Tees, Esk and Wear Valleys NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained as requires improvement. The service had made improvements since our last inspection, however we identified a breach of Regulation 12 Safe care and treatment, in relation to risk assessments and documentation of risk with regards to safety summaries and safety planning. At our previous inspection, this had been highlighted however had not sufficiently improved. The service will be asked to provide an action plan in relation to this breach.

The services that we visited were safe, clean, well equipped, well furnished, well maintained and fit for purpose with specific rooms for appointments to take place, seating within waiting areas and reception staff available to greet young people, carers and other professionals. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely assess, signpost, treat and manage young people well within their local communities. The services managed patient safety incidents well and ensured thorough investigations took place to identify any learning and improvements.
Feedback from carers, young people and stakeholders reflected the staff’s commitment to provide young people with safe, therapeutic relationships to address ongoing mental health difficulties and staff were dedicated to ensuring young people received the best care possible.
 

This service scored 62 (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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.
There were no serious incidents reported on the Strategic Executive Information System, (STEIS) for any of the CAMHS teams inspected during the reporting period (12 months prior to this inspection). STEIS is an NHS tool used to report, track, and manage serious incidents and "Never Events" within healthcare services in England. It was being replaced by the Learn from Patient Safety Events (LFPSE) service at the time of this inspection. The service had completed two after action reviews in response to incidents and identified and implemented learning from these (a structured, psychologically safe debriefing method used to learn from both successful and unsuccessful patient safety incidents or operational events). The services continued to report any incidents such as incidents of self-harm, high risk behaviours and any admissions to general hospitals due to young people’s mental health. We reviewed data we held which evidenced continuous reporting via the LFPSE system.
All staff that we spoke with understood what incidents to report and how to report them. Staff were able to describe how incidents were reported through an electronic system and how incidents were shared with appropriate teams or professionals involved in young people’s care. All staff were aware of the duty of candour and the importance of involving families when investigating incidents, including apologising if, and when, things went wrong. Staff told us debriefs happened following any incidents and staff teams were well supported, which was reflected within care records.
We spoke with staff who told us about the CAMHS Clinical Network for the Trust and how this was used for reflection, shared learning and embedding improved practice throughout the Trust. Services also utilised peer reviews to identify learning and improvements. This included inviting other similar services to review ways of working and offer feedback.
The Trust had an incident policy in place to ensure safety incident investigations were accurately and thoroughly completed to identify what happened in an open and transparent way, identifying areas of systemic learning and opportunities for improvement, including systems-based improvements to prevent or significantly prevent the risk of repeat incidents.
 

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.
We visited a range of specialist community mental health teams during the inspection, some of which were the first point of access for young people entering mental health services. Getting Help Teams, Getting More Help Teams and the CAMHS Crisis Team were closely interlinked to ensure young people were directed to the most appropriate service to meet their needs and level of risk. We observed daily huddle meetings in which new referrals were discussed and the most appropriate pathways were identified. This included input from specialist services such as the eating disorder team and the intensive positive behaviour support team.
The service’s referral processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met where professional referrals were made to specialist services. Clinicians completed assessments which focussed on young people’s risk presentation towards both themselves and others and included home dynamics. These were discussed during morning huddle meetings. Staff we spoke with praised improvements to the pathways, stating that more appropriate referrals were now reaching the teams best suited to the needs of the young people, ensuring those with more complex needs could be seen quicker.
The Trust made sure there was continuity of care, including when young people moved between different services or into adult mental health services.Waiting times were less than the national comparison for the majority of teams, although were high for a small number of neurodevelopmental services. Services had applied keeping in touch processes to identify if a young person’s risk was escalating.The service had clear policies for transitions from CAMHS to adult services and primary care, which aligned with the Trust’s Our Journey to Change strategy which launched in 2021, involving young people, carers and partners in care to help ensure transitions of care were as seamless as possible.
Staff told us that there were good working relationships with social care, the integrated care boards and schools to ensure young people had continuity of safe care both whilst using CAMHS community services and post discharge. The CAMHS crisis team also ensured wrap around support for young people who were being discharged from inpatient wards. We spoke with staff who had a good understanding of the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients, including referrals, transfers and collaborative working between services.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.
Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate to do so. Staff training compliance in safeguarding in level 1 was 100% across all services inspected, from 80% to 100% in level 2 safeguarding, and 77% to 100% in level 3 safeguarding. Staff had the training level appropriate to their roles. All staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies such as social services, schools and GPs.
The Trust completed audits to assess the quality of referrals made into local authorities for safeguarding children and adults to ensure standards were met. The Trust provided assurance that staff were completing referrals as per record keeping guidance and to identify any areas of improvement which could be followed up, allowing for action development with local procedures. The audit completed in April 2025 identified area’s for improvement such as full carer/parent details not being recorded, which were action planned and completed upon our review. We reviewed a further safeguarding audit from November and December 2025 that evidenced onward referrals were made to third party agencies, appropriate actions had been taken to safeguard the patient.
Following the audits, results were communicated with staff via safeguarding e-bulletins and safeguarding link professionals email round ups.The Trust also presented the audit findings at the Quality Standards Groups for the Trust’s CAMHS Clinical Network and Care Group.

We scored the service as 1. The evidence significant short falls. The service did not always work well with people to understand and manage risks, however, they provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.
A review we completed of 25 care records across all the services we inspected showed that not all risk assessments were fully comprehensive or included safety summary planning [CH2.1]with young people and carers. 10 risk assessments did have recorded risks but did not always have plans to manage the identified risks or contingency plans. The assessments we reviewed did not always include information to support the mitigation of risk, and some records were unclear in terms of what was historic and what was current. Where some safety plans were in place, these identified risk but were not always clear on how these risks would be managed. This had been raised at our previous inspection of the service. However, this was not evident across all services but more so within the Crisis and Intensive Home Treatment Team and Getting More Help Teams. Other services did have completed risk assessment and safety summaries. Overall, we found inconsistency in record keeping relating to risk across the CAMHS pathways. This was identified at our previous inspection and had not sufficiently improved.
We spoke with staff regarding gaps within safety planning and they explained to us that initially risks would be assessed and recorded during an initial assessment and/or at the point of triage and safety summaries would then be built upon during follow up sessions. In 6 of the records we reviewed staff had documented in clinical notes that safety summaries would be completed at follow up sessions as per standard operating procedure. Most records of young people who had been involved with services for a longer period of time did have updated risks documented. 10 showed evidence of triangulation of risk between services to help inform formulations (a collaborative "working hypothesis" or map that summarises a person’s difficulties, explaining why they are happening and what maintains them).
With regards to involvement of young people and carers in safety planning, this was not always fully recorded, with 10 care records stating “verbally completed” but lacking detail of what was discussed We spoke with leaders who told us the current standard operating procedures were being reviewed around this. Young person and carer feedback did indicate that they felt involved within developing risk management and 8 carers fed back they gained a better understanding of their child’s mental health and associated risks.
 

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
We found evidence of regular risk assessments of the buildings at each service visited. Where there were any ligature risks, these were mitigated by young people only being able to access rooms with staff present for appointments. Waiting rooms were adequately sized and offered comfortable seating for young people and family members waiting for appointments. The décor in the services provided a calming space for people. Buildings were securely managed with young person and carer access to certain area’s only being available with staff present.
Rooms where assessments and appointments took place were spacious, provided natural light and had comfortable seating. Conversations could not be heard from outside of the rooms we inspected, which was an improvement from our previous inspection, ensuring young people and carers had privacy maintained during appointments. All services that we visited were accessible and met the needs intended for the client group. Staff had access to alarms within the services.
 

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.
Of the 9 services that we inspected, only two services had vacancies for 2 registered nurses and 1 service had a vacancy for 1 support worker. All services had a full establishment of psychologists and 1 service had 2 vacancies for medical staff. Data was reviewed regarding unfilled shifts, which showed a reduction of unfilled shifts within the last 3 months across the services.
The services mitigated unfilled shifts through permanent staff undertaking overtime, cross cover or additional hours, which was monitored at daily staffing huddles under the Trust’s OPEL Framework (integrated operational pressures escalation levels), ensuring safe staffing was maintained and the escalation process was followed as required to prevent staffing shortfalls. The Trust also introduced a staff bank for urgent care services in September 2025, which enhanced the cover available for unexpected absence. Team managers were able to request more staff when needed and teams worked well together to ensure any required cross cover was provided. Services had a process in place with team managers following trust policy in terms of sickness reviews and wellbeing check-ins when a member of staff was off and they had good relationships with the Trust’s long term sickness team to ensure processes were followed when meetings were required.
In the Community Teams we visited, processes were in place so that, in the event of any staff absences, the staff member’s scheduled work was reviewed and appointments were either rescheduled or reallocated dependent upon patient need and acuity. If a community team staff member had a period of long-term absence, their caseload would be fully reviewed and formally reallocated accordingly. A consultant was always available across the teams to provide advice and support including medication reviews.
Turnover rates for all but one of the services inspected were below national average (10%), apart from one service with a rate of 11%. Reasons for turnover included staff progressing into higher level roles, retirement and the completion of fixed term contracts.
Staff were up to date with mandatory training across all services, this had improved since our last inspection. Training completion for the services we inspected overall was over 90% for all services and over 95% for 7 out of 9 of these. All mandatory training was relevant to the service user group.
 

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.
Infection prevention and control posters were clearly displayed. Staff maintained equipment well and kept it clean where applicable. The services visited were clean, had good furnishings and were well-maintained. Where there were any damages, these were reported. Any concerns regarding infection prevention and control were dealt with by management effectively and all staff adhered to policy, such as reporting any issues, documenting any new risks and regular cleaning records being updated. Cleaning records were up to date and demonstrated that services and areas where young people were seen had been cleaned regularly. All staff had received mandatory training in infection prevention and control, with 100% completion in Infection Prevention Control Level 1. The Trust had up to date policies in place regarding infection prevention and control.
 

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.
Not all the services we inspected handled medications directly, but ensured that young people had access to medication reviews by a consultant psychiatrist, were able to access medication in a timely manner and safely and that GP’s were aware of any mental health medications prescribed by services. The CAMHS crisis team ensured that medication was correctly stocked, managed and dispensed with regards to Patient Group Directions (PGDs) which are written instructions allowing authorised health professionals (such as nurses or pharmacists) to supply or administer prescription-only medication to patients without a doctor present during a mental health crisis. The service complied with British National Formulary (BNF) limits and there was a clear process for staff signing out medication.
Staff reviewed the effects of medication on patients’ physical health regularly and in line with National Institute for Health and Clinical Excellence (NICE) guidance, especially when the patient was prescribed antipsychotic medication. Physical health anti-psychotic monitoring was completed either monthly, 3 monthly or 6 monthly in accordance with Trust policy and national guidelines and depending on the medication prescribed. Staff told us about improvements with physical health monitoring and the implementation of a clinic for young people requiring anti-psychotic monitoring. Consultants had full oversight of blood monitoring for Getting More Help patients through a process which was established just under a year ago.