Tees, Esk and Wear Valleys NHS Foundation Trust

On this page

• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good.
Staff assessed the mental health needs of all young people referred to their services. They developed individual assessments, risk assessments and care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for young people based on national guidance and best practice. The clinical team included or had access to the full range of specialists required to meet the needs of young people within their services. Staff from different disciplines worked together as a team to benefit young people. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.
 

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them, but these were not always consistently documented well.

We reviewed 25 care records during this inspection. Care records evidenced that assessments were carried out in a responsive manner, including assessments that took place within accident and emergency departments. Staff completed comprehensive mental health assessments of each young person in a timely manner at, or soon after, being referred to the service. Where assessments were more complex, staff added to assessments over the initial three sessions. Our observations of appointments and assessments had evidenced clinicians across all services to be thorough, personalised and holistic, discussed risk and acted upon this during handovers, although action taken in relation to risk was not always clear within clinician notes. Where young people had follow up appointments, these were updated accordingly with plans and goals in place for future appointments, including liaising with other services.
 

We scored the service as 3.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.
Staff provided a range of care and treatment interventions suitable for the patient group and the specific needs of the service and provided young people and their carers with information about different therapies available. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). This included medication and psychological therapies and recovery based goals. The services had developed good working relationships with stakeholders and external agencies to ensure young people had access to the correct pathway indicated for their individual needs, including access to specialist services where needed, such as eating disorders, neurodevelopmental pathways and social care.
The service undertook a quality assurance audit on a rolling basis to assess and measure the delivery of key quality indicators. Audit compliance and themes from audits were reported by Community Modern Matrons via the service’s Improvement and Delivery Group (IDG) and Specialty Improvement and Delivery Group (SIDG). Any issues for escalation or celebration were included within the CAMHS specialty reports which were reviewed by the Trust’s Integrated Combined Governance Group.
Young people had access to a full range of specialists required to meet the needs of those using the service. As well as doctors and nurses, young people could access clinical psychologists, services linked with social workers, pharmacists, speech and language therapists, dieticians and were signposted to appropriate community-based groups.
Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Staff were skilful in delivering interventions during appointment observations, and engaging young people, and were compassionate in the delivery of this. The Trust had an induction policy and procedures, which included newer staff having time to shadow clinicians.
The services had access to specialist training in a wide range of subjects relating to delivery of care including low intensity cognitive behavioural therapy (CBT), high intensity CBT, dialectical behavioural therapy (DBT), systemic family practice, psychotherapeutic counselling, psychotherapy, art therapy, children’s counselling, invest in play, parent led CBT and parenting for conduct.
We reviewed 3 months of supervision data for the services we inspected, 1 team had 75% clinical supervision completion, however this figure had not included 120 minutes of group supervision within the data. Mangers had received management supervision; however, 5 services were under 85% completion. Frontline staff we spoke with told us they had received regular supervision and found reflecting on difficult cases helpful. During our observation of a Serious Risks meeting, leaders discussed the use of live supervision in clinical practice to help support staff and develop skills. Appraisals were completed in line with Trust policy and although the overall percentage was 89%, this was due to staff sickness. All medical staff had received clinical and management supervisions and appraisals.

Mental Health Act
Clinicians we spoke with all had a good understanding of the Mental Health Act (MHA) and Mental Capacity Act (MCA) and when appropriate use of legislation was necessary. Staff within children and young people’s services all had knowledge and awareness of Gillick competence (a UK legal principle determining that children under 16 can consent to medical treatment without parental knowledge or permission if they possess sufficient understanding, intelligence, and maturity to fully appreciate the proposed care).
Training in both the MHA and MCA was mandatory for staff and training compliance across the services was above target with the majority of services at 100% training compliance. MHA and MCA mandatory training included assessing mental capacity, best interests, deprivation of liberty, MCA and young people aged 16/17, MCA as part of human rights, the relationship between the MCA and the MHA, restraint and MHA levels 1 and 2.
 

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings within the services we visited. We observed morning meetings that shared information relating to patients, risk and appointments which were effective and concise, with involvement from specialist teams to determine how best to meet the needs of young people. Team meetings had standard agendas covering service specific topics, such as wait times for assessments and any access issues which teams could discuss to determine if any other team input was required, ensuring any training issues or needs were addressed, any sickness or staffing related issues.

Staff we spoke with told us that they felt comfortable seeking the advice of other teams and always felt supported when doing so. Getting Help and Getting More Help Teams were streamlined to ensure young people with more intensive needs were supported and the crisis team also worked well with inpatient wards to help facilitate structured discharges into the community. The teams had effective working relationships with teams outside the organisation such as schools. Some staff told us relationships between schools and mental health services had previously been strained, but that these have improved. Social services and GPs were regularly contacted in relation to medication changes and any safeguarding concerns.
 

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and, where possible, reduce their future needs for care and support.

Staff worked well with young people to create collaborative plans and healthier coping skills to deal with periods of distress. We observed appointments where staff and young people discussed coping strategies and healthy habits, including advice around sleep hygiene. Staff also explored other services such as groups in the community that could be beneficial to young people, including groups for young parents and young carers, encouraging social engagement within their own communities to establish healthy friendships and bonds.
 

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes and utilised the i-THRIVE model of care. The i-THRIVE Framework is an integrated, person centred and needs led approach to delivering mental health services for children, young people and families across five categories; Thriving, Getting Advice and Signposting, Getting Help, Getting More Help and Getting Risk Support. Emphasis is placed on the promotion of mental health and wellbeing, and for children, young people and their families to be empowered to be actively involved in decisions about their care through shared decision making.

The service has utilised the Community Quality Review Tool as part of the Trust's Quality Assurance Schedule since 2023. Data was previously collected through Microsoft Forms and bespoke reporting dashboards before transitioning to the InPhase platform in January 2026. The migration enabled data to be captured through the audit application and made results available through interactive dashboards to support compliance monitoring, quality assurance and the identification of areas requiring improvement.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable young people to make their own decisions and be fully involved in their appointments. For patients who were felt to have impaired mental capacity, staff assessed and recorded capacity to consent appropriately, with reference to Gillick competence where appropriate. They did this on a decision-specific basis and utilised risk assessments to determine if sharing of information was required. Staff ensured that consent was adhered to where families were involved in a young person’s care.