Questions and answers from the 2022 AGM

Questions for guest speaker Rai Waddingham and Chris Morton, lived experience director for Tees, Esk and Wear Valleys NHS Foundation Trust.

What advice do you have for someone who wants to get involved in lived experience but doesn’t know where to start?

For anyone trying to explore how to use their lived experience to support other people, I think it’s best to first contact spaces that do it well. So think about local voluntary sector organisations or places like Mind and Rethink, as well as Recovery Colleges. This will help people see how others use their lived experiences, both in terms of sharing their story with others and in helping to build helpful relationships – such as like peer support forums. That’s where I’d recommend anyone start, and from there it’s about exploring opportunities more broadly.

You can use lived experience to support change and help others. That might be within the voluntary sector, or by working in support roles in the NHS. There are broader opportunities too, like community engagement or other roles where lived experiences are really critical – such as community development work, youth work, helping older adults and carers support work. We are also exploring ways of sharing lived experience in safe, supportive ways to help inform change and support others.

You can find more information about getting involved here.

How will ‘lived experience leadership’ make a difference to people using services now and how will we know its making a difference and isn’t another buzz? There has been so much ‘buzzing’ over so many years and still people suffer.

The key is to value experiential knowledge on a par with scientific evidence based knowledge. It is about being able to articulate how stories inform how we behave, and how we treat and influence and impact each other. So the key aspect to making lived experience and leadership more than just a buzzword is around being able to see it as a valid. We have to ensure that people’s experience can help create a knowledge framework. It’s how we find ways to that lived experience evidence sits on a par with more reductionist, positivist knowledge frameworks like medicine.

By valuing lived experience, we can better understand the world in which we are trying to reach and help people. We need to recognise the benefits which come from exponential knowledge and learn from the expertise that comes from lived experience. Basically, what you live, breathe and have to overcome will give you different skills than just engaging in theoretical study.

People who have had quite transformative lived experience sometimes have to go back to very basic spaces to gain a sense of themselves again. You know, for me, I had to completely relearn how to build relationships with people – just by having basic conversations. When I was in my late teens, early 20s, it became almost impossible. So it meant that, for me, there had to be a complete re-evaluation of the world, which I think gave me skills around reflectivity and reflexivity. It was about being aware of myself in the moment, how I function, how I react, how I kind of interpret people’s behaviour. This gave me an awareness which I would never have had without lived experience – and it means that I can understand what other people are going through now.

We have to make lived experience a real foundation for providing help and support – it is much more than just a buzz word. It can help inform treatment, especially in mental healthcare, and sit alongside medical treatment too. It is part of the bigger picture, a way of helping people through living the values of the Trust of compassion, respect and responsibility. It is about trying to break down barriers and build bridges between what makes us human and what helps us.

In the past, healthcare has always emphasised power relationships – it’s always been around professional expertise and knowledge, which means that the relationship is quite unbalanced. But lived experience can help promote true patient-centred recovery and care. It is a completely different relationship. It is about empowering an individual to take control of their own lives.

If you go in and say to someone seeking support “I’m Chris and I’ve got lived experience of using mental health services”, it creates a completely different dynamic from the outset. It’s about utilising something that can build bridges very quickly, help establish report. You are saying “we are going to empathise; we are going to be compassionate. We want to make sense of your world and not just the label we’re giving you.”

I’ve really valued listening to Rai and Chris (Waddingham and Morton, speakers on Lived Experience and Lived Experience Leadership) but it’s increased my feelings of isolation in the Trust. Do we not see carers as Experts by Experience or Leaders or having equal opportunity to have their voice heard?

The simple answer is yes. Yes we do see carers as experts by experience, and yes they should have an equal opportunity to have their voice heard.

When we talk about lived experience, we’re not just talking about people with health issues, but carers, families and friends as well. I think there has been a heavy emphasis on lived experience from the perspective of an individual having a health problem in the past, the person with the diagnosis or the experience of services. But lived experience is about anyone. But anyone and everyone can tap into learning from lived experience if they are willing to engage in that reflective space.

Carers often have life-changing experiences because of the responsibilities they take on. They have a right to have their voices heard. We should value the experience of a carer on the same level as someone who has had the experience or condition themselves – but it sheds a different light on the matter. All types of lived experiences must be considered to make our support truly inclusive. Lived experience needs to be a part of the agenda of making an equal and inclusive society and healthcare system.

There are lots of ways you can get involved to ensure that your voice is heard and to help you feel involved and less isolated which you can read more about here.

What are Lived Experience Directors doing to become, and stay connected to, the carers and service user groups and meetings within the Trust and their issues and ideas to prevent being institutionalised?

As lived experience directors we are determined to meet the challenge of trying to engage across such a large geographical and broad demographic within the Trust’s area.

There is already a framework of support in place, such as through the Community Health Transformation, participation groups, mental health forums and provider forums, which we will be tapping into to stay connected with what people want and need. These provide the opportunity to have conversations with a great many people across the region with a wide range of experiences.

It is, as the question illustrates, a real challenge to become and stay connected – but I think it is about being able to build solid and clear connections to groups across the Trust area, including the voluntary sector as well. There is a priority to get this right. This is the first stage, and we want to do it properly.

We need to ensure that we’ve got the structures, the safe spaces, the rigor in terms of processes around bringing the lived experience voice into the Trust. But then, at the same time, recognising the importance of our partners in the communities and our citizens as well. One of the critical things that I’m setting up is my own lived experience reference group. It will meet monthly and include a representation of carers and service users and hopefully citizens – which will help to hold me to account by having that check and balance of different opinions and experiences. It will ensure I know their needs and their perspectives on issues – so I can always keep them in mind.

There is always a risk that you can become institutionalised and habituated to the organisation you are working for – so you need special spaces, like my monthly meetings, to keep in you in check and up-to-date on the latest information. I’m very mindful that I want structures around me that support me to do that. There is a lot we need to do, and we will do it.

I want to be accessible and available. If there are any community partners that would like to utilise my time, please do bring me in for conversations. We have a lot of partners we want to build relationships with, so I want to be as accessible as possible and always available for them to reach out to. I think this is a key part of building trust.

Chris (Morton, lived experience director), how would you prioritise your four objectives in terms of resource allocation, management focus, more staff etc? (These are Care planning, Involvement, Leadership/peer roles, Patient experience)

For me the key core priorities are care planning and patient experience – because they’re about quality and safety. Involvement is critical too, as are the leadership and peer roles – but we’ve got a really good foundation to be working from in terms of those at the moment. What needs to happen in involvement in particular is more refinement around support, integration and knowledge of involvement and engagement in terms of the leadership and lived experience roles.

The key thing about care planning is to make sure it is co-produced care planning. It must be owned by the patient, the carer and anyone else involved. Sharing the care planning is helpful for everyone, because it provides a contract in terms of trust that the care will be delivered – and we need to get that right. We need to have something that is centred on the individual and their experience.

We also need to be more proactive around getting feedback – and then acting on it. So we not only act on the feedback but implement changes and have clear accountability of that. That is a key priority. We would want to continue to build resource around that one.

Chris (Morton, lived experience director), how does this model dovetail in with the coproduction/cocreation networks of the two wider ICB (Integrated Card Board) systems?

Involvement and Engagement is a critical aspect in terms of the ICBs. Each ICB has an engagement manager and someone who’s leading coproduction in terms of involvement across the integrated care system. I think creation is now firmly embedded at national level in terms of the expectations – both around commissioning, as well as how the new systems are run. It’s not just in terms of policy, but it’s also in terms of statute and legislation now.

It all filters down in terms of how that then feeds into what we’re doing, and we build very close relationships with the ICB. There is work happening about trying to engage the communities that we currently fail to listen to, we fail to continue to engage, that feel very left behind. You know, thinking about how we bring them both into employment, as well as engage with them across our services. This is work that’s kind of led from a national level around poverty-proofing and trying to address poverty in the area, particularly around children and young people and accessing services.

These aren’t just isolated, organisational-only, focuses – these are system-wide agendas around co-production – bringing in a real plurality of perspectives that are governed by policy as well as legislation now.

How far ahead are you with ‘educating’ everyone at TEWV NHS Trust about the value of Lived Experience?

There are a lot of people with lived experience at TEWV, and this experience is very important. We already have a good foundation in the organisation with lived experience and have created a real kind of energy and appetite towards embracing cocreation. There’s a more thorough process of how we organise ourselves and think about the work that we’re doing. I think the challenge is primarily around capacity, as well as having to manage the challenges in terms of some of the regulatory challenges the Trust has faced. It does create particular constraints, but at the same time there is a need to be a bit more radical in transformation and how we’re working.

Also the roles that we have can be a real opportunity for the organisation to move beyond this point – for example with the recovery program and the work that was laid out by experts with experience.  Our first peer involvement members and peer workers are now really well embedded – they are part of the organisation now. So is the peer support program – we’ve got 26 plus and growing peer support workers working across a variety of settings. These are intentional lived experience roles, they’re there to use their lived experience, they support people, and it is really well developed, but there’s still work to do with them.

The foundations are really there. I mean now what it’s about kind of threads into everything that we do and are trying to kind of achieve. It’s a very complex aim in a wide array of spaces which serve very different needs. There are so many kind areas where there’s great practice going on and we can build on that and grow them.

How can TEWV harness the passion of lived experience without diluting the sometimes uncomfortable, direct way of communicating that message for fear of triggering or offending?

We are formalising a co-creation framework and creating more lived experience roles. The specific framework will guide how we are doing the work, and this will support teams. Moving forward, we will be rolling out and developing training and workshops that we will deliver with services.

With anything like this you are exposing psychological wounds. The concept is that you don’t want to just throw people into a space where they may, for want of a better word, have to expose their still-healing wound. So the key thing is around preparation. It is taking a very trauma-informed approach, which prioritises having psychologically safe discussions. That means clearly defined boundaries and principles on how you are going to engage in conversations – based around respect. It’s obviously around ensuring that there is the right kind of support and supervision.

You can’t not expect triggers to happen, I think it’s impossible. If we did take that attitude we would become highly averse to trying to engage in conversations where we can challenge the stigma and bias that can prevent us from doing what we are doing. It has to be done in a humanistic way. The key thing is around setting clear expectations and boundaries and having the right preparation and support for everyone that gets involved. And that’s what we should be doing anyway, because this is hard emotional work. At the same time, for lived experience workers, we need to be providing as high a standard of supervision and training and support as we would for a frontline clinician.

We can’t hold back on having strong reflective spaces, where people can engage in time where they can just think about what they’re doing, and why they’re doing it. We need to think about how we’re behaving and engaging with each other. So you know in, in simple terms, it’s about having space to ensure people have got time to reflect – while prioritising psychological safety and being trauma-informed. We really need to prepare people, by making sure the training is right, making sure there’s enough spaces to have conversations and setting the right boundaries and expectations.

I think a regular lived experience webinar where people like yourselves who are willing to share openly could share their stories would be helpful for staff.

Within the organisation we are creating lots of spaces where people such as service users, involvement members and carers, can come together and share their lived experiences. Obviously we are focusing on a wide range of projects and programmes, and we don’t want to leave anyone out. If staff members wish to share their stories about lived experience, I would support that. Whether that be via a webinar, or through a group or meeting – it has to be a safe place where people feel comfortable. I would argue there is a good rationale for creating staff-specific lived experience networks. We would be very keen to keep a very consistent co-creation lived experience space open for communication. There are lots of opportunities, and we are able and willing to support ideas around lived experience. It is all about how we bring stories in in a safe way.

If there was an appetite for webinars or monthly discussions focused on a particular experience that a staff member had, followed by a particular experience that a service user, that would be a great thing to do. I think that should be kind of an integral part of will the communication strategy moving forward around this work.

How will Chris’ (Morton, lived experience director) new Community Development Workers operate? Will this follow Rai’s (Waddingham, guest speaker) suggestion of ‘a guest in other people’s spaces’ or something else? How will this be measured as against David’s (David Jennings, TEWV Chair) priority as a Good Partner?

We have only got 2 roles at the moment and we’re thinking about what community development work we need to do – what we need to do in communities and how we actually reach those who are hard to reach. One of our focusses will be on the Romany and Gypsy travellers, as they have been identified as hard to reach. We really need to demonstrate that we understand them and are being inclusive and trying to work and adapt to their needs.

There are also 12 critically impoverished wards in the United Kingdom, and five of them – so nearly half – fall under our remit. This represents a broad spectrum of challenges that really do impact on what we’re doing – such as educational attainment, social, economic outcomes, life expectancy, health and mental health. There is a whole range of things to consider – so we are thinking about helping with poverty-proofing, engagement and how we can adapt our services to really work effectively with those communities.

It is in these two areas that we want to channel these community development workers in the first instance. And then, I think, it will develop into something a bit broader – to create a kind of a truly inclusive service. It might be a real challenge, but I think having that particular focus in the first instance is how we feel we could best meet people’s needs.

Other questions answered by members of our executive team at the AGM

Is patient safety the number 1 priority of the Trust?

Yes, we have an unrelenting focus on patient safety, with clear priorities set out in our patient safety strategy – this is our absolute priority.

This is supported by a quality assurance programme. Our quantitative and qualitative data shows that we have made considerable progress, and these are continually measured, evaluated, and reported upon.

Do you feel that complaints should take longer than 6 months before a response is formulated and how do you feel such delays affect severely ill young people?

We’re very mindful that complaints are taking longer than we would like, and we are sorry. We acknowledge the impact that a delay can have on the people who raise their concerns with us.

Formal complaints should be concluded within 60 working days. However, this does not take into account the complexity of the cases that we can receive.

All complaints are triaged, and with our clear focus on patient safety, any immediate actions that address concerns about the wellbeing of patients will be acted on while the complaint process is underway.

We are about to embark upon a review of our complaints processes to address this issue. The review will be carried out together with patients and carers so that their insights and experiences are at the centre of this work.

What specific work is being done/progress being made to bring volunteers into all aspects of the Trust’s day to day strategic work and boards so that they are there at the start of any seeds of opportunity? To use them as an ongoing team within the Trust?

The volunteer service continues to be incredibly valuable across our Trust and has recently won a national positive practice in mental health award.

The development of volunteer roles is always a careful match of what the service, community and volunteers need and can provide, and as such is a constantly dynamic process.

As Chris (Morton, lived experience director) has described, volunteers and involvement work are related but different, both are trained and supported but for different roles in the organisation.

We’re looking at how we can support people to work with us in a way that bridges these two roles in a more specific employment role. This wouldn’t be for specific paid peer work but would attract pay and employment conditions for those pieces of work that go beyond short term / expenses only / honorarium involvement and volunteer work.

We recognise that volunteers are an important part of our workforce and aim to include them in as many aspects of decision making and consultation as possible. The Voluntary Services Department regularly consult with their volunteers on new developments, procedures and seek feedback on their experiences as volunteers.

Five years ago I asked the same question at the AGM to the then CEO:  Is Yorkshire the poor relation of the Trust?

More specifically, the South Care group remains relatively underfunded, but is still about 45% of the Trust’s population. Yet it’s influence in decisions seems low, many more HQ staff seem to be from the North East than from Yorkshire, and the Trust seems to look far more to the NE&C (North East and Cumbria) ICB (Integrated Care Board) than to H&NY (Humber and North Yorkshire) for direction. Also, there often seems a ‘one size fits all’ approach to all aspects of strategic planning. Does the Trust recognise this, and how should it try and change things?

The Trust covers a large geographical area and our new structure, with two care group boards, allow us to better align around the regional changes that have taken place. We have two Integrated Care Boards in our areas: North East and North Cumbria and Humber and North Yorkshire. We link in with them both.

We are active members of the various mental health, learning disability and autism collaboratives and networks, as well as being involved with a wide range of place-based groups and adult social care committees. For example, in Humber and North Yorkshire, Brent chairs the mental health, learning disability and autism provider collaborative executive group.

We use all these interactions to put the case for further and future funding into the North Yorkshire, York and Selby patch and the services we deliver.

Over recent months we have seen additional funding for eating disorder services, perinatal services and IAPT (Improving Access to Psychological Therapy). We continue to make sure our services and the communities we serve feature in planning, decision making and budget allocation.

Where it makes sense for there to be a consistent trustwide approach we do so. However, we are aware of differences across our areas, and we look at what is needed to deliver the best outcomes.

We welcome Governors’ continued support in ensuring North Yorkshire, York and Selby remains at the centre of system-wide decision making.

How do we ensure that we engage those who are less likely to be using our services such as those from the traveller community to ensure that we are asking the right questions and offering the appropriate support?

We need to work closely with all sectors to link up engagement and initiatives to look for opportunities to reach people who are less likely to use our services.

Through the community mental health transformation we are working with partners to reach into communities in a joined-up way so that we can more effectively meet people’s needs, especially people who previously may have found our services difficult to reach.

In North Yorkshire and York we’ve commissioned local Healthwatch to conduct a comprehensive survey into mental health provision across region.

We’re also regularly engaging with people from those communities in our lunch and learn sessions to give staff time to listen and talk with groups that they might not frequently work with. The feedback is that these are increasing staff confidence to do their work more effectively.

What improvements have been made to the learning disability wards at Lanchester Road Hospital following the CQC report? How can you ensure patients are safe on these wards? What lessons have been learnt from the incidents highlighted in the CQC Report?

When will a written apology be given to the patients who suffered inappropriate care and were injured by your staff highlighted in the CQC report? Also, an apology to the relatives who are also trying to come to terms with the trauma you have caused not only to the patient but also their relatives.

Given the previous good ratings, this is clearly disappointing. We have:

• Immediately commissioned an independent peer review into the service after the inspection in May.
• Put an action plan in place that is already showing improvements.
• Continued to work with partners on the future provision of learning disability and autism services.

We are already seeing a reduction in restrictive interventions that we monitor through frequent clinical reviews, and we are working on getting more support to develop and roll out a restrictive intervention reduction plan

To address the last point, we recognise the seriousness of the recent CQC report and accept the findings in the report. We are truly sorry and offer our commitment to ensuring the safety and quality of our wards moving forward is our highest priority. Where there have been incidents, we have met with carers and families, this includes offering support and listening to any concerns. We continue to have regular contact with those families and carers whose loved ones are currently in our care and proactively encourage their participation in every aspect of their loved one’s care.

Why don’t the mental side and the physical side of the NHS work together? As a human being I am body, mind, spirit and emotions. I am not just a body nor am I just a mind they are connected.  Why aren’t people treated as a whole?

This issue is recognised across the system and in the North East and North Cumbria area there is a regional group looking at Parity of Esteem and how we can enable both physical and mental health services to understand each other more and work better together to understand the whole person.

There are some great examples of physical health and mental health wards coming together up to spend time with each other.

Why don’t staff hold two-way conversations with the patients? In my experience nothing was explained.

We would expect everyone receiving care and support from our services to feel heard and that the care they receive is jointly agreed and reviewed with the clinician or team working with them.

We recognise that this is not everyone’s experience and receiving feedback helps us improve our services.

Our priority work around co-creation starts with an understanding that our starting point is the extent to which an individual feels heard in the context of the care they receive. The inspiring words and challenge we have heard on the call today from our presenters will help us strengthen further our approach.

Do you feel that it is appropriate to signpost vulnerable young people, who have suicidal thoughts or attempts, to charities that are administered by untrained volunteers when they have not been seen or assessed by a clinician?

The agencies we signpost people to on our website and also on our crisis line are ones that we work incredibly closely with.

They are involved in our crisis transformation work. It means people have a range of options to access support.

The organisations will refer people to our services if they feel that the person’s needs will be better met through one of our services.

The organisations were all part of the NHS England and our local care primary care network response to COVID-19 and have provided a really valuable service to people across our communities.

Do you feel that the current waiting list of 2 years plus for CBT (Cognitive Behavioural Therapy) is appropriate and timely?

We absolutely acknowledge that access to Cognitive Behavioural Therapy (CBT) and other evidence-based psychological therapies is not always as readily available in all services in our Trust as we would like it to be.

We are using training and development opportunities to increase the resources we have to deliver these therapies, for example in Adult and Older Adult Services we have approximately 20 staff currently or about to start training in CBT for people with severe mental health problems.

Is there still a backlog of Serious Incident Review reports, and if so how many?

There are currently 38 cases that are waiting to be allocated for review.

Reviews are taking longer as we continue to work very closely with families in relation to the scope of reviews and setting terms of reference. We also have to wait until families are ready to be involved in the reviews as equal partners.

In addition some are very complex and take more time.

We are doing everything we can to reduce the backlog including working with partners to get additional resources and recruiting into vacancies.

All cases have had an initial early learning review where immediate learning is picked up with the teams involved.

How has this document (best practice document for Community Health Transformation) been integrated into the new processes being developed within TEWV? The document is from Rethink and titled Thinking differently: A ‘first steps’ guide for transforming community mental health

This relates to the best practice document for Community Health Transformation. Actually, we are one of the best practices quoted within the document.

The Hartlepool Community Mental Health Hub is quoted as an area of best practice, so it’s fair to say we are aware the document and working with Rethink.

We’re delighted to note that within the document the Hartlepool hub was highlighted as one of their case studies highlighting the good practice.

Will you welcome a Public Enquiry?

It’s not for us to decide that. What is our responsibility however, and what we are doing, is making sure we continue to make improvements to our services, and we have already made significant progress. This includes investing £8 million in making our wards safer, recruiting more staff and putting patients and carers at the very heart of everything we do.

Why is it such a long timescale from offering someone a job to doing employment checks? I’m hearing some cases its 2-3 month after a job offer is made for checks to be complete. I accept its never an easy process recruitment as a whole, but those timescales seem excessive

The sheer volume of recruitment which we have undertaken has, at times, meant that we have struggled to keep up with the flow for applicants.We have reviewed the recruitment process – reduction in time to hire from 106 to 65 days for majority of vacancies.

The NHS Business Services Authority support with pre-employment checks. This has vastly reduced the time taken to send conditional offers and commence pre-employment checks.

We have introduced a new Trust handbook and improved induction process.

We held a very successful large scale healthcare assistant recruitment event in Durham Tees Valley in partnership with Middlesbrough FC and Derwentside College. Our service staff helped people complete applications and we held interviews on the day.

We also have a recruitment team in India at the moment.

Looking to the future retention of staff we are creating a compassionate and inclusive culture with initiatives including:

• a reviewed freedom to speak up process.
• launched the Star Awards with over 400 nominations.
• a monthly prize draw for staff.
• Equality Diversity and Inclusion lunch and learns – over 1,200 attendees so far.
• established regular Schwarz rounds (a structured forum where all staff come together regularly to discuss the emotional and social aspects of working in healthcare).

How do you comply with the Autism Act 2009?

The TEWV Trustwide Autism Project was developed in order to try and address the requirements of the governments ‘Think Autism’ Strategy (2014) which developed to help statutory organisations comply with the Autism Act (2009). The Project has the following aims:

• Clear pathway to diagnosis across TEWV.
• All staff trained in autism awareness; clinical staff more highly.
• Reasonable adjustments embedded in clinical pathways.
• Service user and carer perspective.
• Consistent high-quality transitions.

There is now an update of the Government strategy which includes children as well as adults (National Strategy for Autistic Children, Young People and Adults: 2021 to 2026: 2021) and we are endeavouring to address the key areas within this strategy.

The Trustwide Autism Project is quite a small team which covers all specialities across the entire Trust. We provide training and supervision and work on specific projects as well as supporting the integration of autism-informed practice into all aspects of Trust business. Co-production has been a core part of our work from the beginning, and we have an increasing number of experts by experience and carers who work within the Project in a variety of ways.

Over the last 4 years, how many nursing staff has the Trust referred to the Nursing and Midwifery Council due to failing to meet the standards of Nursing Care?

From 2019 to 31 January 2023 there have been 28 referrals to the Nursing and Midwifery Council, relating to allegations whereby standards of nursing care were not met.

Some people in services have no voice or are too ill at times to communicate. The carers of those people have lived experience which is equality important but too often feel not listened to.

We have a real mix of people who are part of our service – such as patients, carers and involvement workers. Whenever we engage in a piece of work, we try to ensure there is that balance between the number of carers actively involved versus the number of people who use our services. There is obviously more work to do on this, but we recognise the carer voice as an equal partner in co-creation – because everyone is there as an equal partner. We do want to do more though – as it is a critical part of Our Journey to Change – and we are open to suggestions on how to move this forward.

Is anybody at the Trust being held accountable for the years of ongoing mistreatment and abuse of patients; failure to give basic care; repeated mistakes; regular breaching of the duty of care; lack of honesty and transparency about the failings and poor standards of care? AND: Are the Senior Management and Directors willing to resign if the Trust continues to allow avoidable deaths to occur and then cover up the true reasons why they occurred?

We are a heavily regulated organisation and we are obviously responsible to the Care Quality Commission (CQC) and NHS England. We have policies and procedures to ensure that people are held to account, and we take that very seriously.

There have been significant changes in the organisation over the past few years, including a complete change in the leadership team, and we’ve got new structures in place. We’ve put in place the necessary measures to ensure that we can improve things within the Trust.

How will the Trust find and reach the patient experience that doesn’t usually speak out? How will the Trust ensure we don’t just rely on the same voices?

We request feedback in a variety of formats, paper survey, electronic tablets and kiosks, email or text link via an app. All our surveys are available in different languages, easy read versions and we use widgets for our child learning disability services to mirror communication used in the education authorities.

We also receive feedback from NHS websites. Clinical services are increasingly utilising peer support workers and volunteers to encourage people who may not usually let us know their experience to share their views, so we gain as much insight as possible to improve our services and learn lessons from positive and negative situations.

How does one get help to go through the Medical Records and make sense of what was done?

Who would provide help to do this depends on what has happened. If help is needed in relation to the care of the patient, it would be a clinician who would do this. If help is needed to resolve inaccuracies in the medical record, then the Trust’s Information Governance (IG) team, headed by Andrea Shotton, would lead from a data protection/rights of the data subject viewpoint – supported by clinical input. Please forward any queries to the IG team mailbox and we can agree the best course of action on a case-by-case basis.

If TEWV keeps avoiding telling the truth when it fails so badly, how do they expect to have the trust of the public?

We have new values of respect, compassion and responsibility and, as part of the responsibility value, we’re committed to being honest. We would always seek to own our problems and ensure that we were held to account.

We understand that, as a consequence of recent reports and things that have happened in the past, that some people will have a view regarding the Trust. However, our job is to ensure that we keep improving.

Why does the Trust focus so much on protecting its reputation rather than the lives of its most vulnerable patients?

We don’t recognise the sentiment in the question. We are committed to improving the experience of patients and carers and serving the needs of our communities.

Is TEWV willing to give staff an amnesty to tell the reality of what goes on and what goes wrong – so we can begin to address the real issues rather than spend all this money on ‘smoke and mirrors’ to make it look like action is being taken which will make a difference when it clearly won’t?!

It’s really important that colleagues are able to speak up and we have a number of mechanisms within the organisation to support this, including our freedom to speak up guardian and our Raising Concerns process.

We operate an approach which does not proportion any blame. We would seek to listen to people, investigate and understand their issues and do what we can to take any learning from the situation.

Please can you explain the evidence for holding this AGM (Annual General Meeting) online?

The Trust’s Board made the decision to hold the AGM online at its meeting on 27 October 2022 – this was unanimously agreed. From 1 September last year, there had been a steady rise in COVID cases across the North East, and we had seen this rising through October. As a Trust we had been feeling the impact of this both in inpatient settings and in staff absence. When the Board met at the end of October COVID cases were decreasing, however we were concerned about the potential impact of bringing a large group of people together at this time, combined with Winter flu pressures. COVID figures are available here.

Furthermore, any decision on this was needed well in advance of the date of the AGM, for notice requirements. Consideration was also given to plans to include a marketplace showcasing our services, which would have involved bringing staff together in a large group, with potential risks to their health. This would also create risks to the provision of services should COVID and Winter flu pressures continue to impact sickness absence rates as well as potential risks to inpatient settings.

We also believed that a virtual event would encourage greater engagement from the vast geographical area that our Trust covers, and provide a more inclusive and diverse alternative to the communities we serve, as well as offer a more flexible option for the Trust’s membership and Governors, some of whom work and/or have caring responsibilities.

Please can you give some recent examples of change that has been introduced by TEWV as a result of listening to patients, carers, or staff raising concerns about lives being put at risk, mistreatment or just not doing their job?

We have an unrelenting focus on patient safety. Change is ongoing, but a list of recent improvements includes:

Co-creating a great experience for patients, carers and families

• Waiting list for children needing to access support for mental health or emotional wellbeing needs down by nearly half.
• Launched our carers charter that sets out our commitment to working with and supporting carers.
• Invested in our estates by opening a new community mental health hub in Northallerton and a new centre for young people in York.
• Installed innovative patient safety technology on some of our wards.
• We’re better placed to support members of the Armed Forces since signing the Armed Forces Covenant.
• 46% more people than last year helped to find employment by our Individual Placement Service.
• Putting patient experience at the heart of what we do.

Being a great partner

• More mental health nurses are working in GP surgeries across our region – supporting people to get the right help early on and close to home.
• 27 more schools are part of our mental health support programme helping young people and training teachers.
• Our innovative and world-class research team is part of a vital COVID-19 vaccine trial along with NHS partners and the University of York.
• Together with Hartlepool Borough Council we supported rough sleepers with their mental health.
• Our apprenticeship team has developed a strong partnership with Derwentside College to deliver a range of apprenticeship training to colleagues.

Co-creating a great experience for colleagues

• Recruited 700 more staff since start of COVID in 2020.
• Streamlined our processes, reducing the time it takes to hire.
• Our staff networks are going from strength to strength and helping everyone have a voice in our Trust.
• Invested in the health and wellbeing of our people.
• Introduced a staff awards and recognition scheme.
• Recruited two lived experience directors and a head of co-creation who are supporting teams to put patient experience at the heart of decision making.

We’ve invested in safe and kind care:

• £5m spent on making our wards safer since 2019, and almost £3m more planned in 2023.
• Installing new technology that supports clinical teams to monitor patients and keep them safe.
• Reviewed more than 55,000 patient safety plans and achieved 100% compliance for our observation recording.
• Human rights training.

Why isn’t the Trust listening to the people who are already telling them about serious issues that have led to numerous deaths; and instead doing lots of talking itself and activity which is not addressing these failings?

Listening to the experiences of patients and carers is really important to us, this includes how we more closely involve the families and loved ones of people who have died in our care.

Of course we do not always get things right and we have strengthened our understanding of the serious issues and our ways of learning so we can improve care. Examples of how we are doing this include:

• We have recruited two lived experience directors into leadership teams to make sure the patient voice is heard at the very highest level of the organisation.
• We have held a number of quality improvement events with our patient safety team involving the loved ones of people who have died. This is helping to improve people’s experience during a very difficult time and is also improving our serious incident review process.
• Since June 2021, we have introduce a robust quality assurance schedule that tells us how we are doing on fundamentals of care and relates to the themes from serious incidents. This includes audit, patient experience and peer reviews.

What networks exist or are being developed between like-minded areas to share lessons learnt and expertise gained from process improvements across the Trust to stop each having to work through experiences themselves?

As part of our recent restructure we’ve established clinical networks whose function it is to ensure that we set stretching clinical standards. We share best practice and identify areas for innovation.

These networks are led by expert clinicians and those with lived experience, and have a clear remit to ensure that we are focused on embedding improvements across the organisation.

What is the Trust doing to ensure that all patients are being given a personalised care plan?

This is one of our quality priorities under our Advancing our Journey to clinical, quality and safety programme. We are trying to change the culture around care and intervention across the Trust. We understand that patients leading, directing or being engaged in their own care is transformative for them and rewarding for staff and are therefore committed to a number of improvement actions to take this forward including:

• Extended staff briefings and workshops with clinical services. These briefings are designed to start a process of focused improvement work leading up to the launch of CITO and includes what is planned, why it is important and the expectations of leadership teams. The second part of the day is a ‘live’ workshop working directly with patients to critically review current care plans.
• The implementation of DIALOGUE and DIALOGUE+ across our services. These are goal focused care planning tools. Using a scale of 11 questions, people can rate their satisfaction across a range of domains that provide a subjective score for quality of life and treatment satisfaction. They have been widely adopted for use across the NHS now and is an approach specifically designed to make routine patient-clinician meetings more therapeutic, effective and person centred. IT developments will further support this engagement and personalisation but for now we are rolling out a paper-based system.
• As part of our well-established quality assurance schedule we are regularly auditing the co-creation and personalisation of care plans. These tools were reviewed in January 2023 and we have included in the audit the need to include the person who’s care plan it is in these reviews for their opinion. Results are fed back to teams and improvement actions can be put in place where needed.

We are concerned about staffing issues in adolescent mental health services. Lack of support for people waiting for an appointment. Your response please?

Child and Adolescent mental health services are experiencing significant challenges with recruitment and retention, combined with an increase in ‘presenting need’ in our local population. Many other health and social care services are experiencing the same challenges, and this is reflected nationally.

Within TEWV Child and Adolescent Mental Health Services (CAMHS) services, the scale of the issue varies. Several of our community mental health teams are performing very well currently in terms of access to service, with average waits for assessment in those teams being in-line with key performance indicators and better than the national average. A small number of teams are particularly struggling with capacity (vacancies and sickness) and demand (referral volume) currently and those teams have longer waits for access and initial assessment. For any young person who is waiting to be seen, the service provides a ‘Keeping in Touch’ process to provide regular touch points and provide opportunities to engage with the service and notify us of any changes that may need picking up more urgently. The ongoing roll-out and development of the wider system initiatives, in supporting child and adolescent mental health and emotional well-being (such as school-based teams), is also starting to have an impact in terms of being able to intervene with young people and address needs earlier and reduce demands on traditional CAMHS community teams.

Our community Eating Disorders teams have benefited from investment in recent years, and this has helped them to manage the increase in demand in this specialist area. Currently the majority of urgent referrals are seen within 1 week and the majority of routine referrals seen within 4 weeks; these standards are nationally monitored.

Our crisis team has been able to maintain 24/7 coverage throughout these recent challenges and provide an appropriate and timely response to the majority of referrals and queries received.

Our neurodevelopmental assessment teams, who are commissioned to assess for autism and ADHD, have seen a 300% increase in referrals post pandemic.

Also, during national lockdowns, assessments could not be completed. As a consequence we have significant waits for assessment for these two specific conditions; which is also replicated nationally.

We are working with system partners and commissioners to improve this position.

Any young person who has co-existing mental health needs (such as anxiety, low mood or potential eating disorders) are able to access the other teams described above (with more favourable waiting times) for specific support in relation to those needs whilst they wait for a neurodevelopmental assessment to progress and conclude. The same Keeping in Touch process is also applied by these teams. In addition, a range of other services have been commissioned, from other providers, as part of a bubble of support that can provide advice, training and support to schools and families in relation to neurodiversity, irrespective of diagnosis.

All of the above represents a marked improvement in response to the concerns highlighted by the CQC in their inspection of CAMHS services in June 2021.

We have an urgent IT issue re:lack of availability of TEWV Laptops for our students of all disciplines – it’s essential we can provide these urgently. Are there any potential solutions on the near horizon please?

Historically there has been no funding for laptops for students coming into TEWV other than for medical students provided via medical education. At one stage there was additional funding from Health Education through the ‘laptops for nurses scheme/funding’ which allowed us to buy a number of laptops just for that staff group, although this was a one-off and did include ongoing or replacement costs.

Over the last couple of years, we have had ongoing discussions about sourcing laptops for students, including potential funding streams, and the possibility of trying to purchase virtual licenses for students to use their own devices rather than laptops.

We have now agreed that laptops rather than virtual licenses are the way forward and are working with the Central Asset Management team to see if we can provide laptops for students alongside laptops for new starters/exchanges from a central stock as part of the bigger trustwide picture.

Our finance department have also been doing a significant piece of work to allocate IT hardware as capital rather than revenue. This will allow us to buy IT equipment in advance, get improved value for money, and be more responsive to the needs of our staff, as well as being able to include the needs of students in with those of employed staff members.

The Central Asset Team are creating profiles for types of users in relation to their digital and data needs (including IT hardware), and a profile for medical students has already been created. This profile will be used to go on to develop a profile/or profiles for students from other professions.

We are hopeful that laptops for students will become available through central stock systems during the financial year 2023-2024.

We acknowledge that our processes as a Trust have not been flexible enough across the whole starter area. This will be a major part of our infrastructure improvement journey going forward. We have recently introduced a new process to get new laptops to people in a timelier manner and it will continue to improve.

In relation to autism friendly services is the Trust going to ensure that all teams are aware of the Care and Treatment Review (CTR) process which is integral to their care, especially in supporting the prevention of admission? Many teams haven’t heard of it and have no idea how it applies, including inpatient units.

Care and Treatment Reviews (CTR) are discussed as part of the Autism Awareness training that is delivered by the Autism Project Team. We do know that, for many teams this is something that they are not familiar with so members of the Autism Project Team regularly attend CTRs in order to support the process. Whilst we are aware that there is still some way to go before everyone is aware and confident with the process, we have seen a significant increase in the use of CTRs over the past year as well as a growth in requests for support in relation to them by staff.