County Durham and Darlington NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

County Durham and Darlington NHS Foundation Trust’s vision is to deliver care, which is right first time, every time and guided by core values of respect and dignity, compassion, quality care, improving lives, everyone counts, and working together for patients. During out inspection, we saw evidence that staff shared this vision and worked hard to apply this to their work.

Staff told us they had the opportunity to contribute to discussions about the strategy for their service, put forward ideas, and said that they felt listened to by senior leaders.

Leaders in community services had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. Leaders were visible in the service and approachable for patients and staff.

Overall, staff told us they felt listened to by leaders at all levels within the trust. Teams said that leaders understood what was working well and what challenges were faced by staff on a daily basis.

Leadership development opportunities were available to those who wished to pursue this.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to feedback from patients, carers and staff and used it to make improvements. Patients and carers were involved in decision-making about changes to the service.

Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback. Staff told us that managers and senior leaders were visible and approachable.

The service had a Freedom to Speak Up Guardian in place. There were also posters displayed to remind staff about speaking up. Staff told us they knew how to access the Freedom to Speak Up Guardian if they needed to.

The teams we visited reflected the cultural make up and diversity of the communities they served.

A range of staff networks were in place to support staff with a range of protected characteristics including BAME and LGBTQ+ networks. Staff told us they knew how to access these if they needed them. There were trust, directorate and individual team plans to address workforce race equality and workforce disability standards.

Managers and staff were able to describe how a range of reasonable adjustments had been explored to support individual staff to carry out their role or balance their work and home lives. Overall, staff felt there was flexibility with working hours to support with personal circumstances. The trust provided us with data which showed of 496 requests for flexible working arrangements, they had approved 45.5% of these.

The trust had a People Matter Action Plan 2025/26 which focused on health and wellbeing, equity and inclusion, and workforce sustainability. It provided quarterly updates on initiatives such as leadership development, sickness reduction pilots, flexible working analysis, and health inequalities projects. Key actions included embedding wellbeing in team meetings, rolling out Making Every Contact Count training, improving clinic efficiencies, and exploring digital solutions like Healthcall and SystmOne Connect. The plan also highlighted ongoing work on medication safety, staff engagement, and strategies for workforce planning and retention.

We reviewed meeting agendas and minutes for a range of meetings. Community nursing governance meetings took place monthly and covered governance updates, patient safety investigations, and quality performance metrics. Additional items addressed medical device safety, ID compliance, lone worker policies, and preparations for upcoming service changes and inspections.

We also reviewed meeting agendas and minutes for the Community Services Community Care Group Therapy Speciality Meeting which covered Quality Governance, Quality and Performance Dashboard, and Workforce Updates. Business items address IT and Governance, Budgets, Health Inequalities, and Demand and Capacity and Issues for Escalation.

Mandatory training was monitored and alerts sent to managers if staff were non-compliant. The lead nurse told us they ensured that nurses had protected time to complete their training. However, some staff told us they completed training outside of their working hours and were not compensated for this.

The trust had business continuity plans for emergencies, for example, adverse weather and flu outbreaks.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level.

Staff understood the arrangements for working with other teams, both within the provider and externally, to meet the needs of the patients.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well for the most part and helped to improve the quality of care. We noted that connectivity issues were reported but plans were in place to improve technology. Information governance systems included confidentiality of patient records. Information was in an accessible format, and was timely, accurate and identified areas for improvement.

We observed good levels of partnership working between the Advanced Nurse Practitioners, care homes, District Nurses and GP surgeries. We found that the Outpatient Parenteral Antimicrobial Team (OPAT) worked effectively across the community, liaising with teams from the acute parts of the trust. We received feedback from these teams that the work undertaken by the outpatient parenteral antimicrobial therapy team was integral to the positive outcomes for patients.

During triage calls, we observed staff signposting patients to other community resources available for information and support.

We spoke to the manager of the social services team who worked alongside community health services for adults. They told us that the integrated way of working that the team had developed supported good outcomes for people using the services and assisted in communication.

Patients told us that the services they were involved with all worked well together and provided additional services like flu and COVID-19 jabs for people who were unable to access them elsewhere in the community.

Staff used quality improvement methods and knew how to apply them. Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes. Innovations were taking place in the service. For example, we reviewed evidence of improvements made in the Community Respiratory Team where challenges included low morale, stress-related sickness, and reluctance to collaborate across North and South teams. To address this, managers had introduced Health Wellbeing activities based on the “5 Ways to Wellbeing,” an external tool fostering connection, learning, and appreciation while improving team culture. Since the introduction of wellbeing activities, the trust had seen an improvement on wellbeing and sickness levels, had received positive feedback from staff about this, and now had a fully recruited team.