Humber Teaching NHS Foundation Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement.

Requires improvement: Staff did not consistently assess the physical and mental health of all people who used services on admission. They did not always develop individual care plans and these were not always reviewed regularly nor updated as needed. Staff did not always discharge their responsibilities under the Mental Health Act 1983 well.

However, staff provided a range of treatment and care for people based on national guidance and best practice. The team included or mostly had access to the full range of specialists required to meet the needs of people who used services. Staff from different disciplines worked together as a team to benefit people.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not consistently maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Care plans we reviewed during our inspection were not always fully completed, personalised or holistic. They did not always reflect actual needs and preferences, placing people at risk of care and treatment that did not meet their needs. We reviewed 15 care records and found in 7 records plans were not fully completed, or person centred. Staff did not record if care plans had been shared with people in 8 records we reviewed.

However, most people we spoke with told us their care plan was regularly reviewed and updated.

Audits of people’s care records for March 2025 to March 2026 showed overall compliance of 83% with completion across all community mental health teams (CMHT). The Psychosis Service for People in Hull and East Riding (PSYPHER), early intervention in psychosis team had overall compliance of 94%. However, there were areas of low compliance in some CMHTs and in some specific areas of record keeping. For example, the service audited if there was evidence that care and treatment provided was relevant to the person’s current needs and/or the care plan. In Holderness CMHT compliance with this metric was 40% and in Hull CMHT this was 65%.

Staff did not always complete a comprehensive mental health assessment for a person after their admission to the team. We reviewed 15 care records and saw a mental health assessment had been carried out in 5. Following our inspection, the service told us they operated a trusted assessor model, where assessments were completed by staff in the Mental Health Triage and Assessment Team (MHTAT). This meant assessments were reviewed when accepted by the CMHT and people not reassessed. However, some people waited lengthy periods before being allocated to a CMHT practitioner.

Staff did not always discharge their responsibilities under the Mental Health Act 1983, in relation to community treatment orders well. However, the service mostly planned and delivered people’s care and treatment with them, including what is important and matters to them and in line with and current evidence-based good practice and standards.

Though service did not employ any peer support workers, peer support workers worked in the primary care mental health networks and linked with the community mental health teams (CMHT). Peer support workers worked between CMHT and primary care networks to support discharge planning and transition and to support people beforethey needed secondary mental health intervention. A peer support worker is a mental health professional who uses their own lived experience of mental distress to support others on their recovery journey. Managers told us they had a vacancy for a peer support worker in the Psychosis Service for People in Hull and East Riding (PSYPHER), early intervention in psychosis team. The peer support worker is identified as a key role in NHS England ‘Implementing the early intervention in psychosis access and waiting time standard’ guidance February 2023.

The service ensured that people who used services who were under a community treatment order (CTO) had their rights read to them as required by section 132 of the Mental Health Act (MHA) at the point the CTO was applied. A CTO isa legal order under theMHAthat allows a person with a mental health problem to be treated in the community instead of hospital, provided they follow specific conditions (like medicines or appointments). Audits showed everyone had been initially given their rights under section 132 of the MHA. Though staff told us the service audited to check people on CTOs had their rights regularly explained to them in line with the MHA, audits provided by the service did not show this. There was no evidence people had their rights explained to them when CTOs were renewed. The audit showed 5 people had been on a CTO for longer than 12 months and did not record if they had their rights explained to them at CTO renewal. This meant they could not be assured people were aware of their right to appeal or access independent advocacy. The service told us a CTO audit had been added to the online incident reporting system in August 2025 to monitor compliance with CTO requirements. Staff in community mental health teams would be expected to complete an audit after 1 month of the CTO being applied and then annually. Audit outcomes would be monitored through the mental health legislation steering group. This was not in place at the time of our inspection. The trust CTO policy did not outline how often a person should have their rights explained to them. However, the section 132 rights standard operating procedure stated, “ongoing frequency of repeating rights should be on a regular basis, which will depend on the patient’s individual assessed need”.

Staff completed mandatory training on the Mental Health Act with compliance at 84.5% across the service.

Staff provided a range of care and treatment interventions suitable for people who used services. The interventions delivered were in line with guidance from the National Institute for Health and Care Excellence (NICE). For example, people could access psychological treatments and interventions, such as dialectical behaviour therapy, cognitive behavioural therapy, psychotherapy, family therapy and eye movement desensitisation and reprogramming. Treatment and interventions were based on clinical formulation, recovery focused and strengths-based practice, and trauma-informed care principles.

The trust had an up-to-date policy on NICE guidance which outlined the process for identifying and disseminating relevant guidance. This ensured staff had access to information on current best practice guidance.

Staff in the service used structured professional judgement to assess the needs of and risk for people using services. They used recognised risk assessment tools such as Functional Analysis of Care Environments (FACE) and Short-Term Assesment of Risk and Treatability (START).

The service worked effectively across teams and services to support people, making sure they only needed to tell their story once by sharing their assessment of needs when they moved between different services.

Staff attended regular multidisciplinary team (MDT) meetings. The service provided minutes of weekly MDT meetings in Goole, Bridlington and Driffield, Haltemprice, Hull and Beverley Community Mental Health Teams (CMHT). The service did not provide minutes of MDT meetings in Holderness CMHT.

We reviewed the minutes of the last 3 MDT meetings for each team and saw they were mostly attended by all relevant staff. People’s current presentation, risk factors and treatment were discussed and plans made. Referrals into the CMHT were discussed and plans for allocation to care coordinator or care and treatment were made. In the Mental Health Triage and Assessment Team (MHTAT) there was a daily safety huddle. MDT meetings followed a set agenda in all teams to ensure they were effective and all relevant business was discussed.

Minutes of MDT meetings showed staff of different disciplines worked together to support people. MDT meetings were attended by staff across different roles including occupational therapy, psychology and individual placement and support (IPS) workers. IPS is a model of supported employment specifically tailored for people with serious mental illness that helps promote recovery through obtaining jobs that align with someone’s strengths and preferences.

We observed safety huddles at Hull CMHT and Psychosis Service for People in Hull and East Riding (PSYPHER), early intervention in psychosis team. A safety huddle is a short, standing team meeting held at the start of a work shift. The team talks about daily risks, shares safety updates and plans the work for that day. They were attended by all members of the MDT, and we saw staff worked well together. Staff described positive multidisciplinary team working, with good working relationships across different roles and grades.

We saw evidence of discussion in MDT meetings in care records we reviewed.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

In Hull Community Mental Health Team (CMHT) there was an ongoing quality improvement project to support people to access an allotment. This gave people the opportunity to participate in an activity in a therapeutic outdoor setting.

The trust small grant scheme supported the set up of the ‘Edible Marsh’ group, which people who used services could attend to learn about growing their own food, and cooking and eating it.

Teams had occupational therapists who carried out assessments and developed care and support plans aimed at improving people’s day to day skills and quality of life.

The mental health division Pulse survey between July 2025 and February 2026 showed 54% of people using services said their mental health team gave them help and advice for joining groups or taking part in an activity. The Pulse survey was a short questionnaire used to gather feedback from people using services. People we spoke with told us staff had supported them to manage their wellbeing giving examples such as support and advice on exercise, healthy eating and mindfulness.

Though the service monitored people’s care and treatment to continuously improve it, it did not always ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used Patient Reported Outcome Measures (PROM) to monitor outcomes for people using services. However, audits showed staff did not always complete these. For example, in February 2026 Hull Community Mental Health Team (CMHT) recorded 74 people had completed treatment, but PROM scores were only recorded for 27 people. In Haltemprice CMHT, PROM scores were recorded for 4 out of 12 people who had completed treatment and in Holderness CMHT, PROM scores were recorded for 9 out of 19 people. The audit only measured if a score had been completed and did not show actual outcomes for people using services.

In April 2026 the trust introduced the ‘big 5’ audits. These were new quality audits based on 5 priority areas, patient and family engagement, quality of care planning, medicine compliance and support, clinical supervision of decision making under the Mental Health Act, and quality of discharge arrangements. These had not started at the time of our inspection and therefore outcomes were not available.

Clinical leads told us they carried out a peer review of other teams once every 18 months which covered the care environment, support to carers, interviews with people using services, interviews with staff, looking for any concerns about closed cultures and interviews with team leaders. However, the service did not share any reports or outcomes related to these reviews.

Staff used recognised rating scales such as the Recovering Quality of Life (ReQoL) tool to assess and record severity and outcomes. Staff in some teams used a nationally recognised patient-rated satisfaction scale to measure outcomes for individuals they were working with. However, this was newly introduced, and not all staff had yet received training. Managers told us they were rolling out training at the time of our inspection.

The service did not always ensure people consented to care and treatment.

Staff completed training on the Mental Capacity Act. Compliance with level 1 training was 95% and with level 2 was 89%.

However, audits of people’s care records for March 2025 to March 2026 showed low compliance in some community mental health teams (CMHT) for recording capacity assessments and best interests decisions. In Holderness CMHT compliance with this was 0% and in Hull CMHT it was 13%. We also found staff did not always record consent to care and treatment in people’s care records. We saw consent was not recorded in 8 out of 15 records we reviewed.

People who used services could access independent advocacy services.

In August 2025 Hull CMHT implemented a quality improvement project to improve the quality of recording people’s capacity and consent to treatment and ensure this was reflected in letters to GPs. The project led to a positive change from 8% to 76% in the content and quality of capacity and consent recorded in letters to GPs.