CQC highlights need for improvements at County Durham and Darlington NHS Trust
The report relates to Surgical Services, Community Health Services for Adults and the Trust's Well-led arrangements
County Durham and Darlington NHS Trust says it's making changes after new reports from the health regulator highlighted several areas for improvement.
The Care Quality Commission (CQC) reports relates surgical services, community health services for adults and the Trust's well-led arrangements.
The inspections took place during late 2025 and, since then, the Trust says significant work has been undertaken across the organisation to strengthen patient safety, improve services and support staff.
The reports include an inadequate rating for the Trust's well-led arrangements, requires improvement ratings for surgical services and a good rating across all domains for community health services for adults.
The Trust say they accept the findings of the reports and remains fully committed to delivering the improvements identified.
Improvements
Since the time of the inspections, the Trust say they've put in place a number of improvements, strengthening leadership across the Trust, introducing safer staffing arrangements within surgical services, improving how concerns and complaints are handled, and providing additional training to support learning, openness and continuous improvement.
The Trust add that they've significantly reduced backlogs relating to incidents and complaints. All complaints are now reviewed by executive leaders, and ward sisters and charge nurses are being supported to spend dedicated time speaking directly with patients and families to hear concerns, resolve issues more quickly and ensure learning is acted upon.
Additional work has also been undertaken to strengthen oversight of services delivered through external providers, improve how risks and concerns are escalated, and ensure issues are identified and addressed earlier.
The strengths
The reports also recognise important strengths across the Trust. Community health services for adults received a good rating across all domains, reflecting the high-quality care, strong teamwork and positive patient experiences delivered by staff.
Patients consistently told inspectors that staff were caring, compassionate, professional and respectful.
Chief Executive Steve Russell said: "We fully accept the findings of these reports and apologise where we have fallen short of the standards our patients, communities and colleagues rightly expect.
"I know some of the findings in these reports will be difficult to read and may understandably cause concern. It is important that we are open and honest about where improvements were needed.
"It is also important to recognise that these reports reflect a point in time. Since the inspections took place late last year, a tremendous amount of work has happened across the Trust to strengthen patient safety, improve governance, support our staff and drive improvement.
"We have strengthened leadership, introduced safer staffing arrangements within surgical services, improved how we listen to and learn from patients and families, and strengthened oversight of quality and patient safety. While there is still more to do, we are already seeing progress in a number of areas.
"I was particularly pleased to see community health services for adults rated good across all areas. The reports also recognise the compassion, professionalism and dedication shown by colleagues across our organisation every day.
"We remain focused on delivering the improvements identified, being open and transparent about our progress, and making sure those improvements are felt by our patients, communities and colleagues."
The Trust say they will continue to work closely with the CQC, NHS England and North East and North Cumbria Integrated Care Board to deliver further improvements and provide regular updates on progress.
A significant programme of improvements - in detail:
Governance and oversight
• They now have much stronger systems for identifying concerns, escalating risks and acting on problems earlier. Services are subject to greater scrutiny and there are clearer routes for concerns to be escalated from frontline teams to senior leaders and the Trust Board.
• 106 of 119 actions linked to the Surgical Section 29A Warning Notice have now been completed. Remaining actions are largely related to embedding training and communication improvements.
• Governance arrangements have been redesigned and strengthened across the Trust, including new executive-led groups overseeing quality, patient safety, clinical effectiveness, performance, workforce, finance and risk.
• A new Clinical Effectiveness Committee has been established to provide dedicated scrutiny of clinical outcomes, audits and service quality.
• Triple A reporting (Alert, Advise, Assure) is now operating across Board committees, providing clearer escalation and accountability.
• Board and committee structures have been overhauled with external support.
• Quality Committee membership has been strengthened with additional Non-Executive Directors, including clinical expertise.
• Clinical audit arrangements have been strengthened in response to the Well-Led warning notice.
• Care Group, specialty and ward governance arrangements are being redesigned and strengthened Trust-wide.
Risk management and escalation
• The Trust has completely redesigned its risk management process, with clearer ownership of risks at specialty level, defined escalation thresholds and new training for leaders.
• Monthly Risk Compliance Group meetings are now in place to ensure risks are identified, tracked and escalated appropriately.
• "Floor-to-Board" performance reporting is being used to identify issues at specialty level before they become wider organisational problems.
Patient safety and learning
• Significant reductions have been achieved in overdue incidents and complaints
• New arrangements are in place to improve incident management, complaints handling, Duty of Candour and organisational learning.
• More than 80% of over 900 staff have now completed risk management training.
Breast Services
• The changes made to the breast service are now being reflected in patient outcomes. Rates of breast-conserving surgery, reconstruction and re-excision are all performing above national benchmarks, meaning more patients are receiving treatment in line with best practice and fewer require additional surgery.
Clinical leadership and governance
• Specialist oncoplastic breast consultants appointed and an experienced external specialist was brought in to stabilise and transform the service.
• Dedicated Breast Surgery Governance and Breast Radiology Governance Forums have been established and are meeting regularly.
• A dedicated Breast Surgery Clinical Governance Lead has been appointed.
• Every patient is now discussed by a full multidisciplinary team and treated in line with national guidance and best practice.
Diagnostics and technology
• One-stop breast clinics have been modernised.
• Breast imaging technology has been upgraded and the ageing PACS system replaced.
• New processes allow clinicians to access previous mammogram images, addressing a key safety issue identified by reviewers.
Improved patient outcomes
• Breast-conserving surgery rates increased from 53% to 72%, above the GIRFT standard of 65%.
• Re-excision rates reduced from 25% to 12%, better than the national benchmark of 17%.
• Immediate reconstruction rates increased from 14% to 33%, above the national benchmark of 30%.
• More than 80% of patients are now treated as day cases.
• Fewer patients require diagnostic surgery.
Leadership
• Executive and Non-Executive leadership capacity has been strengthened.
• Five new experienced Non-Executive Directors have joined the Board.
• A Deputy Chief Executive has been appointed alongside substantive executive appointments including Chief Nurse, Chief Medical Officer and Chief Finance Officer.
Culture and speaking up
• A Culture Improvement Plan has been developed.
• Team Talk, CEO Roadshows, Executive shadow shifts and Board Leadership Visits have all been introduced or expanded.
• Freedom to Speak Up Guardian capacity has been increased.
• Staff are being actively encouraged to raise concerns through multiple routes.
Full copies of the inspection reports, together with detailed information about the improvements already made and the work continuing across the Trust, are available on the Trust's website.