CQC drops rating for leadership at North East NHS mental health trust
The Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust is now rated as "requires improvement"
The Care Quality Commission (CQC) has downgraded the rating for leadership at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust from outstanding to requires improvement following an inspection from 30 September to 2 October.
The trust provides specialist mental health services across the north. It’s one of the largest trusts of its type in England.
CQC carried out this inspection as part of its continual checks on the safety and quality of healthcare services.
During this inspection, CQC found the trust was in breach of regulation regarding its management systems, as leaders didn’t always have effective processes in place to consistently assess, monitor, and drive improvement in the quality and safety of its services.
CQC currently gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at that level. CQC consulted on this approach and will use the feedback gathered to consider whether this well-led key question at NHS trust level is appropriate for the new innovative, complex and integrated models of care being created.
CQC previously rated how well-led the trust is as outstanding in an inspection using its previous methodology for trust ratings.
Gemma Berry, CQC deputy director of mental health in the north east, said:
“During our well-led inspection of Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, we found the standard of care had deteriorated in some services since our last inspection. Senior leaders didn’t always have appropriate systems and processes in place to monitor this and keep people safe.
“This meant leaders couldn’t always take effective and timely action to address risks which could result in people coming to harm. For example, improvements were needed around staff safety, reducing restrictive interventions, managing environmental risks, and improving staff training.
“Additionally, across the organisation there were pockets of poor culture, and staff told us leaders were making decisions about frontline services, without always consulting staff who were providing the care.
“Also, some staff didn’t feel safe speaking up when they had concerns, including those which could impact the quality and safety of people’s care. They told us they weren’t confident that their feedback would be acted on and lead to improvements.
“It’s absolutely critical that the trust tackle this issue as a priority. Everyone should feel respected, and able to speak up and be listened to. Staff have important information to share that can keep people safe.
“However, we saw examples of great partnership working to help improve the health and wellbeing of people and local communities. Such as working with the local integrated care board on the ‘better health and wellbeing for all’ strategy, which focuses on reducing inequalities, improving life expectancy, and giving children the best start in life.
“We’ve shared our findings with the trust’s management, and they’re aware what improvements are needed, including improving the trust’s culture. We’ll continue to monitor the trust, including through future inspections, to ensure people are safe while the necessary improvements are made.”
Inspectors found:
- The trust didn’t always ensure safeguarding concerns were accurately reported to the local authority, and staff were confused about what types of incidents should be reported and when
- Leaders didn’t always communicate with staff in a timely way, to update them on important information they needed to be aware of to keep people safe
- The trust had workforce challenges, including high vacancy and sickness rates in some areas, which meant there was an increased reliance on temporary staff and inconsistent supervision to keep people safe
- Some staff felt there were barriers to career progression, and work was needed to address bullying and discrimination, to help embed a more inclusive culture.
However:
- The trust was focussed on continuous learning, innovation and improvement across the organisation and with local partner organisations, to improve the quality of life for people using services.
Chief Executive: 'We must raise our standards'
James Duncan, Chief Executive at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust said: “Today the Care Quality Commission published its Well-Led inspection report for our Trust, rating it as Requires Improvement.
"We accept the findings of this report and recognise the seriousness of what the CQC has set out. This report follows previous inspections where improvement has been required and makes clear we must raise our standards more consistently across the Trust. The CQC has identified that our systems for identifying, escalating and addressing concerns about quality and safety are not working consistently enough. We accept that this must improve.
"The CQC is clear that our staff continue to deliver compassionate, safe and respectful care, often under significant pressure. Feedback from patients and carers about their day-to-day care, staff kindness and involvement in decisions has been positive. This feedback matters deeply. It reflects the commitment and professionalism of our workforce, and these are strengths we are determined to protect.
"The CQC also recognised our focus on innovation, improvement and continuous learning, as well as the way we work effectively with our partners across health and care. This focus helps us build the foundation for the changes we need to make.
"At the same time, the report highlights areas where we must do better. In particular, it makes clear that we need more consistent and effective leadership at all levels of the organisation. Where leadership is not consistent, it has a direct impact on organisational culture, speaking up, equality and inclusion. Some staff have told us they do not always feel listened to or supported, and that is not acceptable. When leadership and culture are not experienced consistently, risks can increase and opportunities to make improvements can be missed.
"We have already begun work to address these issues. We are strengthening leadership development and simplifying our processes for managing the organisation. We are improving how we listen to staff, act on concerns and involve them in decisions. But I am clear that this now needs to move faster and be felt equally and effectively across the organisation. I understand the urgency of this and we are actively addressing all of the areas the CQC has highlighted. I, together with the Board, am accountable for ensuring this happens.
"My focus is on improvement, not reassurance. We will be open about our progress. We will involve staff, patients and partners in shaping solutions, and ensure that improvements lead to real, measurable change.
"Our priority is to provide safe, high-quality, compassionate care for the people and communities we serve. We also aim to create a Trust where our staff feel valued and supported, allowing them to give their best.”