Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Ratings - Community-based mental health services for adults of working age

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Good

• Responsive

  Good

• Well-led

  Requires improvement

Our view of the service

• We assessed Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Community-based mental health services for adults of working age on site from 25 to 27 February 2025.
• We assessed the service due to information that we had received about the service and due to the length of time since it was last inspected.
• Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust was registered with CQC in April 2010 to deliver the regulated activities: Personal Care, Treatment of Disease, Disorder or Injury, Assessment or medical treatment for persons detained under the Mental Health Act 1983 and Diagnostic and Screening procedures. The service had a controlled drugs accountable officer and a Nominated Individual.
• We visited the following teams as part of the assessment:
• South Northumberland Adult Community Treatment Team
• Early Intervention in Psychosis Team Northumberland
• Early Intervention in Psychosis Team North Tyneside
• North Tyneside Community Treatment Team
• Newcastle North and East Community Treatment Team
• Early Intervention in Psychosis Team Newcastle
• Sunderland West Community Treatment Team
• Early Intervention in Psychosis Team Sunderland and South Tyneside
• Gateshead East Community Treatment Team
• Early Intervention in Psychosis Team Gateshead
• North Cumbria East Community Treatment Team
• North Cumbria Early Intervention In Psychosis Service
• At this assessment we identified breaches of regulations 17 Good Governance and 18 Staffing.
• At this assessment we assessed the assessment service group Community-based mental health services for adults of working age where we assessed all 33 quality statements.

Requires Improvement rating

We rated the service as Requires Improvement. We found 2 breaches of the regulations in relation to staffing and governance.

Leaders had not implemented the lone worker policy fully to assesses and mitigate the risk to lone workers. Care records were not complete and contemporaneous. Staff did not manage risk consistently for people waiting to be assessed by the service. Governance systems and audits were not effective in identifying or addressing areas for improvement.Staff were not provided with the support, training and supervision required for their role.

However, there was positive feedback from patients and carers about the service they received. Staff were delivering care in line with best practice recommendations. Patients were supported to have choice and control and could give feedback on their care.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Action we have taken

At this assessment we identified breaches of regulations:

• Regulation 17 Good Governance, in relation to the implementation of the lone worker policy, sharing learning from incidents, assessing and managing the safety of the environment, gaps in records and the consistency of management of waiting lists.
• Regulation 18 Staffing, in relation to supervision compliance levels and learning disability and autism training not being mandatory and having low compliance rates. Drug and alcohol awareness training was not accessed consistently across the teams we visited.

We have asked the provider for an action plan in response to the concerns found at this assessment.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

• 90% of staff had received training in the Mental Health Act.
• Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice.
• Patients had easy access to information about independent mental health advocacy. Information was on display in the waiting rooms and the patient information leaflets included contacts for the independent complaints advocacy.
• Staff did not always explain to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We reviewed the records and found that in North Cumbria East CTT 4 out of 12 (33%) patients had not had their rights explained to them in past 3 months. Gateshead East CTT records showed that 1 out of 10 (10%) patients had not had their rights explained to them in past 3 months. Sunderland West CTT records showed that 2 out of 6 (33%) patients had not had their rights explained to them in past 3 months. Newcastle East CTT records showed 3 out of 23 (13%) patients had not had their rights explained to them in past 3 months. Newcastle EIP records showed 1 out of 6 (17%) patients had not had their rights explained to them in past 3 months. Gateshead EIP records showed 1 out of 2 (50%) patients had not had their rights explained to them in past 3 months. This had been an action following the last inspection of the service.
• Staff did regular audits to review patients on a Community Treatment Order (CTO) and whether their rights had been explained to them. Results of this were stored on a dashboard that managers accessed.

Mental Capacity Act

• 90% of staff had had training in the Mental Capacity Act.
• Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
• Staff knew where to get advice from within the provider regarding the Mental Capacity Act.
• Staff took all practical steps to enable patients to make their own decisions, records showed, and staff told us of an individual who was not communicating verbally. Staff were communicating via email to plan the sessions, and ask questions in advance and pictures were also used to communicate with the patient and aid their decision making.
• For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. These were recorded in the patients care records. Joint work also took place with social care to assess capacity and support patients, for example in relation to accommodation.
• There was one example from staff we spoke to and records we reviewed where for a patient who lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.
• Staff did not audit the application of the Mental Capacity Act and did not take action on any learning that resulted from it.

People's experience of this service

Patient Experience

We spoke with 38 patients; 12 patients during the on site assessment and 26 patients remotely after the on site assessment.

Patients were mainly positive about their experience with the service, with 26 people saying they received information about the service and 22 people said they had received a copy of their care plan.

Patients told us staff treated them with respect, listened to them and treated them as individuals.

Four patients told how helpful the employment support had been with helping them return to work or find work.

One patient spoke very positively about the voyage to recovery opportunity they had, where mental health professionals and patients lived, worked and learnt to sail side by side.

However 5 patients told us that there had been a long wait to access the service, up to 2 years. Patients had received the contact phone calls but did not always find them helpful and were still waiting to access therapy.

Two patients told us that they would find it helpful if they could text back to the number when appointment reminders were received. One patient told us that they did not always receive the text reminders for appointments.

Two patients told us there had been changes in staff and a lack of consistency with workers either supporting them or doing the phone reviews which was not helpful.

Carer Experience

We spoke with 29 carers; 3 carers during the on site assessment and 26 carers remotely after the on site assessment.

Carers were mainly positive about the service, with 20 people saying they received information about the service.

Carers felt involved in their loved ones care, 21 carers told us they were involved in care planning and 15 carers had been invited and involved in reviews of their loved ones care.

Carers valued the carer group opportunities and spoke very positively of the caring for carers course that they had attended.

Carers told us that the service was mostly responsive, however 5 carers told us that the changes in staff and lack of continuity had been disruptive for their loved one, especially for autistic people and carers told us that they felt staff needed more training in neurodiversity. Carers from North Cumbria spoke of challenges with cancelled appointments and venues to hold appointments, including miscommunication about where the appointment would take place.

Carers spoke of the challenge with accessing support out of the core hours of 9am to 5pm, especially if people work and people’s experience of the crisis team was that there was an inconsistency of staffing and a lack of understanding of their loved ones needs and presentation.

Two carers talked about a lack of support for families and lack of information and signposting for carers assessments.

Two carers were concerned about their loved one’s pending discharge from the team and what support would be available in the future.

Two carers spoke about the sensory needs of their loved ones in relation to visual impairment and hearing impairment, with a lack of reasonable adjustments and difficulties with accessing interpreters.

Stakeholder Experience

We received feedback from 5 stakeholders. Stakeholders told us that links with primary care colleagues was improving, with a greater understanding of both services. Opportunities were available to discuss patients to ensure the most appropriate interventions and pathways were considered in parts of the Trust, it was hoped this would be introduced across the service. Feedback in some areas was that there was a lack of clarity about pathways and limited communication with the community teams supporting patients.

Stakeholders told us staff within the community teams were skilled and knowledgeable, however as the teams were stretched it was difficult to provide timely interventions.

Access to community treatment teams was a concern raised by stakeholders, with the length of time patients were waiting for intervention. This had a negative impact on patients being able to access support from other services due to referrals needing to be made by the community treatment teams.

Difficulties were noted with referrals not being accepted for people with associated needs including ADHD (Attention Deficit Hyperactivity Disorder) and substance misuse issues. Concerns were shared by stakeholders regarding discharge of patients from community treatment teams, including lack of oversight for patients with 117 aftercare arrangements and patients who weren’t engaging with the team but required more of an assertive approach.

A lack of understanding of autism was noted with services not making reasonable adjustments for autistic patients. Stakeholders felt the skills and knowledge of different disciplines in the team, for example occupational therapists and psychologists were not used to the benefit of patients, as people in these roles were usually community practitioners, working with a caseload of patients. Stakeholders told us that the service in the community treatment teams could be more person centred.