Tees, Esk and Wear Valleys NHS Foundation Trust

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• 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 means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.
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. Staff we spoke with felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well and any issues were actioned and monitored. Teams had access to the information they needed to provide safe and effective care. Staff collected and analysed data about outcomes, quality and performance. They used this to identify improvements.

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 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. Staff we spoke with knew and understood the Trust’s vision and values and how they were applied in the work of their team.

Managers and the senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service through team meetings, supervisions and internal communications. Staff had the opportunity to contribute to discussions about the strategy for their service, and told us they were able to make suggestions and contribute to service improvement. Leaders we spoke with told us that they encouraged all consultants to be part of transformation work in CAMHS. Most of the medical staff attended clinical transformation meetings. Study leave was also given to medical staff (10 calendar days per year) to enable time for research projects. Staff told us the Trust had recently appointed a new chief executive. Staff were complimentary about their immediate line managers and told us that senior managers often visited services.

We observed multidisciplinary meetings which evidenced collaborative discussions around the service delivery and approaches to enhancing care to ensure it was safe, effective and right for the young person. Managers explained how they were working to deliver high quality care within the budgets available, such as skilled and experienced CAMHS staff on a bank register as opposed to using unfamiliar agency staff.
 

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

We spoke with managers and leaders from each service who had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed and the needs and demands of the service. They could explain clearly how the teams were working to provide high quality care, including through leadership governance meetings, regular audits and listening to young people, carer and staff feedback.

Staff we spoke with told us leaders were visible in the service and were approachable. A member of staff we spoke with told us “I always feel valued and well supported. My manager always checks in to make sure I am not overwhelmed by work loads”. Leadership development opportunities were available, including opportunities for staff and additional specialist training was available including the Community Manager Programme, People Management Skills Programme and Leadership Training – Self as Leader. Feedback from staff in relation to the support received from managers was overall positive.
 

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.
Young people and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs, this included different methods of raising concerns where needed and staff supported young people and their families to do so. Our review of the 12 months of complaints prior to our inspection demonstrated that people were able to raise complaints both locally and at Trust level.

Managers and staff had access to the feedback from young people, carers and staff and used it to make improvements. Services had action plans in place where areas of improvement had been identified and people had the opportunity to be involved in service development and improvement groups. A young person we spoke with told us they were a member of the Involvement Team and said they felt their voice was valued, they also told us they felt the service should recruit more young people. A member of staff we spoke with told us “Staff surveys come through and we can feedback that way. We can also raise things with managers when needed. There is a monthly group for feeding back about services.”

The senior leadership team and Board had oversight of complaints and concerns raised about services and this was fed back monthly through the service’s’ governance structure. This also included oversight of staff surveys. Staff we spoke with knew how to speak up and different ways they could do this. In November 2025, the Trust’s Freedom to Speak Up process changed to an external provider but this change had not impacted on delivery.
 

We scored the service as 3. The evidence showed a good standard. 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 service undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.
The Trust was signed up to the Disability Confident Scheme. This meant the Trust and its services had to demonstrate that they were taking positive action to attract, recruit and retain disabled people. There were a range of staff networks which all staff were able to join in work time, including: Long term health conditions, Rainbow network, BAME network, working carers and the neurodiverse network.

Where required, staff had reasonable adjustments made. Some staff we spoke with felt flexible working could be improved, however, noted that service demand and shifts meant this was not always possible. We spoke with staff who told us that adaptions and adjustments had been made for their neurodiversity and said they felt extremely well supported.
 

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.
There was a clear framework of what required discussion at a team or directorate level meeting to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level and this was observed during senior leadership meetings that we observed. This included the management of risk, any identified service issues such as staff sickness or absence and performance indicators. Risks were dynamically reviewed and updated during meetings to ensure information was up to date and that any outstanding actions had been addressed.

Staff undertook or participated in local clinical audits on a monthly basis. The audits were sufficient to provide assurance and staff acted on the results when needed and where issues where identified, such as documentation issues, these were discussed at team or individual level during supervision. Services had access to risk registers and could escalate concerns when required. Services had business continuity plans in place and plans for emergencies – for example, adverse weather or a flu outbreak.

The service used systems to collect data from teams and directorates that were not over-burdensome for frontline staff and were working with local universities as part of a project around this. All staff had access to the equipment and information technology needed to do their work. Staff did raise concerns that the current electronic patient record system could be difficult to use at times. There were plans in place to move to a new electronic patient record system in 2027. Information governance systems included confidentiality of patient records and these were stored securely on online systems. Team managers had access to information to support them with their management role and staff supervisions and appraisals. This included information on the performance of the service, staffing and patient care.
 

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement. Leaders regularly engaged with external stakeholders such as commissioners and the integrated care boards. Services worked closely with partners in care such as GP’s, school specialists, social workers and community groups.

Staff we spoke with told us that “the service have been linking in with local authority to do some launch events planned for next month, including task and finish groups with partners and the local authority”. Staff spoke highly of interagency working with external partners in order to meet the care needs of young people and to manage risk. Services also covered schools to offer consultations and huddles, creating good relationships and delivering bespoke sessions. Staff told us how the service had delivered assemblies on mental health awareness and these had been very well received. The service saw young people and their families as partners in care and actively sought feedback and learning if and when things did not go right. Feedback from carers corroborated this.
 

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement. Leaders regularly engaged with external stakeholders such as commissioners and the integrated care boards. Services worked closely with partners in care such as GP’s, school specialists, social workers and community groups.There were also excellent examples of new service models delivered in partnership.

Staff we spoke with told us that “the service have been linking in with local authority to do some launch events planned for next month, including task and finish groups with partners and the local authority”. Staff spoke highly of interagency working with external partners in order to meet the care needs of young people and to manage risk. Services also covered schools to offer consultations and huddles, creating good relationships and delivering bespoke sessions. Staff told us how the service had delivered assemblies on mental health awareness and these had been very well received. The service saw young people and their families as partners in care and actively sought feedback and learning if and when things did not go right. Feedback from carers corroborated this.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

The service actively contributed to safe, effective practice and research. Staff were given the time and support to explore opportunities for improvements and innovation and this led to changes. This was evident within development of services and feedback from staff was very positive around their involvement in developing the multidisciplinary team structure.
Staff had opportunities to participate in research and had clinical research time in their calendars to do so. Some research projects that were taking place in the service included taking part in national studies around ADHD medication for management of neurological behaviours such as tics, clinical research around menstrual cycles in relation to mental health in young people, working with local universities for data collection and auditing and both staff and young people had been involved in the development of an App for young people which utilised artificial intelligence to use as a means of chat and support for mental health.

In 2025 the CAMHS community services received the Positive Practice in Mental Health Award. The service is involved with STARCAT (Supporting parents and their autistic children through anxiety treatment) which is a research project funded by the National Institute for Health and Care Research. Services measured success through goal based outcomes to see what progress the services were making. Other projects included ‘poverty proofing’ services and increasing awareness of the NHS Patient and Carer Race Equality Framework. This included more involvement of translators, consideration of travel for those who were financially struggling, language barriers and harder to reach communities.

Services were involved in family hub initiatives, and Young Futures Hub initiatives (one of eight national pilot sites)which looked to work in partnership with youth offending services, with the goal to look at groups for young people to get support with well-being conversations, play games and link in with local sports centres with the aim due reduce anti-social behaviour, having identified this as an unmet need in the local system.Other projects included system level improvement work for young people with neurodevelopmental needs, capacity, demand and flow (led by the Royal College of Psychiatry).