Pennine Care NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation
• Environmental sustainability – sustainable development

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The trust had a shared vision, strategy and culture. This was based on transparency, human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and the communities served by the trust in order to meet them.

The trust’s 2025–2030 strategy was built on its earlier 2020 strategy. The updated strategy aimed to streamline and clarify the trust’s ambitions by embedding them more clearly within delivery plans. The trust ambitions were to:

• Deliver outstanding care
• Be great place to work
• Listen in order to improve.

It was aligned with the priorities of the NHS Long Term Plan, such as expanding community‑based mental health services, focusing on prevention and early intervention, reducing health inequalities, and improving outcomes for people with learning disabilities and autistic people. The strategy also acknowledged growing demand on services, alongside recruitment and financial pressures, while recognising strengths including staff commitment and strong partnership working across the local system.

The trust’s vision was “a happier and more hopeful life for everyone in our communities.” This vision underpinned the trust’s focus on improving mental health, learning disability and autism outcomes, and reflected its commitment to reducing inequalities and supporting wellbeing across the population it serves.

The trust’s purpose was to maximise people’s potential to live healthier and more rewarding lives, while creating a great place to work. The dual focus acknowledged the importance of delivering high‑quality, compassionate care alongside supporting and valuing the workforce who provide it.

Pennine Care’s values described how the trust expected its staff and leaders to behave and make decisions:

• Kindness – Care and compassion underpin everything the trust does, with a strong emphasis on teamwork, respect and support for others.
• Fairness – The trust is committed to inclusion, empowerment and accountability, working to reduce stigma and promote equity for people who use services and staff.
• Ingenuity – Staff are encouraged to be resourceful, creative and curious, with a focus on continuous improvement and innovative ways of working.
• Determination – The trust aims to be ambitious and courageous, learning from mistakes and striving to achieve the best possible outcomes together.
• Clinical Strategy
• Partnership Strategy
• Estates Strategy
• Research & Development Strategy
• Digital Strategy

Leaders described the strategy as a balance of performance, quality and finance.

The strategy was supported by a suite of enabling strategies:

Each of these strategies included delivery plans which were reviewed annually taking into account national and local commitments. This then informed their overarching business plan (which included their transformation programme) and delivery programme plans at corporate, network and care hub level.

Progress was overseen through the trust’s governance framework, including board and committee oversight, performance reporting and the Board Assurance Framework (BAF), ensuring alignment between strategic priorities, risk management and operational delivery.

The trust were reducing the number of strategies, in response to feedback from colleagues and partners. They had supporting theme-specific strategic delivery plans such as the Culture and Leadership Plan and Green Plan, which set out the priorities and objectives for those areas which were linked to the overarching strategy and ambitions and delivered through the annual planning process.

The trust demonstrated a clear commitment to medicines optimisation aligned with its overall vision and values. The trust’s three strategic ambitions (Outstanding Care, Great Place to Work and Listen to Improve) were reflected in the trust medicines priorities, including safer prescribing, strengthened medicines governance and workforce development. Patient and staff feedback was used to drive improvement. For example, staff, people with lived experience and carers participated in a ward accreditation development day to help inform and shape the trust approach to a proposed ward accreditation scheme. We also saw examples where patients had shared their stories to support the trust’s medicines related ‘Listen to Improve’ events.

Non‑executive directors reported that the strategy had been clear, clinically led and well‑understood across the organisation, with staff able to articulate it confidently. They felt that the supporting plans, particularly digital, estates and performance, had strengthened over time and that committee oversight reinforced the strategy effectively. Overall, they were assured that the strategy had been well embedded and aligned with collaborative board working.

However, governors described having inconsistent involvement in shaping the trust’s strategic direction. They reported feeling excluded from key decision‑making forums, unclear on how national priorities were applied locally, and uncertain about their evolving role, highlighting the need for a clearer and more consistent approach to using governor input.

Staff across most services understood and aligned with the trust’s vision and values, though their experiences of contributing to the strategy varied. Acute, community and forensic teams demonstrated strong awareness of the values and had opportunities to be involved in strategic discussions, with forensic staff in particular showing clear understanding of how values shaped their work. In contrast, staff on older people’s wards felt they had limited opportunities to influence service strategy, saying their suggestions often went unanswered despite understanding the trust’s values.

The trust consistently embedded the consideration of health inequalities into its core governance and quality improvement processes, ensuring that variations in access, experience and outcomes were actively identified, monitored and addressed. Through routine scrutiny of patient safety, effectiveness and experience measures via groups such as the Mortality Review Group, the Safer Staffing Group and the Reducing Restrictive Practice Group leaders were able to detect disparities, including those affecting specific populations or pathways such as children and young people awaiting neurodevelopmental support or older adults waiting for memory assessment. These insights informed targeted improvement actions, escalation processes and investment decisions, enabling the trust to use evidence about unequal outcomes to shape business planning and strengthen equity across services.

This systematic approach was demonstrated in the December Mortality Review meeting which provided a focused example of how health inequalities were being actively considered in practice. The group reviewed deaths of people with a learning disability through a dedicated Learning from Lives and Deaths of people with a learning disability and autistic people (LeDeR) agenda item, supported by an established task group and an updated action plan to reinforce governance and learning. Links were made between LeDeR findings and the wider health inequalities agenda, ensuring alignment with trust wide priorities. Additional themes highlighted broader inequality related risks including physical health issues in drug-related deaths, risks to deteriorating patients with long term conditions and gaps in mental health input within child death reviews showing that the trust was approaching health inequalities through multiple review pathways and using these insights to drive improvement.

Leaders across the trust consistently demonstrated their commitment to compassionate and inclusive leadership through a range of visible actions and assurances. Board and executive leaders actively championed equality, diversity and inclusion (EDI), embedding these priorities in Board development sessions and organisational culture programmes such as the Respect campaign, anti‑racism initiatives, and kindness and civility training. They supported lived‑experience involvement in service design, strengthened staff networks, and promoted trauma‑informed and person‑centred approaches across services.

The NHS Staff Survey 2024 showed a clear improvement in staff engagement and perceptions of leadership at Pennine Care NHS Foundation Trust. The trust achieved a 49% response rate from 2,089 staff; the highest it has recorded.

The trust showed sustained improvement in the 2024 NHS staff survey, with scores rising across all 9 themes and remaining above the national average for its peer group. Progress had been steady since 2021, with the strongest gains in the We are always learning theme, reflecting a more embedded culture of development. The trust achieved several highest‑in‑group results regionally and nationally, including being rated the best place to work in the North and scoring highly for staff feeling free to act, use initiative, and suggest improvements, indicating strong empowerment. Leaders have attributed these gains to work on values, recognition, communication, and visibility.

From our visits to the service groups, we found that staff understood and lived the provider’s vision and values, which were clearly communicated by senior leaders and visible across the wards. Staff were involved in shaping service direction through regular meetings, and the overall strategy focused on supporting their wellbeing, development and ability to deliver high quality care. In the committee meetings we attended, we observed a strong focus on organisational culture, with staff feedback informing discussions on wellbeing, leadership development and inclusion.

Our visits to the service groups prior to this assessment showed leadership visibility was generally good but variable between services. On older people’s wards, staff appreciated the visibility of ward managers, quality matrons, and the Chief Executive, though some felt other senior leaders were less present in clinical areas. Acute wards benefited from scheduled and unscheduled senior leader visits, with leaders seen as approachable, though supervision for managers was sometimes lacking. In community services, managers and leaders were accessible, supportive, and often directly engaged with staff, although some teams requested more consistent visibility. Forensic services saw strong and regular leadership presence; staff and patients knew leaders well, and senior staff provided visible support through audits, reflective sessions, and ward visits.

Across the trust, we heard consistently that staff experienced a generally respectful, supportive and team‑oriented culture, with many describing positive relationships, strong teamwork and a sense of pride in their services. Staff on older people’s wards reported feeling valued despite pressures, while acute staff highlighted pride in their teams alongside challenges with supervision and preceptorship due to workload. Community teams reflected cohesive and supportive cultures, and forensic services described strong emotional and physical wellbeing support. Our observations aligned with this feedback, and demonstrated continued strengthening of a compassionate, safe and learning‑focused culture, supported by visible leadership, lived‑experience involvement, and active EDI work. We also saw the trust prioritising sexual safety, workforce culture and violence reduction through new policies, training and clearer reporting. Broader improvement work, including digital modernisation, quality‑improvement activity, wellbeing offers and the Respect campaign, further reinforced a positive cultural direction.

Stakeholder feedback indicated that Pennine Care was viewed as a valued and transparent partner, aligned with locality plans and demonstrating openness and equity. Stakeholders generally felt informed and involved in strategic developments, though a few had limited visibility.

Some governors described the trust’s culture as open, diverse and receptive to staff and public feedback, while others experienced inconsistency across boroughs, limited follow‑up on concerns, and weak partnership working. Several felt undervalued or isolated, suggesting that cultural openness did not always translate into meaningful influence.

The trust had inclusive senior leaders who understood the context in which they delivered care, treatment and support. They had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. However, some staff felt less confident that middle managers always had the same skills. Allied healthcare professionals felt their leadership needed to be strengthened.

In assessing this Quality Statement, we considered feedback from leaders, staff, people using the services and local system partners, as well as reviewing trust processes and survey results.

The Chief Executive Officer joined Pennine Care NHS Foundation Trust in April 2022. They came with experience from previously held senior leadership roles within the NHS, including Regional Chief People Officer and Chief Accountable Officer. They also held system leadership roles within mental health and had experience in mental health charity governance and service user engagement.

The trust Chair had been in post since October 2025, having previously served as a non‑executive director from November 2020 and Deputy Chair from September 2023. They had senior leadership experience in health and social care, including roles across the NHS, local government and integrated care systems. Their background included experience of system‑wide transformation and integrated working across health and care, as well as engagement with staff, people who use services and local communities. The Chair had worked in the Greater Manchester system for over 40 years. The Chair demonstrated a passion about the organisation, was eager to learn and connect with people, and was highly motivated to drive transparent, ambitious improvement through collaborative working and strong strategic delivery.

The board consisted of 7 executive directors and 9 non‑executive directors, including the trust Chair, representing a broad range of experience and professional backgrounds. To enhance the Board’s diversity, 2 associate directors with lived experience of using mental health services had also been appointed. However, we identified and the trust acknowledged, a gap in digital expertise at board level and the absence of a member with experience in the corporate sector external to the NHS field.

We observed the trust’s February 2026 Board meeting, attended several governance meetings and reviewed minutes. During all observed meetings, leaders demonstrated credible, effective and compassionate leadership, and the trust took appropriate steps to ensure accessibility and supported diverse communication needs.

For example, our observation of the People and Workforce Committee showed capable, compassionate and inclusive leadership, with non‑executive directors providing robust challenge on workforce risks and performance, and a strong focus on staff wellbeing, fair employee relations, and embedding equality, diversity and inclusion across discussions regarding recruitment, training and culture.

Leaders told us they undertook regular visits to frontline services. These visits improved leadership visibility and ensured leaders were able to triangulate the information received through the trust’s governance systems, particularly in relation to staff experience.

Non‑executive directors said leaders were increasingly strategic, clinically informed and collaborative. Leadership capacity had grown through skilled deputies and structured development, enabling wider leadership at all levels. Recent structural and governance changes strengthened accountability, and leaders were outward‑facing, people‑centred and committed to continuous improvement and staff wellbeing.

The trust had recently undertaken an organisational restructure to reduce duplication, clarify responsibilities and create greater consistency across services. Leaders described this restructuring as a deliberate shift toward more streamlined management, enabling decision‑making to take place closer to clinical teams, increased consistency and ensuring that operational oversight better reflected frontline realities.

However from the assessments of services and focus groups we heard that staff experiences, were varied. Medical consultants, nursing staff, health care assistants, and ethnically minoritised groups reported less positive results in some areas. Additionally, Allied Health Professionals described limited leadership and inconsistent supervision.

Trade Union representatives told us that their members continued to raise concerns about leadership, communication, and decision‑making, which had contributed to low morale and reduced trust across services. Staff reported under‑resourcing, increased incidents of violence and aggression, and insufficient wellbeing and training support. They also described a disconnect at middle‑management level, where issues were perceived to be delayed, minimised, or poorly handled, widening the gap between frontline experience and senior leadership. However, the representatives acknowledged emerging positive cultural shifts, including listening events, improvements to the wellbeing service, and the visible and valued presence of the new Chair.

Feedback received from a small number of staff since announcing our assessment presented a mixed view of leadership and organisational functioning. While some staff expressed confidence in senior leadership particularly the CEO, and felt leadership culture had improved, many raised significant concerns about how organisational change and operational pressures were being managed. Key issues included dissatisfaction with consultation processes, delays in decision‑making, insufficient and inconsistent communication, and limited engagement with clinical leaders. Staff also reported that prolonged uncertainty around organisational change had contributed to higher staff turnover, increased waiting times, and negative impacts on patient care.

The trust had processes in place to identify and address behaviours that were inconsistent with the values of the NHS. The trust’s grievance and disciplinary policies were within their review dates at the time of our assessment. We reviewed 5 examples of grievances, and 5 disciplinaries between 1 December 2024 to 30 November 2025; all had been completed in line with the trust’s process.

The trust had systems to identify and address behaviours inconsistent with NHS values. Between 1 December 2024 and 30 November 2025, there were 30 disciplinary cases and 23 grievances (including 3 collective). Processes were thorough but often exceeded the expected timeframes. for resolving disciplinary cases, which the policy stated was 12 weeks (84 days). Of the 5 completed cases we reviewed the quickest resolution was 136 days with the longest being 243 days.

Of the disciplinary cases, 15 involved white staff, 14 involved staff from non‑white ethnic backgrounds and 1 was unspecified. As 23% of the workforce was non‑white, these staff were overrepresented in disciplinary activity. All grievances in the period were raised by white staff, with over half (13) relating to how organisational change and recruitment processes were managed.

Common disciplinary issues included patient harm, sleeping on duty, failing to follow procedures, and breaching professional boundaries. All related to inpatient services. Grievances most frequently concerned recruitment and organisational change, treatment by managers, application of dignity at work and capability processes, and access to reasonable adjustments. These mostly arose in community mental health teams, estates and facilities, and CAMHS.

The disciplinary policy (9 June 2025) aligned with NHS Just and Learning Culture principles, outlining expectations and a structured process including fact-finding, Just Culture panels, investigations and hearings, with sanctions ranging from warnings to dismissal.

Grievances followed the Early Resolution policy (25 January 2022), which included informal options, mediation, formal meetings and appeal routes. All five reviewed cases met process requirements but most exceeded target timescales of 15 days for early resolution and 30 days for formal cases, taking 19–132 days.

Processes to ensure front line staff remained fit and proper for their roles were effective and ensured staff remained qualified and suitable for their roles.

Stakeholder feedback indicated that leaders were regarded as capable, compassionate and collaborative, with strong understanding of local context and effective relationships at strategic and operational levels. Some systems noted the challenge of maintaining leadership presence across all 6 localities.

The Board papers showed a continued focus on strengthening Board development through annual development sessions, refreshed BAF exercises, and scenario‑based training that embedded inclusive, anti‑racist, and psychologically safe leadership behaviours. While a trust‑wide succession planning framework was not yet in place, succession activity occurred at sub‑Board level, and a national self‑assessment process was scheduled for launch in summer 2026. Leadership pipelines were supported through targeted recruitment, structured career‑pathway development, and enhanced appraisal processes that included equality, diversity, and inclusion objectives for senior leaders.

Fit and proper person checks were in place for all directors in line with the requirements of the regulation. All files we reviewed showed the trust had completed appropriate checks of directors’ suitability for their roles. All directors had received an annual appraisal within the previous year.

The trust fostered a positive culture where people felt that they could speak up and that their voice would be heard. Staff described an environment where they felt empowered, and confident to raise concerns, and share ideas without fear of reprisal.

In assessing this Quality Statement, we considered feedback from leaders and staff as well as reviewing trust processes and survey results.

The Freedom to Speak Up (FTSU) Strategic Delivery Plan outlined Pennine Care NHS Foundation Trust’s proposed approach for 2026–2028 to strengthen its internal arrangements for raising and addressing staff concerns. The plan identified recurring themes in recent FTSU data, including issues relating to HR processes, bullying or inappropriate behaviour, discrimination, workplace safety, and operational change and set out objectives aimed at improving organisational culture, reducing barriers to speaking up, and ensuring concerns were managed without detriment to staff. It also aligned the Trust’s approach with national frameworks such as the NHS People Plan, Equality Act requirements, and guidance from the National Guardian’s Office.

Across the two‑year period, the plan proposed actions to support leadership capability, standardise investigation processes, update policies, and improve communication channels so staff understand how to raise concerns and how these are acted upon. It also included measures to strengthen diversity and inclusion, with particular reference to overseas‑trained staff and those with protected characteristics. Progress was intended to be monitored through data such as case volumes, resolution times, staff feedback, and indicators relating to bullying, discrimination, and safety concerns, with the purpose of informing continuous improvement across the trust.

The evidence that we reviewed demonstrated an open culture in which staff felt able to raise concerns, report incidents and suggest improvements. Staff were confident that their feedback, suggestions and concerns would be welcomed and lead to improvements in the trust. Leaders role-modelled good speaking up behaviours, they listened to staff feedback and concerns, they demonstrated candour and empathy when things went wrong, and they celebrated speaking up.

The NHS Staff Survey results indicated that Pennine Care staff increasingly feel safe to raise concerns, supported by a strong Freedom to Speak Up (FTSU) structure and high levels of engagement. Although the survey does not provide a specific score for the statement “I feel safe to speak up about anything that concerns me in this organisation”, the results showed positive movement across related themes such as raising concerns and autonomy and control. Staff also reported nationally leading scores for feeling free to act within their role, use their initiative, and make improvement suggestions. In addition, the trust recorded a higher‑than‑average number of FTSU cases per 1,000 WTE (7.6 compared with the national average 5.4), which could be interpreted as evidence of growing staff confidence in speaking up rather than an indication of increased issues.

Staff spoken with during our visits to services consistently reported strong awareness of FTSU processes and confidence in raising concerns across services. Staff on Older People’s wards described clear, confidential routes and felt well protected. Acute ward staff highlighted the value of an established Guardian and a growing ambassador network, with staff increasingly willing to speak up. Community teams reflected supportive environments where raising issues felt safe and constructive. Forensic ward teams also described strong managerial backing and a visible FTSU presence, contributing to a positive culture of openness.

Pharmacy staff described a positive, inclusive culture where they felt comfortable speaking up to senior leaders. Incident reporting related to medicines was encouraged, with an increase in low level and near miss reports described as a positive indicator of an improving safety culture. Learning from medicines related incidents, audits and external reviews was discussed within medicines governance forums and shared across networks.

The Board papers showed that FTSU activity continued to give valuable insight into staff experience, organisational culture, and areas needing improvement. In Q3 2025/26, 14 concerns were raised, including 5 group cases, and most respondents indicated they would speak up again. Key themes across the period included policy and procedural fairness, staff safety and wellbeing, inappropriate behaviour, quality and safety of care, and bullying and harassment, with smaller numbers relating to service changes, anonymous disclosures, and fear of repercussions. Benchmarking indicated lower bullying and harassment levels and stronger worker safety and wellbeing scores than national averages. The Board reviewed progress against the December 2025 Strategic Delivery Plan, which focused on clearer HR processes, stronger reporting, embedding FTSU in leadership induction, and aligning learning with quality improvement. External updates included the planned June 2026 closure of the National Guardian’s Office and an ongoing MIAA audit. Assurance discussions with senior leaders emphasised transparency, responsiveness and multiple confidential reporting routes. Overall, the papers illustrated a maturing and increasingly embedded FTSU culture, with staff feeling more able to raise concerns and see change as a result.

The Freedom to Speak Up Guardians told us they operated in a full‑time standalone role supported by 36 trained ambassadors who acted as the trust’s “eyes and ears.” They explained that they planned ongoing recruitment to ensure full organisational coverage and described meeting regularly with a regional guardian network to draw on wider experience. They worked collaboratively with a partner trust and shared a strategic delivery plan. The Freedom to Speak Up Guardian felt supported by an executive leader, governance lead and a responsive board. They were positive about the CEO’s visible support, including the “Ask Anthony” email route, and said monthly meetings with the executive team ensured actions progressed. FTSU had been embedded in leadership courses, and the Guardian was now working with quality matrons. They identified key risks, for example, inexperienced managers, HR processes, and the need to prevent closed cultures despite a generally positive, open environment. They attended Board meetings quarterly and told us that data processes worked well. FTSU monitoring was now included in the trust’s audit cycle.

Stakeholder feedback indicated that Pennine Care promoted a transparent and open culture, communicating issues early and engaging in shared learning. They felt the trust’s FTSU programme had a positive wider system impact.

The trust valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. However, further work was needed to improve staff experiences across different groups and strengthen the data capture required to monitor this effectively

Pennine Care demonstrated clear intent and growing commitment to equality, diversity and inclusion (EDI), but this was not yet matched by robust governance, consistent implementation or measurable impact. Despite collecting WRES, WDES and EDS data, the trust lacked strong accountability, clear milestones and systematic use of data to drive improvement. Persistent disparities remained particularly for racially minoritised and disabled staff. The governance routes for staff feedback were not fully developed.

The trust set out its EDI agenda in its strategy for 2024 to 2027. Delivery of this agenda was overseen through an EDI working group and a health inequalities oversight group, each of which had executive leadership. All board members had an annual objective that related to equality or health inequalities. Eight staff networks were in place, each supported by an executive sponsor and allocated protected time for network chairs. The trust reported a range of activities which included work to reduce bias in recruitment processes, scoping of a cultural intelligence training package, changes within disciplinary processes to support fairness, and deeper analysis of staff survey results by protected characteristic supported by listening sessions. Regular EDI e sessions had been made available for staff, and a trust-wide health inequalities oversight group had been established.

Governance arrangements set out a range of actions at organisational level. Appraisal processes were strengthened with updated guidance that required equality objectives and structured career development discussions. Digital capacity and data availability were identified as areas requiring further development, as some dashboards including Patient and Carer Race Equality Framework (PCREF) datasets were not fully populated. This limited the availability of live data for staff.

Across governance structures, workforce data, strategy delivery and patient and carer race equality work, the trust continued to expand its improvement activity. The structures in place supported oversight of EDI and health inequalities, and work continued to develop data quality, reporting, leadership accountability and the consistency of action planning.

Evidence from the Equality Delivery System (EDS22) assessment showed strong performance in service delivery and workforce wellbeing, reflecting leadership focus on improving equity and inclusion. Leaders also prioritised transparent performance monitoring using Workplace Race Equality Standard (WRES) and Workplace Disability Equality Standard (WDES) data and strengthened equality impact assessments demonstrating ongoing accountability for creating an inclusive, learning culture within the trust.

However, Pennine Care continued to show inequalities in experience for ethnically minoritised staff. WRES data showed that in 2024, ethnically minoritised staff reported significantly poorer experiences than white staff across all four indicators. Harassment or abuse from patients and the public had been reported by 33% of ethnically minoritised staff compared with 22.3% of white staff, and harassment from colleagues had been reported by 18.4% compared with 15.7%. Only 55.6% of ethnic minority groups felt that the trust offered equal opportunities for career progression, compared with 64.7% of white staff, and 10.3% had reported discrimination by a manager or colleague compared with 6.3% of white staff. Although two indicators improved for ethnically minoritised staff between 2023 and 2024, levels of harassment from patients and the public and from colleagues worsened while outcomes for white staff improved across all measures. The trust employed staff from more than 100 countries and had undertaken detailed analysis of staff survey results by protected characteristic to better understand these disparities. The trust put actions in place through its 3 year improvement plan, including the introduction of equality advocates in recruitment, strengthened diversity measures within leadership objectives, cultural intelligence training, active bystander training for 500 inpatient staff and a trust wide Respect campaign. They also become the first trust to achieve Bronze status within the regional antiracism framework. Despite these developments, ethnically minoritised staff continued to experience disproportionate levels of discrimination, aggression and barriers to progression, and the trust acknowledged that further sustained and systematic action was required to narrow the gaps in experience and deliver equitable outcomes.

The WDES showed that disabled staff continued to report poorer experiences than their non-disabled colleagues, although there had been steady improvement across most indicators. The organisation saw a gradual increase in the proportion of staff declaring a disability, which suggested improved confidence in disclosure and reinforced the need for consistent workplace support. Despite this progress, disabled staff continued to experience higher levels of bullying, harassment and discrimination. In the most recent reporting year, 28.4% of staff with a long-term condition reported harassment or abuse from patients or the public compared with 22% of staff without a long-term condition. Experiences of abuse from managers and colleagues had reduced over time, improving from 17.6% to 8.9% and from 25.4% to 17.2% respectively.

Staff with a long-term condition remained more likely to feel pressure to work when unwell. 18.2% said they had felt this pressure, which was double the rate for staff without a long-term condition. Although this figure was slightly above the national comparison for staff with a long-term condition, the organisation still demonstrated better than national performance in 5 of the 7 Workforce Disability Equality Standard metrics.

There was evidence of improving cultural indicators. Engagement scores for disabled staff rose from 6.73 in 2023 to around 7.10 in 2024. The proportion who felt their work was valued also increased from approximately 40.8% to 47.7%. Perception of equal career progression opportunities improved to around 64.2%. However, disabled staff continued to feel less valued than their non-disabled colleagues, with 47.6% feeling valued compared with 59.9% of those without a long-term condition.

Delays and inconsistency in accessing reasonable adjustments remained a recurring theme. Around 82% of disabled staff reported receiving appropriate adjustments, which had remained broadly stable. Staff feedback gathered during inspection activity confirmed ongoing concerns about timely adjustments, confidence in raising concerns and the overall experience of workplace culture.

These disparities were recognised by the trust and actions included in their improvement plans. This included developing a reasonable adjustments policy with clear guidance, piloting a new reasonable adjustments pathway to ensure consistency, strengthening inclusive and compassionate leadership skills, and implementing a bullying prevention framework. Progress was monitored through established EDI governance structures.

According to the 2024 staff survey data, approximately 7% of staff identified as LGBTQIA+, with a further 5.87% choosing not to disclose their sexual orientation. However, we were unable to evaluate staff experiences by sexual orientation due to insufficient data. At the time of the assessment, Pennine Care did not publish detailed LGBTQIA+ experience metrics. As a result, it was not possible to determine whether national trends were reflected locally.

The trust demonstrated a small but persistent gender pay gap. This was not caused by unequal pay within bands but was influenced by the distribution of men and women across different roles and seniority levels. Although the position had improved over time, the trust continued to face challenges in increasing the number of women in senior roles. In Pennine Care, women formed the majority of the workforce, particularly within clinical and administrative roles. The median gender pay gap remained relatively small. This reflected the national NHS pay framework, which limited variation in basic pay across roles. The gap that remained was largely the result of occupational segregation. Men were more likely to be employed in senior clinical or leadership positions, while women were more likely to work in roles that were placed within lower paid bands. The overall trend showed that the gender pay gap had been stable or had improved gradually over recent years. However, structural issues continued to affect the representation of women in senior leadership and higher paid roles.

The trust had a wide range of staff networks designed to promote inclusion, wellbeing and equality including:

• Race Equality Network
• Positive Ability Network
• LGBT Network and Allies
• Women’s Network
• Faith and Beliefs Network
• Carers Network
• Neurodivergent Network
• Health and Wellbeing Champions

Each network appointed chairs and deputies and received a budget to support development, activities and learning. Staff said this structure had strengthened networks and helped them move forward. Chairs confirmed they had protected time, although pressures of work sometimes made this difficult to use effectively.

The inclusion council brought together representatives from all networks, with reports submitted to the EDI working group and then to the Board. Staff said the trust’s culture was broadly positive, though inclusive practice varied between teams. Delays in adjustments for disabled and neurodivergent staff created avoidable stress, and some networks were still establishing clear escalation routes. Awareness of networks was inconsistent, and staff requested more accessible and digital communication. Experiences of inclusion were mixed: some colleagues felt well supported, while others experienced slow processes or limited understanding. Race Equality Network members said organisational commitments were not always reflected in day‑to‑day practice, and neurodivergent staff often felt misunderstood. Despite issues, networks were valued for peer support and increasing online engagement. They continued to develop their offer, including guidance, toolkits and coaching. Staff described the networks as committed and influential, with potential for greater impact with additional organisational support.

Governors reported that the trust was a diverse and welcoming organisation. They stated that people were listened to and treated with respect, and they felt the trust demonstrated a clear commitment to fairness. They also told us that diversity was evident across both the governor body and the board

External partners reported that the organisation demonstrated a visible commitment to inclusion and that staff showed inclusive behaviours.

The trust had arrangements in place to ensure clear roles and responsibilities, systems of accountability and governance. These systems largely enabled the delivery of good‑quality, sustainable care. There was a recognition that improvements were needed to strengthen the governance arrangements with recovery plans to address these; however, these improvements were not always implemented with sufficient pace.

The trust operated a structured governance framework comprising Board subcommittees and operational groups, which provided oversight, scrutiny and assurance in relation to statutory, regulatory and contractual requirements. Board subcommittees, supported by both executive and non-executive directors, formed the primary assurance mechanism within this framework. However, these arrangements were relatively newly established and were not yet fully embedded or sufficiently mature to demonstrate consistent effectiveness.

Operational performance, quality and workforce information flowed from ward and team meetings into Care Hub meetings, and then into the Network meetings. These networks reviewed performance, identified risks and escalated issues to a single trust-wide operational meeting chaired by the Chief Operating Officer.

Quality governance was delivered through key groups such as the Care Quality Oversight Group, Clinical Effectiveness Group, Central Safety Summit, Central Safeguarding Assurance Group and the Patient and Carer Voice Impact Group, which reported into the Trust Management Board. Together with reports from 16 corporate governance groups, these enabled the Board to maintain oversight of risk, quality and organisational control.

The Trust Management Board, chaired by the CEO, acted as the central management body and provided committee Chairs’ assurance reports to the trust Board. A governance review in late 2025 identified opportunities to strengthen the system, leading to revised sequencing of meetings from early 2026 to improve information flow between local services and the Board.

The trust’s strategic objectives set out what it aimed to achieve and were supported by a Business Assurance Framework (BAF) which mapped, monitored and measured risks and controls to support delivery. The BAF was refreshed in December 2025, with clearer risk definitions, strengthened controls and assurances, and updated scoring. At the time of review, the operational risk register held 602 risks, representing a small reduction.

A maturing risk management framework ensured that risks were routinely identified and reviewed at network, corporate and trust-wide levels, aligned to strategic risks and escalated through established governance routes using the AAA (Alert, Advise, Assure) system. Following an independent audit, the trust strengthened its BAF through clearer and more consistent risk descriptions, controls and assurance mapping. This included refreshed strategic risks, improved action tracking and tighter integration between the BAF, operational risks and the Outstanding Care Improvement Programme, which enhanced early visibility of emerging risks and supported evidence-based decision-making.

The BAF was structured in line with national NHS guidance, with risks clearly described, scored for likelihood and impact, and linked to strategic objectives. Each risk was overseen by an executive director and a Board sub-committee. Non-executive directors reported that the framework had been well embedded, supporting more effective committee oversight and alignment between strategy and governance.

Committee observations showed that the BAF was a standing agenda item and was consistently used to scrutinise and challenge risk and assurance information. Committees reviewed strategic and performance risks, with non-executive directors challenging discrepancies and driving improvements, demonstrating strong cross-committee and integrated oversight.

The Outstanding Care Improvement Programme, aligned to the trust’s 2025 to 2030 strategy, aimed to standardise and improve safe, effective and accessible care, reduce unwarranted variation and strengthen community-based provision. It supported consistent, evidence-based, person-centred care through improved clinical pathways, partnerships, digital systems and estates, with progress monitored through quality, experience and regulatory measures. Enhanced reporting mechanisms, stronger alignment with digital, workforce and safety priorities, and strengthened governance processes provided more robust oversight and earlier visibility of emerging risks, supporting a more proactive and evidence-based approach to assurance and decision-making.

We observed a range of committee meetings. The structure provided strong and cohesive governance oversight. There was consistent scrutiny of the BAF, strategic risks, and performance issues. The committees demonstrated aligned and joined‑up governance, with information flowing effectively between them to ensure risks were identified, triangulated, and escalated appropriately. Non‑executive directors (NEDs) offered thoughtful challenge throughout, probing risk hotspots, testing assurance levels, and shaping improvements to governance and reporting processes. The committees collectively provided robust oversight of key areas such as safety, culture, staffing, complaints, reasonable adjustments, finance, and business cases. Their combined work ensured timely escalation, disciplined decision‑making, and strengthened organisational assurance overall.

The trust ensured that Board subcommittees received performance data aligned to their areas of oversight, including Business Plan updates, Outstanding Care Improvement Plan updates, Safer Staffing reports and Learning from Deaths reports. However, senior leaders highlighted that data was often difficult to gather, lacked key metrics, and was not consistently presented through accessible dashboards, resulting in slower and less efficient reporting processes.

In recognition of this, the trust were making improvements in terms of accessible data reporting. They were strengthening their digital and business intelligence functions by implementing structured prioritisation processes, reviewing capacity and capability, and establishing an insight and intelligence team. Digital requests were overseen by the Digital Board, while the Strategic Performance and Information Service managed all data and reporting demands through routine triage, workload planning and a digital management system, ensuring work was prioritised according to strategic importance, technical requirements and organisational need.

There were processes to manage the financial resources and sustainability of the trust. Overall, the trust demonstrated strong financial governance, good financial discipline, and a track record of delivery. There was good progress on reducing the underlying deficit and a plan to ensure recurrent financial balance over the next 3 years. However, there remained a high level of savings at 6% (£17.8m) to deliver in 2026/27 and a need to achieve this recurrently whilst continuing to manage operational pressures.

The trust maintained a stable Executive Team, with an experienced Finance Director in post for several years, supported by an experienced and consistent finance team.

Financial performance was stable, with delivery against control totals and achievement of at least break-even plan targets in both 2023/24 and 2024/25 and with the expectation to meet the breakeven plan for 2025/26.

However, financial sustainability remained a concern due to a continued reliance on non‑recurrent measures. This had been positively reduced from a £25.3m underlying deficit, as reported in the external audit assessment for 2024/25 at the start of 2025/26 to a £4.1m underlying deficit. This demonstrated strong progress to long term financial sustainability remained a focus.

The Trust’s 3-year financial plan aimed to achieve recurrent break-even by 2028/29, supported by savings targets each year of 5%, 3.5% and 3% respectively over the three years.

This underlying deficit reduction had largely been achieved through agreements to identified non recurrent income as recurrent for SDF funding with the commissioners and treating non recurrent benefits as recurrent.

The trust strengthened its performance and accountability framework through the Executive Finance Group (chaired by the Finance Director and deputy-chaired by the Director of Strategy), supported by network‑level budget meetings and dedicated management accountants. Quality impact assessments were jointly signed by the Medical Director and Director of Nursing.

Workforce pressures remained a material cost driver. Despite a 40% reduction in agency spending, bank expenditure was rising, with an £8m pressure forecast in 2025/26. Inpatient services remained significantly overspent (£5.5m forecast). This was supported by underspend elsewhere in order to achieve breakeven.

The ICB supported £7.4m for a safer staffing investment which was part way through being implemented. Workforce indicators also showed pressure in sickness rates (6.16%), turnover (10%), and fill rates (75.9%).

There had been a significant reduction in out-of-area placements which had been a successful outcome for both service users and financial sustainability.

Internally generated capital investment was c£5m per annum. Investments have focused on digital developments, estates upgrades, service expansion, and workforce transformation which support the trust’s strategic priorities.

Financial governance structures were strong, with well‑chaired Audit and Finance Committees and good discussion, review and challenge in the committees and Board. Strategic risks included financial sustainability, workforce pressures, demand growth, and investment requirements.

Although governance was generally strong, the quality and consistency of reports varied, highlighting the need for shorter reports, greater standardisation and accountability. Extensive governance activity and evolving structures meant some roles were still embedding, particularly amidst workforce pressures. External assurance remained positive, with strong engagement from Coroners and confirmation from internal audits of sound processes. Meetings observed demonstrated effective oversight, proactive horizon scanning and strengthened governance across the Risk Management Group and Trust Management Board.

At the time of our assessment, the trust was placed in Segment 3 of the NHS Oversight Framework, indicating below‑average performance. The trust was ranked 39th out of 61 non‑acute trusts, reflecting low performance across several key domains, including access to services, effectiveness and experience, patient safety, and workforce.

The trust had an absence rate of 6.9% reported from their February Integrated Performance Report with mental‑health related illness remaining the leading cause of days lost. However, the overall staffing position was strengthening, with all Registered Nurse posts now filled and sustained progress in healthcare support worker recruitment, supported by clearer career pathways and targeted resourcing. The Board were monitoring defined month‑by‑month improvement trajectories, and several actions had been introduced aiming to reduce absence, including a new Managing Attendance Policy, enhanced wellbeing support, and improved Occupational Health pathways. Further improvements were expected through standardised shift patterns, digital rostering, strengthened supervision processes, and continued reduction in agency reliance as recruitment pipelines.

The trust progressed the introduction of an electronic rostering (e‑roster) system following approval of a business case in January 2026 and final Board sign‑off in February, recognising that the previous absence of an e‑roster significantly limited real‑time staffing oversight and assurance. The programme formed a core component of safer‑staffing improvement, enabling standardisation of shift patterns across wards, reducing reliance on temporary staffing, and strengthening compliance with national workforce standards. A phased deployment was planned for 2026/27 with full trust implementation expected by April 2027, supported by structured governance through the Strategic Delivery Board and routine reporting into quality and safer‑staffing structures. The system was intended to enhance workforce visibility, strengthen risk triangulation, improve data quality, and address gaps in staffing assurance and oversight.

The trust continued to experience pressure from long lengths of stay and delayed discharges, with 24.1% of inpatients in December 2025 remaining over 60 days, and 44.8% of older adult patients exceeding 90 days, placing the organisation above national averages for prolonged stays. They performed comparatively well on system flow, with bed days lost to delayed discharge at 10.8% in December 2025, which remained below regional peers (17.6%). They identified overwhelming demand, high acuity, and workforce instability as key drivers of delays in discharge and inpatient flow. A programme of improvement was in place, including the Inpatient Transformation Programme, strengthened discharge coordination, daily flow meetings, and targeted recruitment alongside shift‑pattern standardisation and full e‑rostering implementation. Oversight was maintained through daily huddles, monitoring, Performance dashboards and Board‑level governance with the aim of reducing delays, improving patient experience and ensuring safe, effective inpatient flow.

The trust reduced out‑of‑area placements to very low levels with remaining cases being reviewed daily for repatriation. Strengthened flow processes, gatekeeping and inpatient transformation reduced reliance on external beds and delivered over £3m savings. Out of area placements had previously been associated with higher acuity and safety concerns, prompting continued oversight through the BAF.

For complaints received by the trust, performance against response times remained below the required standard, although there had been an upward trend. The trust also reported fewer cases exceeding 100 working days and an overall reduction in complaint volumes. Acknowledgement within 3 working days remained consistently strong. To improve complaints handling, the trust introduced interim leadership arrangements and tested early process changes, leading to the implementation of an early‑resolution stage that had a positive impact from June 2025. Work focused on reducing older cases, strengthening caseload oversight and improving live reporting, supported by weekly reports to network directors. A complaints process improvement group developed a revised model, and wider quality‑improvement activity began to enhance investigatory capacity, capability and organisational learning. Monthly reporting to the Trust Management Board ensured oversight of caseload trends and the impact of improvement actions, with updates also provided to the Patient and Carer Voice and Impact Group and executive directors.

In response to this, along with actions required following recent CQC service group assessments and identified risks from their Integrated Performance Report, the trust introduced a time‑limited Outstanding Care Improvement Plan to ensure the required improvements were delivered and embedded. The programme ran from August 2025, covered 11 themes, each with designated leadership and programme support, and progress was being monitored through the Outstanding Care improvement Group which reported regularly to the Board and Trust Management Board. At the time of assessment, improvements had been achieved across supervision, care planning, safer staffing, training, built environment, digital infrastructure, inpatient quality, and community standards. With 67% of actions completed, the trust was in the process of transitioning this work into routine processes, with remaining long‑term actions incorporated into planning and transformation programmes.

Several areas for improvement in medicines optimisation had been identified through internal and external audit and regulation. These were captured in the trust’s Outstanding Care Improvement Plan, with improvement driven through dedicated workstreams. The trust had a comprehensive governance framework for medicines optimisation, with a clear reporting structure and escalation mechanisms providing oversight for the delivery of these workstreams. Interdependencies with other improvement workstreams and any risks for delivery of the related medicines improvement work were captured and kept under review. However, capacity to develop medicines reporting from the trust’s electronic medicines and patient record systems limited the information on for example, use of injections for rapid tranquilisation, medicines reconciliation and missed doses. Better data would enable the trust to more easily identify and explore variation in performance, facilitating sharing of learning and good practice. The trust recognised the need for a sustained focus on medicines optimisation to embed consistent practice and support continuous improvement for example, in rapid tranquilisation and covert medicines administration where new policies and guidance had been implemented.

Our findings from our assessments at service level showed there was a clear framework outlining the required discussions at ward, team and directorate level meetings, ensuring that essential information, including learning from incidents and complaints, was shared and reviewed.

Stakeholder feedback indicated confidence in Pennine Care’s governance and information‑sharing, with leaders seen as open about challenges and progress. The trust was viewed as a reliable partner in managing risk and service change, especially in urgent and emergency care.

The trust had effective governance and oversight of the Mental Capacity Act 2005 Code of Practice. Staff followed established processes for assessing capacity and recording best interest decisions, and leaders maintained oversight through audits, multidisciplinary review mechanisms and strengthened digital documentation. Most areas demonstrated sound practice in how staff applied the Mental Capacity Act and used the Deprivation of Liberty Safeguards, with clear escalation routes where concerns were identified. Some isolated areas showed less consistent documentation or variable confidence among staff, but these issues were not widespread and were being addressed through improved supervision, digital enhancements and targeted training.

The trust also had effective governance arrangements for the Mental Health Act, supported by experienced leadership, structured scrutiny groups and clear reporting lines from ward to Board. There was strong clinical oversight of detention processes, consent to treatment requirements and the delivery of patient rights, with regular audits and established mechanisms to identify and address concerns. Most areas operated in line with the Mental Health Act and Code of Practice, although some local variation in documentation quality and training compliance persisted. These risks were limited to specific teams and were already the focus of improvement actions including strengthened monitoring, enhanced training and better digital support.

The trust had governance arrangements to protect data integrity and confidentiality, with oversight from the Board, Audit Committee and Quality Committee. Although progress was being made, some services had not yet met full compliance with the Data Security and Protection Toolkit, and gaps in evidence and documentation remained. Systems such as the Ulysses incident reporting platform and reviews through the Central Safety Summit and Network Safety Panels supported data quality and security. Incident reports showed increases in sexual safety and data‑related issues, prompting thematic reports to support learning. The trust also managed national data security alerts. Confidentiality was maintained through secure digital platforms, clinical safety standards, privacy assessments and lawful data‑sharing processes. Cloud‑based systems and regular audits strengthened data management, though some processes were unreliable. The Safer Staffing Tool had not been updated since 2024, affecting reporting accuracy and compliance. The governance and risk function was well‑resourced, but inconsistencies remained between incidents reported nationally and those presented to the Board. Despite these challenges, the trust demonstrated awareness of required improvements and continued strengthening its assurance and compliance.

The trust maintained strong oversight of its estates and equipment through structured safety reviews, routine monitoring processes, and clear escalation routes. Risks relating to the fabric of buildings and the care environment were identified through regular inspections, safeguarding reviews, and incident‑reporting systems, with issues such as fire safety, environmental hazards, and ward‑level concerns managed via joint monitoring between operational teams, estates staff and clinical leaders. Targeted capital programmes, continuous engagement with external partners and focused improvement work ensured that environmental and infrastructure risks were mitigated promptly and effectively, maintaining safe and fit‑for‑purpose facilities across the organisation.

The trust had an established approach to business continuity supported by the governance structures’ review of strategic risks and compliance with national emergency preparedness standards. Staff training included a business continuity e-learning module launched at the end of 2025 together with scheduled business impact analysis reviews and ongoing tabletop live and communication exercises. Awareness of continuity arrangements was being strengthened ensuring all staff could consistently access and apply business continuity plans.

The trust understood their duty to collaborate and work in partnership, so their services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

At the time of our assessment, Pennine Care NHS Foundation Trust demonstrated a strongly outward-facing, collaborative approach, working extensively with system partners, NHS organisations, local authorities, voluntary and community groups, and people with lived experience. Evidence consistently showed the trust’s active role within the Greater Manchester health and care system. Leaders worked closely with a neighbouring mental health trust on strategic service redesign, shared governance and a joint digital and data strategy for 2025 to 2031, including alignment of infrastructure, procurement of a shared electronic patient record and shared ambitions for research, workforce development and sustainability, including progress towards Net Zero.

Partnership working across digital, transformation and children and adolescent mental health services was well developed. A close working relationship with the neighbouring trust’s Chief Nurse was supported through regular forums and joint initiatives such as ward accreditation, the REACH antiracism programme and reducing unwarranted variation in quality. The trust also demonstrated learning from its partner, including responding to findings from external reports and concerns by bringing in external expertise to address closed cultures, strengthen listening to patient experience and enhance the patient voice. Board members recognised the benefits of this partnership approach.

The trust worked collaboratively with the Integrated Care Board and wider Greater Manchester providers, contributing to system planning, locality boards and commissioning discussions, particularly in crisis care, community transformation and models such as Living Well. It engaged with the Greater Manchester Combined Authority, police and NHS England through multi‑agency forums, safety networks, digital boards and provider collaboratives, and acted as lead provider in the Tier 4 CAMHS collaborative. These arrangements supported operational resilience, incident response, digital development and long‑term planning. The chair’s role on the Integrated Care Partnership Board demonstrated system-level leadership.

Joint working with local authorities included a significant partnership with Bury Council to develop a community mental health and learning disability hub aimed at improving access and integrated delivery. The trust also maintained strong links with the voluntary, community and social enterprise sector, supporting community interventions, inclusion and co-produced pathways. Its charity secured external funding to enhance green spaces and patient environments.

The trust worked with universities, Royal Colleges and NHS England to support training, digital literacy, clinical improvement and national pilots, and participated in regional improvement networks. There was a strong focus on multi-agency safeguarding and risk management, with involvement in MAPPA, resilience partnerships, complex case panels and safety forums, supporting coordinated management of risk across agencies.

Safeguarding arrangements were well embedded and demonstrated a maturing multi-agency approach. The trust worked closely with partners through safeguarding boards, safety summits, quality groups and violence reduction forums, maintaining oversight of themes such as violence, sexual safety and hate crime. Staff contributed to integrated working, joint planning and shared learning, alongside PSIRF-aligned reviews and continuous improvement activity, including a safeguarding adult review and multi-agency learning following a prevention of future deaths report.

The pharmacy team worked collaboratively across the Integrated Care System and nationally, including action on promazine prescribing and embedding pharmacy within neighbourhood mental health teams. Work to improve shared care pathways and review long-term prescribing was underway, supported by quality improvement activity. The trust also co-delivered a joint improvement conference with a neighbouring trust to share learning, including safe use of high-risk medicines and strengthening patient voice.

There was a strong commitment to involving people with lived experience, with service users contributing to policy, digital development, quality improvement and strategic programmes through a range of forums and co-produced work, including the sexual safety approach. This was recognised through internal awards. Stakeholders described the trust as a key system leader, with proactive engagement from staff and leaders, although some noted capacity limitations across localities.

Feedback from governors was mixed. Most described leaders as open, approachable and willing to engage, with positive interactions at senior level. However, some reported limited influence on strategy, inconsistent leadership visibility and a gap between feedback and action. Concerns were also raised about communication during organisational change, although governors had access to induction, training, workshops and service visits.

The trust focussed on continuous learning, innovation and improvement across their organisation and the local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The trust demonstrated a structured and maturing approach to organisational learning that was embedded across committees, safety processes and operational governance. Governance systems used the ‘Alert Advise Assure’ model and information moved from operational groups through the Trust Management Board to the Board of Directors. Committees were well chaired and completed annual effectiveness reviews that supported openness. Reports were escalated consistently through operational governance structures.

The trust strengthened its learning culture through the introduction of a Just Culture charter in October 2025. This was supported by quarterly reporting and a range of learning forums. A Central Safety Summit met regularly to review key performance indicators, initial learning responses, thematic learning and duty of candour compliance. The organisation increasingly used approaches such as ‘After Action Reviews’, Appreciative Inquiry and thematic analysis templates to accelerate learning and identify recurring issues. Structures to support learning from deaths were established and themes were shared through groups such as the Mortality Review Group.

Patient and service user involvement contributed to organisational learning through mechanisms such as My Voice Matters, lived experience forums, awards and engagement panels. Staff across disciplines including matrons, clinical leaders, digital teams, research teams and patient safety partners contributed to learning and innovation. Board members and committees maintained oversight of thematic reviews and patient safety information to ensure that insight from patients and staff informed decision making.

Staff survey results showed improvement in organisational learning between 2021 and 2024. The theme ’We are always learning’ improved. Appraisal and development scores also improved, reflecting strengthening professional development opportunities. Appraisal compliance reached almost ninety per cent which exceeded the target. Although supervision compliance remained below target, the trust implemented targeted improvement plans, automated dashboards and strengthened oversight.

The trust used a structured approach to quality improvement which included the’ Aims Benefits and Changes’ methodology (ABC) and the ‘Plan Do Study Act’ cycle. Staff were encouraged to undertake improvement projects and change champions supported this activity. The trust held celebration events to showcase progress. This work resulted in improvements including reduction in medication errors, redesign of crisis pathways including NHS 111 access and strengthened crisis resolution through home treatment teams. Improvement activity was also becoming more visible across community mental health teams.

The trust continued to learn from external scrutiny including Prevention of Future Deaths (Regulation 28) reports. Three reports were issued between August 2025 and January 2026 which identified concerns relating to mandatory training, digital observations and investigation quality. The trust responded with improvement actions such as increasing life support training capacity, developing a digital observations application and strengthening governance oversight.

The trust also strengthened its approach to restrictive practice. Service leads acted as critical friends and undertook independent reviews of seclusion and segregation. Work was underway to align processes with national models and to relaunch ‘Safewards’. Data maturity required improvement and EDI data for restrictive practice was not yet fully visualised. The trust analysed increases in physical restraint and rapid tranquillisation, especially for female patients, and commissioned thematic reviews in response. Enhanced observation training had been expanded and a quality assurance framework aligned to national standards was in progress. Patient insight was gathered through debriefs, surveys and lived experience contributions.

The trust had a comprehensive audit programme to assess medicines handling in accordance with the trust’s medicines policies and national guidance. The trust participated in relevant POMH UK (Prescribing Observatory for Mental Health UK) audits to facilitate benchmarking of prescribing practice against other similar trusts and against national guidance. Targeted actions supported ongoing improvement in key areas of medicines safety including the use of rapid tranquilisation, valproate and clozapine, with sustained board level oversight. Staff medicines training needs had recently been reviewed, expanded and mapped to role (May to November 2025) to help ensure safe medicines handling in line with trust policy. Overall compliance with all medicines related training increased from 27% in July 2025 to 49% in December 2025, with safe administration of medicine training compliance at 83%. Additionally, the trust’s structured ‘ABC’ (Aims, Benefits, Changes) framework for quality improvement had been employed for example, to identify changes to support safer, more consistent medicines practices across inpatient wards.

The trust was preparing to roll out (February 2026) an electronic prescribing service benefitting patients through enabling community teams to issue prescriptions directly to patients’ chosen pharmacies. The trust recently won funding to lead research looking at the use of metformin in preventing antipsychotic-induced weight gain in people newly diagnosed with psychosis, with patient recruitment starting in 2026. The trust was supporting recruitment to a University of Liverpool led trial to find out which treatment was most effective and preferred by patients who experienced excessive salivation when taking Clozapine.

The trust took part in the NHS Benchmarking Mental Health Pharmacy and Medicines Optimisation Pilot (2025) designed to support evidence-based workforce planning and an increased understanding of how pharmacy teams contribute to safe patient centred care. The report supported the position agreed with the trust pharmacy leadership team in 2024 related to gaps in services and pressures on pharmacy staffing. These findings were incorporated into the Pharmacy Workforce Strategy 2025-2030. Pharmacy provision was included within a trust business case to support community transformation.

Innovation was supported through digital partnerships. The trust partnered with a patient platform to deliver appointment notifications directly through the NHS App. This allowed patients to manage mental health appointments alongside other NHS services and supported national ambitions to provide equal access to digital tools across physical and mental health care. Staff and patients were able to manage appointments, receive communications and complete forms online.

Research activity was visible and embedded across the organisation. The trust increased its success in securing national research funding and broadened involvement in portfolio studies. Research champions were appointed and almost 100 staff acted as research advocates. The trust delivered a wide range of studies including the CONNECT study which used smartphone and wearable technology to detect early signs of relapse in psychosis. The Children and Young People Research Centre delivered programmes such as My Voice Matters and contributed to regional work. The ‘OptiMed’ unit undertook medicines optimisation research and other specialist units focused on psychosis, learning disabilities and older people.

The trust worked with a wide range of partners including universities, other NHS organisations, clinical trials units and voluntary and community organisations. This included collaborations with universities in the United Kingdom, Brazil, Italy and Australia, as well as joint work with acute trust partners which supported learning and service improvement.

Partners were positive about the learning culture within the trust and reported that it demonstrated a clear commitment to improvement and innovation.

Pennine Care had been an early adopter of the Patient and Carer Race Equality Framework (PCREF) and had established a steering group in 2024 and 2025 reporting to the Health Inequalities Oversight Group. The trust had strengthened its ethnicity data reporting and developed a PCREF dashboard to identify inequalities in access, experience and outcomes. It had also progressed its community leadership approach, including planning a joint community leadership event with a neighbouring trust for October 2025. PCREF activity had been prioritised within the wider equality agenda and was aligned with the People Plan, anti-racism work and staff support initiatives. Despite this, PCREF had remained a significant organisational risk due to limited analytical capacity, resource constraints and slower than required progress, with full implementation planned by March 2028. There had been a recognised need to improve demographic data capture across all delivery areas, including addressing challenges in collecting PCREF data and ensuring staff were trained to have appropriate conversations to support this.

The trust understood any negative impact of their activities on the environment and strived to make a positive contribution in reducing it and supporting people to do the same.

Leaders were aware of the trust’s impact on environmental sustainability. They were able to provide examples of where the trust had made changes to reduce the trust’s carbon footprint.

The trust demonstrated a clear and comprehensive approach to environmental sustainability and had set out its ambitions within the Green Plan for 2025 to 2030. The plan described the trust-wide commitment to respond to climate change and recognised that climate change was already affecting health through extreme weather and worsening inequalities. The plan outlined that the trust intended to achieve Net Zero for emissions it directly controlled by 2040 and for wider emissions by 2045, with interim reductions between 2028 and 2032. National NHS reporting requirements shaped the trust’s trajectory and annual returns were made to the integrated care board and the Greener NHS programme.

The trust had made notable progress in the years preceding the plan. Between 2022 and 2025 it had expanded digital systems, improved waste segregation and invested substantially in energy management. Four thousand LED lights and 500 solar panels had been installed and saved more than £100,000 annually. Some solar installations supported both heating and water systems. Birch Hill Hospital, which was a Victorian site, received further solar panel installations and insulation improvements. Work undertaken by the estates team included the use of data loggers to monitor temperatures, adjustments to heating systems and alterations to areas such as the North ward nurses’ station, which no longer reported overheating after changes were made.

The trust advanced its programme for electric vehicle use. Electric vehicle charging points were installed at Birch Hill Hospital, which was the trust’s flagship site, and at 4 other sites across Greater Manchester. These points supported staff who did not have access to home charging facilities. The trust planned further installations including at The Meadows and other satellite sites. Electric vehicles were already used for the estate’s engineers. The trust aimed to fully transition to electric fleet vehicles by 2027.

Digital transformation played a significant role in reducing emissions. The trust reported that it had reduced carbon emissions linked to paper by 98%. It used telehealth, electronic prescriptions and digital appointment systems to reduce travel and reliance on physical records. Out of area placements had reduced by around 90%, meaning more care was delivered closer to home which further reduced travel and emissions.

Waste management had developed considerably. The trust sent no waste to landfill and both domestic and clinical waste streams were monitored through governance groups. Historical waste records were not always robust, but improvements had been made. The trust used a system where only needles required incineration, and other components were recycled through the tiger bags initiative. Energy was recovered from all incinerated waste. Waste data was monitored and reported through the green portal on the intranet, which also provided updates and guidance for staff. In food and nutrition, menus were locally sourced wherever possible. The trust reported 55 tonnes of food waste in 2024 to 2025. The trust was exploring opportunities to transport food from Birch Hill Hospital to other locations to reduce duplication of catering operations.

The trust pharmacy team used the Royal Pharmaceutical Society Greener Pharmacy toolkit to support more sustainable pharmacy practice, achieving bronze certification. Digital improvements planned for 2026/27 had been identified as supporting progress in this area.

Procurement activity included the application of 10% sustainability weighting in all tenders, and the trust made use of a local organisation to redistribute unwanted furniture rather than dispose of it. The trust implemented sustainability and Net Zero responsibilities within job descriptions and annual performance conversations.

Governance arrangements supported delivery of the plan. Sustainability work was overseen by the Sustainable Management Governance Group chaired by the Executive Director of Finance, who also acted as the Net Zero lead. The group met quarterly and received reports from senior leads across all areas of focus. Chair’s reports were taken into the Trust Management Board. The trust maintained a network of around 22 sustainability champions at different levels, and regular updates were published on the Green Portal. The trust also had separate governance groups for waste and energy management that used ISO compliance criteria.

Training was an important part of the trust’s approach. More than 200 senior staff had undertaken sustainability training, with modules covering greening the NHS, general waste and healthcare waste. Additional training for all managers had been introduced. The sustainability lead had been invited to Westminster to present the trust’s work, and the model was being considered for wider adoption across Greater Manchester.

The trust assessed climate change risks, including heat, flooding and power outages. Flood risks were reviewed and none were identified across the trust’s estate. Heatwave planning had been undertaken jointly between sustainability and emergency planning teams, and lessons from issues in North ward had informed updated heat management processes. Emergency planning colleagues contributed to broader climate resilience work.

Stakeholder feedback suggested that although many partners were not fully aware of the scale of the trust’s sustainability work, those who commented recognised the trust’s positive contribution to local environmental initiatives.

Evidence showed that sustainability was embedded into decision making, supported by strong governance, staff training and clear reporting arrangements. The trust had taken practical steps to reduce emissions and waste, had implemented a structured oversight system and had set ambitious but nationally aligned targets within its Green Plan.