Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

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.

People's experience of this service

The trust monitored people’s experiences through several channels, including the ‘Your Voice’ survey, launched trust-wide in April 2024. This survey collected feedback from service users and carers on care, safety, information, medication, treatment, and waiting times, it was distributed after discharge and available online. Results were themed for quality improvement and shared quarterly with the quality and performance committee.

In the past year, 6,239 surveys were completed (10–12% response rate per quarter), with carers providing about 20% of feedback. Positive experiences remained high (85–87% satisfaction), while negative responses were 6–8%. The survey included the NHS Friends and Family Test, with trust scores just below the national average.

Involvement in care was the highest scoring area (89–91% of people felt involved), especially in inpatient services. Some community service users felt unheard. Positive comments praised staff for their care and support, while negative feedback focused on long waits for specialist services and crisis support.

Overall, most feedback was positive, especially regarding involvement and staff attitudes, but concerns remained about waiting times, crisis services, and communication.

During our assessment service group inspections, we visited four services, spoke with 76 people using services and 60 carers.

Feedback was mixed for learning disability and autism wards: some carers felt safety and care had improved, especially at Rose Lodge. While others raised concerns about safety, staff shortages, and inconsistent support. Medicines management and clinical leadership were praised, but there were concerns about psychotherapy access, healthy living support, and dignity.

In community mental health services for adults, most patients reported respectful, supportive care and valued employment and recovery support, though some experienced long waits for therapy and inconsistent staff contact. Carers generally felt involved but highlighted issues with staff changes, neurodiversity training, and crisis support.

Feedback from older people’s wards was overwhelmingly positive, with patients and carers describing compassionate, knowledgeable staff. Patients felt involved in their care, and end-of-life support was highly valued.

On child and adolescent mental health wards, young people mostly described staff as kind and helpful, and said that they felt safe, though some carers were concerned about agency staff and communication. Young people valued activities and peer support. Carers praised education staff and the family ambassador but raised concerns about food provision and inconsistent communication.

In the 12 months prior to the inspection, the CQC had also carried out Mental Health Act review visits to 10 of the trust’s inpatient wards.

Patients across all sites generally reported feeling safe, respected, and supported. Staff were described as caring, approachable, knowledgeable, and proactive. We heard positive feedback about therapeutic activities, autonomy, and involvement in care.

Carers were mostly satisfied with communication and involvement in care planning. Family involvement was reported positively, especially in units like the mother and baby unit and ward for older people. There were some concerns about inconsistent updates and accessibility of meetings. We found that IMHA (Independent Mental Health Advocacy) services were present and valued, but advocacy referrals and access to MDT (multi-disciplinary team) meetings were noted as an area for improvement.

Reviews found that wards were generally clean and therapeutic, but our concerns included patients describing poor catering, lack of air conditioning, hot water issues, insufficient communal seating and some units had locked garden doors or inaccessible bathrooms.

During visits we found that patients were regularly reminded of their rights under the Mental Health Act and that noticeboards and advocacy information were widely available, though some wards had outdated or missing materials.

The annual Community Mental Health Survey, conducted by CQC, assesses the experiences of people aged 16+ using NHS community mental health services in England. The 2024 survey, conducted between April and May and published in April 2025, had a 19% response rate for CNTW (down slightly from 20% in 2023).

CNTW’s 2024 benchmark report compared results with other trusts and its own 2023 data. Compared to other trusts, one question was rated ‘much better than expected’, five ‘better than expected’, four ‘somewhat better than expected’, and one ‘somewhat worse than expected’. Compared to last year, one question was ‘significantly better’, with none significantly worse.

Key strengths included enough time for patients to discuss needs (‘somewhat better than expected’), more frequent care planning reviews (‘better than expected’), and positive discussions about medication, especially side effects (‘much better than expected’). Crisis support and carer involvement also improved. Respect, dignity, and compassion were rated ‘somewhat better than expected’, and overall experience was positive. The only area needing improvement was support with financial advice or benefits.

The trust’s service user and carer reference group is a user-led forum ensuring meaningful involvement in designing and evaluating CNTW services. Meetings are held regularly, featuring Q&A panels with senior leaders and inclusive sessions led by service users and carers, supported by the involvement team.

We observed a meeting, attended by around 200 people (including executives, staff, service users, and carers), it included presentations on trust priorities and group discussions on topics like service redesign, digital developments, equality frameworks, and workforce wellbeing. Service users shared involvement work, and members described valued opportunities to participate in training, interviews, and service development.
The group’s chair attended the executive management group, ensuring service user and carer perspectives influence trust decisions.