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 requires improvement. At this assessment the rating has remained requires improvement.

Requires improvement: This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of regulation for good governance.

This service scored 61 (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 knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff told us values were shared via a newsletter and through the intranet.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. The Trust had strategic ambitions linked with their values and vision, which were broken down into quality aims and quality priorities. This provided staff with clear goals based on the trust’s vision and values.

We scored the service as 2. The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Although leaders had the skills, knowledge and experience to lead, staff at ward level did not always feel effectively supported by senior leaders.

Leaders had the skills, knowledge and experience to perform their roles. Ward managers had a good understanding of the services they managed and they could explain clearly how the teams were working to provide high quality care.

Senior leaders were visible in the service; however, staff did not feel they were always approachable or supportive, for example some staff said that senior leaders did not always introduce themselves when on site, and other staff felt they only turned up when things had gone wrong. This reflected themes within the freedom to speak up report. The trust told us group directors had contact with the wards including engagement with ward managers, weekly visits to the site and scheduled ward visits. They also attended complex multi-disciplinary team meetings and safeguarding reviews. However, leaders had not identified some of the concerns we raised during our inspection, such as young people not being invited into multi-disciplinary team meetings.

Leadership development opportunities were available, including opportunities for staff. For example, there was a leadership course which was available to staff members.

We scored the service as 2. The evidence showed some shortfalls. People felt they could speak up and that their voice would be heard but did not feel involved in decisions made about the service or that improvements would be made.

Young people and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from young people, carers and staff and used it to make improvements.

Young people and carers had opportunities to be involved in decision-making about changes to the service. For example, young people and carers were involved in the recruitment process and the trust had a youth involvement bank which provided opportunities such as assisting staff training and becoming involved in steering groups.

Staff did not always feel they were involved in decisions about changes to the service. The staff survey for Ferndene, which was the location for the Riding, Stephenson ward, Redburn ward and Fraser ward showed 43% of staff felt involved in decision about changes that affected their work and 38% felt able to make improvements happen at work. The service had a freedom to speak up guardian who produced reports which were discussed at senior managers meetings. Staff were aware of the trust’s whistleblowing policy.

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 trust had an equality, diversity and inclusion strategy and action plan, which was monitored through the equality, diversity and inclusion group. Actions included to be a more inclusive organisation for disabled staff and service users, and addressing progression within the trust for staff protected under the equality act 2010. There were equality and diversity champions within the service, for example there were Lesbian, Gay, Bisexual, Transgender plus (LGBT+), and Black and Minority Ethnic (BAME) networks.

Staff were able to apply for reasonable adjustments to account for personal circumstances such as caring responsibilities and health issues.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group.

We scored the service as 2. The evidence showed some shortfalls. The service 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 trust had a range of governance meetings including monthly leadership meetings, quality meetings, quality standards meetings and team meetings. There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff had implemented recommendations from reviews of incidents, complaints and safeguarding alerts at the service level. However, we were not assured that all safeguarding incidents were reported and actions taken following incidents were not always effective. The trust held a learning and improvement group for young people’s services. This involved reviewing learning from incidents, clinical audits, police and partner feedback and safeguarding and identifying actions from this.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

Staff did not always understand the arrangements for working with other teams to meet the needs of the young people. Stakeholders raised concerns about effective working both with the local authority and with commissioners, although they felt that recent work with the trust had shown some improvement in communication.

Oversight of risk management was not always effective. Effective systems were not in place for completing ligature audits and security was not always being managed effectively. For example, security checks were not always being carried out and there were incidents where young people accessed areas they should not have had access to such as the roof and cupboards containing equipment that could be used to self-harm or harm other people.There were high levels of prone restraint, although numbers of prone restraint were decreasing. Mechanical restraint was not taking place in line with national guidance.

The trust did not have sufficient management of staff training. This meant that a high number of staff on wards for autistic young people and young people with a learning disability had not completed learning disability or autism training.

Staff maintained the risk register at ward and directorate level. Staff at ward level could escalate concerns when required. However, some items on the risk register were not regularly reviewed and it was not clear why items were on the register for some wards and not others. For example, fire risks were on the risk register for Stephenson ward and The Riding but not for any of the other wards. Staff concerns matched those on the risk register.

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. However, staff told us one of the vehicles used to transport young people often broke down and this affected their leave. Information governance systems included confidentiality of young people’s 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 young peoples’ care. Information was in an accessible format, and was timely, accurate and identified areas for improvement.

We scored the service as 2. The evidence showed some shortfalls. The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Directorate leaders engaged with external stakeholders such as commissioners. Stakeholders provided mixed feedback regarding the effectiveness of this engagement. Stakeholders said that information wasn’t always shared in a timely way but some stakeholders felt this had recently improved.

Links with social services were not always effective, the systems in place were complicated and staff did not always share relevant information with safeguarding teams, including where they were directly responsible for young people.

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. They actively contribute to safe, effective practice and research.

Staff were given the time and support to use opportunities for improvements and innovation and this led to changes. For example, The Riding had been involved in the Culture of Care: staff care and development programme. This involved coaching sessions and completing a quality improvement project which was ongoing at the time of our inspection.

Innovations were taking place in the service and staff used quality improvement methods and knew how to apply them. For example, there was a project to decommission the seclusion room on Lotus ward. This involved researching how other organisations managed this and staff collaborated with young people with lived experience during the project. One of the young people involved in the project was creating an animation and audio recording of their experiences to inform and improve staff practice.

Staff participated in national audits relevant to the service and learned from them. Wards participated in accreditation schemes relevant to the service and learned from them. For example, The Riding, Lotus ward and Redburn ward had taken part in the quality network for inpatient CAMHS (QNIC) comprehensive reviews.