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. Processes in place to encourage people to speak up and have their voices heard did not always work effectively. Staff felt disconnected from the Trust senior leadership team. Whilst the Trust had policies, procedures and processes in place to support good governance and management of the service, these were not fully embedded at team level, including learning lessons from safety incidents, oversight of buildings management, mandatory training, appraisals and supervision. However, 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. There were examples of innovative practice.

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 told us they supported the vision and values of the Trust, they said they were passionate about their roles and proud of the work they did. Staff said they held themselves to a high standard and this aligned with the values. Staff told us that services had become less easily accessible and inclusive than previously. Some staff members felt that community adult mental health services were not a priority for the Trust and reported a disconnect between local senior leadership and Executive level leaders. Staff reported feeling removed from the Executive team and told us changes to the team had not yet made much impact. However, some staff told us that it felt like the culture was improving and becoming more inclusive.

The service had a vision for what it wanted to achieve. Local service managers promoted a positive culture that supported and valued staff, creating a sense of common purpose at a team level. However, staff perceived systems had multiple layers making it difficult for staff to be heard at senior leadership and executive team level.

Staff spoke highly of their local service managers, they said they were strong, supportive and inclusive. Although staff praised their local managers, few said they knew any above Service Manager level and were sceptical about their role and input and some staff told us they had never met anyone from the senior leadership team. Staff said that senior leaders have a strategy on paper, but they have no idea what this looks like. Some staff said they had worked for the Trust for a long time but still have no idea what the senior leaders do. They said the senior leadership team have many words, but they mean very little and have not translated into any changes for the service. Staff told us the turnover of senior leaders was high. They said at local level they were supported, but at overall Trust leadership level they had no faith, that the culture was self-serving and not transparent, staff said they would not go to senior leaders. They said they received a message each week with a time that the Interim Chief Executive is available, but some staff said they didn’t think attending would be very helpful. Clinicians felt they had not been approached enough about ways of working, they said people that hadn’t worked on the ground themselves, were making the decisions about the new structure of the service and not consulting with them.

Structures and processes had not been effective in ensuring that staff felt they had full confidence in the capability and inclusivity of senior leadership team in the Trust.

Most staff told us they felt comfortable to raise any concerns and knew other staff who had done so and they had been listened to and action taken. Staff were aware of the Freedom to speak up guardians and ‘safe to care’ safer staffing programme. Staff told us they felt able to speak up to managers at a local level and they felt their voice was heard. Staff shared their experience of speaking up and said they felt senior leaders at Trust level paid “lip service and eventually they felt silenced, nothing changed, and they ended up with extra work”, staff said as a team they felt “left alone to try and manage everything”. A member of staff told us that someone at the service used “stop the line”, and wished they hadn’t, as they were “given a tough time after”. Staff felt that this was not always an effective mechanism.

Whilst the Trust had processes in place to encourage people to speak up and have their voices heard, some of these processes were not working as effectively as they could have been. These included Freedom to speak up guardians, “Stop the line”, an initiative which sets out to empower staff at all levels to highlight patient safety issues and deal with them quickly and “Safe to care” safer staffing programme.

Staff told us that at a local level they felt valued and appreciated, they said their manager could not be more supportive and they were part of a great team. Staff said there was a LGBTQ+ group within the Trust, and they had a representative that would attend anything the group had organised and would then provide work and support in this area to the team. Staff had celebrated pride month. Two staff we spoke with referred to a perceived lack of diversity in their team and the wider mental health services which they felt resulted in discrimination towards some groups of clients.

The service 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 equality, diversion and inclusion training. At the time of the assessment, the service compliance rate for equality and diversity training was above the service target for all teams.

Some staff told us that they did not have clear guidance on their roles and responsibilities, due to recruitment and retention difficulties, staff had been taking on responsibilities outside of their role. Staff said the service was being restructured so things may become clearer after the changes are made. Staff told us they had effective systems to help monitor the care given, this included internal audits, caseload reviews, supervision and multi-disciplinary team meetings. Staff were able to raise risks that were captured on team and directorate risk registers. Staff attended regular team and governance meetings. Minutes from the meetings were shared with staff.

There were established governance structures and processes in place including monthly governance meetings. Managers held regular team meetings with staff. However, it was not always clear from the staff team meeting minutes we viewed those discussions from the governance meetings had been consistently shared at a team level. Whilst the service had policies, procedures and processes in place to set out clear roles, responsibilities, and systems of accountability to support good governance and management of the service, these were not fully embedded at team level. This was evidenced by some staff who told us they lacked clarity in their role and responsibilities and during the assessment we found there was confusion among staff about who had oversight of buildings management. There were not effective systems and monitoring arrangements in place to ensure that all staff were kept up to date with mandatory training, appraisals and supervision or that this information was accurately recorded. We saw risk registers were in place for each team and at directorate level. Common risks identified at team level included potential ligature risks and general environmental risks within office buildings and staffing levels impacting on workloads, waiting lists, well-being, the capacity to complete administrative tasks, and for CAMEO South team the ability to discharge to locality teams. Directorate level risks identified staffing levels, mandatory training compliance and the lack of office space. Risks were rated according to the level of severity and likelihood, with actions and progress monitored.

We did not collect the evidence to score this evidence category.

All staff we spoke with were able to name a variety of key partners from the third sector and voluntary groups. For example, staff in Cambridge told us the key partners in delivering the service such as the local authority, MIND, Richmond fellowship and Substance Misuse Services. Staff said they had good relationships with these services. Peterborough staff told us they work with the local council, on things such as benefits and homelessness. They also work with schools in some situations and staff attended meetings for children under safeguarding. Staff also worked with drug services, garden house (voluntary organisation) colleges for employment opportunities and the local gym which included 6 free sessions for patients.

We did not collect the evidence to score this evidence category.

The Trust provided a list of key partners for both the adulty locality teams and CAMEO service. They described how they worked together, the role they each had in the partnership and how they communicated with one another. Examples included, Cambridge community Volunteer service, MIND, recovery college, welfare benefits office, housing providers and GP social prescribers.

Staff talked to us about evidence-based audits and innovative practice. Staff told us they could access the Trusts mandatory training but there was a lack of professional development and training opportunities outside of essential courses. Staff said this may be due to financial pressures.

We saw examples of evidence-based audits that were used to improve services such as, National Institute for Care and Excellence guidelines for treatment of depression in community mental health service, young people accessing psychological intervention and First Episode Psychosis in women at mid-life. We saw many examples of innovative practice happening across the teams. Such as, the introduction of a joint working post between the Trust and CGL (Change, Grow, Live) piloting direct referrals from CGL into locality teams. This post was jointly funded and commissioned; a regular pain clinic interface, working with Psychology colleagues and colleagues at Cambridge University Hospitals and a sensory group programme run by an Occupational Therapist based in Peterborough that had won an award.