Tees, Esk and Wear Valleys NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service provided effective care. People had their needs assessed, and most people we talked to said they were involved in the planning of their care and that their care was regularly reviewed. We saw staff supporting people with their mental health needs and the physical health monitoring. People received evidenced based care and treatment and there were regular multidisciplinary meetings where learning could be shared and staff at all levels attended various meetings. People were able to and encouraged to give consent to care and treatment. However, the service’s approach to monitoring outcomes was not robust. When we requested the trusts quality of life outcome tools, they provided data on a tool that was very rarely being completed at the correct timescale as per the trust’s guidance. People using the service had mixed reviews about the effectiveness of the service to liaise with external organisations and to share information with each other.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff working for the mental health crisis teams worked with patients and families and carers to develop individual care plans and updated them when needed. 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. Two of the carers we spoke to had been provided information about being a carer. None of the people we spoke to had accessibility or communication needs.

Staff assessed the mental health needs of all patients. Care plans reflected the assessed needs, were personalised, holistic and recovery oriented. Staff told us that all people using the service had comprehensive assessments of their health. This included any support required with communication needs, religious needs and if their families or carers were to be included in their care. Staff told us that they worked with people using the service to make decisions about the care they would receive and they link in with external organisations who can offer additional support.

Staff assessed and managed risks to patients and themselves. We saw evidence of all patient needs being documented and responded to appropriately through both care plans and interactions between staff and people. The trusts’ “Our Journey to Change” strategy included co-creating with patients, carers and their families. Durham and Darlington Crisis team were in Business Continuity at the time of the assessment. This was due to low staffing and the trust had recognised this may lead to a potential reduction in treatments being offered to people.

Most people were happy with the amount of information and support provided to them. 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 of care plans. Ten of the people we spoke to said they felt staff were genuinely interested in their health and wellbeing. Some people said the service liaised with their GP about physical health concerns and that their physical health was reviewed during the assessment including any allergies. They also said that there were multiple professionals who provided support such as occupational therapy and social workers.

Staff provided a range of care and treatment suitable for the patients in the service and delivered care in line with best practice and national guidance (from relevant bodies eg NICE). Staff told us there was oversight from senior medics and pharmacy teams in regard to medicines and that staff regularly engaged in clinical audits.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. Managers used results from audits to make improvements. The care plans we reviewed showed all physical health monitoring was completed as expected and all medications were prescribed in line with NICE guidance. The trust told us that medical and non-medical staff all attend various committees and meetings to aid their knowledge and expertise. The trust completes a rolling annual assessor peer quality review where learning is shared and improvements undertaken. Care records we reviewed contained evidence that good practice was adhered to. There were regular MDT reviews and appointments with patients to ensure ongoing monitoring and assessment of risk. People were offered help to access cognitive behavioural therapy (CBT) and trauma therapy.

Some of the teams did not always have effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation. Ten of the 14 people and 5 carers said the service liaised well with other teams and organisations. However, 1 carer and 1 person said there had been issues with the service when liaising outside of the trust which had led to a formal complaint being submitted against the trust and also delayed treatment for 1 person.

Staff told us they supported each other to make sure patients had no gaps in their care. They said they took part in regular daily and monthly meetings to discuss people’s care and treatment and the running of the services. They said there was a lot of teams who worked collaboratively with the services including the police, and they were able to access the information they required. Agencies had worked with the trust to create processes and policies to enable joined up working that benefited the people who used crisis services. Staff working in the acute trust told us they hoped to have more training on mental health or had more input from the mental health trust.

Staff we saw from different disciplines worked together as a team to benefit patients. We observed multiple interactions where staff worked closely with each other and support was provided and where staff interacted and supported people using their service including referring them to appropriate services. Teams were observed sharing information in the daily multi-disciplinary meeting at the Durham crisis service and discussing the need to share the information externally to ensure people received appropriate care from all relevant providers.

We saw evidence that internal teams and external services worked together. This included crisis teams working alongside patient liaison psychiatry teams, community mental health teams and housing support networks. However, some external organisations told us that transport to Section 136 suites was an issue due to lack of ambulance availability. Within the Cleveland district, between April 2023 and March 2024 there had been 172 section 136 detentions of which 152 had been transported in a police vehicle. Organisations told us that due to the size of the trust, that any closures of services, such as section 136 suites, had a large impact on other parts of the system and that travelling times to services due to reduced resource placed additional pressure on professionals having to travel longer distances. There had been a closure of a section 136 suite in Harrogate and organisations told us this meant more people were now attending the Darlington, Durham and Tees region to access a suite. There were medical on-call rotas that covered all sites to ensure staff could access further support if needed at any time and the trust had a Sharing Information and Confidentiality policy in place to ensure all staff were aware of what information could or could not be shared about people who used the service.

Staff made sure patients had support for their physical health and mental health needs, either from their GP or community services. Eleven of the 14 people we spoke to said they had been offered support to manage their own health and wellbeing and maximise their own independence. This included being referred to other external organisations who offered additional counselling, group therapy and home visits.

Staff supported patients to live healthier lives by supporting them to take part in programmes or giving advice. Staff told us that they provided advice to people about their health and wellbeing and promoted healthy lifestyle options. They referred people to external agencies when they have needed additional physical health support.

We saw evidence that staff educated people on the benefits of healthy lifestyle options. The trust did have a voluntary service team which supported people in areas such as activity support, gardening and the use of therapy pets.

People gave mixed feedback on the outcomes of their treatment. Out of the 14 people we spoke to, 8 said there was no forward planning that they were aware of. Others told us that their care was regularly reviewed and they were referred to appropriate teams when they no longer had crisis needs such as the community mental health teams or their local GP.

Staff told us they used multiple tools to monitor outcomes from people’s care and treatment and that these were audited. Durham crisis service also told us that they had started quality assessing the calls coming in to the crisis services and held meetings to discuss the findings.

Staff did not always use recognised rating scales to assess and record severity and outcomes. Although we did see evidence in some care records that outcome measures had been used when planning care, this wasn’t in all the care plans we reviewed. The trust used a subjective quality of life outcome tool where people rate their satisfaction on life domains and treatment aspects. The trust said there had been no returns completed for the York Crisis and Home Treatment team during the period of May 2024. In the other services, the percentages of this tool being completed as per the trust guidance was 0% for both the Darlington and Durham Crisis teams and the Harrogate Community team. Darlington and Durham Liaison teams were 43%, Scarborough, Whitby and Ryedale Crisis Resolution teams were 33%, and York Psychology Liaison team was 29%. All other teams were within compliance. The trust told us they were reviewing the suitability of this assessment tool within the service. It was unclear how staff knew whether their interventions had been successful and some staff described “routine offenders” who would regularly contact the service and have multiple admissions to inpatient mental health settings. However, we did see some attempts by the occupational therapy team to measure outcomes and review the effectiveness of their treatments. At Roseberry Park Hospital crisis assessment suite, whilst the trust monitored length of stay for people who were detained under Section 136 of the MHA, they were not doing so for those who were voluntary attenders or who did not come in under Section 136. Therefore, it was not possible to measure how long patients were staying in this area and as such whether they were cared for appropriately whilst there. Additionally, the data provided measured time from the start to end of detention under Section 136 but did not measure how long a person was actually in the suite despite detained status.

Staff did not always explain to people their rights in a way that they could understand or inform them about advocacy. Of the people we talked to, half had been informed about their rights to consent and / or advocacy that may be available to them. Whilst the other half said they had not been informed.

Staff received and kept up to date with training on the Mental Health Act (MHA) and the MHA Code of Practice and could describe the Code of Practice guiding principles. Staff were aware of patients’ rights around the Mental Capacity Act and the Mental Health Act and could access support from the trusts Mental Health Act team and relevant external advocates if needed. Training compliance for all MHA and MCA courses were above 75% in all teams. However, there was a 72.22% compliance rate for training about the relationships between the MCA and MHA in the Scarborough, Whitby and Ryedale crisis resolution team. Staff had access to support and advice on implementing the MHA and its Code of Practice. Staff knew who their Mental Health Act administrators were and when to ask them for support. There was a clear policy on the Mental Capacity Act, which staff could describe and knew how to access. The trust had a Mental Capacity Act policy in place.

Staff supported patients to make decisions on their care for themselves. We observed staff asking for consent from a person using the service to ensure they were comfortable with their information being shared with the inspection team.

The trust had regular contact with advocacy services. We saw within care records that most patients had their capacity assessed and consent was gained before making referrals to other external services. The trust had a MHA (Mental Health Act) administration team who completed regular MHA and MCA (Mental Capacity Act) audits to ensure compliance and were also available to support the teams with advice around these legislation’s. All people who accessed the section 136 suites, (is a facility for people who are detained by the Police under Section 136 of the Mental Health Act), regardless of MHA status, received appropriate access to food and drink. The trust confirmed that people using the suites had access to snacks, toast, water and hot drinks all day and night.