Tees, Esk and Wear Valleys NHS Foundation Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service was responsive to people’s needs. Staff told us and we saw in some documentation that people are included in their care and treatment choices with carers being involved where appropriate. We observed a multi-disciplinary meeting where it was clear that people’s preferences were considered when deciding on appropriate treatment options. We saw carers included at assessment stage and throughout. Although people’s involvement was not always documented in their care plans. There were mixed views from service users and external partners on how feedback could be given about the service. Only half of the people we spoke to said their care planning included decisions about their future and what that looks like.

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 involved patients in decisions about their care. Eleven people of the 14 we talked to said they were involved in their care planning. Care plans we reviewed evidenced an intention to allow the patient to be involved in decision about their care and treatment.

Staff supported, informed and involved people using the service and their families or carers. Staff told us and we saw in some documentation that people are included in their care and treatment choices with carers being involved where appropriate.

Staff in the mental health crisis teams involved patients in care planning and risk assessment. We observed a multi-disciplinary meeting where it was clear that people’s preferences were considered when deciding on appropriate treatment options. We saw carers included at assessment stage and throughout. Although people’s involvement was not always documented in their care plans.

Staff in the mental health crisis teams involved patients in risk assessments. We saw evidence in care plans of appropriate risk assessments being completed and appropriate referrals made to external organisations if required.

Staff had did not always have effective working relationships with external teams and organisations. Ten of the 14 people who have used / use services 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 made sure they shared clear information about patients and any changes in their care. Staff told us that the service was flexible but that the staff people saw whilst accessing the service could change due to the way work was allocated. Staff said this could sometimes delay discharge due to having to learn the persons case if they had not been involved previously but confirmed the overall decision was a multi-disciplinary discussion.

Partners we spoke with gave mixed views about integration and continuity of care. Some external organisations told us there was a lack of understanding from some staff at the trust about their duties and responsibilities such as Section 117 aftercare. (Some people who have been kept in hospital under the Mental Health Act can get free help and support after they leave hospital). Some organisations told us they had access to the trusts systems to be able to support joined up care, whilst others did not. The trust’s street triage team was seen as holding a positive relationship between the police and the trust. The trust crisis assessment suite at Roseberry Park Hospital had been shortlisted for an award in September 2024 for joint working between police and mental health services. They also had joint policies in place to better support people accessing services, ensuring they got the appropriate care when needed.

The service was available 24/7 with flexible appointment times and locations if required. Care plans reflected peoples protected characteristics and we saw evidence of reasonable adjustments being made for people who needed them. The trust has in place medical on-call rotas that cover all sites out of hours (Monday to Friday 5pm to 9am and Saturday, Sunday and Bank Holidays 9am to 9am). The trust’s voluntary service team also supported people by helping with delivering prescriptions and equipment. We saw evidence of regular contact being maintained with people from staff at the service and if people did not attend appointments, these were appropriately followed up with. There was also evidence of the crisis team working collaboratively with the community mental health team.

Staff made sure patients understood their care and treatment (and found ways to communicate with patients who had communication difficulties). The 14 people we spoke to who used the service and 8 carers had no accessibility or communication needs. Within care plans we saw information being provided to people about the care they would be receiving and external agencies they could access. The Trust had an external interpretation and translation service available if needed. Half of the people we spoke to had been informed about how their information may be shared with third party organisations whilst the other half had not.

Staff ensured people understand their care and treatment options and plans. Staff told us that information could be provided to people in an easy read format and that interpreters and signers could be requested either in person or over telephone. The Trust’s patient system had any communication needs highlighted when staff entered their records. Staff told us they could show leaflets to people if they needed extra support to understanding their treatment.

The trust had systems and processes in place to ensure people were provided with up to date information in formats that had been tailored to individual needs. The trust had an interpreter and translation policy and guidance available for staff on how to access the service available. The 111 telephone service has translation options for those requiring British Sign Language (BSL) and for those who do not speak English as a first language. There was a data management policy in place which aligned with the Data Protection Act 2018 and explained how the trust would access, use, storage and process information and data in the trust’s systems.

People told us they were not always given information on how they could feedback on the service they received. The trust showed us a range of ways that patients and carers were asked to share their views and how feedback and improvements made are shared with them. Twelve people and 2 carers said they were not told how they could feedback on the service they had received. One person had been given a feedback form and another person was told the service would call them for feedback at a later date. Most people we spoke to had never raised a complaint about the service, but 3 people who had raised complaints were not happy with either not getting a response or the response being generic. The trust had records of these complaints and told us that 1 concern was responded to via telephone and 2 were responded to via the trusts local issue resolution pathway which the trust defines as an “everyday conversation not a complaint” and as such, formal complaint response letters were not sent.

Staff said there were various opportunities for people to feedback on the service. Staff told us about the friends and family feedback forms, the patient advise and liaison service, and leaflets that had a QR code for people to use. Some staff said that people providing feedback about the service was low and this was possibly due to the type of service and the persons individual situation at the time of needing the service.

Staff gave people the time they needed to give feedback. We observed staff giving people who were using the service time to explain their situation and concerns. This included supporting the reporting of concerns about other services.

The trust had a complaints policy in place with two pathways. There was the local issue resolution pathway where complaints could be responded to more locally and a complaints manager pathway for more formal complaints. During the period of 1 December 2023 and the 31 May 2024, the services had received a total of 35 Local Issue Resolutions and 37 complaints. The trust provided multiple examples of thank you cards from people who had used the service and their families.

The service was accessible. People told us the service was available 24/7. When using the services premises, people told us they were wheelchair accessible.

People were offered reasonable adjustments. Staff told us that reasonable adjustments were offered to people including using a different, more accessible room, seeing same gender professionals and utilising quiet space. Staff generally attended appointments at people’s homes but if the appointment or activity was in a different location and the person was in financial difficulty then taxis have been used by the trust to provide additional support.

External organisations had no concerns about the access to services due to discrimination or lack of equity. Concerns however were raised about the availability of services.

The trust referred to the Workforce Race Equality Standard, the Workforce Disability Equality Standard and the Workforce Sexual Orientation Equality Standard and these were all reported on annually with approval from the trust Board of Directors. All trust policies were screened using the equality analysis screening form.

Most of the people we spoke to told us they were not always given information on how they could feedback on the service they received or were not aware of avenues to do this. Following the inspection, the trust showed us a range of ways that patients and carers were asked to share their views and how feedback and improvements made are shared with them. In the trust’s patient and carer surveys that had been completed. The trust gave people the opportunity to report on their experience of care and actions plans were created for teams who scored below 49% however response rates were very low. Between January 2024 to June 2024 the Durham and Darlington Crisis team had received feedback from 5 carers, 2 partners, and 20 people who had used the service. Scarborough, Whitby and Ryedale crisis team had feedback from 3 carers, 11 people who had used the service. The Teesside crisis triage and assessment team had feedback from 13 carers, 1 partner and 23 people who had used the service. York and Selby crisis teams had feedback from 1 carer, 2 partners and 6 people. The Scarborough Psychiatry Liaison team had feedback from 1 carer, 2 partners and 10 patients and the York Psychiatric liaison team had feedback from 3 partners and 13 people.

Staff took into account people’s preferences. Staff told us they always try to ensure people are met in a place that is comfortable for them and they have an awareness of people’s different cultures and needs.

The trust actively sought out people to ensure their strategy empowered the people who used their services and the colleagues who worked for the trust. Part of the trust’s strategy was to create a great experience for people and their families, which included outstanding and compassionate care, access to the care that is right, and support people’s choices and goals . The trust aimed to achieve this strategy using co-creation with patients, carers and their families alongside colleagues and partners. The trust was 3 years into this strategy and progress was reviewed quarterly.

People were not always included in their future care planning. Only five people of the 14 people we spoke with said their care planning included decisions about their future and what that looks like.

Staff told us that discharge from the service was planned as a multidisciplinary team and was discussed at regular meetings with the person being consulted at every stage.

The trust had a clear discharge protocol in place. Discharge was discussed at each multidisciplinary meeting and consideration given to any ongoing care and support that a person would need following discharge from the service. Discharge letters were sent for people who were within 10 days of being discharged from the service with all of the details outlining how care would be continued with any external organisations. We observed referrals being made to external organisations and carer involvement in the person’s care. The trust had a self-discharge protocol in place which included informing relevant external organisations using a discharge letter which details all relevant information about the person including crisis contingencies and medication needs.