Cambridgeshire and Peterborough NHS Foundation Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) was formed on 1st June 2008, succeeding Cambridgeshire and Peterborough Mental Health Partnership NHS Trust. CPFT provides a wide range of mental health, physical health, specialist, learning disability and neuro-rehabilitation community and hospital services to a population of around 950,000 people across the East of England. Staff and services operate from more than fifty locations across the county, with main hubs of service delivery and activity based in Cambridge, Huntingdon, Peterborough and Fenland. CPFT is a designated Cambridge University Teaching Trust and a member of Cambridge University Health Partners; 1 of only 8 Academic Health Science Centres in the UK. The trust employs about 4500 staff.

CPFT are part of the local Cambridgeshire and Peterborough Integrated Care System. In December 2023 the trust was placed in segment 3 of the NHS England (NHSE) Oversight Framework. This identified the trust as having significant support needs against 1 or more of the 5 national oversight themes.

We undertook a trust level (well-led) assessment of the trust which included an onsite visit 10-12 February 2025. We also held 18 staff focus groups on and off site and observed board and committee meetings between December 2024 and February 2025.

We assessed all 8 of the quality statements in the well-led key question in this assessment.

The well-led review followed assessments of 3 of the trust’s frontline mental health services (assessment service groups - ASGs): acute wards for adults, community mental health services for adults and crisis services and health-based places of safety. The initial assessments of the trust’s services were triggered by whistleblowing concerns around patient safety and poor culture within services. We did not inspect any of the trusts community health services on this occasion. The services’ assessments identified concerns around mandatory training, supervision and appraisal, high staff vacancies and sickness, a lack of embedded learning from incidents, a lack of visibility from senior leadership, staff not feeling listened to, environmental issues and issues around record keeping.

CQC carried out enhanced engagement during 2023 and 2024 with the trust looking at culture within the organisation. This highlighted concerns around a culture of bullying and harassment within the trust, where staff didn’t feel safe to raise concerns. Concerns around significant and rapid changes within the trust executive team also prompted our well-led assessment.

We identified areas for improvement within all of the eight quality statements we assessed.These areas were as follows:

• The inspection took place at a time of ongoing instability for the executive leadership team. Moving forwards the trust must ensure the stability of the leadership team, both the executive directors and non-executive directors.
• The trust must ensure that the executive team have tailored support to develop in their roles. Succession planning had been previously lacking and needed to be prioritised.
• The trust must reset its external stakeholder relationships and agree with system partners its short and medium term priorities.
• The trust had started work on a refreshed strategy. The trust must ensure this clearly articulates the clinical strategy for physical and mental health services.
• Whilst the trust can access a wide range of data which is largely accurate and timely, there were variations between directorates and data was not always accessible or usable to drive change. There was scope to bring together data from a range of sources to identify challenged services and potential closed cultures.
• We found that many staff we spoke with during the well led assessment struggled to articulate the trusts top patient safety concerns. Whilst risks are identified we found the pace of these being addressed is variable.
• The support from corporate services (finance, HR, data and insight) for individual directorates was variable and assurance processes across the directorates needed to be reviewed and strengthened.
• Directorate leaders needed the capacity and capability to lean into the system working so they can be active partners in developing local services to meet the needs of the population.
• Significant numbers of staff didn’t feel safe speaking up and do not feel assured about the independence of the speak up guardians. The trust must take action to ensure Freedom to Speak Up processes are effective and must be able to clearly demonstrate that it has acted on concerns.
• Staff reported that senior leaders were not visible. The trust needs an engagement plan and the visits to services by members of the board need to be embedded.
• Staff continued to raise concerns about racial and disability discrimination at work. There is still a lot more to do to ensure that the draft equality, diversity and inclusion strategy is adopted, and meaningful changes take place which improve the equality and equity of staff and people who use services related to their protected characteristics under the Equality Act 2010.
• Co-production with people who use services and carers was at an early stage and was not embedded across the trust. The lead made good use of the resources available, but this is an area needing further development across the organisation.
• Responding to complaints was taking longer than the stated timescales. Whilst action was taking place, the success of these interventions needed to be monitored.
• Quality improvement at the trust appeared to have slowed. Whilst there were examples of quality improvement projects taking place this approach needs to be extended and embedded.
• Whilst managers in the trust had access to a range of learning and development to promote their leadership skills, the uptake of this was inconsistent especially for front line staff.
• Whilst action was being taken to promote environmental sustainability at the trust, there were concerns about sustainability being taken seriously by leaders, and more needed to be done to embed this in the organisation.

However, there were also positive findings across all quality statements. These areas were as follows:

• The new chief executive had been well received both internally and externally. Staff and stakeholders told us that they found him open, that they could raise concerns to him, that he had taken some immediate actions as needed and that there were some early signs of a renewed sense of direction.The board, executive directors and non-executive directors, were working together in a mutually respectful manner under the stewardship of the chair.
• All staff we spoke with were enthusiastic, committed and focussed on people who use services.
• Most staff we spoke with felt able to be candid and open during the well-led review.
• The research and innovation programmes currently being carried out by the trust were inspirational, as were the aspirations of the trust moving forwards.
• Onsite we heard about many high performing and innovative services across the trust and saw the pride staff had in them. We saw positive examples of integrated physical and mental health services as well as significant work looking at further integration moving forwards with the Cambridge children’s hospital project.
• The trust also worked successfully in partnership to support the urgent care pathway for people with physical and mental health care needs.
• We noted significant progress has been made by the mortality team on learning from deaths and further positive action is being taken to embed the learning into front line services.
• The equality, diversity and inclusion team were passionate and engaged in their work.
• The trust was making progress with its Green Plan and there was a clear direction moving forwards.

People's experience of this service

The 2023 NHS community mental health survey showed the trust performed about the same as other trusts in 31/32 questions. They performed somewhat below what was expected in 1 area relating to care planning.Review of cases received by CQC showed patients raised issues around accessing services and inappropriate discharge processes.

A review of patient complaints highlighted significant delays in responding. At the point of onsite inspection 39% of complaints were classed as overdue. People were not always satisfied with how their complaints had been handled, with concerns being raised to CQC that processes were not effective.Review of complaints by CQC highlighted that learning from complaints was not always consistently recorded.

Co-production with people who use services and carers was at an early stage. There are some good examples of this work in individual services and in the children and young people directorate, but this was not consistent within the 3 directorates. The patient experience lead made excellent use of the resources available, but further support and development was needed for this to become embedded across the organisation.

Healthwatch reported regular engagement with CPFT through children’s and young people's forums across the patch, but reported its engagement with the trust’s head of patient experience was in its early stages. Feedback around mental health services also raised concerns about access and long waiting times. It was also noted that it had previously been difficult to engage staff groups.