- SERVICE PROVIDER
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
This is an organisation that runs the health and social care services we inspect
Assessment report published 20 April 2026
Contents
Ratings - Mental health crisis services and health-based places of safety
Our view of the service
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.
People's experience of this service
We spoke with 9 people who used the service and 13 relatives or carers. People were very complimentary about the service and overall felt safe and reassured that the team were helping them. They said communication had been good, they felt supported and staff were responsive. People said their needs had been considered and they had a choice of where and when they were visited. Relatives and carers said they felt included and also felt supported. People said staff listened to them, were respectful, non-judgemental, kind, compassionate and caring. People had received a variety of interventions to help them get better, which included written information. Many people said, ‘I cannot fault them, can’t speak highly enough of staff, top team’.
We observed 4 visits and listened to 5 NHS 111 option 2 calls. We saw that staff were respectful and showed compassion. They built up a rapport with people, gave information in a clear, concise way and provided help and support.
The local Integrated Care Board (ICB) asked primary care and commissioning colleagues to provide feedback about the service following our inspection. They told us that some people who used services and their families said they did not always have a good experience and did not want to be looked after by the teams in the future.