Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This 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 changed to requires improvement. This meant the leaders within the Trust did not have good oversight of the safe management of same sex accommodation, there were environmental issues that had been reported and not acted upon despite audits of the environment being carried out, referrals fora second opinion appointed doctor were not always completed in-line with recommendations stated in the MHA Code of Practice and mandatory training and supervision levels were not always compliant with the trust target. The service was in breach of the legal regulation relating to governance and quality monitoring (Regulation 17).

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.

The trust had a shared vision, strategy and culture that was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Staff could explain how they were working to deliver high quality care within the budgets available.

The Trust had inclusive leaders at all levels who understood the context in which they deliver care, treatment and support and embodied the culture and values of their workforce and organisation. They had the skills, knowledge, experience and credibility to lead effectively and did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. The managers and senior leaders we spoke with were appropriately qualified and experienced for their role and demonstrated a good understanding of the services they were leading. Ward managers could explain clearly how their teams were working to provide high quality care. The staff and patients we spoke with did not raise any concerns about ward managers and senior leaders, this was except for a few members of staff on Ruskin Ward, who did refer to a clique and that they felt like they were not part of the team. They explained that they felt managers were aware of this issue but had not so far acted upon it. This was fed back to the Associate Director on site at feedback.

Leaders were visible in the service and approachable for patients and staff. Ward managers were based on the wards and staff told us that they found their local leaders to be accessible. Leadership development opportunities were available, including opportunities for staff

The Trust created a positive culture where people felt that they could speak up and that their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. We reviewed several forms of feedback including online surveys, community meeting minutes and found most feedback to be very positive. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. The trust collated responses and information was shared with staff through email bulletins and at staff meetings about changes made in response to staff feedback.

Staff had access to a confidential Freedom to Speak Up process and all the staff we spoke with about this were aware of the system for raising concerns and said they would feel safe to do so with no concerns about any reprisals or detrimental impact on them.

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

Staff we spoke to told us they were well supported by the trust in terms of their wellbeing and work life balance, where possible and in line with service need. They did not report any bullying or harassment. The trust were proactive at ensuring flexible working arrangements were in place, and managers made reasonable adjustments where needed.

Managers had access to appropriate human resource support for recruitment, performance management and occupational health support. Relevant policies and procedures were in place to support this. There are equality and diversity champions within the service.

The Trust did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The management of ligature risks was not robust and was spread over several different documents, none of which provided staff with enough information on how to safely manage ligature points and who was responsible for this. Ligature risks were not individually scored but scored as a group (for example, grouping together all the garden ligatures, indoor ligature points and communal ligatures into one risk). There were no heatmaps to show staff which areas of the ward were hotspots of higher risk. None of the documents give staff any guidance on how to manage these risks other than via engagement with patients. The information being spread across several different documents means there was a potential for staff to miss key information, high risk ligatures and how to safely manage the environment. There were environmental issues that had been reported and not acted upon despite audits of the environment being carried out. This included the uneven paving stones in the garden of Oakwood ward and the steep incline into the garden with no handrail. Our mental health act reviewers found that referrals for a second opinion appointed doctor were not always completed in-line with recommendations stated in the MHA Code of Practice, with several referrals only being made on the day the 3 month rule had expired. Mandatory training and supervision levels were not always compliant with the trust target with several key training course such as prevention of management of violence and aggression and breakaway training On Ruskin and Oakwood ward supervision was low and compliance levers were at 58% and 50%respectively. Leaders within the Trust did not have appropriate oversight of the safe management of wards where there was mixed sex accommodation. We found that on both Ruskin and Oakwood Wards male and female patient bedrooms were not appropriately separated and when asked about this staff told us this was not something they had considered. We found evidence both in trust incident logs and from interviews with carers that there had been incidents of patients entering each other’s bedrooms leading to incidents of violence and aggression, there was also evidence of some minor sexual safety incidents(such as patients attempting to kiss one another when confused). The wards we visited all had regular team meetings with a set agenda that covered a clear framework of what must be discussed at each meeting. These fed into directorate level meetings 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. Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. We saw that action plans were put in place following audits to ensure action was taken to address any shortfalls identified and the action plans included clear allocation of responsibility for each action and realistic timescales for compliance. Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Staff maintained and had access to the risk register at ward or directorate level. Staff at ward level could escalate concerns when required. The service had plans for emergencies – for example, adverse weather or a flu outbreak. The service used systems to collect data from wards and directorates that were not over-burdensome for frontline staff. Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care. Information governance systems included confidentiality of patient records. Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. Information was in an accessible format, and was timely, accurate and identified areas for improvement. We saw that improvements were taking place on some wards, for example decorating to the internal care environments. However, in some cases work had not been carried out to improve the environments and these were impacting the quality of patient care, an example of this was the uneven paving stones in the garden area on Oakwood ward, staff told us they had been raising concerns about this for some time. There was also area internally on Oakwood ward that were in need of decoration that had not yet been completed. There were aspects of the governance of the service which were not always effective and embedded. During the inspection we had concerns in relation to the management of mixed sex accommodation and of second opinion approved doctor requests. The checking of emergency grab bags and staff’s compliance with training and supervision was not effective. The trust had not ensured that when environmental issues were reported, these were quickly rectified to reduce risks to patients. The trust had not ensured that training in dementia and learning disabilities were prioritised by teams.

The trust understood their duty to collaborate and work in partnership, so their services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Patients were supported to keep in touch with people involved in their care, for example, their care coordinator. External professionals, including care co-ordinators were encouraged to attend multi-disciplinary meetings.

Managers understood the importance of positive working relationships with external partners and worked closely with other services to improve and develop the service. Staff had good links with other teams in the trust, including the older adult community teams and safeguarding teams.

The trust focused on continuous learning, innovation and improvement across their organisation and the local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes.

Staff had opportunities to participate in research.

Innovations were taking place in the service. At the time of our assessment, the trust was in the process of installing contactless digital patient monitoring technology across their older adult wards. The systems would allow for continuous monitoring of patients from a distance, enabling staff to track vital signs and identify potential issues early on, regardless of the patient's location.The systems had been installed in patient bedrooms but were not yet in use. Some staff we spoke to were wary of the system and felt it could lead to replacement of human interaction with patients and lead to a reliance on technology to observe patients, whilst others were excited about the new technology and felt it would help to support them to care for patients. Some staff felt that concerns regarding the installation of the system had not been listened to, and the system has been installed despite this. Th trust had a standard operating procedure around the use of this technology in the older adult wards, it would be used on an opt in system rather than opt out, meaning it would only be used for patients the whole MDT felt would benefit from it and they felt it would never be used to replace human interaction.

Wards participated in accreditation schemes relevant to the service and learned from them.