Cambridgeshire and Peterborough 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

We rated Well-led as Requires improvement. We assessed 7 quality statements. Staff felt disconnected from the Trust senior leadership team. Whilst the Trust had policies, procedures and processes in place to oversee good governance and management of the services, these were not working as effectively as they could have been for learning lessons from safety incidents, processes for encouraging staff to speak up, mandatory training, appraisals and supervision. However, there were processes in place to encourage people to speak up and have their voices heard. Staff supported the vision and values of the Trust. The service had an equality, diversity, and inclusion policy to ensure people were treated with respect and dignity. The service worked in partnership with external organisations.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were aware of the vision and values of the Trust. They were clear about the aims of their service. Staff described a positive culture within their own team and across the wider service. They were proud of their work. However, staff we spoke with perceived a disconnect between the Trust board and executive leadership team with the local leadership. Staff felt that they were not always kept up to date about changes that impacted on service in a timely way by senior leaders. For example, 1 member of staff gave an example of a management restructure they felt they were “last to know about” and described feeling “undervalued”. Some staff said communication had improved and told us the Chief Executive at the time of the inspection held weekly conversations with staff. They said it felt like a more inclusive Trust to work for. However, some staff said the recent changes at Trust leadership level had yet to make an impact on staff working at team level. Some staff told us they had witnessed bullying or harassment in the workplace. One staff member gave an example of a concern going to mediation, they told us this was managed professionally.

The Trust had set out clear vision and values. The Trusts values were PRIDE (Professionalism, Respect, Innovation, Dignity and Empowerment) these were cascaded down to team level operational policies which set out the aims of the service. However, staff perceived the communication culture between the senior leadership team and local teams as not yet fully effective.

Staff and leaders were clear, and they understood their roles, responsibilities and accountabilities. Staff spoke positively about and praised local leaders. Staff described their immediate managers as compassionate, understanding and available. They felt valued, respected and supported by their immediate managers. Staff had little knowledge of or contact with senior leaders from the executive team. Some staff felt forgotten about. For example, they had been promised a visit from a senior leader, but this had not happened. However, 1 staff member told us they had received a visit and had found this valuable.

Structures and processes were not fully effective in ensuring that staff felt they had access to and visibility of the senior leadership team in the Trust. The Trust had checks in place to ensure leaders and managers had the correct qualifications, skills, training and competencies to fulfil their role.

Most staff told us they felt comfortable and safe to raise any concerns. However, some staff said that whilst they were comfortable to raise concerns within their team, they would feel anxious or uncomfortable to escalate through Trust formal processes. Staff were aware of the freedom to speak up guardians (FTSUG) and how to access them. A staff member told us they had an away day booked in to discuss the themes raised from a freedom to speak up concern about working relationships and communication. However, a member of staff felt that they had found the freedom to speak up process difficult as staff cannot talk about what is happening whilst the process is ongoing. Some said more could be done to promote the freedom to speak up guardians. Staff knew about the “Stop the Line” process (an initiative which sets out to empower staff at all levels to highlight patient safety issues and deal with them quickly). A staff member gave an example of using the “Stop the Line” process due to concerns about staffing levels. They felt the leadership team where doing what they could to improve staffing.

The Trust had processes in place to encourage people to speak up and have their voices heard. This included freedom to speak up guardians, “Stop the line”, and “Safe to care” safer staffing programme. Some of these processes were not working as effectively as they could have been.

Some staff felt that Equality, Diversity and Inclusion had improved in the Trust and were aware there was a network in place. Staff said there was a dedicated Equality, Diversity and Inclusion team and felt cultural awareness had improved. Staff described working within a diverse team that speak languages other than English and hold different faiths. However, some staff told us they had experienced racial abuse from patients. They knew there was a zero violence and aggression policy which they could give out to patients. One member of staff told us they did not think the Trust dealt with low level racial discrimination or discrimination against the LGBTQ+ community well.

The Trust had an Equality, Diversity, and Inclusion policy in place to guide staff on how to ensure people were treated with respect and dignity. Staff had completed mandatory “treating people with respect” training. At the time of the assessment, the service compliance rate was above the Trust target for all teams. The Trust has an Equality, Diversity and Inclusion network and a dedicated team that worked to promote awareness including for example Black History Month events.

Staff had resources to undertake and manage governance and risk. Staff told us they had effective systems to help monitor the care given through regular governance and business meetings. However, some staff told us the IT infrastructure could be improved. Managers were aware of their challenges, they told us these were the availability of inpatient beds and staffing levels. They had systems in place to oversee, monitor and review these.

There were established governance structures and processes in place including monthly directorate governance meetings. Managers held regular team meetings with staff including business meetings and governance meetings. We reviewed examples of minutes from these meetings and found they were structured and covered essential information. For example, incidents, complaints, safeguarding, patient feedback, and the risk register. Teams received quality assurance visits that assessed compliance against a range of key indicators against the 5 Care Quality Commission key questions (Safe, Effective, Caring, Responsive and Well-led). Following the visits reports were shared with the teams to action any non-complaint areas, we saw examples of these. However, whilst there were systems and monitoring arrangements in place, managers had not ensured that all staff were kept up to date with mandatory training, appraisals and supervision or that lessons learnt and identification of themes and trends from incidents took place. We saw risk registers were in place for each team and at directorate level. Common risks identified at team level included safe staffing and workforce capacity, general environmental risks, IT and infrastructure. Risks were rated according to the level of severity and likelihood, with actions and progress monitored. There was effective workforce planning including for managing major incidents or emergencies. Teams had business continuity and emergency response plans in place to ensure staff are prepared for and able to respond to events that could disrupt services.

Patients and carers told us there was effective communication between services.

Staff gave examples of key partners such as the local authority, substance misuse services, the police and local hospital emergency department. Staff said they had good working relationships with these services.

The Trust provided a list of key partners for the Crisis and Resolution Home Treatment teams, First Response Service and the 136 Suite service. They described how they worked together, the role they each had in the partnership and how they communicated with one another.

Staff told us they could access the Trusts mandatory training but there was a limited access to professional development and training opportunities outside of induction training and mandatory courses.

We saw examples of quality improvements and professional learning happening across the teams. Such as, within the First Response Service they undertake random call audits and call reflections for quality improvement. They had recruited an Associate Nurse Consultant to support in quality improvement initiatives and leadership. Protected time was given to staff to arrange for other services to present about their service and pathways and internal teaching sessions about relevant topics (for example, Right Care Right Person, Hepatitis B Virus and forced marriage, health anxiety, Post Traumatic Stress Disorder, Mental State Examinations). Crisis and Resolution Home Treatment teams were going through the full accreditation process for Quality Network (QN- CRHTT) this process would be used to measure where the service was at and identify any developmental opportunities for the team. Crisis and Resolution Home Treatment North team had commenced joint teaching sessions with AUU (acute assessment unit at the Cavell Centre) staff to look at brief psychological interventions with a rolling programme of training planned.