Humber Teaching 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

At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. We found 1 breach of regulation in relation to effective governance including systems and processes to maintain oversight of people waiting for treatment or intervention and of people’s physical health.

Requires improvement: Governance processes did not operate effectively. Performance and risks were not always managed well. The service did not operate effective processes and systems to safely manage waiting lists, particularly at Hull CMHT. The service did not operate effective systems and processes to assess, monitor and improve the safety of services in relation to medicines management. Not all staff felt respected, supported and valued.

However, local leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. The service worked well with partners to support people’s needs and share learning. Staff had opportunities to participate in research and quality improvement projects.

This service scored 57 (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 have a consistently positive culture across all teams. However, they had a shared vision and strategy based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and their communities.

We found a mixed culture across the service. Though most staff told us they were proud to work for the trust and their team, some staff told us morale was low in their team.

Leaders acknowledged the need to improve the culture in Hull Community Mental Health Team (CMHT) and had carried out targeted work to do so. This included conducting exit interviews with staff leaving the organisation to understand the issues within the team. Some staff in Hull CMHT told us things were beginning to improve, demonstrated by falling sickness absence rates and recruiting to vacancies. However, other staff gave examples of feeling not listened to, ignored and frustrated. Some staff expressed concerns that resource issues would impact morale and their ability to deliver the trust vision and strategy.

Though some staff could describe future plans and strategies that impacted their teams and services, others told us they did not feel change and future plans were communicated well by senior leadership.

However, staff knew about and could describe the trust’s vision and values and how this applied to their work. We saw posters displayed in staff areas about ‘Being Humber’, the trust guide to the values, of caring, learning and growing, and behaviours expected from staff.

The trust strategy for 2022 to 2027 was published on their website and outlines 6 strategic goals:

• innovating for quality and patient safety
• enhancing prevention, wellbeing and recovery
• fostering integration, partnerships and alliances
• promoting people, communities and social values
• developing an effective and empowered workforce
• optimising an efficient and sustainable organisation

The trust had a medicines optimisation plan for 2025 to 2026 which set out the key priorities in relation to medicines safety.

The service had inclusive leaders at a local level who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, some staff told us senior leaders were not always visible or approachable.

Though staff told us local leaders were visible and approachable they also recognised managers availability was impacted due to the breadth of services they were responsible for and extensive improvement plans in place at the time of our inspection. The trust had a programme of planned executive visits to services, and all staff could access ‘Ask the Executive’ and ‘Meet the Board’ sessions. Trust induction had a session which ensured staff were aware of the leadership structure. However, some staff told us senior leaders were not visible or approachable, and some were not aware of senior trust leadership and told us they had not seen or met them.

Though the trust had communication systems to share key information with staff, staff in some teams told us communication was limited and they felt managers and leaders did not always share information and key messages.

We spoke with senior leaders and local leaders and managers. They showed a good understanding of the services they managed, and their challenges. Leaders spoke with openness about improvements needed in the services they led.

The service did not always create a positive culture where people felt that they could speak up and that their voice would be heard.

The Freedom to Speak Up policy and procedure was available on the trust website, this was due for review in November 2026. The Freedom to Speak Up vision and strategy published on the trust website was for 2019 to 2022 and had not been updated. However, the updated strategy for 2024 to 2027 was available to staff on the trust intranet. Following our inspection, the service confirmed this was now available on the trust website.

The Freedom to Speak Up Guardian gave feedback to the trust chief executive officer on cases and progress, and there was a nominated non-executive director who had oversight of Freedom to Speak Up from a Board perspective.

The service provided data which showed between February 2025 and February 2026, 6 staff raised concerns to the trust Freedom to Speak Up Guardian. All concerns related to Hull Community Mental Health Team (CMHT) and corresponded with issues we found during our inspection such as waiting lists and vacancy levels. The service told us all concerns were escalated to senior leaders and had ongoing executive leadership oversight. The concerns raised remained open and leaders told us they would be open until all appropriate actions were implemented and concerns addressed.

Staff told us they knew how to contact the Freedom to Speak Guardian. The service had taken steps to support staff to speak up including ‘Safe to Speak Up’ sessions in November and December 2025 and restorative supervision by professional nurse advocates. However, though some staff said they felt confident to raise concerns, some told us they did not feel safe to raise concerns. Some gave examples of feeling not listened to by managers and lack of changes made following approaching the Freedom to Speak Up Guardian.

The service valued diversity in its workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The trust had analysed the results reported in the Workforce Disability Equality Standard (WDES) report for 2024 to 2025. WDES data is only available at trust-level and cannot be broken down to service-level data. In 2025 10% of the workforce identified as having a disability which was an increase from the previous years. The trust had improved in 6 indicators including

• Reduction in staff with disabilities experiencing bullying and harassment from people who used services
• Improvement in the percentage of staff reporting incidents of bullying and harassment
• Improvement in the number of staff with disabilities who believed the organisation provided equal opportunities for career progression
• Improvement in the number of staff with disabilities who felt pressure from their manager to come into work despite not feeling well enough to perform their duties
• Improvement in the number of staff with disabilities reporting reasonable adjustments had been made to enable to carry out their work
• Improvement in the number of staff with disabilities who believed the organisation provided equal opportunities for career progression
• Improvement in the number of staff with disabilities completing the national staff survey

The trust had identified experience of bullying, harassment or abuse from colleagues or managers as an area of focus for improvement and had an action plan to address this.

The trust had analysed the results reported in the Workforce Race Equality Standard (WRES) report for 2024 to 2025. WRES data is only available at trust-level and cannot be broken down to service-level data. In 2025, the trust had improved in all 9 WRES indicators and performed higher than the national comparison in 7 indicators. The trust had identified 2 priority areas for improvement based on the results:

• The number of ethnically diverse staff who experienced harassment, bullying, or abuse from people who used services, relatives, or the public in the last 12 months was 33.5%, which was higher than the national figure of 31.6%.
• The number of ethnically diverse staff who experienced discrimination from their manager, team leader, or colleagues in the last 12 months was 11.5%, significantly higher than it was for white staff at 5.2%.

They had an action plan to address these priority areas.

As well as WRES and WDES the trust used insights from gender pay gap surveys, electronic staff record and the staff survey to develop their equality, diversity and inclusion (EDI) activities. The trust EDI Insight Report February 2026 outlined the trust commitment to be an inclusive employer and recent activities to achieve this such as developing a ‘trans inclusion action plan’ and appointing a chair and deputy to the anti-racism network. The board reviewed the EDI annual report to agree action plans to address any gaps.

Staff could join 1 of 3 staff networks - anti‑racism, disability, and the rainbow alliance (LGBTQ+). These were member‑led groups to provide safe spaces, strengthen staff voice and drive an inclusive culture. The trust monitored the equality characteristics of staff in each team to ensure teams were diverse and representative of the local community.

Staff were able to apply to work flexibly and the service supported them to return to work following a period of absence taking account of personal circumstances such as health issues. The trust had a Flexible Working Policy and toolkit which guided managers and staff on flexible working where it was appropriate and explained the process for staff to apply for flexible working and appeal decisions to not allow flexible working.

The service did not operate effective systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. They did not always act on the best information about risk, performance and outcomes.

During our inspection, we found a lack of effective processes and systems to safely manage waiting lists, particularly at Hull CMHT and told the trust it must make significant improvements to waiting list oversight and management. The trust took immediate action to address safety concerns including reviewing all people on waiting lists and referring to crisis services where their mental health had deteriorated. They conducted a clinical review of 958 people on the waiting list at Hull CMHT. This initial review identified 12 people who required further review. Following a further review, the trust found 2 out of 958 patients required immediate support from crisis intervention. This meant there was a risk 12 people requiring immediate intervention would not have been identified through existing processes. Therefore, processes and systems were not embedded and sustained to ensure people waiting for care and treatment, or reallocation to a care coordinator, were contacted and had risks regularly assessed.

We also found systems and processes to assess, monitor and improve the safety of services in relation to medicines management were not effective. We raised this concern with senior leaders who took immediate action to ensure the monitoring of people on high-risk medicines was carried out. However, processes were not embedded and sustained to ensure the safety of services in relation to medicines management.

The service did not always ensure care records were complete. Staff told us they were not confident in using the electronic care record system. Though staff told us support was now available they said this was minimal when the new system was introduced. During our inspection we saw staff found it difficult to find care plans, risk assessments and risk management plans in the electronic care record. We found gaps in care records in all teams we visited including gaps in care plans, risk assessments and risk management plans. We also found records which were complete were sparse and lacked evidence of holistic, person-centred care. Audits provided by the service of people’s care records for March 2025 to March 2026 showed Hull CMHT had low compliance with evidence the person had been discussed in MDT forums appropriate to the presenting issues over the previous 3 months (0% in Hull East CMHT and 25% in Hull West CMHT). Staff did not always record the outcomes or follow up actions following reporting safeguarding concerns. Audits of care records between March 2025 and March 2026 showed in records audited in Haltemprice Community Mental Health Team (CMHT) only 15% had an outcome or follow up action recorded in the safeguarding section of the electronic care record where a safeguarding concern had been documented. In Hull East CMHT this was 0% and in Hull West CMHT 25%. Staff in Hull Community Mental Health Team (CMHT) did not always complete and record a Functional Analysis of Care Environments (FACE) assessment to assess people’s risk, with 46% of records audited having an up-to-date FACE assessment.

Though staff maintained and had access to the risk register at locality level and actions were recorded on risk registers to manage risks, these were not always effective at addressing the concerns. For example, the risks at Hull Community Mental Health Team (CMHT) were added in May 2024 and reviewed monthly with the last review in January 2026. Recorded risks included lack of adequate oversight of and clinical safety for people on waiting lists, which we still found during our inspection. However, staff concerns matched those on the risk register and issues we found during the inspection were also reflected on the risk register.

We reviewed the community treatment order (CTO) protocol, which was a shared protocol with local authorities, the ambulance service and the police. The service did not audit to check people on CTOs had their rights regularly explained to them in line with MHA. This meant the service did not have effective governance processes to assure themselves people were aware of their right to appeal, or access independent advocacy.

However, the mental health division had a standard operating procedure for clinical governance. This outlined the governance structures and guidance for staff working across the trust’s mental health division, including roles and accountabilities of staff. There was a standardised clinical governance report for each service which included risk management and serious incidents, patient safety, safer staffing, safeguarding, supervision and clinical training. It also identified any items which needed to be considered for inclusion on the risk register.

Individual teams reported performance to the community care clinical governance group, which in turn reported to the monthly mental health division clinical governance meeting.

The service had plans for emergencies which were specific to each team. They included plans for loss of staff, utilities and information technology and telecommunications and gave staff clear processes to follow in such an event. The business continuity plans were reviewed and updated regularly.

The service had up to date policies on information governance, data protection and Caldicott principles and a related confidentiality code of conduct for staff. The Caldicott principles are a set of 8 rules that govern how health and social care organisations handle confidential patient information.

The trust incident reporting policy outlined how relevant information about notifiable patient safety incidents would be shared with external organisations such as the Integrated Care Board (ICB) and CQC. The trust patient safety response policy outlined the requirement for staff to notify other bodies such as NHS England and local safeguarding boards when specific safety incidents required this.

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

The service worked in partnership with local stakeholders to develop and deliver services. Senior leaders had strategic partnerships with both local authorities to deliver integration with social care. In community mental health teams (CMHTs) in East Riding the service had a memorandum of understanding with the local authority on social care delivery including access to Approved Mental Health Professionals (AMHPs). In CMHTs within the Hull local authority area, the service employed social workers and were contracted by the local authority to deliver social care aspects of mental health support and statutory duties under the Care Act.

Senior leaders attended partnership meetings with the local Integrated Care Board (ICB) and linked with other providers within the ICB area. Leaders told us this was an opportunity to share learning and well as collaborating when people moved between services or providers.

The service had shared care agreements with primary care providers in Hull and East Riding, developed with the area prescribing committee. However, the working relationship with primary care networks differed across Hull and East Riding. In East Riding CMHTs had good links with primary care networks and described a clear approach based on the understanding of the population in each network. In Hull relationships were based more on individual GP practices and the service was working to develop the model of care with primary care networks to ensure good connections with GP practices.

Senior leaders sat on Hull’s ‘poverty truth commission’. The poverty truth commission brings together people with lived experience of struggling against poverty and decision-makers from civic and business life to explore local issues that are impacting on people's lives and work in partnership to tackle them. They told us it had been helpful in looking at issues faced by people using services and helped to establish expectations and remits with partners in the voluntary community and social enterprise sector to look at how they could work together.

The service focused 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 had a quality improvement strategy for 2021 to 2026, as well as a draft quality improvement plan for 2026 to 2031. The strategy included reviews and updates from the previous strategy and outlined how quality improvement work would continue. The quality improvement plan was linked to the trust strategic goals.

The Psychosis Service for People in Hull and East Riding (PSYPHER), early intervention in psychosis team were part of a national research project using virtual reality for people who had experienced psychosis and developed agoraphobia. Agoraphobia isa fear of being in situations where escape might be difficultor that help wouldn't be available if things go wrong. This used graded exposure supported by trained virtual reality therapists to help people reduce their symptoms and become more independent.

Psychologists in the PSYPHER team were taking part in research working with colleagues at Oxford University to pilot online programme to offer cognitive behavioural therapy interventions to people experiencing persecutory delusions.

The service provided information to show there had been 13 quality improvement projects in the last 12 months, of which 5 were completed. Examples of ongoing projects included at Hull CMHT with an ongoing quality improvement project that aimed to streamline how people move through community mental health pathways by reducing delays, improving caseload management, and ensuring people accessed the right support at the right time.