Tees, Esk and Wear Valleys NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The service was not always well led. Staff shared a shared vision and culture, worked with capable and compassionate leaders and there were sound structures in place for staff to speak up. There was a strong quality improvement culture, and leaders were encouraged to develop themselves and the services. The trust were aware of the risks in the service and had robust plans in place to make improvements, particularly to issues around staffing and acuity. Staff told us that the recent move to the 111 service as having a positive impact on the service. However, there were some areas of governance which did not ensure the safe running of the service; this included the concerns we found in relation to the governance of medication storage, data and information management and the training and supervision of staff. 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. We spoke to multiple external organisations who work alongside the trust. Some external partners felt the trust did not communicate well and did not include them when deciding targets or agreeing a shared direction whilst others said that local and national initiatives for joint working had been positive.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The trust had a shared vision and strategy. The trust’s strategy was first launched in 2020, named ;’Our Journey to Change. The staff we talked to were all aware of this strategy and felt they had been and were able to feed into the developments. Staff told us they feel included in the vision and direction of the Trust and that they were able to feed back on the service during regular meetings and supervision.

The trust had a clear strategy in place based on engagement with others. The trust had committed to deliver a great experience with people, with colleagues and with partners by focusing on the • clinical journey • quality and safety journey • people journey • co-creation journey • infrastructure journey. The trust reviewed their progress on meeting their strategic goals regularly and a quarterly delivery plan monitored progress and kept senior leaders up to date. At the time of the inspection, the trust had launched their next ‘big conversation’. This is a process by which staff, service users and partners can give their views and support the trust’s ongoing strategic direction. There was also a delivery plan in place to ensure the delivery of the trust wide crisis line where monthly updates of the progress were delivered to board.

Staff told us that there were many opportunities for development including degree level management training. Most staff are very appreciative of the support they receive from their local managers who they say are very visible and keen to help if needed. Although some staff have seen members of the senior leadership team in person, this is not a regular occurrence for all staff.

The trust had a number of leadership programmes in place to ensure capable and compassionate leaders were in place within services. The trust focussed on quality improvement and supported managers and teams to become involved in quality improvement programmes. Senior leaders undertook board and executive level visits to services across the trust footprint. The crisis team at Durham said that the trust’s CEO has been visible to them, especially since they have gone into the business continuity process.

The trust did give people who worked at the trust opportunities to speak up. All staff we spoke to were aware of the freedom to speak up guardian and the whistleblowing policy and felt able to raise concerns without fear of reprisals.

When concerns are raised, leaders investigate sensitively and confidentially, and lessons are shared and acted on. The trust had a Freedom to Speak Up Policy (whistleblowing) in place.

The trust valued diversity in their workforce and they worked towards an inclusive and fair culture. Staff told us the trust had multiple colleagues who had been assigned equity and diversity champion roles for areas such as Black, and minority ethnicity and LGBTQ. The trust provided flexible working arrangements for people who needed it, like people with child care responsibilities.

The trust had various ways to engage and involve staff. These included staff networks and staff support groups. Networks available to staff were for long term health conditions, the rainbow network, BAME (black, asian and minority ethnic) network, working carers, and the neurodiverse network.

Staff were aware of trust policies and where information could be found. Staff told us that they understood the governance processes in place and the standard operating procedures in place for the service. However, staff told us the procedure for clerking in patients was unclear at the crisis assessment suite at Roseberry Park Hospital and staff were unaware of how to follow this safely and leaders could not tell us how many safeguarding alerts they had raised in the last 12 months which had progressed to a section 42 report.

However, there were some areas where improvements in governance were required. We found no standard processes for managing medication for patients who were “bedded down” without formal admission and the procedure for clerking in patients was unclear at the crisis assessment suite at Roseberry Park Hospital and staff were unaware of how to follow this safely. The data collated by the trust in some areas was unclear and did not ensure the trust could make improvements to care delivery. The trust had not ensured that staff were in receipt of appropriate levels of supervision or that all staff had received required mandatory training. The trust could not tell us how many safeguarding alerts they had raised in the last 12 months which had progressed to a section 42 report although the trust told us they had introduced a new system from February 2024 which would capture how many safeguarding concerns had progressed to a section 42 investigation. The implementation of a new computer system had been frustrating and there were daily meetings to ensure fixes were found. Although some data had been compromised, the trust said they had not seen an impact on patient care as a result but rather the quality of the data being provided for governance.

Of the 14 people who had used the service and 8 carers we spoke to, 14 people said the services liaised well with other teams and organisations to ensure their continuity of care. However, 5 people did say services did not liaise well and there was a lack of communication with one leading to a complaint being raised.

The trust told us they had established quarterly Mental Health Operational Groups within each care group which included representation from the police, local authorities, partner organisations and the trust. The first meetings were held in April 2024 and workstreams were identified to ensure issues could be reviewed and actioned upon.

We spoke to multiple external organisations who work alongside the trust. Feedback from each was variable depending on their roles and their locations. In the North Yorkshire and Selby region, some local authority partners felt the trust did not communicate well and did not include them when deciding targets or agreeing a shared direction. They acknowledged that the teams were under a lot of pressure and may have staffing issues, and this may have led various concerns such as, the phone at crisis not always being answered, having difficult relationships with some staff and difficulties in sharing learning. This relationship was much stronger in most of the Durham, Tees Valley and Forensic Care Group, they told us that the issues they had raised have been heard and the trust staff appear to want to listen and support change and learning. Although a shared direction was still missing with partners not being included in operational change decisions and there were still concerns that in some areas individual staff were reported as sometimes dismissive and lacking compassion towards people. Police in the Durham, Darlington and Tees region said that local and national initiatives for joint working had been positive. All representatives found the control room and street triage particularly effective but did acknowledge that this could be variable due to staffing availability. Approved Mental Health Practitioners fed back that they had been unable to raise concerns or have regular meetings to discuss issues with the trust and that information was not always shared or when shared, was sometimes incorrect. The trust told us they had established quarterly mental health operational groups which included representation from the police, local authorities, and partner organisations.

The trust had various groups, networks and meetings in place for working with external organisations. These included, but were not limited to a focus on urgent care, ambulance response, and mental health pathways.

Staff told us they were involved in learning that was shared by the trust in various ways such as supervision, reflective practice and team meetings. Managers said staff were reflective and responsive when there had been any lessons learned.

The trust and trust staff were actively involved in a variety of research initiatives and projects. These included, but were not limited to, the interconnection between mental and physical health to improve diagnosis, research into how to improve the mental health of public and healthcare staff, and staff experience of interactions during crisis interventions.