Tees, Esk and Wear Valleys NHS Foundation Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

The service provided care in a kind and compassionate manner. Staff told us and we observed them treating people who used the service with kindness and respect. People were treated as individuals and offered independence, choice and control. Of the 14 people we spoke to who used the service, 10 said staff were caring, kind and respectful whilst 1 person said they had been hung up on, and another said they were “treated like rubbish”. The trust had not always been able to ensure workforce wellbeing for the staff working in the service. The trust was not always able to respond to people’s immediate needs. We saw evidence that calls had been abandoned and waiting times in some services were outside of recommended levels.

This service scored 65 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people we spoke to said staff were kind, caring, respectful and polite and interested in their wellbeing. Nine out of 14 people who had used the service and 5 carers said the service acted in an open and transparent way. Whilst 5 people who had used the service said the service had not been open and transparent, with 1 person saying they had been hung up on when they had called, and another said they were treated like rubbish.

Staff treated patients with compassion and kindness. Staff told us and we observed them treating people who used the service with kindness and respect. Most staff had received information governance training and all staff we spoke to understood the importance of maintaining patient confidentiality.

Some teams did not always treat colleagues from other organisations with kindness and respect. We held focus groups with external organisations from across all the local authorities that the trust covers. In North Yorkshire, York and Selby some external organisations felt they were not respected by the trust and that some staff were challenging and confrontational. Whilst in Durham, Tees Valley and Forensic Care Group, some external organisations felt they were forgotten about when it came to making operational changes and that they found some staff to be dismissive, not compassionate and not caring. Other organisations said that they found when issues had been raised with staff that they appear to listen and to want to support change and learning.

All interactions we observed between staff and people using the service were kind, caring and compassionate. Staff took efforts to maintain people’s dignity and showed empathy and understanding. This included our observations of face to face appointments, calls into the service, and home visits.

Staff in the mental health crisis teams involved patients in care planning. Eleven out of 14 people we talked to who had used or used the service said they were involved in their care planning. Nine of these people said their care was regularly reviewed and they had received copies of their care plans. Three carers also stated they had been involved in the care planning and reviewing.

Staff made sure people understood their care and treatment (and found ways to communicate with patients who had communication difficulties). Staff said they were confident in how to access interpreters and those trained in British Sign Language should a person need them. Staff told us they were able to adapt interventions depending on the needs of the people using the service and that religious and other protected characteristics were considered.

We saw staff ensuring patients understood their care and treatment. We observed positive interactions between staff and people using the service, including ensuring people understood the information being provided to them and respecting people’s wishes, such as when we observed staff using people’s preferred pronouns during assessments.

The service met the needs of people including those with a protected characteristic. We saw evidence in the care records we reviewed that people were provided with health passports and interpreters. Access to British Sign Language interpreters was advertised in some locations. We saw that people’s communications needs and protected characteristics were flagged and reflective in peoples care plans. The trust had a policy on human rights, equality diversity and inclusion which encompassed the Equality Act 2010 and the Human Rights Act.

Most of the people we spoke to said that staff were caring, respectful and polite to them and that the needs of their carers were considered. They said they were supported to access additional services outside of the trust to maximise their independence. However, some people did say they had not been treated with respect.

Staff supported, informed and involved families or carers. Staff told us that they regularly discussed family involvement and support with the person using the services. They said they actively refer people to external organisations to support other areas of a person’s life such as housing and social issues.

Staff involved patients in decisions about their care and treatment In all interactions we observed we saw staff allowing people the time to speak and explore support available for them.

The trust had multiple patient forums and services available within the North Yorkshire and Selby region. Although the Durham, Tees Valley and Forensic Care Group had no internal forums or services for this group of people, they did have a list of external agencies they could refer to and we saw people being given advice about this whilst we were on site. The trust also had a voluntary service team which provided support to people such as a service who made telephone calls to people and also the option for chaplaincy and therapy pets.

People said that the service generally had enough staff to keep them safe. Ten out of 14 people and 3 carers said there was enough staff to meet the persons needs and were able to respond to any concerns raised. One person did state there was a lack of psychologists on a weekend and a carer said there had been an issue where a member of the team wasn't aware of a change in medications but this was rectified. Care records we reviewed evidenced staff response to immediate needs such as referrals to the intensive home-based treatment team for suicidal thoughts, arranging for a medical review for a patient whose mental health had deteriorated and arranging for psychology sessions. People who did not attend appointments were followed up with and the trust policy followed.

Staff completed and regularly updated thorough risk assessments of all areas and removed or reduced any risks they identified. Staff told us that triage tools at point of contact allow them to identify any immediate risk and they have multiple responses to react to this risk. The trust has response time targets which they can monitor, however, staff did tell us that the providers new computer system did mean there were some concerns with the accuracy of the data available.

All staff we observed were compassionate and empathetic. Decisions about the persons care was based on individual need and ensured care was provided quickly if needed.

The trust had implemented the crisis mental health emergency help line, NHS 111, in March 2024 with national rollout in April 2024. In May 2024 the number of dropped calls to the Durham Tees Valley team were 740 and the North Yorkshire, York and Selby team were 639. When calls were being directed to the triage team, the number of dropped calls were 307 in Durham and Darlington, 286 in Tees and 216 in North Yorkshire, York and Selby. The average time to answer a call in May 2024 was 56 seconds whilst the NHSE ambition is 20 seconds. In April 2024 the Darlington and Tees Valley region had 10% of calls abandoned and this was 29% in North Yorkshire, York and Selby. The trusts risk register noted that the 10% of dropped calls for the Darlington and Tees Valley region had significantly improved from 66% in February 2024. The psychiatric liaison teams 1 hour response time for assessments for May 2024 were achieved over 75% of the time. However, the Darlington and Durham team had achieved it 67.24% of the time and the North Yorkshire team 70% of the time. In 2022 the trust had added “people awaiting inpatient beds are requiring care in the Crisis Assessment Suite and 136 suites for long periods of time. This poses a risk to delays in patients getting timely treatment” on their risk register. The risk rating had decreased from a score of 16 to 12, with a target risk rating of 4. Trust policy states an inappropriate stay in a Section 136 Suite is when it has taken longer than 4 hours to identify an inpatient bed. In the North Yorkshire, York and Selby region, there were 7 times between January 2024 and May 2024 where delays were experienced mainly due to a lack of bed availability and Approved Mental Health Practitioner (AMHP) availability. The suite in York was decommissioned twice due to bed availability. Darlington and Tees Valley region had 20 patients detained to the Section 136 Suite and 17 patients awaiting informal admission for greater than 4 hours.

The crisis team in Darlington, Durham and Tees were on a Business Continuity Plan due to the lack of staffing. Most staff said the workloads felt unmanageable due to these staffing pressures and felt unable to complete documentation within their working hours. Some staff said they received supervision and support from their direct team leads but felt that senior leadership did not understand the pressures, whereas others felt that senior leadership had been more visible recently. The teams said they felt supported and were able to raise concerns without fear of retribution. They gave examples of wellbeing initiatives and processes in place to support safe working practices. Some staff told us that relationships with colleagues from other internal teams and external organisations were not always positive due to their being a negative view of the crisis teams and a lack of understanding about what does or doesn’t require further assessment. The Psychiatric liaison team who worked at University Hospital North Durham (UHND) were no longer located on site in the acute hospital but at a trust location. The team told us they had an hour to respond to people presenting at the emergency department which could be challenging due to them having to travel from another location. The trust and UHND were working together to ensure an appropriate location was found and they were soon due to have access to UHND’s patient system. The York psychiatric liaison team did not have an office space in the emergency department at York Teaching Hospital to support them to work closely with their colleagues. The team shared concerns with us about their safety when accessing their office at night and attending the acute hospital grounds when lone working. We raised this with the trust they confirmed the team are located in a portacabin outside of the emergency department and that York Teaching Hospital will provide chaperones if required. The trust had a lone working policy in place.

The trust acknowledged the pressures on staff. They had provided an updated to the regions Care Group Board on the Durham and Darlington Crisis Business Continuity plan and recognised within this that there was evidence of reduced team morale and this impacted on team wellbeing due to the gaps in staffing. The existing team members are offering high levels of overtime to support the service which has the potential to impact upon the existing staff’s resilience and well-being. The trust had multiple mental health initiatives and mechanisms in place to support staff which included psychology services and peer support networks.