Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Updated 19 April 2023

Our rating of the trust stayed the same. We rated it as outstanding because:

• We rated effective, caring, responsive and well-led as outstanding, and safe as good. We rated nine of the trust’s 15 services as outstanding overall and six as good. In rating the trust, we took into account the previous ratings of the services we did not inspect this time.
• We rated well-led for the trust overall as outstanding. The leadership, governance structures and culture within the trust were used to effectively drive and improve the delivery of high quality person-centred care. Leaders had a comprehensive understanding of the challenges faced by the trust and worked collaboratively to develop solutions.
• Leaders strived to continually review and improve services. The collective leadership model and operational locality delivery structures meant that staff were empowered to drive improvement at all levels of the organisation. Innovation and new initiatives were celebrated both within the trust and externally.
• The quality of performance data was outstanding. Staff at all levels had access to a wide range of real time data which was used to actively inform and shape how services were delivered and how care was provided. Staff on child and adolescent mental health wards used data to change practice. This had resulted in reduced use of restrictive physical interventions for patients.
• Staff maintained high compliance rates for mandatory training.
• There was an open incident reporting culture. Staff knew how to report incidents and there was evidence of learning from these. Staff received debriefing after serious incidents. There were comprehensive arrangements and procedures to safeguard children and young people. Staff in all services inspected demonstrated a good understanding of safeguarding and knew how to protect patients from abuse and report any concerns appropriately.
• Child and adolescent mental health wards and specialist community mental health services for children and young people had a truly holistic approach to assessing, planning and delivering care and treatment to patients. Patients had access to an extensive range of evidence based interventions. Staff worked consistently to ensure patients lived healthier lives and developed individualised approaches to meeting the physical and mental health needs of patients.
• The trust worked collaboratively with other organisations to ensure the highest provision of care for patients. This included facilitating training by specialists to enable staff on the wards to deliver the best care and treatment possible, particularly for patients with complex needs. Staff on inpatient mental health wards worked closely with community teams to facilitate effective discharge pathways for patients. The trust was working collaboratively with commissioners and staff to design specialist community based services for children and young people to prevent admission to hospital.
• Feedback from people who used the services, those who are close to them and stakeholders were continually positive about the way staff treat people. People said that staff go the extra mile and care exceeded expectations.
• There was a strong and visible person centred culture. Staff in all services we inspected were highly motivated to offer care that was kind and promoted people’s dignity. Relationships between staff and people who used services and their carers were supportive and caring.

However:

• The trust acknowledged there was more work to do to review restrictive practices including blanket restrictions across all inpatient services. The trust identified this was an area of development. Whilst there was evidence of significant reduction in the use of mechanical restraint and every use was based on individual risk assessment and subject to director level authorisation, this intervention in the management of violence and aggression was still being used.
• Staff appraisal rates were slightly below the trust target. Whilst there was no trust target for clinical supervision rates, some services had lower levels of clinical supervision. There were delays in staff receiving formal written outcomes following disciplinary and grievance procedures.
• In acute wards for adults of working age and psychiatric intensive care units, staff were not always monitoring the physical health of patients after rapid tranquilisation. Seven of these wards did not have nurse call alarms.
• Waiting times for treatment in community specialist mental health services for young people did not always meet the trust target of 18 weeks for certain specialist treatment pathways.

Updated 15 January 2021

We carried out a responsive, unannounced inspection over three days. This was because of information we had received giving us concerns about the safety and quality of the services.

This was a focused inspection looking at safe effective and well led key questions. We did not rate key questions at this inspection. However, due to a regulatory breach in well led this domain has been limited to requires improvement.

Summary

• The use of restrictive practices had increased significantly since the last inspection, including the use of mechanical restraint.
• Governance systems had identified that limited formal debriefs were taking place. Managers had started to implement changes to address this. However, at the time of the inspection the level of formal debriefs taking place was not in line with trust policy.
• There was evidence of oversight and scrutiny of the use of restrictive practice within the trust management forums. However, the trust had not maintained a continued reduction in restrictive practices within services for children and young people.

However,

• The wards had enough nurses and doctors. Staff usually assessed and attempted to manage risks well.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff felt respected, supported and valued by local leaders.

How we carried out the inspection

We visited four wards at Ferndene and two wards at Alnwood. We spoke with 23 staff members including clinical managers, nurses, support workers and members of the multidisciplinary team, four young people, two carers and reviewed 15 care records and attended three meetings. We also spoke to the advocate and commissioners before the inspection.

What people who use the service say

We were able to speak to four young people who all said that they felt safe on the wards and that staff supported them. The young people said that staff had spoken to them after incidents of restraint, but one young person felt that they weren’t listened to about their experience of a restraint.

Updated 26 July 2018

Our rating of this service stayed the same. We rated it as outstanding because:

• Care records contained up to date individual risk assessments and management plans. Staff could review complex cases in a multidisciplinary risk meeting and seek support and guidance to ensure risks were appropriately managed.
• Staff worked collaboratively with young people and their family/carers to efficiently deliver care in an outcomes based approach. Young people were actively involved in reviewing their progress towards their goals and outcomes.
• Staff were trained in an extensive range of therapeutic interventions in line with National Institute of Health and Care Excellence recommendations.
• Care plans captured the voice of the young person and placed them at the centre of their care.
• Managers and commissioners were working together to reduce waiting lists and ensure the service met the needs of children and young people locally.
• Key performance indicators were embedded within the service and effective governance processes were in place to monitor the quality of the service provided.

However:

• Assessment of Gillick competence was not easily accessible in young peoples care records.
• The service was not always meeting the trusts target of 18 weeks from referral to treatment for certain specialist treatment pathways. Whilst there was an effective process of triage, which enabled the trust to identify higher risk referrals, there was no system for routinely monitoring the risks of young people on the waiting list for treatment.

Updated 1 September 2016

We rated community based services for people with learning disabilities or autism as outstanding because:

• A proactive approach to anticipating and managing risks to people who use services was embedded and was recognised as being the responsibility of all staff. This was reflected in the risk assessments and plans.

• Staffing levels were sufficient to meet the needs of the service. Staffing levels had been estimated by obtaining the advice of staff, carers and other agencies. This model had been implemented in the Sunderland team and was in the process of being rolled out to other teams.

• Staff knew how to report incidents. All staff were open and transparent, and fully committed to reporting incidents and near misses.

• There was a team approach to the prescribing of medication. The approach ensured that psychological and social factors were given full consideration before medication was prescribed. This meant that service users were less likely to be prescribed medication unnecessarily.

• There was a truly holistic team approach to assessing, planning and delivering care and treatment to people who use services. The safe use of innovative and pioneering approaches to care and how it was delivered were actively encouraged. New evidence based techniques were used to support the delivery of high quality care.

• We found the continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care. Staff were proactively supported to acquire new skills and share best practice. This was reflected in the specialist training provided and the effectiveness of multidisciplinary meetings.

• Staff had close links with external agencies, including them in multi-disciplinary team meetings where appropriate. The systems to manage and share the information that was needed to deliver effective care were fully integrated and provided information across teams and services. This was reflected in the training provided to external care providers and families.

• Feedback from people who use the service, those who are close to them and stakeholders was continually positive about the way staff treat people. People that staff went the extra mile and the care they received exceeded their expectations.

• The involvement of other organisations and the local community was integral to how services were planned and ensured that services met people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

• There were high levels of staff satisfaction across all teams. Staff were proud of the organisation as a place to work and spoke highly of the culture. There were consistently high levels of constructive engagement with staff across all teams. Staff at all levels were actively encouraged to raise concerns.

• The leadership drove continuous improvement and staff were accountable for delivering change.

• Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new and more sustainable models of care. This included working with other agencies to reduce the number of people with learning disability or autism living away from their local communities or in long stay hospitals.

Updated 1 September 2016

We rated community based mental health services for older people as outstanding because:

• There was a truly holistic approach to assessing, planning and delivering care and treatment to patients. Staff were responsive to individual patient’s needs and actively engaged in assessing and managing risk. Staff worked effectively together to share knowledge and deliver evidence-based treatment to patients.

• Staff empowered patients and carers to have an active role in their care and treatment. Staff developed positive relationships with patients and carers to ensure their needs and individual preferences were reflected in the planning of their care. Patients and carers reported staff went the extra mile and exceeded their expectations.

• The services were flexible, provided choice and ensured continuity of care for patients. Patients could access services in a way and at a time which suited them. Staff worked collaboratively with other services, within integrated person-centered pathways to ensure they met patients’ needs.

• Staff were committed to continually developing their skills and competencies to ensure they delivered high quality care. Staff attended additional specialist training to enable them to acquire new skills and share best practice. Staff were encouraged to take an active role in research and innovative practices.

• Leaders had an inspiring shared purpose which succeeded in developing a strong, visible person-centered culture. Staff were highly motivated to offer high quality care and were proud of the service they delivered.

• Leaders consistently engaged with staff and actively encouraged them to raise concerns. Staff were open and transparent in reviewing incidents and learning lessons when things went wrong. Staff shared this learning across the trust and this was used to inform service development.

However:

• Staff caseloads were high in some services and some services felt they did not have sufficient administrative support. Managers were aware of this and were continually reviewing ways to develop systems and processes to address these issues. Managers had sufficient authority to increase staffing levels as required.

Updated 1 September 2016

We rated mental health crisis services and health-based places of safety as good because :

• The service had effective systems to assess, monitor, and manage risks to people who used services. There was a clear pathway for people to access services including those people who referred themselves to the crisis teams.
• People who used services received care which focused on their needs and was based on recovery. Care records were of a high standard and most people who used services felt fully involved in their care planning.
• There was good inter-agency working with Northumbria police. The introduction of the street triage service had led to a significant reduction in the number of people detained under section 136 of the Mental Health Act.
• Staff provided kind and compassionate care and treated people who used services with dignity and respect.
• Staff provided support to carers and with consent included them in their relatives care.
• Staff received feedback from incidents and complaints. There were systems in place for learning and sharing from incidents and complaints to be cascaded.
• Overall compliance with mandatory training was good. Where areas were low managers had actions in place to improve.
• Staff were receiving supervision and had had an annual appraisal. Managers had taken steps to improve compliance with supervision. The steps taken had made a difference.

However:

• The service had an action plan with environmental improvements needed for two of the health based places of safety. There was not a date for completion of some of these required actions.
• There were conflicting reports from staff regarding how many staff should be available for police to hand over a detained person in the health based places of safety.
• There was not access to a full range of disciplines in the crisis teams. Staff told us they would like more access to psychology, occupational therapy and social work support.
• Some professionals reported delays in accessing services via the telephone response service.
• Staff removed medication from their original containers for people to use in their own homes which constituted secondary dispensing.

Updated 4 August 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Our rating of this service went down. We rated it as requires improvement because:

• There were not enough staff on Cheviot ward to make sure people always had the staff needed to keep them safe and meet their needs. People told us that when the services were short staffed, they could not do their planned activities and therapies.
• Staff did not receive the right training to ensure they had the skills and knowledge to meet people’s needs. At the time of inspection training in learning disabilities, autism and alternative communication methods was not mandatory and a low proportion of staff had completed training in these areas. Three mandatory / essential clinical training courses and overall rates of supervision and appraisals fell below the trust target.
• For one person, staff applied restrictions which were not proportionate to the current level of risk including long term seclusion and access to personal belongings. There was no plan to end the restrictions.
• One person’s care plan did not reflect an arrangement for communication with their multi-disciplinary team. Staff did not always have access to important information so that they could manage risks and meet the person’s needs.
• People were not always being cared for in safe and therapeutic environments suitable for people with learning disabilities and/or autistic people and people with physical disabilities. On Lindisfarne, people in seclusion did not have privacy and dignity as other staff not involved in their care entered the seclusion area regularly. Seclusion rooms were not fit for purpose on three wards. On four wards, people did not have access to a nurse call alarm system. There were issues with regulating noise and temperature on some wards and three wards had accessibility issues due to stairs. The environmental risk assessment for Rose Lodge had not been reviewed regularly and environmental risk assessments did not detail specific locations of ligature anchor points. The trust was building new wards to improve medium secure environments.
• Staff did not always ensure that people’s records contained evidence of their involvement in decisions about their care and treatment. Blanket restriction register did not contain all the restrictions in operation to ensure these were reviewed regularly.
• The use of restrictive interventions was high and there was a high proportion of prone restraint. There was limited evidence of lessons learnt from incidents shared and there was a delay in staff receiving a post-incident debrief on Acorn ward.
• The food ordering system was not person centred as people had to order their food two days in advance. People also told us mistakes happened with meals and this meant they did not always get their food choice.
• Carers told us that they wanted improved communication and involvement in their relative’s care.
• There were issues with nursing assistants and registered nurses not feeling listened to and involved in multi-disciplinary team discussions and decisions made on Mitford Unit which the trust was trying to improve.
• It was not always clear in some people with a learning disabilities’ records the reason why they had been initially prescribed anti-psychotic medicines.

However:

• The service mostly met the principles of ‘Right support, right care and right culture’.
• Staff managed discharge pathways as well as they could, but people stayed in hospital for longer than needed because it was difficult to find the right care and support in the community. This affected the services’ ability to care for new people who needed the service.
• Staff embraced people’s individuality and preferences on how they wished to live their lives. Some people staying in long-term segregation had regular access to leave to go out and had their own workshops for gardening, horticulture and vehicle repairs. Specialist assessments were completed to enable people to be safe and express their preferences.
• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. Staff had a positive and warm approach to people and their roles.
• People could do the things that they enjoyed than helped them to learn new things, skills and keep well. There were several health improvement initiatives to improve people’s physical health.
• Staff and people participated in research, clinical audits, benchmarking and quality improvement initiatives.
• The service used systems and process to safely prescribe, administer, record and store medicines.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Leaders were visible and approachable and worked flexibly to understand the service, support staff and meet people’s needs. Staff felt respected, supported and valued by managers and colleagues.

Background to inspection

Cumbria, Northumberland Tyne and Wear NHS Foundation trust provide mental health, learning disability and neurological care for people across the north of England. The trust also provides some national specialist services.

The trust provides nine wards that provide care to adults with learning disabilities and/or autistic people at Rose Lodge, Carleton Clinic and Northgate Hospital. These locations are registered to provide the following regulated activities:

• Assessment or medical treatment of persons detained under the Mental Health Act 1983.
• Treatment of disease, disorder or injury.
• Diagnostic and screening.

These wards comprised of:

• Rose Lodge – a learning disability and autism specialist assessment and treatment service for up to 10 people based in Hebburn in South Tyneside.
• Acorn – a learning disability assessment and treatment service for up to six people based at the Carleton Clinic in Carlisle.

At Northgate Hospital in Morpeth:

Autism services:

• Mitford Bungalows is comprised of four bungalows. Three bungalows had one bedroom and one bungalow had two bedrooms. Overall, the service can care for up to five people.
• Mitford Unit is a specialist autism inpatient service for up to 15 people.

Low secure and rehabilitation services:

• Tweed comprises of a low secure ward for up to 15 people and a low secure rehabilitation ward for up to eight men with a learning disability.
• Tyne comprises of a mental health low secure care for up to 12 people and a hospital based rehabilitation in an environment suitable for up to 12 people. At the time of our inspection, Tyne hospital based rehabilitation was being used to care for two people. We only visited the hospital based rehabilitation service as part of this inspection.

Medium secure services were based within the Kenneth Day Unit. All three wards are for men with learning disabilities. We visited:

• Lindisfarne which could care for up to 10 people.
• Cheviot which could care for up to eight people.

There was another medium secure ward called Wansbeck which could care for up to six people. At the time of our inspection, the ward was closed to improve staffing levels across the services. This meant that we did not visit the ward as part of this inspection, however we reviewed data about the service and have included this in our report.

This was the first inspection of all these wards. Our last comprehensive inspection of this core services was prior to the opening of some wards and services being acquired from a different provider. In 2020, following a focussed inspection of some of the wards, we issued four requirement notices in relation to breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These related to:

• Regulation 9 person centred care
• Regulation 12 safe care and treatment
• Regulation 13 safeguarding service users from abuse and improper treatment
• Regulation 17 good governance.

At this inspection, we found that these actions had been met.

In April and May 2022, we completed a focussed inspection of Rose Lodge and issued two requirement notices in relation to breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These related to:

• Regulation 12 safe care and treatment
• Regulation 18 staffing

At this inspection, we found that the action in relation to physical health monitoring had been met.

What people who use the service say

People using the service provided mostly positive feedback.

Most people told us that they liked the staff that supported them and thought that staff knew them and their needs well. Most people told us that they could do the things they enjoyed that helped them to learn new things and keep well.

However, people also told us that they could not always go out or do the activities they had planned when there was not enough staff. Some people told us that there were issues with mistakes being made with meals which meant sometimes people did not get their choice of food.

Carers provided variable feedback.

Most carers told us that they felt their relative was safe and received support from staff that knew them well. Some carers told us their relative was more settled emotionally since after entering the service. They felt were welcomed by staff into the service when they visited.

However, many carers told us that they wanted to have more contact with their relatives, be more involved in meetings and receive more information from staff about their relative’s progress. Some carers told us that technology was a barrier to being able to attend the meetings they had been invited to.

Some carers told us there were delays in their relatives being able to move on from the service and that they did not think that all staff were sufficiently trained or experienced for their roles.

Updated 1 September 2016

We rated Northumberland, Tyne and Wear NHS Foundation Trust Forensic Inpatient/Secure wards as good because :

The service was built around a principle of person centred practice, which was representative of the trusts values, this was demonstrated through the interactions we observed between staff and patients. Staff were seen to demonstrate dignity, respect and an understanding of individual needs within their interactions with patients.

There was an open culture in the service and patients were able to approach staff or managers for support at any time. Patients’ views were sought through regular 1:1 time, weekly multidisciplinary meetings and clinical case reviews; these were reflected in patients care planning, individual therapeutic programme and outcome measures. Patients were also encouraged to provide feedback on the service through the use of comments cards and regular community meetings.

The service held a weekly multidisciplinary single point of referral meeting which included representation from NHS England. All new referrals were discussed to decide if the service could meet the needs of the patient and which ward would provide the most appropriate care pathway. Patients received a multidisciplinary pre-admission assessment, which included an assessment of patients’ physical health and any on-going support which may be required following admission.

Patients had the support of a full multidisciplinary team who worked with patients to provide an individualised support package specific to the patients needs including a range of psychological and occupational therapies. Facilities within the service supported this through the provision of therapy rooms, therapeutic kitchen, activity rooms, a gym and an all-weather outdoor sports arena. The service also had links within the community to provide patients access to activities including an allotment and walking groups.

Patient completed both a Functional Analysis of Care Environments and Historical Clinical Risk assessment with staff. These were live documents which were updated as needs changed or a minimum of every three months. Oswin ward had also developed a formulation pathway for patients which included input from the patients and all relevant professionals to ensure the service had a full risk profile of the patients.

The principles of relational security were embedded within the service and all staff we spoke to were able to describe the importance of this. The use of restraint and seclusion was low, this was seen as a last resort and staff used their knowledge of and relationship with patients to identify potential trigger points and de-escalate behaviours before issues arose

The seclusion room on Aidan did not meet the recommended standards for seclusion facilities, the service was aware of this and work had begun on building new ‘Gold standard’ seclusion facilities.

When incidents did occur there was a process of providing a debrief for both the staff and patients involved. Incidents were monitored and reviewed; lessons learned were shared across the service and discussed within team meetings. The staff we spoke to were able to articulate their responsibility under the Duty of Candour and provide examples of when they would need to fulfil this responsibility. The trusts electronic incident recording system provided prompts for staff to consider the need for the Duty of Candour.

Staff morale was seen to be high across the service; staff were aware of the trusts visions and values and could describe how these were embedded from the point of recruitment in to supervision and appraisals.

Updated 25 July 2018

We did not rate long stay/rehabilitation wards for working age adults at this focused inspection. All ratings shown in this report are from our previous inspection in June 2016.

We found the following issue that the trust needs to improve:

• Patients identified as being at risk of choking or swallowing on Bridgewell ward did not have this documented in their risk assessment, although these were reflected in care plans.

However, we also found the following areas of good practice:

• Patients’ risks were being assessed, monitored, and managed on a daily basis. Staff recognised changes in risk and responded appropriately.

• Staffing levels were adequate to keep people safe and effective handovers were taking place to ensure staff were able to manage risks.

• Staff were raising concerns and reporting incidents. These were investigated appropriately and lessons were communicated widely to support improvement.

• Patients were receiving a comprehensive assessment of their needs. Care and treatment was delivered through care plans, which reflected their needs.

• Staff had the skills required to deliver care and treatment. Learning needs were being identified and training was delivered to meet these needs.

• Staff were working together to assess, plan and deliver care and treatment.

Updated 26 July 2018

Our rating of this service stayed the same. We rated it as good because:

• There were good patient risk assessments on each ward. The service provided a safe environment and managed risks well. Patients told us they felt safe. Risk assessments included monitoring of existing and potential physical health risks.
• Staff understood that the use of restraint was a last resort. They used de-escalation and low levels of restraint to manage incidents of aggression wherever possible. Staff ensured they documented episodes of seclusion, restraint, and rapid tranquilisation in accordance with trust policy. The ward took part in the trust restrictive interventions reduction programme and reported incidents of restraint appropriately.
• Patients had detailed, personalised care plans, which included information about physical health needs. Patients and their carers felt involved in decisions about their care. Staff gathered information from families and carers to complete the Newcastle model of assessment record for patients with cognitive impairment. This reflected a patient’s history and preferences and contributed to their care plan. They used the five P’s assessment tool for patients with a functional mental health issue.
• There was effective multi-disciplinary team working with regular reviews of patients care and treatment needs. We saw the Mental Health Act, detention papers and associated records completed appropriately. Staff understood the application of the Mental Capacity Act. They recorded best interest decisions including when significant decisions were made for patients who lacked capacity.
• Patients, families, and carers appreciated and spoke highly about the quality of care and treatment the service provided. Staff involved patients in decisions about their care where possible. They engaged with and supported families and carers where appropriate. Staff contacted families and carers with updates on patient progress, held regular carers meetings, and invited them to reception meetings.
• The service accommodated patients in trust beds and sent them out of locality rather than out of area, they moved patients back to their local areas as soon as they were able, this meant carers could visit more easily. Staff worked towards discharges from the point of admission and where possible staff visited care homes and/or families to discuss the level of support the patient would need when they left hospital.
• On the functional disorder wards, activities were structured and planned whilst in the organic wards activities were ad-hoc and individualised. All of the wards had activity workers who worked shift patterns; this meant they were available to assist staff with activities on evenings and weekends.
• Internal changes within the service had led to a positive change in culture. Staff focused on the needs of the people using their service, providing high quality patient centred care, which reflected the trust’s vision and values. However:

However:

• On Castleside, there was an unpleasant smell and signage on the doors had been ripped off as well as flooring that had been damaged by a patient.
• We looked at 32 patient records and each patient had a risk assessment in place. However, some of the information was very brief, a question was answered with a tick and no explanation, and some of the information was not dated.
• Staff kept written records throughout the day of the patients’ dietary intake, their health checks and how their mood was. This information was added to the progress notes on the computer. However, we saw that these notes were not always added to the record in a timely way.

Updated 26 July 2018

Our rating of this service stayed the same. We rated it as good because:

• The service was providing effective care. All patients had a care plan which was regularly updated. Patients had access to a range of care and treatment options which were in line with national guidance. Staff were supervised effectively and had access to additional specialist training. Staff understood and implemented the Mental Health Act and Mental Capacity Act effectively.
• Staff were caring. Feedback from patients and carers was consistently positive about staff attitudes. The service was organised in a way that ensured staff focussed on interacting and engaging with patients as opposed to administrative tasks. Care records showed evidence of ongoing patient involvement and engagement through regular one to one sessions with nursing staff. Carers told us that they felt appropriately informed and involved in the care provided by the service.
• The service was providing care in a way that was responsive to people’s needs. Beds were managed appropriately to ensure that people could access the service when they needed it. Wards had a range of facilities to promote comfort, privacy and dignity. Most wards had good accessibility. The service could access interpreters, translators and other services designed to meet individual needs.
• The service was well-led. There was a stable management team with managers at all levels who had the skills, knowledge and experience to perform their roles. Ward managers and senior managers were highly visible on the wards and staff told us that managers at all levels were approachable. Almost all staff we spoke to told us that they felt respected, supported and valued. There were good systems and processes in place to assess and monitor quality and safety on the wards.

However;

• There were areas of improvement to maintain safety on the wards. Staff were not monitoring the physical health of patients after the administration of rapid tranquilisation. Several wards had implemented blanket restrictions. The service was not regularly reviewing blanket restrictions. Nurse call alarms were not available in patient bedrooms on seven of the eleven wards. Ligature risk assessments on two of the eleven wards had not identified all potential ligature points in patient accessible rooms.

Updated 1 September 2016

We rated substance misuse services as good because;

All areas were clean, well maintained and offered good facilities for the service to be delivered. Staff carried personal alarms and adhered to the lone working policy. Clients and staff told us they felt safe using the service. Clients had risk assessments which were comprehensive and up to date. There was a system in place to ensure that incidents were recorded and investigations were undertaken whenever necessary.

Clients spoke positively of the service; they felt involved in their treatment options and told us the staff team treated them with dignity and respect. There was a helpful pack available to clients and carers which described how the service worked and information regarding support available through other agencies.

There were several treatment pathways available to clients depending on their individual needs. Teams took active steps to keep clients engaged in treatment including an initiative for clients new to the service and making contact with clients who did not attend appointments. Staff knew how to support clients in making a complaint and there was information available through the information packs and within all premises informing clients how to make a complaint.

We saw evidence of how the aims of the service were upheld by the staff team. Staff described good working relationships within the partnerships and the other agencies involved, Mandatory training, supervision and performance appraisal was undertaken within all teams.

Staff knew how to report incidents, complaints and safeguarding concerns and the service had developed an APP (software designed to run on a computer) to support staff in getting feedback on incidents, the outcomes and any shared learning or changes to practice. There was a risk register which listed risks, actions, dates and those responsible for taking any action.

However;

In one location services were provided on the first floor of the building and there were no facilities for anyone with physical disabilities to access these areas. Staff told us this could be problematic but this was mitigated by using alternative rooms for clinical interventions or clients manoeuvred the stairs as best they could.

A system for checking medical equipment in one location had recently been introduced but had not been undertaken in the week of our inspection.

The system for checking stocks of prescriptions in one location did not allow for regular reconciliation of unused prescriptions.

Updated 1 September 2016

We rated community-based mental health services for adults of working age as outstanding because:

There was a truly holistic approach to assessment, care planning and delivery of care to patients:

• Assessment and treatment of patients was a multi-disciplinary approach and considered the holistic needs of the patient which was incorporated into their care and treatment.
• Where appropriate patient’s religious and spiritual identity was incorporated in to their recovery journey, care and treatment through access to spiritual therapy which was delivered by the chaplaincy team.
• Creative care planning was used to meet patient’s needs. A pictorial care plan was created for a person with a learning disability written in basic language with easy read pictures.
• There was good access to a range of psychological therapies in both group and individual sessions recognised by National Institute for Health and Care Excellence.
• Patient’s physical health was seen as an integral part of their mental health care and treatment. Robust systems were in place to identify and monitor people’s physical health. Physical health checks and monitoring of medication levels such as, high dose anti-psychotic medication therapies, clozapine and lithium were completed and recorded.
• Teams used recognised outcome measuring tools to measure patient rated outcome and experiences, clinical rated outcome measures were used, such as perspective on side effects of medication.

• Patients and staff participated in research. Hexham community mental health team participated in NHS research in a focussed study into the effectiveness of cognitive behavioural therapy in people with a diagnosis of schizophrenia.

There was a commitment to the continual development of staff and their professional development. Professional development of staff was maximised through team training stars developed using evidence based information, considered patient need and team feedback about staff learning needs.

Teleport house was equipped with a private treatment recovery room which was furnished with comfortable furniture and entertainment facilities.

The feedback from patients and their carers was universally positive. Patients and their carers felt that they were an active partner in their care and told us that staff went the extra mile. Patient’s felt that staff understood the totality of their needs from mental health, physical health to spiritual and religious identity.

• Teams made reasonable adjustments for patients with additional needs.
• Risks to people were assessed and monitored.
• Staff reviewed risk assessments regularly to reflect any changes in risk to people. Teams identified and responded to changes in people’s health. Teams were flexible and saw people urgently when needed.

• Teams used lone worker procedures and equipment was in place to support and protect safety of staff.
• Feedback from investigations was shared with staff in team meetings and in email communications from the trust.
• Gateshead community treatment team (non-psychosis) held weekend assessment clinics when needed.
• The trust’s vision and values were embedded into teams. Staff knew the trust’s values and explained how these applied to their everyday work.
• There was an open and transparent culture to raising concerns or issues to management and there was good staff knowledge of the trust’s whistleblowing policy.
• Services were well managed with good governance structures. Staff knew who senior managers were. Staff felt supported by their managers and managers had the authority to make decisions about their service.