen understanding of trauma and its effects, enabling staff to provide care that is sensitive, supportive, and empowering.
• Addressing the mental health and employment needs of prison leavers:   A unique collaborative project spearheaded by our employment specialists aimed to support offenders due for release.  The group, which was made up of volunteers from South West London and St George’s Mental Health Trust and community probation services, met with two cohorts of men within Wormwood Scrubs who were selected based on their interest in employment opportunities and psychological support post-release. These individuals, all due for release within 90 days, participated in a day full of guidance and informal discussions to help them self-refer to the support they need upon leaving. 
• Improving access and recovery: Our Perinatal Mental Health team has supported cultural awareness training, supporting improved access to perinatal services amongst Black, Asian, and Minority Ethnic communities. We improved our access rate across this service. At the same time, our Talking Therapies global majority work has improved access and recovery rates amongst Black, Asian, and Minority Ethnic communities.

Ethnicity and Mental Health Improvement Programme (EMHIP)

Our Ethnicity and Mental Health Improvement Project (EMHIP) continues to be a key vehicle for transforming the mental health experience of racialised communities.  

EMHIP is delivering impact through five core, co-produced interventions that embed equity, cultural capability, and lived experience into the heart of service transformation. Despite operational and partnership pressures, the programme remained resilient, community-driven, and outcomes-focused.

Working with the South West London ICB, Community Empowerment Network (CEN), and people with lived experience, EMHIP is not only addressing unequal access, experience and outcomes, but also influencing wider system transformation.  

We changed the way we managed and delivered the Ethnicity and Mental Health Improvement Project (EMHIP). Temporary management changes included: SWLStG taking on Key Interventions 2 (Crisis Family Placement) and the Lived Experience Assessment Panel (LEAP), alongside existing interventions 3 (Reducing Restrictive Practice) and 5 (Cultural Capability). Key Intervention 1 (Wellbeing Hubs) continues to be delivered by CEN, New Testament Assembly Church, and Muskhil Aasaan, with clinical input from SWLSTG.

Key Intervention 1. Mental Health and Wellbeing Hubs: The Mental Health and Wellbeing Hubs provide safe, culturally sensitive, and community-led spaces that connect individuals to early mental health support, holistic wellbeing services, and trusted community networks. Based on a hub-and-spoke model, each hub acts as a central access point for social, clinical, and non-clinical support.

Over the year, the hubs welcomed nearly 400 new guests, following targeted outreach and strengthened community partnerships. The hubs have expanded their pathways, formal referral links were established with services like the Macmillan Cancer Support Centre, and community events such as the Musculoskeletal Physiotherapy Day helped generate new referrals.The launch of Voices of Resilience – The Series gave a platform to the lived experiences of guests like Martha, whose story illustrated the transformative impact of belonging, routine, and social connection.

Key Intervention 2. Crisis Family Placement Scheme: This scheme offers a compassionate alternative to hospital admission by placing individuals in mental health crisis with trained host families from their own communities.

This scheme was relaunched in late 2024 under a new Project Manager, with delivery governance revised and a referral pathway re-established.Engagement is underway with Home Treatment Teams and Psychiatric Liaison services across the Trust.Recruited families will be supported with onboarding, training, and structured support, in preparation for first placements in 2025/26.

Key Intervention 3. Reducing Restrictive and Coercive Practices:  We continue to prioritise the reduction of restrictive and coercive practices. We recognise the disproportionate impact these practices have on Black and minority ethnic communities, and we are working proactively through EMHIP to embed more compassionate, patient-centred alternatives that promote dignity, autonomy, and recovery.

A 24-year-old Black African man with a history of multiple admissions and restrictive interventions participated in a mediation session. Concerns raised about detention, medication side effects, and ward safety were addressed in collaboration with the MDT. As a result:

• His depot injection frequency was adjusted in line with his request.
• Use of restraint declined.
• He described improved engagement and trust in his care.

“EMHIP and the mediation team have been helping recently towards my care, rights and medication being incorrect.”

In 2024/25, we piloted Mental Health Mediation (MHM) across three Wandsworth wards (Wards 2, 3 and Jupiter), focusing on reducing the use of seclusion, physical restraint, and forced medication. This model introduces independent mediators to work alongside multidisciplinary teams (MDTs) and patients, creating space for shared decision-making and promoting open dialogue. We have now recruited 20 mediators. Eighty eight people consented to a mediation session, and there were on average 14 mediation sessions a month.

People with lived experience have played a more active role in shaping the MHM model and reflecting on the mediation process, contributing to co-production and feedback loops. Their insights have informed improvements to both practice and policy, while helping foster more equitable, trust-based care relationships.

Key Intervention 5: Building a Culturally Capable Workforce: We are committed to becoming a culturally capable and consciously anti-racist organisation, ensuring that the experiences and outcomes of racialised communities are not just acknowledged but actively addressed. The Cultural Capability initiative, is a transformational initiative designed to embed inclusive behaviours, equitable leadership, and culturally responsive care throughout the organisation.

This programme supports our delivery of the Patient and Carer Race Equality Framework (PCREF) and strengthens our wider Health Inequalities and Equality, Diversity & Inclusion (HIEDI) ambitions. It goes beyond traditional training by building long-term capacity for inclusive, reflective, and accountable leadership and service delivery.

The programme has been co-designed through extensive engagement with lived experience voices, staff groups, senior leaders, and community stakeholders. This collaborative process identified key themes and expectations that have shaped the content and delivery model, ensuring that the programme is relevant, inclusive, and grounded in real-world experiences. In 2024/25, we launched the initial delivery phase in Wandsworth, piloting e-learning modules, action learning sets, and reflective tools designed to challenge assumptions, foster empathy, and build cultural intelligence across clinical and corporate teams.

A key focus of the programme is to promote psychologically safe spaces where difference is valued, feedback is welcomed, and discrimination is actively challenged. It provides teams and leaders with practical tools to embed equity in everyday practice, from clinical pathways to management conversations.

Lived Experience Assessment Panel (LEAP): The Trust is firmly committed to ensuring that people with lived experience are not just heard but are empowered to shape, influence, and co-lead the design, delivery, and evaluation of services. We recognise that true transformation - particularly in addressing racial disparities and health inequalities - must be rooted in the voices of those most affected. This commitment is central to our approach to equity and is embedded across our EMHIP interventions through the leadership and insight of the Lived Experience Assessment Panel (LEAP).

Our LEAP members continued to play a central role across all EMHIP interventions, offering critical insight into the cultural capability programme, hub design, mental health mediation, and the crisis family placement model. Their involvement ensures each intervention remains grounded in lived experience and aligned with the needs and priorities of racialised communities.

LEAP is also being aligned with the Trust’s broader involvement structures, such as the Lived Experience Forum, to create a more connected, strategic approach to co-production. This includes joint working on recruitment panels, service redesign, and feedback on equity dashboards.

Patient and Carer Race Equality Framework (PCREF)

Our implementation of the Patient and Carer Race Equality Framework (PCREF) is central to our work to promote racial equity. We are proud to be an early adopter of PCREF and have been actively involved in the national PCREF Steering Group, helping shape national guidance while sharing our own learning and progress. In 2024/25, we also joined the Pan-London PCREF Network, enabling deeper collaboration with other Trusts across the capital and strengthening our regional alignment.

PCREF is integrated into the Trust’s wider equity approach, including the Ethnicity and Mental Health Improvement Project (EMHIP), the Workforce Race Equality Standard (WRES) High Impact Actions, and our Health Inequalities Strategic Plan 2025–2030.

Performance against objectives

The table below describes how we have performed against our objectives, in terms of outcomes and metrics. We reviewed our delivery of this at the May 2025 Board.

Performance against objectives

Annual delivery plan 1: Better Care Key outcome:  To deliver our Better Care programme, enabling service users to experience care as close to home as possible, with a focus on recovery and outcomes

Year-end delivery rating

Outcomes/Metrics:  Friends and family test (FFT) net positive score[1] (23/24 baseline – 86.5%) April 2024 – 80.3%; Jun 2024 – 78.6%; Aug 2024 – 75.1%; Nov 2024 – 74%; Jan – 75% Maintenance of improved staff survey results on EDI sections[2] – (2023/24: 49.95%; 13.15%; 10.04%; 73.39%); 2024/25 – 50.38%; 13.27%; 10.57%, 74.18% Improved MWRES, WRES, and WDES scores – data available in June 2025 [1] The FFT net positive score is a national measure which asks patients to tell us how likely they would be to recommend our trust as a place to be treated. There are four possible answers, extremely likely and likely (positive responses) and unlikely and extremely unlikely (negative responses). Organisations are told the percentage of respondents who expressed positive and negative answers – the net of these two positions is the Net Positive Score that is used for benchmarking purposes. E.g. if of 100 answers 80 were positive and 20 were negative the net positive score would be 60% (80%-20%). [2] EDI section - Q15 Does your organisation act fairly with regard to career progression / promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age? (22/23 baseline 49.93%); Q16a In the last 12 months have you personally experienced discrimination at work from patients / service users, their relatives or other members of the public? (22/23 baseline 13.1%); Q16b In the last 12 months have you personally experienced discrimination at work from manager / team leader or other colleagues? (22/23 baseline: 10.04%); Q21 I think that my organisation respects individual differences (e.g. cultures, working styles, backgrounds, ideas, etc). (22/23 baseline 73.4%)

Successful merging of transformation programmes under the new Great Care priority. Good progress on the Digital programme with ongoing work to embed the reduction of health inequalities.