- SERVICE PROVIDER
County Durham and Darlington NHS Foundation Trust
This is an organisation that runs the health and social care services we inspect
We served a S29A warning notice on County Durham and Darlington NHS Foundation Trust on 23 December 2025 because we had concerns about the trust’s governance systems, the management of identified risk and the processes for learning from incidents and complaints. This followed a well-led assessment of the trust.
Assessment report published 12 June 2026
Contents
Ratings - Community health services for adults
Our view of the service
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.
People's experience of this service
We spoke to patients and carers who shared experiences of district nursing support for a range of health needs, including wound care, catheter management, insulin administration, and ongoing monitoring for chronic conditions. Feedback was largely positive, with many describing staff as caring, professional, and knowledgeable.
Patients appreciated the nurses’ responsiveness, with several reporting same-day visits when issues arose. Patients praised district nurses for providing practical advice and interventions that helped improve conditions such as leg ulcers and cellulitis, and for supporting patients with injections, dressings, and health checks. Some patients highlighted the value of additional services, such as flu and COVID vaccinations, and regular assessments like Doppler tests, which ensured timely referrals to other specialists.
While most patients felt well-informed and involved in their care, a few reported challenges, including difficulty contacting the team, cancelled visits, and occasional confusion about self-care instructions. There were also comments about inconsistency in staff familiarity with equipment, such as electronic beds, and the need for clearer guidance to help patients feel confident managing their health at home. Overall, patients and carers expressed gratitude for the nurses’ efforts and the continuity of care provided.