Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring - this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. Requires improvement: This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their families gave us mixed feedback about kindness, compassion and dignity. One family member told us “Staff were respectful and "try their best” and a patient told us the staff were nice. However, one person told us, "Not all of the staff are nice to me. Some staff are horrible to me.” Another person told us some staff seemed not to care and some staff did not introduce themselves, even when they were new to the ward. One family member told us, “The majority of times he’s clean, 9 out of 10 times he is." However, another family member told us their relative had worn inappropriate clothing for certain weather conditions and sometimes had their clothes on the wrong way around. These concerns were feedback to the senior managers at the time of the site visit.

Staff told us where people had raised concerns, this was dealt with via the complaint’s procedure. Managers told us that incidents were regularly reviewed, including a review of CCTV footage where appropriate, to review staff's actions and ensure people had been supported appropriately. Staff told us they followed people's care plans. Staff told us there had been some work completed around core teams to provide consistency and support staffs knowledge of the people they were providing care to.

A partner agency told us, "Small gains are celebrated and the team are able to work with humour and encouragement to the individual which he responds well to. [Patient] has been there for quite some time and the team know him well, and this is shown in their responsiveness towards him. They pick up different tones in his vocalisations and know when to intervene to offer support and when to allow him to be on his own." Feedback from the carer reference group included, "Family members and patients now report seeing and feeling a difference in their experience in a positive way. The service users’ carers voice is now listened to and included in all three settings. Of particular note is the positive use of independent advocacy in secure settings and those where restrictive interventions are used."

We observed staff treated patients in a kind and caring way and were engaging with them in a friendly and approachable manner. We observed one staff member supporting a person who was anxious. The staff took the time to explain things to the patient. The staff member reassured the patient and encouraged them to have their personal care needs met. However, we also observed an episode where the response from staff appeared overly restrictive and we had concern’s that high levels of restraint and restrictive practice impacted on the dignity of patients. We also observed what appeared to be a lack of responsiveness and compassion to someone who had raised concerns with us about alleged abuse from a staff member. We were concerned that this, combined with the restrictive nature of the ward and the high levels of restraint use impacted on whether people were not always treated with kindness, dignity and respect.

Family members spoke positive about how staff treated patients as individuals and with respect. One family member told us that their relative loved books and music and staff took him out into the courtyard. Another family member told us that a member of staff is teaching their relative how to play guitar. At Edenwood, one family member told us, “They do offer activities and they keep him stimulated. They know he likes the Muppets, they do pretend Muppet fights” and “He loves soft toys, cartoons, books, they [staff] know what he likes.”

Staff told us that people were encouraged wherever possible to be involved in care planning. Staff told us that understanding cultural diversity was part of the trust’s workforce development. Some staff were trained in 'give racism a red card’ and were going to be an in-house ambassador.

We observed people taking part in activities throughout our visits. We observed people accessing the community and one person able to access the ground of the hospital independently. Patients had access to food to meet their dietary and religious needs. For example, vegan/vegetarian, gluten-free, Halal and Kosher diets were available. People's rooms were personalised and decorated in accordance with their preferences. At Rose Lodge, a room was due to be converted to a multi-faith room. There was a multi-faith box on the ward and patients had access to chaplaincy.

Care records evidenced patients were treated as individuals and their care and treatment was individualised. Care plans contained information on people's preferences on how they wished to receive care and their likes and dislikes. Formulation meetings included consideration of people's faith and culture. Cultural ambassadors were in post. The trust’s equality, diversity and human rights policy was reviewed and in date.

People and their family members told us they felt staff promoted independence and patients were able to make choices. At Mitford Unit, one family member said their relative could make all his own choices. A patient told us, “I have my own car, the staff let me go wherever I want to go. They only say no if there is a proper reason." At Rose Lodge, another family member said staff encourage their relative to be as "independent as they can". One patient did not feel there were enough activities on the ward and said the food was “not great” but the sandwiches were ok. However, they had regular access to Section 17 leave to attend the gym and play football.

Staff told us they supported, informed and involved people in their families in decision making. They told us that they regularly discussed family involvement and support with the person using the services. They said they actively refer people to external organisations to support other areas of a person’s life such as advocacy, housing and other social issues. Staff told us patients had their own snack cupboard where they could get snacks all day from.

We observed people being able to access activities of their choice. One person had access to a games console in their room. We observed some people being supported to move freely around corridors and access a small kitchen area. When we arrived at Mitford Unit, one person was showing signs of being distressed, however, this incident did not impact on their ability to go out later in the day. However, we also observed the environment at Mitford Unit to be very restrictive and we had concerns regarding the impact this had on people’s independence, choice and control. We also observed one patient who had been moved into a seclusion room due to his own bedroom being decorated. However, his independence was restricted due to the environment he was living in during this period.

Care records contained communication plans so patients' rights could be explained to them in a manner they understood. They also evidenced that patients were involved in decisions about their care and treatment. Staff encouraged patients to maintain relationships with people who mattered to them by facilitating visits via the use of tablets and mobile phones which was appropriately risk assessed. There were quiet areas of the wards including lounges and sensory rooms. Patients had access to adaptive equipment such as shower chairs. However, on Mitford Unit there were high levels of restraint used, often to move people against their freewill. We were not assured that the risk present justified the high levels of restrain used and that this was sometimes used as a mechanism for reducing risks to staff rather than in the best interests of the patient because the reasons for use were not always clear and/or recorded.

People and their family members gave us mixed feedback about responding to people’s immediate needs. Whilst some family members told us that staff do meet patients' needs and knew their relatives well, others told us that they felt their personal care wasn’t always attended to leaving them in situations that compromised their dignity.

Staff told us that pre-admission assessments helped them identify how patients may express their feelings and communicate an immediate need or an emotional reactions. Staff told us they also spoke with families and carers to determine the ways their relatives communicated.

We observed sufficient staff to respond to their needs in a timely manner. However, sometimes the number of staff in close proximity to a patient appeared to be overwhelming and appeared to escalate risks. For example, we observed an incident where one patient came out of their room to see the CQC inspector and 4 staff members all stepped forward towards them despite the absence of risk to indicate this response. We fed back our observations to the ward manager.

Care records contained evidence that staff used de-escalation techniques when patients' behaviours became heightened or challenging. However, care records sometimes lacked the detail needed to support people effectively during periods of distress and how best to deescalate. Some patients had a communications passport in place and communication cards to support interactions between themselves and staff to ensure their needs, views and wishes were responded to appropriately. In terms of staff responses feeling overbearing, we discussed with the ward manager where there was a lead staff member who directed the other staff on how to handle situations, avoid confusion and support staff working together. The ward manager explained they didn't currently do this.

At Mitford Unit, staff told us that morale was low and some staff told us they did not feel safe coming to work. Staff told us about incidents in which staff were assaulted by patients and that they had concerns about some staff’s responses to these. They told us about an incident where a patient became distressed and risk escalated and a staff member had “runaway" in response to this. Staff told us they felt this put both staff and people at risk. Staff told us they felt this was due to some staff some colleagues being inexperienced and lacking knowledge of patients and the service. One staff member told us they had concerns about the skills mix in the staffing group and they felt there were a lot of new staff with limited healthcare experience. Some staff expressed concerns about language barrier between the international staff, the patients, and the rest of the staff. Whilst staff said they told us they could raise concerns, they did not always feel listened to. At Rose Lodge and Edenwood, staff and ward managers told us they felt supported and could raise concerns freely. Morale was better at Rose Lodge and Edenwood and staff told us there felt the teams worked well together.

The trust has an external facing health and well-being website ‘Thrive’ which contains detailed information and support available to staff in relation to their emotional and physical health and well-being. Staff are able to access this site from work or home, 24 hours a day. The trust also provides a staff psychological well-being that is led by a Consultant Clinical Psychologist and has a team of five psychological practitioners. There was a regular programme of Schwartz Rounds in place to provide a structured forum where staff can come together regularly to discuss the emotional and social aspects of working in healthcare. These can help staff feel more supported in their jobs, allowing them the time and space to reflect on their roles. The trust also provided an employee assistance programme, access to chaplaincy services, pre- and post- intervention support and occupational health provision. The ward managers told us they were aware of issues around staff feeling unsupported when they raise concerns and had addressed this through supervision and team meetings. However, we found that many of these issues remained unresolved and required the intervention of Care Quality Commission and HSE to improve working conditions for staff.