Annual Report 2023 - 2024

I was delighted and privileged to be appointed by the Governors on 1st October 2023 as Chair of the Council of Governors and Board of Directors for Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.  

Our strategy 'With You in Mind’ is focused upon how we will set about developing and delivering services. The strategy details our commitments to our service users, to families and carers, to our staff, and to our communities. We also make clear our vision, values, and ambitions.  To be successful in delivering what we set out in 'With You in Mind', I believe there are four key challenges. 

The first is to ensure the Trust continues to lead and develop high quality services for the people of the North East and North Cumbria in the face of increased complexity, growing demand and numerous pressures. In doing so we need to make sure we hear, understand, and properly utilise the voices of service users, carers, our staff, our communities, and our partners to inform how we develop, build and deliver services with, and for them.

The second is that we support, develop, and recognise the fantastic people who work with and for the Trust, they do amazing things every day. To do that we need to strengthen our focus on the importance of culture, (something I often refer to as the CNTW ‘X-factor’ when explaining how and why, in my view, this organisation is special). This challenge is often the most difficult to quantify, however we must ensure that we are an organisation that allows people to thrive, be and feel safe, be and feel valued and is supportive in allowing everyone to be at their very best for the people that they care for and serve. 

Third is to ensure that both internally and externally, the Trust works with the right organisations and people to think differently about our care and treatment model, acknowledging that we cannot be successful on our own, that other organisations face similar challenges and importantly understand that change is both necessary and desirable if we are going to deliver on our stated ambitions. 

And finally, ensuring that we work within the finances that we receive and generate and that we do so in the context of the wider health and care system; in other words, we need to be financially sustainable. 
As Chair of the Trust, in addition to attending meetings, reading reports, and speaking to a variety of people, I have found that the richest source of feedback to learn, 'how things really are' comes from visiting services. I am grateful that people are very willing to share directly what it’s really like to work for the Trust, what it’s really like to receive care and treatment, and what things really get in the way of empowering our teams to take decisions, take action and do what they do best, i.e., deliver the best care possible to those who need us.  

To our service users, their families and carers, the staff across all services, our volunteers, our Governors, my Board colleagues, and our partners across the North East and North Cumbria, I would like to say thank you! Thank you for your support, your feedback, and your guidance over the last six months, I look forward to working with all to achieve our vision to work together, with care and compassion, to keep people well, over the whole of their lives.

Welcome to our Annual report for 2023/24. This year has been a challenging year, but we have also achieved a lot together. This is described in this report, but we also recognise that we have much more to do as we continue to implement our strategy “With You in Mind”. The NHS as a whole has faced a lot of pressures through the year, and we have not been immune to this. We started the year facing a very difficult financial position, but also some real concerns about the care we were able to provide. Our plan for the year was to focus on doing the basics of care well, to build relationships with partners across the communities we serve, to continue to embed our approach to involving service, users, carers, and families in everything we do, and to start the process of fundamentally changing the way we deliver our services, particularly those services delivered in communities. And to do this we set out to ensure that our people feel valued, supported, and safe in their work.

We have made some notable progress. We have ensured that from September 2023 we have consistently ensured that no people from the communities we serve receive in patient care outside of the Trust boundaries. We have significantly reduced long term seclusion and restrictive interventions. We have responded to challenges in our urgent care services to ensure that they respond when people need them. We have worked with partners to start the development of new models of community care across all the localities that we serve. We have significantly reduced our reliance on agency staff, reducing by a third from the peak we experienced in 2022/23 following Covid. We completed and opened our new secure hospital at Northgate, which has already won national and international awards. We have improved the way we manage the organisation and changed the way our services are led, to ensure we are better placed to deliver on our strategy. And we delivered on our financial targets for the year. We know we need to do more.

The transformation of our community services is a real priority, creating integrated community hubs and partnerships working alongside GPs, voluntary and charitable sector organisations, local authorities, and our local communities. Waiting times remain far too long, and for some of our services, this represents a real failure of our care and support system. Our crisis services remain under significant pressure. While we have reduced restrictive practices in the year, we saw an increase in violence and aggression towards staff, and this led us to get an improvement notice from the Health and Safety Executive. This is not acceptable, and we are working hard to reduce violence towards staff and are now seeing the situation improve.

Most importantly, to deliver great care and support we need to ensure that the people who work for us feel safe, involved, motivated, and supported. We have put a lot of effort into getting this right, but our staff survey, while still above average for the NHS and for organisations like us, shows we have much to do. We need to do more work to ensure that staff feel that they will be treated fairly when they raise issues, or when they are subject to disciplinary processes. As part of our work on the Patient Safety Incident Reporting Framework, we will focus on learning, understanding system failures and developing a fair and just approach. We also will ensure that teams feel ownership of their own work and the ability to make decisions. We will look after the wellbeing of our staff and we will ensure that everyone who works for us feels equally valued and respected, with equal opportunities to progress. I am hugely grateful for all the work that our people and our teams do and the care and dedication that they show every day. I am hopeful about our opportunities to be better, and I am hugely optimistic about the benefits that we can see from the trusting relationships that we are developing with partners across our communities. As I said last year in conclusion, I know we will succeed because we have so much to build on.

1.1 Overview of Performance 

This report has been prepared on a ‘group’ basis and will refer to Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Group as ‘CNTW’ or ‘the Group’. The CNTW ‘group’ includes NTW Solutions Limited, our wholly owned subsidiary company. Sections of this report that is relevant to the NHS services provided by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust will be referred to as ‘the Trust’.

This overview will provide an understanding of the CNTW Group, including the services we provide, our organisational vision and values, strategic direction, and potential risks as well as a summary of our performance during 2023/2024.

Our History 

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) was formed on 1 October 2019 following the transfer of mental health and learning disability services from Cumbria Partnership NHS Foundation Trust to Northumberland, Tyne and Wear NHS Foundation Trust. Northumberland, Tyne and Wear NHS Trust was established on 1 April 2006 following the merger of three Trusts: Newcastle, North Tyneside and Northumberland Mental Health NHS Trust, South of Tyne and Wearside Mental Health NHS Trust and Northgate and Prudhoe NHS Trust. The Trust achieved authorisation as an NHS Foundation Trust on 1 December 2009. As a Public Benefit Corporation CNTW has members. We have four membership constituencies to represent stakeholder interests: 

• public constituency 
• service users and carers constituency 
• staff constituency 
• partner organisation constituency 

Our Services 

CNTW provides a wide range of mental health, learning disability, autism and neuro rehabilitation services to a population of 1.7 million people across North Cumbria and the North East of England as well as providing specialist services nationally. We are one of the largest mental health and disability organisations in the country with a turnover of approximately £600 million. We employ over 9,000 staff, operate from over 70 sites and provide a range of services including many regional and national services.

We support people in the communities of North Cumbria, Northumberland, Newcastle, North Tyneside, Gateshead, South Tyneside and Sunderland working with a range of 5 partners to deliver care and support to people in their own homes and from community and hospital based premises. Our main hospital sites are:

• Carleton Clinic, Carlisle
• Walkergate Park, Newcastle Upon Tyne 
• St Nicholas Hospital, Newcastle Upon Tyne 
• St George's Park, Morpeth 
• Northgate Hospital, Morpeth 
• Hopewood Park, Sunderland
• Monkwearmouth Hospital, Sunderland 
• Ferndene, Prudhoe 

Chief executive's statement on the performance of the Trust 

2023/24 was another successful, but extremely challenging year for the Trust and the health and care sector as a whole. We broadly delivered on all aspects of performance, achieved our financial objectives for the year, and played a significant role in developing partnerships across the North East and North Cumbria health and care sector. More importantly, we were able to maintain safe services throughout the year for those who need us most.

We recognise areas of challenge and areas where we have more to do. These include tackling unacceptably high waiting times for some services, focus on our challenges within crisis services, ensuring that we eliminate restrictive practices and minimise the use of restraint; ensuring we do everything we can to reduce incidents of violence and aggression to both service users and staff within our services, and ensuring that we continue our journey to being a truly person-centred organisation by embedding service user and carer involvement in all that we do.

Over the years we have achieved a great deal of stability, have achieved and retained our CQC ‘Outstanding’ status, and gained a strong reputation as a leader in change. We recognise that we need to use this solid grounding to go further, to push for better, and especially now, as we move into an uncertain and ever-changing landscape, use this to re-imagine the future so that we can better support the people and communities that we serve.

Chief executive's statement on the performance of the Trust - other areas of performance 

Despite the challenges over the past 12 months, the Trust has continued to move forward with the major change programmes of work which significantly underpin our strategic ambitions. These are:

Care Environment Development and Re-provision Programme (CEDAR)

Construction continues on our CEDAR scheme with the Sycamore facility opening in November 2023. This facility provides state of the art facilities for secure inpatients at our Northgate site. Work continues on developments for our Children and Young People Services (CYPS) at our Ferndene site. It was announced in October 2020 as one of the 40 schemes to be developed under the Health Infrastructure Plan, which commits £3.7bn to deliver 40 hospitals by 2030.

Provider Collaboratives

The Trust continues to work in partnership with Tees, Esk and Wear Valley NHS FT on commissioning Adult Secure Services, Children and Young People Tier 4 Services and Adult Eating Disorders services. The aim of this partnership is to develop and improve services for the population of North East and North Cumbria, ensuring long term stability in full collaboration with partners, service users and carers. The Trust has worked with the NENC ICB and NHSE on a Perinatal Provider Collaborative and will continue to do so through 2024/25.

Supporting and enabling the development of the North East and North Cumbria Integrated Care System

CNTW continues to play a key role in the ongoing development of the North East and North Cumbria Integrated Care System (NENC ICS) which has the potential to deliver significant change in the way health and care services are planned and delivered across our region. We continue to work with system partners including local authorities, voluntary and community sector (VCS) organisations and NHS colleagues to develop innovative approaches to care and support underpinned by meaningful involvement of people with mental health issues and learning disabilities in this work.

As a key partner in the NENC ICS Mental Health, Learning Disabilities and Autism Executive Board over the past year the Trust has supported the delivery of key objectives for the transformation of mental health and learning disabilities services in our region. We look forward continuing to work in partnership with colleagues across the system and with people with lived experience of mental illness and learning disabilities over the coming year as our Integrated Care System continues to develop.

Our key programmes of work 

Over the years we know our health and care systems have become disjointed and we have seen funding levels slow and in some sectors decline. During 2023/24, the Trust embarked on the development of key programmes of work to address the gaps in care, recognising that we need to review and change how we deliver services within some of our key patient pathways. This year, we worked with, and listened to our service users, 8 carers, staff, and key partners across the system to refresh our vision and strategic ambitions and these key programmes of work will be fundamental in our ability to deliver our commitment to working together, with compassion and care, to keep people well over their whole life and ensure our services support the most vulnerable in our communities.

Children and young people

Across the North East and North Cumbria, our children and young people are not receiving the best start in life. Our most vulnerable, marginalised children and young people are at higher risk of poor mental health, exploitation, and offending. The Northern regions have higher levels of child poverty which can have a devastating impact on wellbeing and life chances. Many children and young people do not receive the help they need, and there are long waiting times to access Trust services. This programme of work will seek to work in close collaboration with GPs, paediatrics, schools, colleges, and community groups to wrap around families and improve services for children and young people who need a stay in hospital. It is also important to ensure that help and support is available for children and young people while waiting for a diagnosis and work with other organisations to offer better support for children and young people with complex needs, and their families, so they can live well in their own communities.

Inpatient care for adults and older people with mental ill-health 

Sometimes, people need specialist treatment in hospital because they cannot be safely supported in their communities, yet we know our inpatient wards are busy, stressful environments, demand is high, meaning that people are sometimes cared for far away from their homes and support networks. There are often delays in discharging people out of hospital care because there is nowhere appropriate for them to return to, and people with learning disabilities or autistic people are often admitted to services that don’t meet their needs. This programme of work will look to make significant changes to inpatient services for adults and older people with mental ill-health issues. We will work with social care, housing providers, GPs, and primary care to help and support people to stay well after their hospital stay. This will involve re-designing services to avoid hospital stays where appropriate and people will only be admitted to inpatient care if they need it. As part of this work, we will continue our focus on unavoidable long-term segregation or seclusion.

Community based care for adults and older people with mental ill-health 

This key programme of work will seek to enable people to access the support they need when they need it. GPs, primary care, and community organisations are at the heart of supporting people all through their lives. Each community has its own support and care networks, which we want to work alongside to wrap care around the person that needs it. At any given time, people should have access to care and support that is right for their needs, provided by the organisation that is best placed to meet those needs. We will work with our partners to create new models of care and support which are simple, easy to access and built on strong, trusted relationships.

We have started our journey to look at how we deliver community-based care which will consist of services and teams working together and rooted in our communities, move away from a confusing system of referrals, assessments and treatment, to one of constant support and easy access to the right support at the right time. This work will include ensuring expert advice, support and skilled clinical help is available from our teams when needed including the provision of intensive wrap around support for people who need it most. The programme of work will look to develop real alternatives to inpatient care with our partners across our places so that where possible, we can support people in crisis within their own communities.

People with a learning disability and/ or neurodevelopmental conditions

People with a learning disability and/or neurodevelopmental condition should have the same opportunities as everyone else, to access health and care services. This includes access to extra support to stay well and have a good life. We will seek to ensure all services are able to support someone with a learning disability and/or neurodevelopmental condition, ensuring staff the relevant training, and we will work with other organisations so people with a learning disability or neurodevelopmental condition stay healthy and live well in their communities.

Improving care for autistic and learning disabilities people

Accessing care and support can be challenging for patients living with autism and/or or living with learning disabilities and their families and we are committed to working in partnership with people who use our services to improve the way we deliver care as well as our physical environments. Over the past year we have continued to work in collaboration with autistic people to address how we can improve care, treatment, and the ward environment for autistic people who are admitted to our services.

We continue to work with advocacy services across the CNTW footprint to help strengthen the voice of all patients, including those with autism and living with learning disabilities, within our inpatient units. The Trust continues to work with people with lived autistic experience and community organisations to roll out autism awareness training to Trust staff. HOPEs is the recommended national model for working with individuals in Long Term Segregation (LTS). Individuals with learning disability and autistic individuals are more likely to be subject to highly restrictive practices such as LTS. The Trust is committed to reducing its use and has invested in a HOPEs role to lead the implementation of the model in CNTW and support the work of the National HOPEs team. All individuals in the Trust who are in LTS are supported using the model that addresses their human rights and works to improve their quality of life and end LTS. Staff supporting these individuals are being trained in the model and to use a tool to support them in setting intervention targets to change the situation.

Workforce Development 

Widening Access Programme 

CNTW is the first Trust to employ two colleagues who have had lived experience of homelessness, now working in Community Clinical Business Units (CBUs), as part of the widening access programme, supported by NHSE. The programme aims to support and encourage students whose personal circumstances put them at a disadvantage when pursuing wider education.

International Adult Nurses: Community Mental Health Team (pilot)

The introduction of Internationally Educated Adult Nurses to Community Treatment Teams (CTT) is a new initiative for CNTW. These nurses are primarily working on the physical health pathway of the community teams. This was a pilot and a full evaluation of the effectiveness of this will be reviewed before a decision is made to recruit adult nurses into other community mental health teams.

Internationally Educated Adult Health Nurses (IEAN)

CNTW is offering the opportunity for IEANs recruited to the Trust to work within a mental health unit to gain their mental health registration. They will be supported to complete the mental health computer-based test and objective structured clinical examination to obtain Nursing and Midwifery Council mental health registration as their primary registration. This will support career progression and enable the nurse to lead shifts, supporting the clinical teams as a valuable resource.

Career progression for international nurses

Internationally Educated Nurses have the opportunity for a one-to-one career conversation and develop a career progression plan. This will be linked with the Trust wide ‘Stay conversation’ plan and link with appraisal. The aim is to support development and retain staff.

Digital Culture Lab 

The Trust has introduced a digital resource that can be accessed by all staff. The aim is to increase awareness of the cultures of all nationalities that are employed by CNTW and encourage open conversations. All staff members have been invited to submit information that has been collated into a colourful resource to celebrate the diverse cultures within the organisation.

Trust Business Model and Structure

The Trust structures its operational services geographically into ‘Locality Care Groups’ (Localities). This is to support a collective leadership approach, and to ensure a devolved decision-making model where decisions are made as close to the patient as possible. The Trust’s operational services are arranged across four localities:

North – Northumberland and North Tyneside

Central – Newcastle and Gateshead

South – South Tyneside and Sunderland

North Cumbria

Each Locality is led by a Group Director, Group Nurse Director and Group Medical Director who are jointly responsible for the performance of local services, known as the ‘triumvirate’. The central and south localities consist of four clinical business units (CBUs), the North and North Cumbria localities consist of three CBUs (14 CBUs in total across the Trust). Each CBU is led by a collective leadership team including an Associate Director, Associate Nurse Director, Associate Medical Director, Associate Director for Allied Health Professionals and Associate Director for Psychological Services. A full list of services, with descriptions and contact details can be found on our website. 

Wholly Owned Subsidiary Company

The Trust established NTW Solutions Limited (Solutions) as a wholly owned subsidiary company and it became operational in April 2017. Wholly owned subsidiary companies are an organisational and governance form that NHS Foundation Trusts can legally establish to manage parts of their organisation. Wholly owned subsidiary companies are separate legal entities. Solutions is part of the “CNTW Group”, sharing the vision and values of the Trust in carrying out its activities, with the Trust holding 100% of the Company’s shares. Solutions provides the Trust’s estates and facilities management services and a range of other services including workforce recruitment, staff records, procurement, materials management, some financial services, car leasing and other staff benefit schemes, digital dictation, and outpatient pharmacy dispensing. It employed 775 staff (physical number of staff not full-time equivalents) as at 31 March 2024, the majority of whom were transferred from the Trust to the company under TUPE regulations, thereby protecting their NHS terms and conditions. New company staff appointed since April 2017 are employed on company terms and conditions of service.

AuditOne

AuditOne, is a not-for-profit provider of internal audit, technology risk and counter fraud services which is hosted by CNTW. AuditOne was originally formed from four NHS consortia and delivers independent assurance and advice to public sector clients on a wide range of topics including financial management, governance, major IT 12 programmes, data quality, cost reduction, integrated assurance, and forensic investigations.

CNTW SHINE Charity

The Trust’s charity was established on the 26 February 2016 in which the Trust is the sole Corporate Trustee. The charity holds funds to be used for any charitable purpose relating to the general or specific purposes of the Trust or purposes relating to the NHS. Typically, funds are used to support current and former service users of the Trust by providing items of comfort or therapeutic activities beyond the normal levels expected for patient welfare and amenities. The Charity has one general fund which is called the SHINE Fund and other specific funds which are relevant to individual services, wards, and departments.

This year, patients, carers and NHS staff across the North East and North Cumbria were set to benefit from a grant that will improve services. Following a successful bid, the Trust was awarded a grant of £154,000 from NHS Charities Together. This grant is one of many thousands of awards made by NHS Charities Together thanks to its Covid 19 Urgent Appeal, which raised a massive £162 million.

The funding awarded to CNTW will go towards eight different projects aiming to support the long-term recovery of both patients and staff to help support people accessing mental health, learning disabilities and neuro-rehabilitation services by providing the extra things that can make a real difference.

The initiatives which will benefit from the funding are CNTW’s Children and Young People’s Services, and the adult autism inpatient services, as well as bereavement support for staff provided by the Trust’s Staff Psychological Centre, and support for the carers of children and young people. The Charity’s Annual Report will be available in December 2024.

Our vision, values, commitments and strategic ambitions 

Following an 18-month process to review the Trust’s strategy, we reflected on the significant changes within the health and care sector and the impact of this on CNTW. This included the impact of, and learning from, the Covid pandemic, the impact of the cost-of-living increases to those within our local communities, the increasing demand for health and care services, and the need for us to work more closer than ever with our partners and stakeholders, to change how we deliver health and care services across the North East and North Cumbria Integrated Care System. Following extensive engagement with service users and carers, our workforce, our partners and local communities, our new strategy, With You in Mind’ was launched in Spring 2023. Our vision is to “work together, with compassion and care, to keep you well over the whole of your life”. This vision remains based on our values of being caring and compassionate, respectful, honest, and transparent. To develop our strategy, we asked service users, carers, their families, our staff, and partners to describe what matters to them. They asked us to work together, with them in mind, with compassion, humanity, and care. This is at the heart of our strategy. We have developed long-term commitments which will guide everything we do. Our aim is to deliver on these commitments every day, in every contact. Our vision, values, strategic ambitions, and commitments are outlined below.

Our vision 

To work together, with compassion and care, to keep you well over the whole of your life. 

Our values

We are caring and compassionate - because that is how we'd want others to treat those we love. 

We are respectful - because everyone is of equal value, is born with equal rights and is entitled to be treated with dignity. We want to protect the rights of future generations and the planet that sustains us all. 

We are honest and transparent - because we want to be fair and open, and to help people make informed decisions. 

Our strategic ambitions

Quality care every day - we will aspire to deliver expert, compassionate, person-led care every day, in every team. We will value research and learning. 

A great place to work - We want to be a great place to work. We will make sure that our workforce has the right values, skills, diversity and experience to meet the changing needs of our service users and carers. 

Sustainable for the long term, innovating every day - We will be a sustainable, high performing organisation, use our resources well and be digitally enabled. We will be accountable for the money we spend; we will live within our means, and we will work in a way that is kind to the planet. 

Working with and for our communities - We will created trusted, long-term partnerships that that work well together to help people and communities. 

Our commitments

Commitment to our service users 

Understand me, my story, my strengths, needs and risks. Work with me and others, so I can keep healthy and safe; 

Protect my rights, choices and freedom; 

Respect me and earn my trust by being honest, helpful and explaining things clearly;

Support me, my family and carers in an effective, joined-up way that considers all my needs, and

Respond quickly if I am unwell or in crisis, arranging support from people with the right expertise. Make sure I don't have to keep repeating my story. 

Commitment to our families and carers (also known as our 'carer promise')

Recognise, value and involve me;

Work with me to ensure you're aware of my needs as a carer;

Listen to me, share information with me, and be honest with me when there is information you can't share;

Talk with me about where I can get further help and information, and about what I can expect from you. 

Commitment to our staff 

Respect me for who I am, trust me, value me and treat me fairly;

Allow me freedom to act, to use my judgement and innovate in line with our shared values;

Protect my time by making systems and processes as simple as possible so I can deliver the work I aspire to, learn, progress and get a balance between work and home; 

Offer me safe, meaningful work and give me a voice, working as part of a team that includes other professions and services, and 

Support me with compassionate managers who communicate clearly and understand what it's like to do my job. 

Commitment to our partners and communities 

Explain what to expect from CNTW;

Help us to fight illness, unfairness and stigma;

Make sure that organisations talk to each other and put the needs of people's before their own. Share responsibility for getting things right;

Get to know local communities. Respect their wisdom and history;

Be responsible with public funds;

Share our buildings, grounds and land; and

Protect the planet. 

The key issues and risks to the Trust's strategy 

The Group faces several risks to the delivery of its strategy. A full analysis of the principal strategic risks, together with the controls and mitigation, are included in our Board Assurance Framework. The Group’s principal risks are set out within the Annual Governance Statement (section 2.10).

NTW Solutions limited strategy

NTW Solutions refreshed its strategy in 2021 to build on the firm foundations established since the company was founded. The overall company strategy is to support our partners to deliver better care by:

Being the collaborative partner of choice

Embedding our values in everything we do

Tackling the climate emergency 

Developing a culture of quality and innovation 

Being a great and inclusive place to work 

going concern disclosure

After making enquiries, the directors have a reasonable expectation that the services provided by the NHS Foundation Trust will continue to be provided by the public sector for the foreseeable future. For this reason, the directors have adopted the going concern basis in preparing the accounts, following the definition of going concern in the public sector adopted by HM Treasury’s Financial Reporting Manual.

Summary of performance 2023/24 (April 2023 - March 2024)

This year, there was so much to be proud of at CNTW. Here are just some of the highlights.

In April, we celebrated Lesbian Visibility Week by sharing the stories of three members of our LGBTQ+ Network. They shared their thoughts about coming out as lesbian and why being visible at work is important to them.

In May, we announced we were joining forces with Everyturn to help people waiting for support from our community treatment teams. Everyturn offered emotional support, as well as practical help. The project aimed to ensure people have the support they need to stay well. It also created six new local jobs.

‘Where Hope Begins’ during the pandemic. The charity was also supported by occupational therapist Paul Wales who cycled over 1,300 miles from Newcastle to Nice, raising an incredible £8,000 for SHINE and Brain Tumour Research.

Also in March, two members of staff went to the House of Commons for No Smoking Day. Specialist Tobacco Dependence Service Lead Kerry Apedaile and Acting Associate Nurse Director Gayle Wilkinson represented NHS mental health services at the event, where they spoke to lords, ministers, and other parliamentarians on what a smokefree future could look like.

This is only a small snapshot of the great work our staff do day in, day out, to provide the best possible care to those who need us.

Performance relating to the quality of NHS services provided 

The CNTW Quality Account provides comprehensive information on performance in terms of the provision of quality services, including performance against mandated core indicators, quality indicators and the Trust’s quality goals. Copies of the Quality Account can be obtained from the Trust’s website or the NHS website. 

Registration with the Care Quality Commission (CQC)

The Trust is required to register with the CQC, and its current registration status is registered without conditions and therefore licensed to provide services. The CQC has not taken enforcement action against the Trust during 2023/2024.

In 2018, the Care Quality Commission (CQC) conducted an inspection of our services and once again rated us as “Outstanding”. We are one of only eight Mental Health and Disability Trusts in the country to be rated as such, as of 1 April 2024.

During 2022, the CQC conducted two focused inspections to: Rose Lodge and all wards for people with a learning disability or autistic people. Following these inspections, the CQC identified eight areas of improvement (Must Dos Action Plans), all of which have now been addressed.

In December 2022, the CQC conducted a focused inspection of three acute wards for adults of working age and psychiatric intensive care units on the Campus for Ageing and Vitality hospital site (Fellside, Lamesley and Lowry). Three areas of improvement were identified following this inspection, two of which have now been addressed.

Mental health and learning disability services from North Cumbria transferred to the Trust on 1 October 2019 and with those services accepted 37 areas of improvement that had been identified by CQC at previous inspections. 27 areas of improvement have since been actioned and we continue to address all remaining areas of improvement.

NHS Oversight Framework 

NHS England’s NHS Oversight Framework provides the framework for overseeing providers and identifying potential support needs. The framework looks at five themes:

Quality of care 

Finance and use of resources

Operational performance

Strategic change

Leadership and improvement capability (well-led).

Based on information from these themes, providers are segmented from 1 to 4, where ‘4’ reflects providers receiving the most support, and ‘1’ reflects providers with maximum autonomy. A Foundation Trust will only be in segments 3 or 4 where it has been found to be in breach or suspected breach of its licence.

Segmentation 

NHS England have assessed the Trust as ‘segment 1’ – maximum autonomy. There are no enforcement actions placed upon the Trust by NHS Improvement and no actions are being taken or proposed by the organisation. At Month 12 the Trust reported financial outturn for the year end at breakeven.

This segmentation information is the Trust’s position as of 31 March 2024. Current segmentation information for NHS Trusts and Foundation Trusts is published on the NHS England’s website.

Note that finance and use of resources rating was suspended since quarter 1 2020/21 due to the financial arrangements put in place during the pandemic.

Finance and use of resources

Organisations have been managing within an evolving finance regime, post pandemic. Contracts are underpinned by nationally determined block allocations for each organisation based upon adjusted levels of expenditure from 2019/20. Contractual arrangements have continued to develop through 2023/24, but they have essentially remained as a block allocation regime as the NHS payment regime transitions to new mechanisms post pandemic. The Trust committed to delivering financial break-even as part of the North-East and North Cumbria Integrated Care System. The Trust delivered a breakeven position in 2023/24. The adjusted financial performance for the CNTW Group for the period ending 31 March 2024 was £58k (2022/23 £92k). The adjusted financial performance is after exceptional items such as impairments and full details are reported within note 1.26 of the annual accounts.

The Trust has an integrated performance reporting structure, which mirrors the key reporting requirements of the ‘Intelligent Mental Health Board’. The Trust has committed to updating the internal dashboards that contain a clear set of key performance indicators reflecting not only national targets, but local targets linked to the Trust’s strategic and annual objectives balanced across clinical, operational, financial and staff dimensions. The updates will provide staff with more data that is joined up and will aid planning. This ensures that our strategy, objectives, and targets are linked to ensure delivery, with strengthened accountability for performance using key metrics.

In addition to providing a robust analysis of new and existing quality and performance targets and the risk register, the report provides evidence links for the Trust’s compliance to CQC registration requirements and supports Board assurance in its annual self-declaration process.

The Trust provides services to a broad range of commissioners. The main commissioners for the Trust in 2023/24 were as follows:

North East & North Cumbria Integrated Care Board

NHS England

Cumbria and North East Commissioning Hub which is the local team of NHS England;

Integrated Care Boards out of area plus Scottish, Welsh and Irish health bodies who commission on an individual named patient contract basis; and 

Local Authorities. 

The Trust continues to fulfil the contractual requirements of submitting routine commissioner data to the NENC ICB/ICS, allowing us to maintain our positive relationship with commissioners. We continue to be the lead provider for specialised provider collaboratives for adult secure, children and young people’s services and adult eating disorder services, working in partnership with NHS England and Tees, Esk and Wear Valley NHS Foundation Trust. We are also lead provider for OpCourage (veteran’s) provider collaborative working in partnership with four NHS foundation trusts and two voluntary sector organisations to provide services for populations across the North East, Yorkshire and the North West. Commissioners monitor our performance through monthly monitoring reports and regular contract review meetings.

Task force on climate related financial disclosures (TCFD)

NHS England’s NHS Foundation Trust Annual Reporting Manual has adopted a phased approach to incorporating the TCFD recommended disclosures as part of sustainability annual reporting requirements for NHS bodies, stemming from HM Treasury's TCFD aligned disclosure guidance for public sector annual reports. TCFD recommended disclosures as interpreted and adapted for the public sector by the HM Treasury TCFD aligned disclosure application guidance, will be implemented in sustainability reporting requirements on a phased basis up to the 2025/26 financial year. Local NHS bodies are not required to disclose scope 1, 2 and 3 greenhouse gas emissions under TCFD requirements as these are computed nationally by NHS England. The phased approach incorporates the disclosure requirements of the governance pillar for 2023/24.

During 2023/24, the Board of Directors undertook a substantial review of the risk appetite of the organisation and the Board Assurance Framework (BAF), which provides the Board with oversight and assurance of its principal risks to the achievement of its strategic ambitions.

Included in this, the Board ensured that a specific risk appetite category was associated with the impact of climate and ecological sustainability. Risks associated with this continue to be reflected on the BAF and within the Trusts risk management system and process.

On an ongoing basis, the Board of Directors have delegated responsibility for oversight of the organisations progress against the Green Plan to the Resource and Business Assurance Committee which continues to receive regular updates and escalate any issues to the Board. Further information on the Trust’s governance process, management oversight arrangements, metrics, and performance against the ‘Green Plan’ and processes ensuring management oversight and delivery can be found in section 2.8, the Sustainability Report.

NTW Solutions Limited (Solutions) Performance

Service Level Agreements and Key Performance Indicators (KPIs)

The Trust’s subsidiary company is included within the financial performance for the group. All profits generated by Solutions are retained and reinvested by the Trust as part of the CNTW Group. The company did not issue any dividend payment in 2023/24. The annual accounts for Solutions will not be formally approved until November 2024.

At the end of 2023/24, Solutions had 134 KPIs in place, (an increase from 118 the previous year). Of these, 112 hit the green expected target every month of 2023/24, two KPIs were not reported (on hold) by mutual agreement, leaving 20 KPIs where amber or red results were recorded. Any KPI recorded as “amber” or “red” i.e., not meeting agreed target levels, requires us to provide the Trust with an explanation or an action plan setting out how performance will be improved. The KPIs are also reviewed twice per year by us and the Trust to ensure they remain relevant, with appropriate target levels.

Across the full year Solutions reported on 1,558 KPI measurements, with 94.55% of these meeting the mutually agreed target, as shown in the chart below.

Other Benchmarking and Assessment Reports

For some services, Solutions can benchmark performance with other NHS organisations or undertake self-assessment using national processes.

The ERIC Report (Estates Return Information Collection) is the main national annual benchmarking tool for NHS estates and facilities services which enables comparisons to be made against services in 45 Mental Health and Learning Disability Trusts. The majority of the many indicators for 2023/24 placed Solutions “mid-table” or better. This data set, as with other benchmarking tools, should be considered in the context of wider quality of service assessments, such as Patient Led Assessment of the Care Environment results (PLACE), CQC inspections, cleaning audits, Degree Day Data (weather) etc.

The Premises Assurance Model (PAM) annual report is based on self-assessment against 366 estates related questions covering safety, patient experience, efficiency, effectiveness, and management of estates services. This data collection is now part of a national electronic submission (previously data was held locally by individual Trusts). National results for 2023/24 have not yet been released but performance is expected to evaluate as well as in recent years. Any areas requiring improvement will have action plans developed and monitored to make improvements.

Annual PLACE (Patient-Led Assessments of the Care Environment) assessments are designed to provide motivation for improvement by receiving feedback directly from patients and others, about how the environment or services might be enhanced. PLACE inspections have been undertaken and services compare well with others.

Social, Community, anti-bribery and Human Rights issues 

Mental health issues are common but nine out of ten people who experience them say they face stigma and discrimination as a result. People with learning disabilities, autism and other disabilities and impairments also experience unfairness in many areas of life. CNTW aims to be a campaigning organisation which challenges discrimination of all types, and which has an important role to play in improving outcomes for people with mental health issues, learning disabilities and other disabilities in the region.

As part of our quality priorities for 2024/25 we are looking at how we embed being trauma informed in everything we do, including our policies and pathways, our communication, leadership, and governance and how we make the organisation a trauma informed place to work. This is underpinned by seven key principles, collaboration/coproduction, empowerment, providing environments that are culturally, psychologically, physically, and sexually safe, offering choice, establishing trust, emphasising people’s strengths and minimising traumatisation/re-traumatisation.

Tackling health inequalities

Over the past year we have focused on developing and linking datasets to better understand inequalities of access and health outcomes among our patient population. In collaboration with the North East Quality Observatory Service (NEQOS) we have developed a population health profile and core health inequalities dataset aligned to NHS England’s Statement on Information on Health Inequalities (duty under section 13SA of the National Health Service Act 2006), publishing our data and analysis on our Trust website alongside this report. Key messages from the report include:

Detentions under the Mental Health Act

• In the CNTW area, 91 people per 100,000 population were detained under the Mental Health Act between April 2023 and March 2024. 
• The rate of detentions is higher among young people (mid-20s to mid-30s), and among people aged 76 or older. 
• The rate of Mental Health Act detentions is higher in more deprived areas. 
• The detention rate for people from black, mixed and other ethnic groups is higher than the detention rate for white people. 

Restrictive interventions

• On average, between April 2023 and March 2024 CNTW patients experienced restrictive interventions 41 times for every 1,000 days spent in hospital. 
• Rates of restrictive interventions are highest among people aged 17 and under at 337 restrictive interventions per 1,000 days spent in hospital.
• The rate of restrictive interventions is higher among younger female patients.
• There are some big differences in the rate of restrictive interventions for people from different ethnic groups.

Talking Therapies recovery

• There is a small increase in Talking Therapies recovery rates as people get older.
• Recovery rates are similar for males and females, but females are more likely to be referred to our Talking Therapies services than males.
• People from black, mixed, and other ethnic groups have higher Talking Therapies recovery rates than people from a White ethnic background or an Asian background.
• People living in more deprived areas have lower Talking Therapies recovery rates. In these areas, more people are referred to Talking Therapies.

Children and young people's access to mental health services 

• Most of the children and young people who received at least one contact from CNTW mental health services between April 2023 and March 2024 were White (91%).
• The rate of children and young people receiving at least one contact with CNTW mental health services is higher in more deprived areas.
• The rate of children and young people receiving at least one contact with CNTW mental health services is higher among older children, and highest among children aged 14-17.
• The rate of children and young people receiving at least one contact with CNTW mental health services is slightly higher for males than for females.

We look forward to developing this dataset further in partnership with our patients, staff, and communities, and strengthening our approach to using health inequalities data to challenge and inform decision-making across the Trust.

CNTW provides care to patient groups that are likely to experience significantly poorer physical health outcomes than the general population. People living with severe mental illness die on average 15 to 20 years earlier than the general population, and 2 in 3 deaths among people living with severe mental illness are caused by physical illnesses which can be prevented and treated, including cardiovascular disease and respiratory disease. Learning from the LeDeR (Learning from lives and deaths – People with a learning disability and autistic people) programme shows that in 2022, 42% of deaths among people with a learning disability were avoidable.

In collaboration with colleagues from North of England Care System Support (NECS) and the North East Quality Observatory (NEQOS), during 2023/24 we completed a project to link data from the Mental Health Services Dataset (MHSDS), Births and Deaths Dataset, and hospital admissions data to better understand mortality trends and cause of death among our patient population. We look forward to building on this initial piece of work to improve understanding, at both a provider and system level, of the physical health inequalities impacting people receiving specialist care for mental illness, learning disabilities, autistic and to developing a greater focus on prevention and early intervention for this patient population.

Over the course of this year, we have reviewed our approach to tackling health inequalities across the Trust and developed our priorities for this work in 2024/25, taking an asset-based approach which builds on areas of innovation across the organisation and prioritising delivery of key programmes of work. These include the development of our Patient and Carer Race Equality Framework (PCREF), an anti-racism, race equality and accountability framework for mental health services, and the rollout of our Reasonable Adjustments Digital Flag which will support us to deliver a more personalised experience of care which better meets the holistic needs of our patients. We continue to contribute to the North East and North Cumbria Integrated Care Board’s Healthier and Fairer workstreams, and look forward to developing and strengthening our work with system partners to tackle health inequalities.

Fraud prevention and management of interests

The Trust works closely with its Internal Audit Team including the Local Counter Fraud Service and support awareness raising of the potential for fraud. The Trust has a Declarations of Interest policy, aligned to NHS England requirements that all CNTW Staff must comply with to ensure the Trust is transparent in all business conduct. To support compliance with the policy, the Trust developed an online reporting system to enable all staff to easily declare any interests or potential interests they may have. The policy has been successful in providing clarity that it is the responsibility of all staff to declare interests to ensure they are impartial and honest in the conduct of their official duties. To ensure the Trust is transparent in all business conduct the declarations can be viewed on the Trust website or can be accessed on request by contacting Debbie Henderson, Director of Communications and Corporate Affairs, Chief Executive’s Office, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne, NE3 3XT corporateaffairs@cntw.nhs.uk

Important Post Year End Events

The directors have confirmed that there are no expected post balance sheet events which will materially affect the disclosures made within the Accounts 2023/2024.

Overseas Operations

The Trust does not engage in any commercial overseas operations.

James Duncan 

Chief Executive 

26 June 2024 

The Board of Directors 

The Trust’s Board of Directors keeps its performance and effectiveness under constant review and undertakes an annual self-assessment of effectiveness. The Board also have ‘away day’ meetings, a development programme and regularly review governance arrangements. A regular review of the terms of reference and an annual self-assessment exercise is also conducted on all committees. The Board also uses the outcome of the annual Care Quality Commission Well Led Review as a means to measure Board effectiveness and identify areas for further development.

Council of Governors and Board of Directors and newly appointed Non-Executive Directors. The Trust recognises the implementation of Integrated Care Systems and Integrated Care Boards and partnerships and the need to operate within a system that incorporates the NHS ICB structures. Alongside this, we have also made the following organisational changes:

• Implementation of a new strategy 'With you in mind' (from Spring 2023)
• A review of the Trust governance framework (during 2023/24)
• A review of the Trust risk management systems, processes and policy (during 2023/24)
• A review of the Trust operational structures (implementation from April 2024)

On this basis, during 2023/24, a review of the Board Assurance Framework, Risk Management Policy and process was undertaken. Following the implementation of the Trust’s ‘With You in Mind’ strategy, all supporting strategies were withdrawn to enable a single strategy for the organisation to shape a clear direction, and culture. This included the withdrawal of the Risk Management Strategy for 2017-2022. Further information on the outcome of the review of risk management can be found in the Annual Governance Statement in section 2.10 and the Audit Committee report in section 2.5.

Alongside the review of the risk management policy and process, the Trust’s governance framework was also subject of review, led by the Director of Communications and Corporate Affairs during 2023/24. The review was undertaken in the context of:

• Individual and group discussions with the Director of Communications and Corporate Affairs.
• Review of Board, corporate, group and individual accountability and responsibilities (Scheme of Delegation).
• The launch of the Trust’s ‘With You in Mind’ strategy.
• Changes to leadership within the organisation. 
• Learning from best practice and governance failures detailed in the publication of external reports into other NHS organisations.

Further information on the outcome of the review can be found in the Annual Governance Statement in section 2.10.

NTW Solutions has its own Board of Directors. In accordance with the company’s Articles of Association, all proposed changes to the Articles of Association, and director appointments require the approval of the Trust Board and/or the Trust’s Chief Executive or his nominated representative, on behalf of the Trust’s Board of Directors as shareholder of the Company.

Chair and Non-Executive Director (NED) appointments 

A term of office for the Trust Chair and NED is up to three years. The Trust considers the need for progressive refreshing of the Board of Directors. Therefore, the Chair or a NED is subject to an annual appraisal of their performance, similar to the Chief Executive and Executive Directors. Any term beyond six years (i.e., two terms) is only made in exceptional circumstances and is subject to an annual re-appointment process which includes a rigorous review of performance and satisfactory appraisal. The Chair and all NEDs report the outcomes of their annual appraisal of their performance to the Council of Governors’ Nomination Committee.

The Council of Governors’ Nominations Committee is responsible for managing the process for the appointment and removal of a Trust Chair and NEDs. Circumstances that may lead to the removal of a Chair or NED include, but are not limited to, gross misconduct, a request from the Board for the removal of a particular NED, the Chair losing the confidence of the Board or Council of Governors and the severe failure of the Chair to fulfil the role.

The Trust Chair 

During the period of 1 April 2023 – 30 September 2023, the role of Chair of the Board of Directors and Council of Governors was held by Ken Jarrold, who commenced his role with the Trust on 1 February 2018 and was re-appointed for a second term of office on 1 February 2021. Following an external recruitment process, supported by an independent recruitment firm, undertaken by the Council of Governors’ Nomination Committee, Darren Best was appointed as Chair of the Council of Governors and Board of Directors and was appointed into post on 1 October 2023. NRG Executive Search and Recruitment Agency was appointed to support the process. The firm has no connections with the Trust or individual directors.

The Chair is responsible for providing leadership to the Council of Governors and Board of Directors, ensuring good governance is maintained across the organisation. The Chair is also responsible for ensuring the integrity and effectiveness of the relationships between Governors and Directors. The Chair leads the performance appraisals of the Council of Governors, NEDs and the Chief Executive.

The Trust Vice Chair 

During the period of 1 April 2023 to 30 September 2023, Darren Best held the role of Vice Chair. From 1 October 2023, Brendan Hill was appointed into the role of Vice-Chair and continues in this role.

The Trust Senior Independent Non-Executive Director 

David Arthur was appointed as the Senior Independent Director from 1 July 2021 and continues in this role. The Senior Independent Director leads the performance appraisal of the Chair.

The Chief Executive 

The role of Chief Executive has been held by James Duncan since 1 February 2022. The Chief Executive’s principal responsibility is the effective running and operation of the Foundation Trust’s business. The Chief Executive is also responsible for proposing and developing the Trust’s strategy and business plan objectives in close consultation with the Chair of the Board of Directors. The Chief Executive is responsible for preparing forward planning information, which forms part of the Annual Plan, taking into consideration the views expressed by the Board of Directors and Council of Governors. The Chief Executive is responsible, with the executive team, for implementing the decisions of the Board of Directors and its committees and leads the performance appraisals of the Executive Directors and Director of Communications and Corporate Affairs/Company Secretary.

Directors' skills, expertise and experience - CNTW Group 

The Board of Directors believes that it continues to operate effectively. The Board keeps the size, composition, and succession of directors under review, in line with the Trust’s business objectives, and makes recommendations as appropriate to the Council of Governors and the Governors’ Nomination Committee via the Chair and Chief Executive. As a result of the work of the Nominations Committee and the Council of Governors relating to the Chair and NED appointment and reappointment process, the Trust formally acknowledged and accepted the recommendation that appointments to the Board should seek to ensure consideration of gender, equality, and diversity balance with the Board of Directors. The Trust continues to be committed to this recommendation and will ensure a strong focus on equality, diversity and inclusion is maintained as part of future appointment and re-appointment processes.

The qualifications, skills, expertise and experience of the Trust’s directors as of 31 March 2024 are shown below.

Ken Jarrold CBE, Chair (until 1 October 2023)

• BA [Hons] in History from Cambridge University
• Diploma of the Institute of Health Services Management
• Honorary Doctorate from the Open University
• 36 years as an NHS Manager including 20 years as a Chief Executive and 3 years at national level as Director of Human Resources and Deputy to the Chief Executive of the NHS in England
• Chair of the North Staffordshire Combined Healthcare NHS Trust
• Chair of Brighter Futures Housing Association of Stoke on Trent
• Patron of the NHS Retirement Fellowship and of the Cavell Nurses’ Trust
• President of the Institute of Health Services Management
• Chair of the County Durham Economic Partnership
• Board member of the Serious Organised Crime Agency [SOCA] and of the Child Exploitation online Protection Centre [CEOP]
• Co-Chair of the National Institute of Mental Health Development Board for the North East and Yorkshire
• Chair of the Pharmacy Regulation Oversight Group [PRLOG] and of the Rebalancing Board for Medicines Legislation and Pharmacy Regulation
• Honorary Professor of the Universities of Durham, Salford, and York
• President of the Cambridge Union Society
• Director and Shareholder of Other People’s Shoes Ltd

Darren Best, Non-Executive Director, and Vice-Chair (until 1 October 2023) and Chair (from 1 October 2024)

• 30 years ​​​​​​​as a Police Officer with over a decade working in senior police leadership roles.
• Head of Professional Standards, Area Commander and Head of Criminal Investigation Department, Cleveland Police.
• Temporary Assistant Chief Constable, Durham Constabulary.
• Assistant Chief Constable and Deputy Chief Constable, Northumbria Police.
• Chair of Teesside Safeguarding Adults Board (October 2021 – April 2024).
• CNTW Non-Executive Director and Vice-Chair. 

David Arthur, Non-Executive Director, and Senior Independent Director 

• Chartered Accountant (1977).
• Fellow ​​​​​​​of the Institute of Chartered Accountants in England and Wales (1982).
• 40 years as a partner in Tait Walker LLP, Chartered Accountants.
• National head of Forensic Services of MHA, Chartered Accountants network.
• Chair of Percy Hedley Foundation. 
• Trustee of Mental Health Concern, Chair of Finance Committee and Member of Governance Committee.
• Chair of the Governors of Dame Allan’s Schools.
• Director and founder member of North East Fraud Forum.
• ICAEW representative on National Business Crime Forum.
• Member of North East Bank of England Panel.
• Chair of Bulman Property Limited.
• President of Northern Society of Chartered Accountants.
• Member of Business Engagement & Advisory Board Newcastle University.

Michael Robinson, Non-Executive Director 

• BA ​​​​​​​[Hons] in Law from Oxford University.
• Qualified Solicitor (now retired). 
• Experienced non-executive director and board member.
• Former partner in the corporate department of a large UK-based law firm.
• Company Secretary and Group Legal Director at the Sage Group plc for 14 years.

Paula Breen, Non-Executive Director 

• MA (Strategic Human Resource Management).
• Chartered Institute of Personnel and Development (CIPD) and Institute of Leadership and Management (ILAM).
• BA Business Management and Finance.
• Post Graduate Diploma in Education Leadership.
• Over 30 years business leadership in medium sized public and private organisations in both Executive and Non-Executive roles.
• Strategic Practice Management Primary Care, Northumberland.
• Managing Partner Primary Care, Cumbria.
• Chair and Head of Finance and HR Eden Primary Care Network, Cumbria.
• Chief ​​​​​​​Operating Officer Cumbria Education Trust.
• Elected Member and Cabinet Resources Portfolio Holder, Eden District Council.
• Founding Director (NED) Heart of Cumbria Ltd.
• Governor and Chair of Finance, Ullswater Community College.
• Director (NED) Eden Valley Hospice.
• Director of Finance and Resources and Company Secretary, Education.
• Group Chairman (NED) Coast and Country Housing Ltd.
• Director of Business Management, Norcare Ltd.
• Business Leadership Member, North East Region School Leaders Forum.
• Chair, North East Academies Forum.
• Board Member Darlington College.

Brendan Hill, Non-Executive Director (Vice-Chair from 1 October 2023)

• Registered Mental Health Nurse. 
• Postgrad in Dip Mental Health Practice.
• 38 years working in health and care both in senior clinical and managerial positions.
• 17 years as CEO of national mental health charity Mental Health Concern and Insight IAPT.
• Executive ​​​​​​​Chair Bluestone Collaborative (VCSE development agency).
• Partner in Human Learning Systems Collaborative, supporting organisations to adapt and respond to complex systems.
• Trustee of Association of Mental health providers.
• Board member- Newcastle Well-being for Life Board.
• Chair of Chilli Studios (Community Arts Company).
• Chair of Mental Health Northeast (Regional infrastructure organisation).
• NED/Trustee for Charity – Ways to Wellness.
• Coaching and mentoring. 
• RSA fellow. 

Louise Nelson, Non-Executive 

• PhD in Mental Health (Crisis resolution and home treatment- Service User experience).
• 37 years working in health with 20 years directly in mental health trusts and legacy institutions for Cumbria Partnership NHS Foundation Trust.
• 17 years working in Higher Education, culminating as Head of Nursing, Health, and Professional Practice at University of Cumbria.
• Previous role as Non-Executive Director for CPFT/NCUH and then NCIC.
• Chair of MIND Carlisle and Eden.
• Previous advisor for Borderline UK.
• Member of Quality Foundation.
• Volunteer for Project 5 offering mental health specialist support to NHS staff.
• Qualified and practising Executive Coach.
• Previous external advisor for Open University.
• Health and Wellbeing Champion for NCIC.
• Executive leadership in both Health and Education.
• Ofsted nominee for university first inspection in Health apprenticeship.
• Nursing education, clinical governance, and strategic planning.

Vikas Kumar - Non-Executive Director (from 29 January 2024)

• 30 years working in the creative and voluntary sector with over two decades working in senior leadership roles.
• Strategic Leadership - setting strategy, governance, programme development and delivery, innovation, financial management, fundraising, marketing, recruitment, coaching, mentoring, board development, quality assurance – specialising in EDI.
• Founder and Director of GemArts a visionary arts charity based in Gateshead.
• Extensive experience and knowledge working in partnership with cultural, public, private, and voluntary sector to engage with and deliver culturally relevant services to improve access and participation with Minority Ethnic communities.
• Awarded an MBE in the 2017 Queen’s Birthday Honours list for services to Arts and Culture.
• In 2009 received the Gateshead Award by the Mayor for outstanding service to Gateshead.
• Awarded Asian Business Connexions Arts and Culture award in 2016, and then again in 2019.
• Other Non-Exec roles include - Vice Chair and Trustee of Bensham Grove Community Centre; Trustee of Northern Stage; Member of Newcastle University Court and Nominations Committee.

Rachel Bourne - Non-Executive Director (from 29 January 2024)

• BA in History. 
• Member of CNTW Involvement Bank.
• Woman and Non-Binary Officer for Student Union at Kings College, Cambridge.
• Organised and chaired panel discussions on Learning Disabilities and discrimination in health and social care.
• Involvement as a writer, speaker, and consultant for the national ‘Hearing the Voice’ project an interdisciplinary study into voice-hearing.
• Chaplaincy ​​​​​​​Assistant at Kings College Chapel.
• Personal Assistant for Young People with Learning Disabilities and Epilepsy.
• Assistant Regional Safeguarding Officer for the Methodist Church – North East.
• Safeguarding Officer at Jesmond Methodist Church.

James Duncan, Chief Executive

• Degree in Politics and History. 
• Chartered Institute of Public Finance and Accountancy).
• Extensive board experience in the NHS over 24 years.
• Significant experience in leading major and transformational programmes across Trusts and systems.
• Extensive work in public, service user and carer involvement.
• Experience in managing mergers, FT application process, PFI and significant capital investment.
• Has undertaken national leadership roles in financial and system development.
• Senior responsible officer for capital and estate development for the Integrated Care System.

Dr Rajesh Nadkarni, Deputy Chief Executive / Executive Medical Director

• FRCPsych, MMedSc in Psychiatry (University of Leeds).
• Doctorate of Medicine (MD). 
• Diplomate of the National Board in Psychiatry from India and Bachelor of Medicine and Bachelor of Surgery (MBBS).
• 24 years’ experience as a forensic psychiatrist with extensive expertise in the clinical. assessment and management of people with mental health difficulties and involvement in criminal or court pathways.
• Continues to provide clinical expertise to the Newcastle Crown Court Mental Health Team and Northumbria Stalking Intervention Project.
• Provider Partner Board Member of the Integrated Care Board North East and North Cumbria.
• Member of GMC Advisory Forum on GMC procedures and doctors health.
• Member of the Mental Health Economics Collaborative, Mental Health Confederation.
• Member of the National Health and Justice Clinical Reference Group.

Ramona Duguid, Chief Operating Officer 

• MBA, BA in Business Management. 
• Over ​​​​​​​20 years’ experience of working in the NHS.
• Strategic development and transformation delivery
• Complex change management and stakeholder engagement.
• Operational delivery. 
• Extensive experience in governance, risk management and regulatory compliance.
• Quality improvement and service development.
• Partnership working and integration.

Lynne Shaw, Executive Director of Workforce and Organisational Development

• MA in Human Resource Management.
• Post Graduate Certificate in Strategic Workforce Planning.
• BA (Hons) in Business Management.
• Member of Chartered Institute of Personnel and Development (CIPD).
• 30 years’ experience in the field of HR, including over 20 years in the NHS.
• Extensive experience of generalist HR, change management, transformational leadership, workforce development, training, organisational development, wellbeing, equality, diversity and inclusion, transactional HR processes.
• National NHS Aspirant HR Director’s Programme.
• Member of the National Healthcare People Management Association and Regional Vice President for the North East and Cumbria.
• Co-Chair of the regional HRD network.

Kevin Scollay, Executive Director of Finance 

• Degree in Economics. 
• Chartered ​​​​​​​Institute of Management Accountants.
• Range of experience across NHS sectors 
  • ​​​​​​​​​​​​​​​​​​​​​Acute (11 years)
  • Ambulance (3 years)
  • Commissioning (3 years) 
• Previously Director of Finance at an NHS Foundation Trust.
• Experience in contracting, financial management and financial recovery.

Sarah Rushbrooke, Executive Director of Nursing, Therapies and Quality Assurance 

• Registered General Nurse. 
• Diploma in Professional Studies in Nursing.
• BSc (Hons) Nursing Science.
• Post Graduate Diploma with Commendation in Academic and Professional Learning.
• MSc Academic and Professional Learning.
• Nye Bevan Executive Leadership Programme.
• Extensive Nursing experience in NHS (38 years).
• Experience of implementing large scale change through quality improvement methodologies and qualifications.
• Extensive Experience in a wide range of nursing specialities and organisations including oncology, urology, elderly care, mental health and learning disabilities, surgery, urgent and emergency care.
• Director of Quality, Patient Safety, Innovation and Improvement at North East Ambulance Service.
• Director of Community Services and Deputy Chief Nurse at Royal Marsden NHS FT.
• Group Director South Locality at CNTW.
• Director of Quality and Patient safety at North of England Cancer Network.
• Deputy Director of Nursing, Quality & Safety at NHS England Cumbria, Northumberland, Tyne and Wear Area Team.
• Qualified Virginia Mason Production System Coach.
• Insights Discovery Facilitator.

Number of meetings and attendance 

The Trust’s Board of Directors met formally 13 times during 2023/24 which included three extra-ordinary Board meetings. Table 1 below shows the members of the Board of Directors including their titles, attendance at Board meetings, the date of appointment and the expiry date of the current tenure of the Chair and each Non-Executive Director.

Independent Non-Executive Directors (NEDs)

The Board of Directors is satisfied that the NEDs, who served on the Board of Directors for the period under review were independent. The Board of Directors is satisfied that there were no relationships or circumstances likely to affect independence, and the criteria at B2.6 of the NHS Foundation Trust Code of Governance was considered in arriving at their view. This continues to be reinforced through the appointments/re-appointments process applied by the Governors’ Nominations Committee.

NTW Solutions Limited - Board of Directors 

The qualifications, skills, expertise and experience of NTW Solutions Limited directors as of 31 March 2024 are shown below:

Malcolm Aiston, Non-Executive Director and Chair NTW Solutions

• Chartered Engineer with an Honours Degree in Engineering.
• 40 years’ experience in NHS estates and facilities services.
• Over 19 years as professional lead for these services in CNTW and its predecessor organisations.
• Developing and leading implementation of strategic change, including overseeing major award-winning capital projects.
• Experience in leading organisational change.
• Membership of national estates forums.
• Chair of Northern and Yorkshire NHS Apprenticeship Training Scheme for over 10 years.
• Trustee of Pagabo Foundation a charity focusing on Mental Health in the construction industry.

Andrew Buckley, Non-Executive Director NTW Solutions (appointment commenced April 2019)

• BA in Modern Languages. 
• Masters in business administration.
• Graduate Member of the Institute of Export.
• 30 years commercial experience in marketing, sales, communications, business development and customer services.
• Experience in leading organisational change.
• Held senior level posts with Stanley Tools, Britvic, Seagram, The Sage Group, FTSE and Make UK.
• Latterly Chief Executive with RTC North, a consultancy company helping businesses to innovate, compete and grow.
• Currently Trustee and Chair of The Northern Stage from September 2023.

Tracey Sopp, Managing Director 

• Membership of the Chartered Institute of Public Finance Accountants (CIPFA).
• 28 years’ experience in NHS financial services including extensive experience in production of annual accounts, taxation, cash management, transactional processing and financial governance and systems.
• Leading business transformation projects and delivering efficiency and process improvements.
• Experience of leading a range of other business support services.

Paul McCabe, Director of Estates and Facilities 

• Chartered Engineer. 
• 30 years’ experience in the NHS in estates and facilities operational, capital development and strategic management roles.
• Former Secretary of the North East Committee of the Institute of Building Services Engineers.
• Secretary and Chair of the Northern and Yorkshire Energy and Environmental Group, promoting effective implementation of energy management and sustainability in the NHS.

Matthew Lessells, Director of Estates 

• Chartered Engineer. 
• Masters degree in building services engineering. 
• 30 years’ experience in the NHS estates in both acute and mental health services.
• Experience in leading organisational change.
• Membership of national estates forums.
• Volunteer as Blood biker supporting Northumbria blood bikes.

Kevin Scollay, Shareholder representative

• Degree in Economics. 
• Chartered Institute of Management Accountants.
• Range of experience across NHS sectors
  • ​​​​​​​​​​​​​​Acute (11 years )
  • Ambulance (3 years) 
  • Commissioning (3 years) 
• Previously Director of Finance at a Foundation Trust.
• Experience in contracting, financial management and financial recovery.

The NTW Solutions Board of Directors met 11 times in the year. Table 2 below shows the members of the Board during 2022/23, date of appointment and attendance at Board meetings.

Table 2: Membership of NTW Solutions Board of Directors and Attendance 

CNTW Board Committees

The Trust’s Constitution requires the Board to convene a Remuneration Committee and an Audit Committee and any other committees as it sees fit to discharge its duties. As a mental health provider, the Trust is also statutorily required to convene a Mental Health Legislation Committee.

During 2023/24, the Trust undertook a review of its Governance Framework. Further information on the outcome of the review can be found in the Annual Governance Statement in section 2.10.

In addition to the Remuneration Committee, Audit Committee and Mental Health Legislation Committee, there are also four other standing Board committees delivering an assurance function. These are, the Resource and Business Assurance Committee (RABAC), the Quality and Performance Committee (Q&P), the Provider Collaborative and Lead Provider Committee (PCLP) and the People Committee.

Each committee is chaired by a Non-Executive Director, supported by other Non-Executive Directors, as well as Executive Directors and subject experts to ensure receipt of appropriate assurance. The delegated responsibilities of each committee in relation to risk management is reviewed by the Audit Committee underpinned by regular reviews of the Trusts Board Assurance Framework (BAF), which provides information on key risks to achieving the Trusts strategic ambitions. Each BAF risk is aligned to the relevant Board Committee for ongoing review and assurance. Each committee annually self-assesses its effectiveness annually against its terms of reference.

In relation to NTW Solutions, the Scheme of Reservation and Delegation between the Trust and Solutions reserves the company’s audit and director remuneration functions to be overseen by the Trust’s Audit Committee and Remuneration Committee. This includes the reporting of the company’s risk management arrangements to the Trust’s Audit Committee. A full review of the Solutions Scheme of Delegation was undertaken and approved by the Trust Board in October 2022, and is scheduled for a further review in June 2024. A full review of the Trust’s Standing Financial Instructions and Scheme of Reservation and Delegation was undertaken and approved by the Trust Board in July 2023.

Solutions has a Board of Directors which has established one Board committee, the Health, Safety and Security (HSS) Committee, which meets quarterly, and which is chaired by the Director of Estates and Facilities. The HSS Committee self-assesses its effectiveness annually and the NTWS Board of Directors reviews and approves any changes to its terms of reference.

The Solutions Leadership Team meets monthly and focuses on issues including workforce, commercial governance, innovation and risk.

The Trust’s Executive Director of Finance attends the NTWS Board as the Shareholder Representative.

Register of Directors' Interests 

The Trust maintains a formal Register of Directors’ Interests. The Register is available for inspection on the Trust website or on request, from Kirsty Allan, Corporate Governance Manager, Chief Executive’s Office, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne, NE3 3XT corporateaffairs@cntw.nhs.uk. The Board of Directors do not consider any of the interests declared to conflict with their management responsibilities and therefore they do not compromise the directors’ independence.

Annual statement on renumeration 

Members of the Board of Directors are the individuals who have responsibility for controlling the major activities of the Group including the Trusts’ subsidiary companies, and their remuneration is included in this report. This is in line with the requirement to include those who influence the decisions of the Group as a whole rather than decisions of individual directorates or business units within the organisation.

The Trust has a Remuneration Committee, whose role is to determine and review all aspects of the remuneration and terms and conditions of the Chief Executive and other Executive Directors and to agree associated processes and arrangements including appointments and Terms of Conditions. The Remuneration Committee is chaired by the Trust Chair and its membership is comprised of all Non-Executive Directors (NEDs). The Chair of the Board of Directors makes this annual statement as Chair of the Remuneration Committee, whose remit covers Executive Directors, and as Chair of the Council of Governors (Nominations Committee), whose remit covers NEDs.

In 2017/18, the Remuneration Committee agreed to a three-year process to align the salaries of Executive Directors to the salaries of individuals in comparable positions working in Trusts of a similar size and complexity. In line with this process, the Remuneration Committee reviewed the salaries of Executive Directors during 2019/20. No reviews of Executive Director salaries took place during 2020/21 and 2021/22. In October 2022, the Remuneration Committee considered the recommendations to government on the pay of health service- related public sector staff, including increases to reflect the cost of living. The proposals included consideration of an increase of 3.0% for all very senior managers to be applied and backdated to 1 April 2022. The Committee approved the recommended increase of 3% to Executive Directors and NTW Solutions Board members.

The Trust very senior manager (VSM) staff groups have previous come under the remit of the Senior Salaries Review Body (SSRB). The SSRB’s 2023/24 pay recommendations for VSMs in provider Trusts, ICBs and arms-length bodies were accepted by the Government in a written ministerial statement from the Secretary of State for Health and Social Care on 13 July 2023.

Detail of the recommendation was presented to the Remuneration Committee in December 2023.

Local Remuneration Committees had the discretion whether to implement the recommended 5% across-the-board increase to Executive Directors (in this case, this applied to the Executive Directors of both the Trust and NTW Solutions Limited). The Remuneration Committee approved the recommendation that an across-the-board increase of 5% is paid to Executive Directors of the Trust and NTW Solutions, except for the Medical Director who would receive the uplift on the management element of the post only. Due to work carried out in 2017/18 to align pay to the NHSI Benchmark figures, there were no pay anomalies identified in the Trust which would need to be addressed.

Darren Best

Chair

26 June 2024

Senior Managers' Renumeration Policy 

The Trust complies with all aspects of the NHS Code of Governance. This includes the main principle that:

‘Levels of remuneration should be sufficient to attract, retain and motivate directors of quality, and with skills and experience required to lead the NHS Foundation Trust successfully, but an NHS Foundation Trust should avoid paying more than is necessary for this purpose and should consider all relevant and current directions relating to contractual benefits such as pay and redundancy entitlements’.

The term ‘very senior manager’ includes all individuals who have held office as a member of the Trust Board of Directors and Directors of NTW Solutions Limited. Very senior managers remuneration comprises basic pay and NHS pension contribution only (variations are salary sacrifice benefits as set out in the table). This applies to all very senior managers. No performance related pay applies to very senior managers.

There are no provisions for the recovery of sums paid to senior managers or for withholding the payments of sums to senior managers.

During 2023/24, the Trust has had two substantive Executive Directors paid more than

£150,000, the Chief Executive Officer and the Executive Medical Director. The Trust is satisfied that both pay packages are reasonable.

The Executive Medical Director’s package includes a sum for clinical duties as set out in table 8 remuneration reflects the complexity of the role and its responsibility.

All substantive Executive Directors' contracts are permanent with three months' notice (except the Chief Executive whose notice period is 6 months) and all Executive Directors’ termination payments (including redundancy and early retirement) were as per the general NHS terms and conditions applicable to other staff.

Performance related pay did not apply during 2023/24 and benefits in kind relate to lease cars and salary sacrifice schemes.

No non-contractual payments were made during 2023/24.

The Trust pays a fee to Non-Executive Directors which is detailed in table 8.

The Trust reimburses the Chief Executive, Executive Directors, and Non-Executive Directors any reasonable travelling, hotel, hospitality and other expenses wholly, exclusively and necessarily incurred in the proper performance of their duties. This is subject to the production of relevant invoices or other appropriate proof of expenditure in respect of claims submitted.

Policy on payment for loss of office

In accordance with the Senior Managers’ Remuneration Policy, all Executive Directors’ termination payments (including redundancy and early retirement) are aligned to the general NHS terms and conditions applicable to other staff.

Statement of consideration of employment conditions elsewhere in the Foundation Trust 

Pay for other directors, senior managers and all other non-medical and dental staff is in accordance with the national Agenda for Change terms and conditions, (except for a small number of senior staff who have been appointed onto a single point within a local pay range, using the flexibilities within Agenda for Change for bands 8C and above). Pay for medical staff is in accordance with the national terms and conditions of service for hospital, medical and dental staff, and may include clinical excellence awards.

Policy on diversity and inclusion used by the renumeration committee 

When appointing senior managers to the Trust, the Remuneration Committee aligns with the Trust’s strategy to deliver Workforce Race Equality standards, Workforce Disability Equality Standards and increase inclusive leadership, as a Stonewall diversity champion. The Trust values and promotes diversity and is committed to equality of opportunity for all. CNTW believes that the best Boards are those that reflect the communities they serve and applications are particularly welcomed from women, people from the local black and minority ethnic communities, and disabled people who we know are under-represented in senior manager roles.

Table 6: Future policy table 

Annual report on renumeration 

Service contracts obligations

The date of service contracts, unexpired term, and details of the notice period of Executive Directors who have served during the year are disclosed below and within the Accountability Report.

Renumeration Committee and Disclosures required by Health and Social Care Act 

The purpose of the Remuneration Committee is to decide and review the terms and conditions of office of the Chief Executive and Executive Directors in the CNTW Group, comply with the requirements of the Code of Governance and any other statutory requirements. The Remuneration Committee’s terms of reference are included on the Trust website, and its role includes agreeing processes and arrangements (and receiving and considering the outcome and recommendations from such processes) for approval, e.g., interview processes. Ensuring compliance with the requirements of “NHS Employers: Guidance for employers within the NHS on the process for making severance payments” was added to the committee’s remit during 2013/14 following instruction from, at the time, NHS Improvement.

All Group Executive Director’s appointments and terms of office are considered by the Remuneration Committee. This includes the Chief Executive, whose appointment must be agreed by the Council of Governors.

The Council of Governors is responsible for the appointment/reappointment of the Chairman and NEDs with the associated work carried out by its Nominations Committee, which provides the Council of Governors with recommendations. The work of the Nominations Committee is described later in this report.

The Remuneration Committee is chaired by the Trust Chair and its membership is made up of all NEDs. The Remuneration Committee met twice during 2023/24. Table 7 below shows the membership of the Remuneration Committee during 2023/24.

Table 7: Membership of the Renumeration Committee and Attendance during 2023/24 

The Remuneration Committee has received advice from James Duncan, Chief Executive, Lynne Shaw, Executive Director of Workforce and Organisational Development and Debbie Henderson, Director of Communications and Corporate Affairs/Company Secretary to assist their considerations. Members of the Trust in attendance at meetings in an advisory capacity only are not in attendance during discussions of their own remuneration and/or Terms and Conditions.

In 2017, the Remuneration Committee agreed an approach to increasing the salaries for Executive Directors as part of a three-year strategy to benchmark salaries against the upper quartile of directors of medium-sized NHS Mental Health providers and the upper quartile salaries of medium-sized acute NHS providers. During 2023/24, the Trust has had two substantive Executive Directors paid more than £150,000, namely the Chief Executive Officer and the Executive Medical Director. The Remuneration Committee was satisfied that both pay packages were reasonable and commensurate with the role.

The Council of Governors has established a Nominations Committee to provide it with recommendations relating to the appointment of the Chair and Non-Executive Directors and the associated remuneration and allowances and other terms and conditions. Details of the work of the Nominations Committee is included in the section on “Disclosures set out in the NHS Foundation Trust Code of Governance”.

During 2023/24, there were 14 individuals fulfilling the role as director in the Trust, four of them receiving expenses in the reporting period totalling £3,363.64. The equivalent for 2022/23 for the Trust was 15 individuals, with five receiving expenses totalling £2,248.37.

During 2023/24, there were five individuals fulfilling the role as director in the Trust subsidiary company NTW Solutions, two of them receiving expenses in the period totalling £189.64. The equivalent for 2022/23 for the Trust subsidiary company NTW Solutions was five individuals, with three receiving expenses totalling £308.72.

During 2023/24, there were 37 individuals in Governor roles. Seven Governors received expenses during the year which totalled £445.28. The equivalent for 2022/23 was 41 individuals in Governor roles. Eight Governors during 2022/23 received expenses totalling £919.16.

Table 8: CNTW Board of Directors remuneration – Salaries and pension entitlements for Board members who served during 2023/24 along with prior year comparatives.

For Dr Rajesh Nadkarni, £25,000 of the remuneration relates to clinical duties (2022/23 £24,000 ). The remuneration of all other Executive Directors relates to management posts.

*The Directors highlighted with * have salary sacrifice schemes during the year, which can result in increases/decreases in both salary and pension related benefits as salary sacrifice schemes are entered into and withdrawn from. All taxable benefit costs are met by the employee as part of the salary sacrifce scheme arrangements.

Table 9: NTW Solutions Board of Directors Remuneration - Remuneration for NTW Solutions Board members who served during 2023/24 along with prior year comparatives.

The Directors highlighted with * have salary sacrifice schemes during the year which can result in increases/decreases in both salary and pension related benefits as salary sacrifice schemes are entered into and withdrawn from.

Fair Pay 

Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director / member in their organisation and the 25th percentile, median and 75th percentile of remuneration of the organisation’s workforce. Total remuneration of the employee at the 25th percentile, median and 75th percentile is further broken down to disclose the salary component.

The banded remuneration of the highest paid director in the organisation in the financial year 2023/24 was £232,500 (2022/23 £227,500). This is a change between years of 2.2%. The relationship to the remuneration of the organisation's workforce is disclosed in the below table.

The total remuneration includes salary, benefits in kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pension.

For employees of the trust as a whole, the range of remuneration in 2023/24 was from £6,750 to £231,076 (2022/23 £6,750 to £225,466). The percentage change in average employee remuneration (based on the total for all employees on an annualised basis divided by the full- time equivalent number of employees) between years is 5.6%. No employees received remuneration in excess of the highest paid director / member in 2023/24 (There were none in 2022/23).

The remuneration for of the employee at the 25th percentile, median and 75th percentile is set out below. The pay ratio shows the relations between the total pay and benefits of the highest paid director (excluding pension benefits) and each point in the remuneration range for the organisation’s workforce.

*CNTW do not pay performance bonus to managers.