County Durham and Darlington NHS Foundation Trust

Updated 12 June 2026

County Durham and Darlington NHS Foundation Trust is an NHS acute and community services trust consisting of Darlington Memorial Hospital, University Hospital North Durham, Bishop Auckland Hospital, Chester-Le-Street Community Hospital, Shotley Bridge Community Hospital, Sedgefield Community Hospital, Richardson Community Hospital, Weardale Community Hospital and Peterlee Community Hospital.

Services include acute medicine, urgent and emergency care, maternity services, acute frailty units, rehabilitation services and surgical services to a local population of approximately 650,000 people.

The Trust employs over 7,500 people across the sites.

Our last trust-level assessment at County Durham and Darlington NHS Foundation Trust was in 2019. The inspection looked at how well led the trust was. At that time, we rated them as Good.

Following concerns identified in 2025, we undertook an inspection of the Trust’s surgical services. As a result, we asked the Trust to take urgent action and issued a Section 29A Warning Notice. We found that the ineffective senior leadership previously in place at the Trust contributed to the failures identified during our assessment of surgical services. In the three months leading up to our well-led assessment of the Trust, there were several changes within the senior leadership team, including the appointment of a new Chief Executive Officer (CEO) and a new interim Chair. Consequently, we wanted to assess how well led the Trust was overall.

Our assessment of County Durham and Darlington NHS Foundation Trust included an on-site visit on 2-4 December 2025. We observed a board meeting as well as internal Operational Performance & Assurance Committee (OPAC) and Integrated Quality & Assurance Committee (IQAC) meetings. We also held focus groups with staff members and the Council of Governors.

We assessed all 8 of the quality statements in the well-led key question using our current framework methodology for NHS trusts. We reviewed evidence for all quality statements under our single assessment framework.

Each quality statement assessed is awarded a score. Details on how we score can be found on our website: https://www.cqc.org.uk/about-us/how-we-do-our-job/ratings

You can find further information about how we carried out our assessments at: https://www.cqc.org.uk/about-us/how-we-do-our-job/what-we-do-inspection

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred, sustainable and reduced inequalities.

This is the first assessment for this service under our single assessment framework. We rated the well led key question as inadequate.

We found the following breaches of regulation:

Regulation 16 - The Trust must ensure that complaints are reviewed and acted upon in a timely manner. The potential for learning lessons from complaints and lack of action planning means opportunities are missed to prevent patients being exposed to the risk of harm.

Regulation 17 - The Trust must implement and operate an effective governance and risk management system to ensure the safe and effective delivery of care.

Regulation 17 - The Trust must ensure that incidents reported are reviewed and acted upon in a timely manner. The potential for learning lessons from incidents and lack of action planning means opportunities are missed to prevent patients being exposed to the risk of harm.

Regulation 19 - The Trust must ensure it has appropriate and adequate processes in place to ensure the safe recruitment of all staff.

Updated 17 October 2025

We assessed County Durham and Darlington Foundation Trust from 18 to 25 November 2025. We carried out a short notice announced inspection of community health services for adults as part of our continual checks on the safety and quality of healthcare services. At this assessment we assessed community health services for adults where we assessed 34 quality statements.

The service delivers a wide range of community-based care across multiple sites, including Bishop Auckland Hospital, Chester-Le-Street Hospital, Hundens Lane Day Hospital, and Shotley Bridge Community Hospital. It supports a diverse population across urban and rural areas, including areas of deprivation, and provides services such as district nursing, tissue viability, diabetes care, respiratory services, leg ulcer clinics, and specialist long-term condition management.

County Durham and Darlington Foundation Trust Community Health Service for Adults was registered with CQC to deliver the regulated activities:

• Surgical procedures
• Termination of pregnancies
• Transport services, triage and medical advice provided remotely
• Treatment of disease, disorder or injury
• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Diagnostic and screening procedures
• Family planning
• Maternity and midwifery services

We visited the following hospitals as part of the assessment:

• Bishop Auckland Hospital
• Chester Le Street Hospital
• Hundens Lane Day Hospital
• Shotley Bridge Community Hospital

We last inspected Community health services for adults in February 2015 when we rated it as good overall. At that time, we found that the service demonstrated strong governance, effective multidisciplinary collaboration, and a positive culture where staff felt supported and respected. Care was compassionate, patient dignity was maintained, and emotional support was provided. Safety standards were upheld through robust incident reporting, proper equipment maintenance, infection control, and safe medicine management. Electronic records were complete, and care planning was effective. Staff were well-trained in safeguarding and legal frameworks, and there were no long-standing vacancies. Leadership was strong and visible, audits were used to monitor quality, and complaints were handled constructively with lessons learned and shared.

Following this inspection, ratings for safe, effective, caring, responsive and well led stayed the same and were rated as good.

Our overall rating stayed the same, and the service was rated as good. We found:

Consistently compassionate, person‑centred care
Staff treated people with kindness, dignity and respect, taking time to understand personal preferences, cultural needs and wider social circumstances. Patients and families praised the way nurses explained care, involved them in decisions, and minimised distress during visits and clinic appointments, reflecting a genuinely caring culture across district nursing and specialist teams.

Effective multidisciplinary working and joined‑up care
Teams collaborated well within the Trust and with external partners (GPs, social care, care homes), ensuring people only needed to “tell their story once” and that referrals and handovers were timely. Regular huddles, case reviews and integrated working between district nursing, tissue viability, diabetes and leg ulcer services led to coordinated, holistic care and positive experiences for patients and carers.

Strong learning culture with clear feedback loops
There was an open, supportive safety culture in which staff felt able to speak up, incidents were reviewed promptly, and lessons were shared through forums like safety huddles and the “Tuesday Topic” bulletins. A thematic review of insulin‑related incidents led to practical changes (e.g., strengthening patient identity and dosing checks) that staff were implementing and monitoring for impact.

Robust governance and routine quality improvement
Governance structures and performance oversight were well‑established, with regular meetings, dashboards and audits used to monitor standards and drive improvement.

Mental Capacity Act compliance:

Staff had received training in the Mental Capacity Act and demonstrated a good understanding of the five statutory principles. They assessed capacity on a decision-specific basis and supported patients to make their own decisions wherever possible. When patients lacked capacity, staff acted in their best interests, considering their wishes, feelings, culture, and history. The provider had a clear MCA policy, and staff knew where to access advice. However, documentation of consent and capacity was not always robust, and at the time of our inspection, work was underway to improve this through a new electronic template.

Updated 29 September 2015

There were systems in place for reporting and investigating incidents involving children and families. Systems were in place, through the integrated governance reporting system, to identify themes and to learn and share the learning from incidents. Incident reporting was increasing and support was available for practitioners who reported incidents. There was a good understanding of infection control procedures and we saw that staff used hand hygiene gels during two immunisation sessions we attended. Similarly, there was good knowledge of how to keep medicines safe in schools and children centres. Health visitor caseloads were within an acceptable range and met Lord Laming (2009) recommendations. There was one risk identified in relation to raising the level of safeguarding training required to Level two for clinicians. There was an action plan that set out the timescale for this change and a targeted approach.

The Healthy Child Programme was delivered to children and young people and initiatives such as UNICEF baby friendly were in operation. Children and young people’s needs were assessed and treatment was delivered in line with current legislation, standards and recognised evidence-based guidance. For example, the trust had a Family Nurse Partnership team. Staff worked to deliver assessment and treatment in accordance with standards and evidence-based guidance. There was some monitoring of outcomes for patients and plans were in hand to redesign and restructure the services to make better use of resources and improve effectiveness. Multidisciplinary team working was effective. Staff were competent and working well as an integrated team in the interests of patients. Staff development, supervision and performance appraisal were in place and compliance was good.

Overall we rated children’s and young people’s services good for the quality of care. In all the services we visited we staff were providing compassionate and sensitive care. Children and families were encouraged to be involved in their care. Patients we spoke with, and their families, felt that they were treated with dignity and respect.

We found that the services were planned and delivered to meet the needs of children and their families. Structures had been redesigned in response to the people’s changing needs and the need to manage resources between ‘universal’ and ‘targeted’ services. We found that there was good access to translation services and an understanding of the need to respond to cultural differences in the area. There was an open and transparent approach to complaints and they were treated as an opportunity for shared learning and service improvement.

There was a clear vision and strategy where the priorities of the trust were understood locally. Staff working in community children’s services were committed to their work and understood the priorities of the service and their individual teams. The integration of community services into the trust was ongoing. There was strong support for the local leadership and staff appreciated the high levels of honest communication and new drive for quality.

Updated 29 September 2015

Overall, we rated community dental services as good. We found dental services provided safe and effective care. Patients were protected from abuse and avoidable harm. Systems for identifying, investigating and learning from patient safety incidents were in place.

Dental services were effective and focused on the needs of patients and their oral healthcare. We observed good examples of effective, collaborative working practices within the service. It can be difficult for the service to recruit dentists essentially because of the rural nature of County Durham and the current financial climate of the NHS. However, the service was able to meet the needs of the patients who visited the clinics for care and treatment because of the flexible attitude of all members of the service.

The patients we spoke with, and their relatives or carers, said they had positive experiences of their care. We saw good examples of care being provided with compassion and of effective interactions between staff and patients. We found staff to be hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed how dedicated they were through what they did.

At each of the clinics we visited the staff responded to patient needs. We found the service had begun actively seeking the views of patients using a variety of means. People from all communities, who fit the criteria, could access the service. Effective multidisciplinary team working ensured patients were provided with care that met their needs at the right time. Through effective management of resources, delays to treatment were kept within reasonable limits.

The service was well-led. Organisational, governance and risk management structures were in place. The operational management team of the service were visible and the culture was seen as open and transparent. Staff were aware of the vision and way forward for the organisation and said that they generally felt well supported and that they could raise any concerns.

Updated 29 September 2015

Overall, community in patient services were good. Medical cover was provided in different ways at each location. Advanced nurse practitioners held responsibility for inpatient services at night, but in some locations the most senior member of staff on duty was a band 5 staff nurse. Services did not use a nursing dependency tool to calculate numbers of nursing staff required. On most wards there were two qualified nurses on duty for all shifts. When the ward was full this meant that there was a qualified nurse ratio of 1:11 or 1:12 (1 qualified nurse for 11 or 12 patients). This falls outside the recommended Royal College of Nursing (RCN) ratio of 1:8.However, managers supported staff to access additional nursing and healthcare assistant staff when clinical needs or new complex admissions required extra staff. Staff told us that their managers were supportive and trusted them to make clinical decisions regarding staffing.

Most patient records were appropriately completed, care plans were individualised and we found evidence of goal setting and discharge planning. However, medical nursing documentation received from the acute site with patient transfers was not always complete and all pages were not always sent to the community ward. We found that nursing assessments and risk assessments were in place and where risks were identified relevant to scores and patient status, appropriate action plans were in place and regularly reviewed during inpatient stays.

Incidents were reported, managed and investigated. There was evidence that learning and subsequent changes had taken place as a result of incidents. Staff understood their personal and professional responsibilities and applied the principles of the Duty of Candour legislation as part of their working roles.

Staff followed infection control principles and were seen to wash their hands and use hand sanitising gel appropriately. All staff were ‘bare below the elbow’. Staff felt involved and were encouraged to give feedback on patient care both informally and at ward handovers.

Peer review was carried out across the care closer to home directorate using an observational site visit tool. This gave a rating against each quality assurance target and recommendations for actions where appropriate. Staff told us that this activity was valued by all senior staff as an opportunity to share good practice. There was little evidence that community hospitals benchmarked their outcomes or quality of care against national guidelines or standards.

Admission criteria and pathways were in place and patients were mostly admitted appropriately for nursing care and/or therapy input, although there were some inappropriate admissions to the community wards from the acute services, especially A&E. Access to therapy was inconsistent between services. Some had access to part-time therapy support on weekdays while others carried out assessments prior to admission but on-going maintenance therapy was not available. Discharge planning was integral to the care of patients and home visits were incorporated into the plans to help assess the patients’ moods, wellbeing, safety and mobility needs. This allowed sufficient time to identify any equipment required and to allow efficient ordering prior to a formal discharge. Delayed transfers of care throughout the trust were due to a range of causes, most of which scored equally or considerably less (better) than national averages.

Patients and visitors told us that the care they received from staff was excellent and that patients felt safe and cared for during their stay. We observed staff speaking to patients in a sensitive and compassionate manner. There was a good range of quality information leaflets for patients and families to read and keep. Staff ensured they were as involved as possible about making decisions about their care and feeling empowered to care for themselves as soon as they were able.

Staff understood the trust’s overall vision, but there was no clear vision or strategy for the future regarding community services. There had been recent changes within community inpatients and staff expected further change in future. Risk management meetings were held monthly, but staff awareness and the engagement of risk management was inconsistent. Staff we spoke to were very positive and proud of the service, the team and provision of care to patients. Ward staff encouraged patients to complete a questionnaire prior to discharge. Although low numbers of patients completed the questionnaires the results were good overall and all patients commented that the staff had been kind, considerate and caring. Staff felt they provided a good link between acute services and the community and had good connections with therapy teams who followed up patients’ progress at home.

Updated 29 September 2015

Overall community end of life services were good, although there were some aspects of well-led that required improvement. The community specialist palliative care service (CSPCS) provided a safe service. Staff were clear about their responsibilities for clinical safety, operated within clear national clinical guidelines and reported and analysed clinical safety issues and incidents. The service had arrangements in place for reporting and analysing incidents. Staff were aware of current infection prevention and control guidelines and we observed good infection prevention and control practice. Medical support for the CSPCS was provided by one full-time consultant in palliative care medicine. The consultant in post had been absent for several months. The post had been covered by a recently retired consultant who provided cover six sessions per week. A second consultant post was vacant.

CSPCS had been developed in line with national guidance. The service used the palliative and end of life guidelines developed by the North of England Cancer Network. These provided staff with guidance on palliative and end of life care planning, pain management, symptom management and emotional and psychological support. CSPCS staff were appropriately qualified and experienced to give specialist advice and we saw evidence of good multidisciplinary team working as part of the approach to supporting patients in the community. The service had arrangements in place for managing patient’s pain, managing symptoms and supporting their nutrition and hydration needs. The Liverpool Care Pathway had been replaced by guidance developed by the Northern England Strategic Clinical Networks, ‘Guidance for care of patients who are ill enough to die’, June 2014. There was no access to specialist palliative care advice out of hours. There was no specialist or general training programme in place for palliative and end of life care. Some community nursing staff who were coordinating people’s care had not received training in palliative and end of life care.

Patients were treated with dignity, respect and compassion.

The service worked well with other services and had developed services in partnership with the local clinical commissioning group to ensure patients needs were met. Specialist community palliative care staff reviewed the needs of newly referred patients and adjusted their priorities to ensure they provided a responsive service. Any complaints were reviewed and investigated, and any learning from complaints was cascaded to staff.

The service had been without senior leadership for some time. The consultant in palliative care medicine in post had been absent for several months. The post had been covered by a recently retired consultant who provided cover six sessions per week. A second consultant post was vacant. Team leaders had been identified for each of the localities. These were senior nurses who took on operational management responsibilities over and above their clinical caseloads. Staff understood the strategic aims of the organisation and felt involved in the clinical quality improvement framework.