Hampshire and Isle of Wight Healthcare 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

This is the first inspection for this service since the formation of the new trust. This key question has been rated Requires Improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

Some staff told us that turnover and instability at senior levels had affected morale and left staff feeling unsupported. The service did not have good governance in place and this was evidenced throughout the report. There had been no quality improvement project outcomes for the CRHTTs or HBPoS in the past two years.

However, the trust had a shared vision, strategy and culture and some staff reported that leadership was approachable. Most people felt they could speak up and their voice would be heard and the service valued diversity in their workforce. The service understood their duty to collaborate and work in partnership and the Southampton CRHTT were actively working toward accreditation through RC‑PSYCH standards.

The service was in breach of regulation for governance at the service.

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 trust had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. However, not all staff felt informed about this.

Some staff across all the Crisis Resolution Home Treatment Teams (CRHTT) told us they felt negatively impacted since the trust merger in October 2024 and some staff were not aware of the trusts vision and values. Some staff in the Isle of Wight (IoW) CRHTT felt they were less appreciated than services on the mainland.

The trust launched a 5-year strategy in June 2025 with 4 aims. These were improving population health outcomes, delivering outstanding care, improving staff experience and delivering value for money. The trust was also entering stage 2 of their Adult Mental Health Community Programme and we reviewed their draft strategic outline case which included a review of crisis services but no dates had been set.

Staff experiences of senior leadership were mixed. Turnover and instability at senior levels affected morale and left some staff feeling unsupported. Whilst other staff reported that leadership was approachable.

Staff feedback on leadership was split. Some staff felt that the senior leadership team were approachable and they could raise concerns. Whilst others felt that due to the amount of change within the senior leadership team that they were not yet embedded in to the teams or able to make effective changes.

The service fostered a positive culture where most people felt they could speak up and their voice would be heard.

The trust had a Freedom to Speak Up (FTSU) policy. The trust told us that since the merger on 1 October 2024 all of the Freedom to Speak Up Guardians (FTSUG) had worked together to transition to one team. There had been 48 cases raised from non-inpatient mental health settings during that time which included CRHTTs, community mental health teams (Older age and working age adults), early intervention in psychosis teams, psychiatry liaison teams and the Health Based Places of Safety (HBPoS). The majority of concerns were in relation to a poor culture, with 8 of the concerns directly related to patient safety that were linked to discharge decisions and high workloads which impacted on staffs’ ability to provide adequate patient care.

Some staff at Mid and North Hampshire CRHTT and South West CRHTT told us they were not aware of the FTSUGs but felt they could raise concerns to the trust if they needed to. Staff awareness of the FTSUGs at Portsmouth CRHTT was mixed as some staff told us they were not aware of it, and others told us they had used it but did not feel confident in what the trust response would be.

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

The Workforce Race Equality Standard (WRES) is a set of nine indicators that are used to measure workforce race equality. The Workforce Disability Equality Standards (WDES) is a set of 10 specific metrics that compare the workforce experience of staff with a disability and non-disabled staff. Implementation of the WRES and WDES is a requirement for NHS healthcare providers. The trust undertook equality monitoring of its staff and reviewed its WRES and WDES results using data from 1st April 2024 to 31st March 2025. WRES and WDES data were only available at trust-wide level and WRES data was only for substantive staff.

The WRES report showed that 15.6% of the trust workforce were colleagues from a minority ethnic background and they were just as likely to access development such as non-mandatory training and continuous professional development as often as colleagues who were white. The reportidentified3 areas for improvement. These werethe relative likelihood of staff from ethnic minority groups entering the formal disciplinary process compared to white staff, the percentage of staff experiencing harassment, bullying or abuse from patients, relatives, or the public inthelast 12 months and thepercentage of staff personally experiencing discrimination at work from a manager/team leader or other colleagues. The trustidentifiedactions to improve these indicators including a review of employee relations cases, zero tolerance campaigns’inclusion in the trust anti-racist action plan,and increased signposting to support.

The WDES report showed that 6.3% of colleagues had declared a disability, however, 8.1% had not declared whether they had a disability or not and the trust reported this is below national data of 24%. The trust recognised that there may be a stigma associated with having a disability or a lack of trust from colleagues and this is an identified area of improvement. Of the 6.3% colleagues who had declared a disability, 81.3% said adequate adjustment had been made and 57.4 % of colleagues with a disability and or long-term health condition believe the trust provides equal opportunities for career progression or promotion.

The trust was a disability confident employer and had securedcharitablefundsto supportthemtoachievethe Disability Confident Employer/Manager status. The Disability Confident scheme is a UK government initiative encouraging employers to recruit,retain, and develop disabled people.The trust had a new centralised reasonable adjustment process in place to ensure staff were fully supported in the workplace to access what was needed to support them.

The trust had a team dedicated to embedding and developing Equality, Diversity, Inclusion, and Belonging (EDIB). Since the merger, 9 networks had been created:

• Carers
• Ability
• Race Equality
• Neurodivergent
• 50+
• Spirituality
• Armed Forces
• Women
• LGBTQ+

Each network had an executive director as a sponsor and the network chairs met every 6 weeks. The trust told us about some of the achievements of the networks, including, the Armed Forces Network who had worked in partnership with the LGBTQ+ Network toward accreditation through the Pride in Veterans Standard, the Race Equality Network hosted a Black History Month celebration attended by over 80 colleagues, and the Carers Network hosted an event during Carers Week 2025, under the theme “Caring About Equality”, which looked to raise awareness of the social, financial, and health inequalities faced by carers.

All the policies we reviewed that had been created by Hampshire and Isle of Wight Healthcare NHS Foundation Trust had an equality impact assessment (EIA) completed. An EIA is an evidence-based, analytical tool used by organisations to ensure policies, practices, and decisions are fair, transparent, and do not disadvantage people with protected characteristics.

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

As the trust had merged in October 2024 there were multiple variations of each CRHTT’s name within governance documentation. For example, East CRHTT was also called South East CRHTT, Fort Southwick, Basepoint Havant, and also referred to by a numerical code across various governance documents. This made it difficult to align data to the correct team and ensure the trust had full oversight of each team.

We raised concerns with the trust about the East CRHTT which included high turnover rates, safeguarding referrals, sickness rates and low supervision compliance. The trust provided us with an action plan with 24 actions listed which covered all areas of the concerns raised. The dates for these actions to be completed ran from 31 August 2025 to 1 January 2026 and none had yet been completed. Three actions had not yet been started and one did not have a status applied. We also reviewed the weekly meeting minutes from the Weekly Quality Improvement Meetings which showed clear discussions of risk and required actions needed and the trust board meeting in August 2025 noted the team was under intensive support. Following the inspection, the trust provided us with an updated action plan and strategic plan for the improvement of the East CRHTT. The action plan was split into 4 sections which covered leadership development, caseload management, training and appraisal, and inter-team development.

The trust had a Home Treatment Team Business Continuity Plan from January 2024 from the Isle of Wight NHS Trust which was due for review in January 2025 and a Business Impact Analysis and Business Continuity Plan 24/25 from December 2024 from Southern Health NHS Foundation Trust. There was no business continuity plan in place from after the merger for the Hampshire and Isle of Wight Healthcare NHS Trust. Under section 48 of the Health and Social Care Act 2008, CQC were commissioned to carry out a rapid review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) in 2024, all mental health trusts were asked to review and reflect on the findings and recommendations of the board. The trust completed an audit of their CRHTTs from October to November 2024. The audit reviewed risk assessments and record keeping, care planning and engagement, medicines management, and the discharge process. However, no data was received for East CRHTT.

The audit showed that across the services reviewed, 100% of the time consent had been sought and recorded where a carer or family member was involved, and 100% of the time people had received a medication review in the past 12 months. However, only 53% of people had received their required physical health assessments, 69% of people had evidence of discharge planning, and 53% had evidence of carers or families being involved in the care planning process. There were no action plans as a result of this audit. The trust told us that the reason for these compliance rates were due to other teams being responsible for these actions and staff within the crisis teams not having the option to select “Not Applicable.”

We reviewed the last 3 meeting minutes of the trust-wide monthly risk management group meeting. We saw top scoring risks were discussed and an update given on actions to address risk. The group also considered any new or escalating risks for addition to the risk register.

Across the trust, clinical networks operated differently and had different structures. Clinical networks were multidisciplinary groups of clinicians working collaboratively to improve the quality of services, embed evidence-based best-practice and share learning. This was due to legacy arrangements from previous providers, that continued post-merger. In August 2025 the trust put forward a unified framework for the governance and operation of clinical networks. This had not been implemented at the time of our inspection.

The trust merged their clinical effectiveness team in May 2025, whose role was to review audits and service evaluations from the previous 12 months. The team produced a report about the audits across services but stated that services used 3 different systems due to the trust merger in October 2024. There was a clinical audit under the “2025-26 plan” listed as “in progress” for crisis and contingency plans in mental health but no further details had been provided.

Across the inspection, we found multiple policies that were out of date, a lack of auditing, a lack of comprehensive and clear documentation, a lack of central and consistent processes and various missing data points. This was all exacerbated by the dual care records system and lack of monitoring of integral data sets.

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

The CRHTT’s attended regular meetings with external stakeholders. This included quarterly safeguarding board meetings which included liaison with integrated care boards (ICB), local authorities (LA), and constabulary representatives.

People using services and staff could meet with members of the provider’s senior leadership team to give feedback. We reviewed the minutes of the ‘Working in Partnership Committee’ and saw it was attended by stakeholders from the NHS and voluntary sector as well as people who used services and those representing them.

Most staff across services told us about various concerns they had about partnership working with other teams within the organisation and with external organisations. Concerns ranged from there being a lack of understanding of what the CRHTT’s provided to people who used services and a lack of agreement about the right course of treatment for people who used services, to the impact of low staffing levels in other teams directly negatively affecting the work load in these services and negative working relationships.

The Southampton CRHTT were actively working toward accreditation through RC‑PSYCH standards, but the trust reported no quality improvement project outcomes for the CRHTTs or HBPoS in the past two years.

Southampton Crisis Resolution Home Treatment (CRHTT) team were listed as a member of the Quality Network for Crisis Resolution and Home Treatment Teams (QN-CRHTT) from the Royal College of Psychiatrists (RC-PSYCH) which meant they were able to self-review and peer-review against RC-PSYCH standards to be able to meet accreditation. We saw evidence in the crisis resolution home treatment teams meeting minutes of actions the teams were doing to achieve the standard needed for accreditation.

We asked the trust for outcomes of any quality improvement projects from the last 2 years and they told us there had been none for either the CRHTT’s or HBPoS.