Hospital Trust Leadership Rated as Requires Improvement

The leadership of the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) has been downgraded from outstanding to requires improvement following an inspection by the Care Quality Commission (CQC).

The CQC report indicates that standards of care within the trust have deteriorated since the previous inspection, which took place in autumn. The trust is one of the largest of its kind in England, providing mental health, neuro-rehabilitation, autism, and learning disability services to approximately 1.8 million people across the North East of England and North Cumbria.

Findings on Safety and Governance

Gemma Berry, the CQC deputy director of mental health in the North East, stated that senior leaders did not consistently maintain appropriate processes and systems to ensure patient safety.

The inspection highlighted several critical failures in governance and reporting. The CQC found that the trust failed to consistently ensure that safeguarding concerns were accurately reported to local authorities. Staff members expressed confusion regarding which specific types of incidents required reporting.

The report also identified systemic issues regarding workforce stability. High rates of sickness and vacancies have led to an increased dependency on temporary employees to maintain service delivery.

Workplace Culture and Staff Concerns

While the CQC noted examples of great partnership working, the inspection also uncovered pockets of poor culture within the organization. Some staff members reported that bullying and discrimination remained issues that required further attention.

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Staff members informed inspectors that leadership often made decisions without consulting the personnel providing direct care. Berry noted that some employees did not feel safe speaking up when they had concerns, emphasizing that it is absolutely critical for the trust to address these cultural issues.

Trust Response and Scale of Operations

Chief executive James Duncan accepted the findings of the CQC report. He stated that the trust has already initiated work to address these issues, specifically focusing on improving how the organization listens to staff, acts on concerns, and involves employees in decision-making processes.

The scale of the CNTW operations is significant, with the following characteristics:

• Headquarters located at St Nicholas Hospital in Newcastle.
• Management of more than 70 different sites.
• An employed workforce of more than 9,000 staff.
• An annual turnover of approximately £647 million.

Broader Regulatory Context

The CQC has moved toward a simplified rating system for NHS trusts, focusing on a single trust-level rating centered on leadership and culture. This approach is based on a correlation the regulator found between the quality of leadership and the quality of care delivered. While the trust-level rating focuses on leadership, the CQC continues to inspect and rate individual hospital services and locations separately.

Other trusts have faced similar leadership challenges. For example, the Leeds Teaching Hospitals NHS Trust was also rated as requires improvement for leadership following a June inspection, where the CQC found that some leaders were unclear on how to improve services and that staff had reported bullying and harassment.

In contrast, the Sandwell and West Birmingham Hospitals NHS Trust saw its leadership rating improve to good overall as of February 18, 2026, marking a significant step forward from a previous requires improvement rating, although some specific services, such as maternity at Midland Metropolitan University Hospital, still require improvement.