Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Updated 16 April 2026

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) provide specialist mental health, learning disability, and neuro-rehabilitation services across the North of England. It is one of the largest trusts of its type in England. CNTW operates from over 70 sites across:

• Cumbria
• Northumberland
• Newcastle
• North Tyneside
• Gateshead
• South Tyneside
• Sunderland

We assessed all 8 of the quality statements in the well-led key question used when assessing an NHS trust using our current framework.

We identified positive findings within 4 of the 8 quality statements and areas for improvement within 4 of the 8 quality statements. We used our professional judgement to moderate the rating for this assessment due to the breach of regulation we identified during our assessment within these 4 quality statements. We took into account the quality of the services we assessed prior to our trust level assessment and NHS England’s oversight of the trust to ensure our rating was fair and proportionate. We also took into account the changes the trust was already making to ensure improvements to the care it provides and the trust’s innovative approach to service delivery.

The trust provides 12 services within our assessment service groups (ASG’s). The well-led review followed assessments of these frontline services. The initial assessment of the trust’s services was triggered by information received about risk in some of the trust’s frontline services and the age of the trust’s ratings.
The ASGs we assessed included:

• Wards for people with a learning disability and/or autism
• Community mental health services for adults of working age
• Wards for older people with mental health problems
• Child and adolescent mental health wards
  

We undertook these assessments to ensure we had a thorough understanding of a range of services provided by the trust ahead of our well-led review.

During the assessment we undertook a visit to the trust’s headquarters from 30 September to 2 October 2025. We carried out interviews with more than 20 members of the trust’s executive leadership team, including the chief executive, trust chair, executive medical director, and deputy chief executive, chief operating officer, executive director of nursing and therapies, and interim executive director of finance. We also held interviews with non-executive directors. During the assessment we also:

• undertook group interviews with the directors of all three care groups, directors of research and innovation, estates and sustainability and of public health.
• ran focus groups with; trade union leads, staff network leads, governors, freedom to speak up guardians, nurses, doctors, allied health professionals and healthcare support workers.
• spoke with trust leads for allied health professionals, equality diversity and inclusion, use of force and reducing restrictive practice leads, patient safety and safeguarding.
• received feedback via our give feedback on care process from more than 90 members of staff.
• observed a range of trust meetings and committees which included; quality and performance committee, people committee, mental health legislation committee, patient safety learning and improvement panel, service user and carer reference group, and mortality review panel.
• wrote to stakeholders including; local authorities, NHS England, the police, Healthwatch and the Integrated Care Board (ICB) to seek feedback about the trust.

During the trust’s well led assessment, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

The trust did not have effective systems to consistently assess, monitor, and drive improvement in the quality and safety of the services provided. Regulation 17, 1, 2 (a) (b) Good Governance.

Key Question Summary:

Shared direction and culture
We scored this quality statement as 2, the evidence showed some shortfalls and the trust were in breach of Regulation 17 (Good Governance).

Risks to staff welfare and patient safety arising from poor culture and workforce instability were not fully mitigated. The trust did not consistently embed its values and foster an open, inclusive culture, with persistent barriers to speaking up, ongoing bullying and discrimination concerns, and workforce challenges, with an increasing impact on people from ethnic minority groups and disabled staff.

Leaders ensured a clear, shared vision and strategy across the organisation, and staff understood how their roles contributed to achieving these goals. The vision, values, and strategy were developed collaboratively with staff, service users, and external partners through a structured planning process. The vision and values were well-articulated and widely known.

The trust actively considered the demographics of the local population and tried to address health inequalities. The trust’s priorities included tackling health inequalities, promoting digital inclusion, and reducing morbidity and mortality through improved physical health outcomes. The patient and carer race equality framework (PCREF) was in development with consultation underway.

While strategic clarity existed, the culture within some areas of the trust did not always reflect trust values in day-to-day practice. There were pockets of poor culture, and staff feedback indicated that the values were not consistently embedded across all teams. The 2024 staff survey results indicated a decline in staff satisfaction.
Leaders had assessed and documented risks to the delivery of the strategy, and mitigating actions were in place. Whilst the trust’s ambitious transformation programme would support achievement of its strategic goals, it was not consistently supported by a clear line of sight between operational risks and the Board Assurance Framework, limiting assurance that strategic risks were being effectively reduced.

Capable compassionate and inclusive leaders

We scored the trust as 3. The evidence showed a good standard.

Leaders had the experience, capacity, capability and integrity to ensure the organisational vision could be delivered. Executives were visible, approachable, and committed to the trust’s values. Regular structured visits to frontline services by executives, non-executive directors, and governors had improved leadership visibility and allowed leaders to triangulate governance information with real staff experience.
Stakeholder feedback described the board and senior leaders as experienced, values-driven, and committed to partnership. The trust was recognised as an active and constructive member of the integrated care system.

The board was stable and experienced, with a development plan in place.

The trust had robust policies for disciplinary and grievance processes, and had made key changes to improve them, but cases often took a long time to resolve.

Freedom to speak up
We scored this quality statement as 2, the evidence showed some shortfalls. The trust were in breach of Regulation 17 (Good Governance).

Not all leaders demonstrated an open culture where staff felt safe and empowered to raise concerns, with some staff fearing detriment or lacking confidence that their feedback would lead to change. Staff feedback highlighted ongoing negative experiences, including reports of retaliation, performative feedback mechanisms, and whistleblowers feeling isolated or pressured to leave.

Freedom to speak up reports showed that bullying, management processes, and safety were common themes which staff raised concerns about, but reporting rates across the trust remained low in comparison to other trusts of a similar size.

Senior leaders were seen as supportive and role-modelled good speaking up behaviours, but engagement from middle management was inconsistent, and the trust acknowledged that more work was needed to ensure staff could safely raise concerns. To support leaders, the trust had launched a leadership academy programme. This was a central part of the trust’s approach to developing leadership capability, supporting cultural change, and ensuring the development of compassionate, skilled leaders. It offered structured programmes, supported by executive leaders.

Workforce equality diversity and inclusion
We scored this quality statement as 2, the evidence showed some shortfalls. The trust were in breach of regulation 17 (Good Governance).

Despite executive engagement and some positive initiatives, barriers to engagement and progression persisted for some people with protected characteristics, and ongoing work was needed to address bullying, discrimination, and to embed a more inclusive culture. Sustained focus on board and workforce diversity, as well as on tackling inequalities, is essential for the trust to achieve its ambition of being a ‘great place to work’.

The trust had made progress in representation of people from ethnic minority groups, particularly at board level, and had developed ten-point action plans for both race and disability equality, including anti-racism initiatives, improved reporting, and targeted support.

Staff networks played a key role in shaping policy and supporting staff.

The 2024 NHS Staff Survey and the trust’s annual workforce race/disability equality standard report(s) highlighted persistent inequalities for staff from ethnic minority groups and those with disabilities or long-term conditions.
Staff from ethnic minority groups reported higher rates of discrimination, bullying, and harassment, and felt less positive about career progression compared to white colleagues, with these gaps often wider than national averages. Disabled staff also reported more negative experiences than non-disabled staff, including higher rates of bullying and lower satisfaction with workplace support and reasonable adjustments.

Governance and assurance
We scored this quality statement as 2, the evidence showed some shortfalls. The trust were in breach of Regulation 17 (Good Governance).

The trust’s governance systems did not always ensure effective and timely action was taken to address risks in services including areas of low compliance highlighted through internal governance systems. Early warning signs of deteriorating quality and safety were sometimes missed prior to external reviews. This included in staff safety, reducing restrictive interventions, managing the assessment of environmental ligature risks and training and supervision compliance. These cross-cutting risks were not always included in corporate risk registers to ensure clear oversight, action and mitigation.

There were established clear governance structures, defined roles, and systems of accountability from ward to board level. However, inspections and reviews found that these systems had not always operated effectively, with some early warning signs of deteriorating quality missed and a lack of consistent assurance that governance drives high-quality, sustainable care.

Committee oversight lacked clarity and focus in some areas, with complex papers and assurance reports that did not always identify clear actions, ownership and timescales.

The trust had undertaken significant organisational change, including leadership restructuring, new strategies, and external audits, to strengthen governance and risk management. Despite these improvements, board and committee papers were lengthy and complex, sometimes obscuring key issues and making effective scrutiny challenging. Assurance reports did not always have clearly identified actions, ownership, or timescales for improvement, and there was a need for more outcome-focused oversight and escalation of significant risks.

Risk management was structured and proactive, with a tiered system of risk registers and regular reviews. However, some key patient safety risks such as high use of restraint, delays in discharge, and mandatory training gaps were not always reflected on the corporate risk register, raising concerns about the visibility and management of cross-cutting risks.

Workforce challenges persisted, including high vacancy and sickness rates in some areas, increasing reliance on temporary staff, and inconsistent supervision and training compliance at team level.

Board, committee and governor meetings did not always demonstrate a culture of challenge. There was room for more robust scrutiny, clearer linkage of risks to patient experience, and more consistent action on assurance gaps.

The Trust’s approach to financial management was robust, but the sustainability of ambitious cost improvement plans was unclear at the time of the inspection.

The trust did not always ensure they worked with partners to ensure safeguarding concerns were accurately reported. The Trust’s safeguarding processes were complex due to working with eight local authorities. During inspections, it was found that local authorities were not always aware of incidents involving harm to patients, and there was confusion among staff about what types of incidents should be reported and when. The Trust had not undertaken audits in relation to safeguarding children, and the 2024 safeguarding audit was primarily process-based rather than practice-based, highlighting the need for more robust assurance on the quality of safeguarding practice. Safeguarding supervision was well-embedded, and learning from reviews was disseminated through meetings and training.

Estates, pharmacy, infection prevention, and digital governance were well-developed, with clear oversight and evidence of innovation and improvement. The trust’s subsidiary, NTW Solutions, supported operational resilience.
There was effective management of information governance, and digital transformation is a strategic priority.

Partnerships and communities
We scored the trust as 3. The evidence showed a good standard.

There was strong strategic engagement with local authorities, police, and other agencies, and the trust participated in statutory reviews and multi-agency audits.

The trust demonstrated strong partnership working across health, social care, voluntary, and community sectors, with a clear commitment to collaborative service delivery and quality improvement. Stakeholders consistently recognised the trust’s openness, adaptability, and willingness to co-produce solutions. There were examples of innovative joint projects and effective multi-agency governance.

However

The trust had clear and embedded processes for the management of complaints, but the trust did not always clarify whether complaints had been upheld in line with good practice.

Learning, improvement and innovation
We scored the trust as 3. The evidence showed a good standard, our concerns relating to learning from incidents are outlined in the governance and assurance section of this report.

The trust’s focus on continuous learning, innovation, and quality improvement across the organisation and local system was a key strength in their delivery of services. The trust’s transformation agenda was led by senior leaders and specialists, with a particular emphasis on co-designing new models of care that integrate social care and health services.

A robust quality improvement (QI) ethos underpinned the trust’s work, with leaders trained in QI methodologies and a programme board overseeing transformation. Staff, service users, and carers were actively involved in shaping services through workshops, reference groups, and the involvement hub, ensuring that transformation was meaningful and co-produced.

Research and innovation were central to the trust’s approach, with strong partnerships across academic, clinical, and community sectors. The trust is recognised nationally for its research activity, leadership in co-production, and the development of accredited services.

However

The learning culture at CNTW is present but the governance processes were variably embedded. There were structures for learning, but they were not applied consistently, leading to missed opportunities, uneven implementation of guidance, and limited evidence that learning always translated into sustained improvement across the Trust.

While the Trust had established frameworks for learning from incidents and deaths, we had concerns about missed opportunities for improvement. Incidents were not always correctly categorised according to trust policy, reducing opportunities for learning and oversight. Learning from incidents and reviews was not always triangulated across services and the trust did not always ensure refreshed national guidance was implemented.

There was inconsistent tracking of actions from mortality reviews and incident reviews did not always contain concrete actions for improvement.

There was incomplete application of duty of candour processes and reporting to LeDeR (Learning from Lives and Deaths – People with a Learning Disability and Autistic People which is a national service improvement programme commissioned by NHS England to reduce health inequalities and prevent premature deaths among people with learning disabilities and autistic people) was not always consistent. This concern was addressed in the report section relating to governance.

Ongoing challenges included ensuring the patient voice was heard consistently at board level.

The trust had made some progress in work to reduce restrictive interventions, particularly in the use of restraint. However, this required further progression and has been a key feature at the trust for several years.

Environmental sustainability
We scored the trust as 3. The evidence showed a good standard.

The trust had set a strategic ambition to become a sustainable organisation, underpinned by its green plan (2025–2028). The plan provided a comprehensive framework for environmental sustainability, including detailed strategies for estates decarbonisation, capital planning, heat decarbonisation, and renewable energy initiatives. Governance was robust, with the green plan management group overseeing nine thematic workstreams.

The trust had embedded sustainability into its digital infrastructure and workforce development, supporting staff engagement through apprenticeships, specialist training, and the promotion of greener NHS resources.
The trust had achieved a 14% reduction in carbon emissions over five years, though current levels remained above the required trajectory, and the trust recognised the need for accelerated reductions.

The trust benchmarked its progress against a 2019 baseline, aiming for a 47% reduction in carbon emissions by 2032 and net zero by 2040.

Updated 30 July 2025

We carried out an inspection of the trust’s mental health crisis services and health-based places of safety on 9 to 16 December 2025. The mental health crisis services and health-based places of safety form part of the trust’s mental health services in the community. This inspection was completed as part of CQC's Adult Community Mental Health Programme. The programme of inspections contributes to CQC's commitment to inspect the standard of care in community mental health services across the country. We undertook a short notice announced, comprehensive inspection of this service, looking at all 5 key questions to assess if services are safe, effective, caring, responsive and well-led.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust provides a wide range of mental health, learning disability, autism and neuro-rehabilitation services to a population of 1.8 million people across North Cumbria and the North East of England as well as providing specialist services nationally.

Cumbria, Northumberland, Tyne and Wear NHS Foundation trust have 4 crisis resolution and home treatment teams that provide mental health crisis interventions as an alternative to acute inpatient admission. The North team provides care across the Northumberland and North Tyneside localities, Central team across Newcastle and Gateshead, South team across Sunderland and South Tyneside, and North Cumbria team across North and West Cumbria.

The crisis resolution home treatment teams are multidisciplinary, operate over a 24-hour period and offer assessment of people in a mental health crisis and provide intensive home treatment interventions. They act as ‘gatekeepers’ to hospital admission and facilitate early discharge back into the community with support. From April 2024 the trust introduced the NHS 111 option 2 service for mental health. This service is a single point of access and they triage all referrals for the locality teams. They operate 24-hours a day.

A health-based place of safety (HBPoS) also known as a 136 suite is a designated space within a hospital or other health facility where individuals detained under Section 136 of the Mental Health Act can be safely assessed. This secure environment allows health professionals to determine the best course of action for the individual's mental health needs, whether that's further assessment, treatment, or discharge.

A health-based place of safety is not a ward for long-term admission but a place for initial assessment. People can be detained in a place of safety for up to 24-hours, allowing for the necessary assessment. The trust has 4 HBPoS located at the Carleton Clinic in Carlisle, St Nicholas Hospital in Gosforth, St George’s Park in Morpeth and Hopewood Park in Sunderland.

We spoke with 54 staff of various grades and roles, and 7 people who had used the crisis resolution and home treatment service and 13 relatives or carers. We also spoke with 2 patients detained in the health-based places of safety. We listened to 5 NHS 111 option 2 calls. We reviewed 37 care records from the crisis resolution service, 9 from the health-based place of safety and 27 medicines records. We observed handover and risk management meetings, and shadowed home visits and 1 assessment. We reviewed meeting minutes, incidents and policies. We also reviewed information such as performance data and policies supplied to us by the trust, both during and after the inspection site visit.

We last inspected the service in September 2016 and rated it as good overall. There were no breaches of regulation.

At this inspection we rated the service as requires improvement. We rated safe and responsive as requires improvement and effective, caring and well-led as good. We found 3 breaches of regulation related to safe care and treatment and premises and equipment. Staff were not always up to date with their training needs. Patients in 2 out of the 4 health-based places of safety did not always have access to outside space or fresh air. The service did not always meet the national standard for assessments within 4 hours for very urgent referrals.

However, environments were clean and tidy, people were appropriately safeguarded and their risks were managed well. Staff received regular supervision and were skilled and experienced. Medicines were managed well. Staff were caring and kind. Staff provided information, were responsive to people’s needs and involved them in their care. Managers understood the service and overall governance processes were in place to ensure they operated well. Managers knew where improvements were required and action plans were in place to support this.

We have asked the provider for an action plan in response to the concerns found at this inspection.

Updated 16 July 2025

• We carried out the assessment for Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust CAMHS inpatient wards on 18,19,20 and 21 August 2025.
• We carried out the assessment in response to concerns raised about the service.
• Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust was registered with CQC in April 2010 to deliver the regulated activities: Personal Care, Treatment of Disease, Disorder or Injury, Assessment or medical treatment for persons detained under the Mental Health Act 1983 and Diagnostic and Screening procedures. The service had a controlled drugs accountable officer and a Nominated Individual.
• Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust had 5 CAMHS inpatient wards across 2 locations.
• We visited the following wards as part of our assessment:

Lotus ward – 10 bedded mixed gender general adolescent unit.

Redburn ward - 7 bedded mixed gender general adolescent unit

Stephenson ward – 7 bedded mixed gender medium secure CAMHS ward

The Riding – 7 bedded mixed gender general adolescent unit including 4 psychiatric intensive care beds

Fraser ward 7 bedded low secure mixed gender CAMHS ward for young people who were autistic or had a learning disability.

• We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
• We carried out 6 short observational framework for inspections (SOFIs) which is an observational tool used to capture the experiences of service users who may not be able to express this verbally for themselves.
• We gathered information from young people using the service and their loved ones, staff and managers, other stakeholders and carried out our own observations. We reviewed a range of documents including care records, policies and procedures. We looked at 33 quality statements.

We rated the service as requires improvement. We found 5 breaches of regulation in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, person-centred care, staffing and good governance.

Staff did not always assess risks to people's health and safety or mitigate them where identified. Environmental safety was not always managed effectively or consistently. For example, comprehensive ligature risk assessments had not been carried out. The use of prone (face down) restraint and mechanical restraint was high and mechanical restraint was not carried out in line with national guidance. Staff had not received all the relevant training to enable them to support the young people they were caring for appropriately. For example, autism training compliance was low. Young people were not always involved in their care and treatment; particularly on Lotus ward where young people were excluded from multi-disciplinary meetings, which were meetings about their care and treatment. Governance systems and audits were not always effective in identifying or addressing areas for improvement.

However, there were sufficient staff to meet the needs of young people in the service.

Staff were caring and respectful towards young people and knew them well. Staff provided a range of activities for the young people which included education which was tailored to young people’s needs. Staff had ensured young people had up to date risk assessments and care plans and most young people who needed them had positive behavioural support plans and sensory assessments. The trust used technology effectively to support staff in caring for the young people at the service. Staff carried out effective handovers after each shift which included a reflection session on the shift in order to identify learning.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Updated 1 April 2025

Overall Service Commentary Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust was registered with CQC in April 2010 to deliver the regulated activities: Personal Care, Treatment of Disease,Disorder or Injury, Assessment or medical treatment for persons detained under the Mental Health Act 1983 and Diagnostic and Screening procedures. The service had a controlled drugs accountable officer and a Nominated Individual. We carried out an unannounced on site assessment visiting all 9 wards for older people with mental health problems at Cumbria Northumberland Tyne and Wear NHS Foundation Trust on the 16, 17 and 18 June 2025. We gathered information from patients and their loved ones, staff and managers, other stakeholders and our own observations of care. We reviewed a range of documents including care records, policies and procedures. We looked at all quality statements. We visited the following sites: Monkwearmouth Hospital - Sunderland Carleton Clinic - Carlisle Campus for Ageing and Vitality - Newcastle upon Tyne St George's Park Morpeth The assessment was planned due to an aged rating as well as some emerging risks highlighted by our data which included information about falls where people had come to harm. The wards for older people with mental health problems were last inspected in 2018 and were rated good at that time with an outstanding in the caring domain. We rated the service as requires improvement, with safe and well rated requires improvement and effective, caring and responsive as good. There were 3 breaches of regulation in relation to safe care and treatment, staffing and governance. Staff did not always assess risks to people's health and safety or mitigate them where identified. Oversight of ligatures was managed via several different documents, none of which instructed staff on how to safely manage the environment and where there were hot spots. Staff were not provided with the training and supervision required for their role.Referrals for a SOAD were not always completed in-line with recommendations stated in the MHA Code of Practice, with some referrals only being sent on the day the 3 month treatment rule expired. Furthermore, leaders did not ensure there was adequate oversight of the issues mentioned above, despite audits being carried out, and environmental issues had not been rectified despite staff raising concerns for some time. However, patient and carer feedback about care was positive, there were enough staff to ensure people’s safety and meet their needs. People were supported to have choice and control and could give feedback on their care. Action we have taken We have asked the provider for an action plan in response to the concerns found at this assessment. Ensure care and treatment is provided in a safe way to patients (Regulation 12) Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment(Regulation 18) Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care (Regulation 17)

Updated 5 February 2025

• We assessed Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Community-based mental health services for adults of working age on site from 25 to 27 February 2025.
• We assessed the service due to information that we had received about the service and due to the length of time since it was last inspected.
• Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust was registered with CQC in April 2010 to deliver the regulated activities: Personal Care, Treatment of Disease, Disorder or Injury, Assessment or medical treatment for persons detained under the Mental Health Act 1983 and Diagnostic and Screening procedures. The service had a controlled drugs accountable officer and a Nominated Individual.
• We visited the following teams as part of the assessment:
• South Northumberland Adult Community Treatment Team
• Early Intervention in Psychosis Team Northumberland
• Early Intervention in Psychosis Team North Tyneside
• North Tyneside Community Treatment Team
• Newcastle North and East Community Treatment Team
• Early Intervention in Psychosis Team Newcastle
• Sunderland West Community Treatment Team
• Early Intervention in Psychosis Team Sunderland and South Tyneside
• Gateshead East Community Treatment Team
• Early Intervention in Psychosis Team Gateshead
• North Cumbria East Community Treatment Team
• North Cumbria Early Intervention In Psychosis Service
• At this assessment we identified breaches of regulations 17 Good Governance and 18 Staffing.
• At this assessment we assessed the assessment service group Community-based mental health services for adults of working age where we assessed all 33 quality statements.

Requires Improvement rating

We rated the service as Requires Improvement. We found 2 breaches of the regulations in relation to staffing and governance.

Leaders had not implemented the lone worker policy fully to assesses and mitigate the risk to lone workers. Care records were not complete and contemporaneous. Staff did not manage risk consistently for people waiting to be assessed by the service. Governance systems and audits were not effective in identifying or addressing areas for improvement.Staff were not provided with the support, training and supervision required for their role.

However, there was positive feedback from patients and carers about the service they received. Staff were delivering care in line with best practice recommendations. Patients were supported to have choice and control and could give feedback on their care.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Action we have taken

At this assessment we identified breaches of regulations:

• Regulation 17 Good Governance, in relation to the implementation of the lone worker policy, sharing learning from incidents, assessing and managing the safety of the environment, gaps in records and the consistency of management of waiting lists.
• Regulation 18 Staffing, in relation to supervision compliance levels and learning disability and autism training not being mandatory and having low compliance rates. Drug and alcohol awareness training was not accessed consistently across the teams we visited.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

• 90% of staff had received training in the Mental Health Act.
• Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice.
• Patients had easy access to information about independent mental health advocacy. Information was on display in the waiting rooms and the patient information leaflets included contacts for the independent complaints advocacy.
• Staff did not always explain to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We reviewed the records and found that in North Cumbria East CTT 4 out of 12 (33%) patients had not had their rights explained to them in past 3 months. Gateshead East CTT records showed that 1 out of 10 (10%) patients had not had their rights explained to them in past 3 months. Sunderland West CTT records showed that 2 out of 6 (33%) patients had not had their rights explained to them in past 3 months. Newcastle East CTT records showed 3 out of 23 (13%) patients had not had their rights explained to them in past 3 months. Newcastle EIP records showed 1 out of 6 (17%) patients had not had their rights explained to them in past 3 months. Gateshead EIP records showed 1 out of 2 (50%) patients had not had their rights explained to them in past 3 months. This had been an action following the last inspection of the service.
• Staff did regular audits to review patients on a Community Treatment Order (CTO) and whether their rights had been explained to them. Results of this were stored on a dashboard that managers accessed.

Mental Capacity Act

• 90% of staff had had training in the Mental Capacity Act.
• Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
• Staff knew where to get advice from within the provider regarding the Mental Capacity Act.
• Staff took all practical steps to enable patients to make their own decisions, records showed, and staff told us of an individual who was not communicating verbally. Staff were communicating via email to plan the sessions, and ask questions in advance and pictures were also used to communicate with the patient and aid their decision making.
• For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. These were recorded in the patients care records. Joint work also took place with social care to assess capacity and support patients, for example in relation to accommodation.
• There was one example from staff we spoke to and records we reviewed where for a patient who lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.
• Staff did not audit the application of the Mental Capacity Act and did not take action on any learning that resulted from it.

Updated 28 May 2024

We carried out an unannounced assessment of Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust’s wards for people with a learning disability or autism on 16, 17, 18 July. Due to some of the concerns we found, we asked the trust to take some immediate actions to ensure the safety of people using the service. On 12 September 2024 we conducted a further site visit to check on the progress of improvements. During our assessment we visited the following locations: • Mitford Unit, Northgate Park, Northumberland - This unit provides care for adults who are on the autism spectrum, who have extremely complex needs and display challenging behaviours to the extent that their needs cannot be met by local assessment and treatment services. • Rose Lodge, Hebburn, South Tyneside - This unit provides treatment and an assessment for men and women with a learning disability who have mental health problems or challenging behaviour. • Edenwood, Carleton Clinic, Cumbria - This unit provides assessment and treatment for people with learning disabilities with additional mental health problems. • There were no people receiving care at Mitford Bungalows, so we did not visit this location. During our assessment, we identified significant concerns relating to the use of restrictive interventions, particularly on Mitford Unit. These concerns related to the use of prone and mechanical restraint, staff competency, governance and oversight. We identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014: Regulation 12 – Safe care and treatment Regulation 13 – Safeguarding service users from abuse and improper treatment Regulation 17 – Good governance Regulation 18 – Staffing We visited all 3 sites as part of the inspection. Whilst onsite, we also completed a SOFI and other observations. We gathered information from people who used the service, their family members and carers, staff and stakeholders, and reviewed a range of documents.

Updated 26 July 2018

Our rating of this service stayed the same. We rated it as outstanding because:

• Care records contained up to date individual risk assessments and management plans. Staff could review complex cases in a multidisciplinary risk meeting and seek support and guidance to ensure risks were appropriately managed.
• Staff worked collaboratively with young people and their family/carers to efficiently deliver care in an outcomes based approach. Young people were actively involved in reviewing their progress towards their goals and outcomes.
• Staff were trained in an extensive range of therapeutic interventions in line with National Institute of Health and Care Excellence recommendations.
• Care plans captured the voice of the young person and placed them at the centre of their care.
• Managers and commissioners were working together to reduce waiting lists and ensure the service met the needs of children and young people locally.
• Key performance indicators were embedded within the service and effective governance processes were in place to monitor the quality of the service provided.

However:

• Assessment of Gillick competence was not easily accessible in young peoples care records.
• The service was not always meeting the trusts target of 18 weeks from referral to treatment for certain specialist treatment pathways. Whilst there was an effective process of triage, which enabled the trust to identify higher risk referrals, there was no system for routinely monitoring the risks of young people on the waiting list for treatment.

Updated 1 September 2016

We rated community based services for people with learning disabilities or autism as outstanding because:

• A proactive approach to anticipating and managing risks to people who use services was embedded and was recognised as being the responsibility of all staff. This was reflected in the risk assessments and plans.

• Staffing levels were sufficient to meet the needs of the service. Staffing levels had been estimated by obtaining the advice of staff, carers and other agencies. This model had been implemented in the Sunderland team and was in the process of being rolled out to other teams.

• Staff knew how to report incidents. All staff were open and transparent, and fully committed to reporting incidents and near misses.

• There was a team approach to the prescribing of medication. The approach ensured that psychological and social factors were given full consideration before medication was prescribed. This meant that service users were less likely to be prescribed medication unnecessarily.

• There was a truly holistic team approach to assessing, planning and delivering care and treatment to people who use services. The safe use of innovative and pioneering approaches to care and how it was delivered were actively encouraged. New evidence based techniques were used to support the delivery of high quality care.

• We found the continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care. Staff were proactively supported to acquire new skills and share best practice. This was reflected in the specialist training provided and the effectiveness of multidisciplinary meetings.

• Staff had close links with external agencies, including them in multi-disciplinary team meetings where appropriate. The systems to manage and share the information that was needed to deliver effective care were fully integrated and provided information across teams and services. This was reflected in the training provided to external care providers and families.

• Feedback from people who use the service, those who are close to them and stakeholders was continually positive about the way staff treat people. People that staff went the extra mile and the care they received exceeded their expectations.

• The involvement of other organisations and the local community was integral to how services were planned and ensured that services met people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

• There were high levels of staff satisfaction across all teams. Staff were proud of the organisation as a place to work and spoke highly of the culture. There were consistently high levels of constructive engagement with staff across all teams. Staff at all levels were actively encouraged to raise concerns.

• The leadership drove continuous improvement and staff were accountable for delivering change.

• Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new and more sustainable models of care. This included working with other agencies to reduce the number of people with learning disability or autism living away from their local communities or in long stay hospitals.

Updated 1 September 2016

We rated community based mental health services for older people as outstanding because:

• There was a truly holistic approach to assessing, planning and delivering care and treatment to patients. Staff were responsive to individual patient’s needs and actively engaged in assessing and managing risk. Staff worked effectively together to share knowledge and deliver evidence-based treatment to patients.

• Staff empowered patients and carers to have an active role in their care and treatment. Staff developed positive relationships with patients and carers to ensure their needs and individual preferences were reflected in the planning of their care. Patients and carers reported staff went the extra mile and exceeded their expectations.

• The services were flexible, provided choice and ensured continuity of care for patients. Patients could access services in a way and at a time which suited them. Staff worked collaboratively with other services, within integrated person-centered pathways to ensure they met patients’ needs.

• Staff were committed to continually developing their skills and competencies to ensure they delivered high quality care. Staff attended additional specialist training to enable them to acquire new skills and share best practice. Staff were encouraged to take an active role in research and innovative practices.

• Leaders had an inspiring shared purpose which succeeded in developing a strong, visible person-centered culture. Staff were highly motivated to offer high quality care and were proud of the service they delivered.

• Leaders consistently engaged with staff and actively encouraged them to raise concerns. Staff were open and transparent in reviewing incidents and learning lessons when things went wrong. Staff shared this learning across the trust and this was used to inform service development.

However:

• Staff caseloads were high in some services and some services felt they did not have sufficient administrative support. Managers were aware of this and were continually reviewing ways to develop systems and processes to address these issues. Managers had sufficient authority to increase staffing levels as required.

Updated 1 September 2016

We rated Northumberland, Tyne and Wear NHS Foundation Trust Forensic Inpatient/Secure wards as good because :

The service was built around a principle of person centred practice, which was representative of the trusts values, this was demonstrated through the interactions we observed between staff and patients. Staff were seen to demonstrate dignity, respect and an understanding of individual needs within their interactions with patients.

There was an open culture in the service and patients were able to approach staff or managers for support at any time. Patients’ views were sought through regular 1:1 time, weekly multidisciplinary meetings and clinical case reviews; these were reflected in patients care planning, individual therapeutic programme and outcome measures. Patients were also encouraged to provide feedback on the service through the use of comments cards and regular community meetings.

The service held a weekly multidisciplinary single point of referral meeting which included representation from NHS England. All new referrals were discussed to decide if the service could meet the needs of the patient and which ward would provide the most appropriate care pathway. Patients received a multidisciplinary pre-admission assessment, which included an assessment of patients’ physical health and any on-going support which may be required following admission.

Patients had the support of a full multidisciplinary team who worked with patients to provide an individualised support package specific to the patients needs including a range of psychological and occupational therapies. Facilities within the service supported this through the provision of therapy rooms, therapeutic kitchen, activity rooms, a gym and an all-weather outdoor sports arena. The service also had links within the community to provide patients access to activities including an allotment and walking groups.

Patient completed both a Functional Analysis of Care Environments and Historical Clinical Risk assessment with staff. These were live documents which were updated as needs changed or a minimum of every three months. Oswin ward had also developed a formulation pathway for patients which included input from the patients and all relevant professionals to ensure the service had a full risk profile of the patients.

The principles of relational security were embedded within the service and all staff we spoke to were able to describe the importance of this. The use of restraint and seclusion was low, this was seen as a last resort and staff used their knowledge of and relationship with patients to identify potential trigger points and de-escalate behaviours before issues arose

The seclusion room on Aidan did not meet the recommended standards for seclusion facilities, the service was aware of this and work had begun on building new ‘Gold standard’ seclusion facilities.

When incidents did occur there was a process of providing a debrief for both the staff and patients involved. Incidents were monitored and reviewed; lessons learned were shared across the service and discussed within team meetings. The staff we spoke to were able to articulate their responsibility under the Duty of Candour and provide examples of when they would need to fulfil this responsibility. The trusts electronic incident recording system provided prompts for staff to consider the need for the Duty of Candour.

Staff morale was seen to be high across the service; staff were aware of the trusts visions and values and could describe how these were embedded from the point of recruitment in to supervision and appraisals.

Updated 25 July 2018

We did not rate long stay/rehabilitation wards for working age adults at this focused inspection. All ratings shown in this report are from our previous inspection in June 2016.

We found the following issue that the trust needs to improve:

• Patients identified as being at risk of choking or swallowing on Bridgewell ward did not have this documented in their risk assessment, although these were reflected in care plans.

However, we also found the following areas of good practice:

• Patients’ risks were being assessed, monitored, and managed on a daily basis. Staff recognised changes in risk and responded appropriately.

• Staffing levels were adequate to keep people safe and effective handovers were taking place to ensure staff were able to manage risks.

• Staff were raising concerns and reporting incidents. These were investigated appropriately and lessons were communicated widely to support improvement.

• Patients were receiving a comprehensive assessment of their needs. Care and treatment was delivered through care plans, which reflected their needs.

• Staff had the skills required to deliver care and treatment. Learning needs were being identified and training was delivered to meet these needs.

• Staff were working together to assess, plan and deliver care and treatment.

Updated 26 July 2018

Our rating of this service stayed the same. We rated it as good because:

• The service was providing effective care. All patients had a care plan which was regularly updated. Patients had access to a range of care and treatment options which were in line with national guidance. Staff were supervised effectively and had access to additional specialist training. Staff understood and implemented the Mental Health Act and Mental Capacity Act effectively.
• Staff were caring. Feedback from patients and carers was consistently positive about staff attitudes. The service was organised in a way that ensured staff focussed on interacting and engaging with patients as opposed to administrative tasks. Care records showed evidence of ongoing patient involvement and engagement through regular one to one sessions with nursing staff. Carers told us that they felt appropriately informed and involved in the care provided by the service.
• The service was providing care in a way that was responsive to people’s needs. Beds were managed appropriately to ensure that people could access the service when they needed it. Wards had a range of facilities to promote comfort, privacy and dignity. Most wards had good accessibility. The service could access interpreters, translators and other services designed to meet individual needs.
• The service was well-led. There was a stable management team with managers at all levels who had the skills, knowledge and experience to perform their roles. Ward managers and senior managers were highly visible on the wards and staff told us that managers at all levels were approachable. Almost all staff we spoke to told us that they felt respected, supported and valued. There were good systems and processes in place to assess and monitor quality and safety on the wards.

However;

• There were areas of improvement to maintain safety on the wards. Staff were not monitoring the physical health of patients after the administration of rapid tranquilisation. Several wards had implemented blanket restrictions. The service was not regularly reviewing blanket restrictions. Nurse call alarms were not available in patient bedrooms on seven of the eleven wards. Ligature risk assessments on two of the eleven wards had not identified all potential ligature points in patient accessible rooms.

Updated 1 September 2016

We rated substance misuse services as good because;

All areas were clean, well maintained and offered good facilities for the service to be delivered. Staff carried personal alarms and adhered to the lone working policy. Clients and staff told us they felt safe using the service. Clients had risk assessments which were comprehensive and up to date. There was a system in place to ensure that incidents were recorded and investigations were undertaken whenever necessary.

Clients spoke positively of the service; they felt involved in their treatment options and told us the staff team treated them with dignity and respect. There was a helpful pack available to clients and carers which described how the service worked and information regarding support available through other agencies.

There were several treatment pathways available to clients depending on their individual needs. Teams took active steps to keep clients engaged in treatment including an initiative for clients new to the service and making contact with clients who did not attend appointments. Staff knew how to support clients in making a complaint and there was information available through the information packs and within all premises informing clients how to make a complaint.

We saw evidence of how the aims of the service were upheld by the staff team. Staff described good working relationships within the partnerships and the other agencies involved, Mandatory training, supervision and performance appraisal was undertaken within all teams.

Staff knew how to report incidents, complaints and safeguarding concerns and the service had developed an APP (software designed to run on a computer) to support staff in getting feedback on incidents, the outcomes and any shared learning or changes to practice. There was a risk register which listed risks, actions, dates and those responsible for taking any action.

However;

In one location services were provided on the first floor of the building and there were no facilities for anyone with physical disabilities to access these areas. Staff told us this could be problematic but this was mitigated by using alternative rooms for clinical interventions or clients manoeuvred the stairs as best they could.

A system for checking medical equipment in one location had recently been introduced but had not been undertaken in the week of our inspection.

The system for checking stocks of prescriptions in one location did not allow for regular reconciliation of unused prescriptions.