SLaM NHS Trust ‘Requires Improvement’ by CQC 2026

Key Points

• The Care Quality Commission (CQC) rated South London and Maudsley NHS Foundation Trust (SLaM) as ‘requires improvement’ in its well-led assessment, a downgrade from ‘good’ in the previous June 2021 inspection.​
• Inspections occurred between June and October 2025, including an onsite well-led visit on 1-2 October 2025, 19 staff focus groups, and observations of board and committee meetings from July to October 2025.​
• SLaM serves 1.3 million people across Croydon, Lambeth, Lewisham, and Southwark with community and inpatient mental health services for children and adults, operating from sites like Maudsley Hospital, Bethlem Hospital, Lambeth Hospital, and Ladywell Unit.​
• The trust employs about 6,635 staff across 240 bases, cares for over 40,000 community patients and 712 beds in 48 inpatient wards, with an annual turnover of £701.1 million for the year ended 31 March 2025.​
• Areas requiring improvement span all eight well-led quality statements, including staff culture, freedom to speak up, clinical leadership, governance, strategy alignment, access to crisis care, complaints handling, patient safety investigations, and employee relations.​
• Positive aspects include committed staff, strong partnerships (e.g., new community mental health model in Lewisham), leadership in research with Institute of Psychiatry, Psychology and Neuroscience (IoPPN), National Patient Carer Race Equality Framework (PCREF) implementation, embedded strategy, co-production with service users, and sustainability efforts.​
• Prior inspections in 2025 covered four Assessment Service Groups (ASGs): acute wards for adults of working age and psychiatric intensive care units; community health services for adults; crisis and health-based places of safety; forensic mental health services.​
• CQC considered urgent regulatory action due to concerns at health-based place of safety and Lambeth Single Point of Access but accepted the trust’s action plan.​
• Staff survey completion rate was low at 39% in 2024, reflecting disconnection between frontline staff and leaders.​
• Trust response from Chair Jane Bailey and Interim Chief Executive Ade Odunlade welcomes feedback to guide improvements via 2026 Roadmap and Five Foundations.​

South London (South London News) February 25, 2026 – The Care Quality Commission (CQC) has rated South London and Maudsley NHS Foundation Trust (SLaM) as ‘requires improvement’ in how well-led it is, following comprehensive inspections between June and October 2025. This downgrade from the previous ‘good’ rating in June 2021 highlights significant concerns across leadership, culture, and governance in the trust serving mental health needs across Croydon, Lambeth, Lewisham, and Southwark. The findings, published on 13 February 2026, come amid intense pressures on crisis and acute mental health pathways.​

What Triggered the CQC Inspections?

The CQC conducted a trust-level well-led assessment with an onsite visit on 1 and 2 October 2025, alongside 19 staff focus groups and observations of all board and committee meetings from July to October 2025. As detailed in the CQC inspection summary, inspectors assessed all eight quality statements under the well-led key question, identifying shortfalls across the board. This followed prior 2025 inspections of four key service groups: acute wards for adults of working age and psychiatric intensive care units; community health services for adults; crisis and health-based places of safety; and forensic mental health services, part of the CQC’s Adult Community Mental Health Programme.

Concerns arose prompting consideration of urgent action under Section 31 of the Health and Social Care Act 2008, due to issues at the health-based place of safety and Lambeth Single Point of Access team for community-based mental health services for adults of working age. The trust submitted a detailed action plan, averting further measures, with themes followed up in the well-led review.​

Why Was the Well-Led Rating Downgraded?

Inspectors noted the rating dropped from ‘good’ in 2021 because improvements from prior recommendations were incomplete, exacerbated by board leadership changes and system-wide pressures. As reported in the CQC report,

“We identified areas for improvement across all 8 well-led quality statements.”

Key issues included a disconnect between frontline staff and senior leaders, with many feeling unheard and unappreciated, evidenced by a 39% completion rate in the 2024 NHS staff survey.​

Freedom to Speak Up (FTSU) processes required more promotion and resources, as some staff lacked confidence in raising concerns. Clinical leadership faltered, with the Chief Operating Officer holding excessive control over operations, estates, and finances, limiting challenges from other executives; directorate multi-professional teams often felt sidelined. Staff perceived a top-down, centrally controlled organisation, particularly in financial controls, needing better communication and engagement.​

What Specific Leadership and Culture Issues Were Found?

According to the CQC well-led assessment, further work was needed on trust culture, with staff describing a “demoralising” environment where feedback via surveys felt futile. Relationships with staff networks were ineffective, especially on race, racism, and disability issues.

The board required development for strategic cohesion, with ongoing recruitment and induction of non-executive directors, plus more meaningful service visits. Governance at board and sub-committee levels needed strengthening, including timely information provision and partnership oversight; inpatient records for restraints, seclusion, and health checks were often inaccurate, hindering safety assurances.​

Employee relations drew criticism, with grievances mishandled, and bullying/harassment cases protracted and non-compliant with policy.​

How Do Service Users and Staff Experiences Factor In?

Mixed feedback emerged from 156 service users, relatives, and carers across inspected services. The 2024 NHS community mental health survey showed the trust scoring similarly or worse than peers in psychological therapies privacy and respect/dignity. Complaints responses lagged timescales with variable quality, though new co-produced processes aimed to improve this.​

Local Healthwatch reported access delays but positive in-service experiences; Friends and Family Test hit 79% positive in 2024/25 Q2, below 95% target. Positively, co-production shone, like the Secure Settings Service User Carer Advisory Group (SUCAG).​

Staff were praised as committed and compassionate despite pressures.​

What About Access to Mental Health Services?

Access remains a priority, with high numbers waiting over 12 hours in emergency departments compared to other London trusts, and excessive delays for Mental Health Act (MHA) assessments in crisis services. The CQC urged monitoring initiative impacts. Patient Safety Incident Response Framework (PSIRF) implementation lagged, with delayed investigations and unclear action plans follow-up.​

Other gaps: unacted external auditor recommendations for a data quality framework (two years overdue); audit committee lacking private auditor meetings; protracted capital project reviews.​

What Positive Aspects Did Inspectors Highlight?

Despite shortfalls, the CQC lauded frontline staff’s dedication. Strong local/system partnerships, like Lewisham’s community mental health model, stood out. Research leadership with IoPPN offered staff and patient trial opportunities, though links to service improvements needed clearer articulation.​

The trust pioneered PCREF for equality, embedding it directorate-wide. Strategy was embedded, with refreshed consultation; EPRR and business continuity robust; co-production impactful; sustainability innovative and board-backed.​

What Is SLaM’s Response to the Rating?

As reported on the SLaM website blog, Chair Jane Bailey and Interim Chief Executive Ade Odunlade stated:

“The CQC inspection feedback we have received is invaluable in helping to guide us on our journey of improvement. As an organisation we will be focussing on the areas where we can do better and building on the things we are doing well. We will continue to work closely with our Board, directorate and service leaders to update our action plans, which we have already begun work on as part of the 2026 Roadmap, Five Foundations.”​

The trust acknowledged pressures, delays, and culture needs while praising staff compassion.​

What Is the Broader Context of SLaM Services?

SLaM operates in south east and south west London ICSs, in Segment 3 of the NHS Oversight Framework (mandated regional support). It provides specialist outpatient services in Croydon, Lambeth, Lewisham, with multidisciplinary teams including nurses, occupational therapists, psychologists, social workers, and psychiatrists at sites like Elmfield House and Jeanette Wallace House.

Past CQC ratings included ‘good’ overall in 2021, with outstanding practices like Listening into Action and clozapine clinic testing. Earlier, acute adult wards and PICU improved to ‘good’ in 2021, though community services stayed ‘requires improvement’ due to caseloads. Children’s services rated ‘good’ in 2020, with responsiveness needing work.

What Happens Next for SLaM?

The trust must align clinical/financial strategies with consultation, boost benchmark use for efficiency, deliver electronic patient record replacement with risk escalation, and enhance project governance. Ongoing board development, FTSU rebuilding, and complaint/PSIRF improvements are essential.​

This rating underscores challenges in London’s mental health landscape but highlights SLaM’s strengths in innovation and partnerships, with leadership pledging action. Residents in the four boroughs await tangible enhancements in leadership and access.