The trust provides specialist mental health services across the North and is one of the largest trusts of its type in England.

Gemma Berry, CQC deputy director of mental health in the North East, said the ‘standard of care had deteriorated in some services since our last inspection'.

Improvements were needed around staff safety, reducing restrictive interventions, managing environmental risks and improving staff training.

Inspectors found ‘pockets of poor culture', with staff saying leaders were making decisions about frontline services, without always consulting staff who were providing the care.

Some staff also did not feel safe about speaking up about concerns.

However, the CQC saw examples of great partnership working to help improve the health and wellbeing of people and local communities such as working with the local ICB on its ‘better health and wellbeing for all' strategy, which focuses on reducing inequalities, improving life expectancy and giving children the best start in life.

James Duncan, chief executive, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, said: ‘I want to be clear; this report does not question the compassion of our staff or the importance of the care we provide. It does, however, challenge us to be better, and that is a challenge we accept.'

The trust pledged to take the following actions over the coming months:

• strengthen leadership and culture at every level, with a focus on compassion, inclusion and accountability
• make it easier and safer for staff to speak up, and ensure that concerns are listened to and acted upon
• simplify and improve our governance and assurance processes, so risks are identified and addressed earlier
• continue to improve equality, diversity and inclusion, tackling inequalities for both staff and patients
• keep patients, carers and families at the heart of improvement, by listening, learning and working together.