Judy Terry is a marketing professional and a former local councillor in Suffolk.
Norfolk & Suffolk NHS Foundation Trust is officially the worst mental health provider in the country. It was placed in special measures for the third time in its short history (from 2012), following the latest excoriating report by the Care Quality Commission (CQC), published at the end of November.
What an achievement, when revenue income is reportedly £227 million a year…
I’ve been following the trust’s progress since a young neighbour took his own life whilst in its care some years ago. His parents were rebuffed when requesting an investigation, as was I when I took up the case as a local councillor.
Shockingly, little has changed since CQC’s 2017 report, when it noted that leadership and services were inadequate, with the board failing ‘to address all the previous concerns reported to them since rated inadequate in 2014, with breaches of regulations that had not been resolved’. Despite praise for the staff’s caring culture, the trust was ‘not safe, effective or responsive in all services, and leadership did not demonstrate a safety narrative running through the organisation.’ Training was also inadequate.
Between 1st April 2016 and 31st March 2017, trust data showed 242 incidents requiring further investigation, including 184 “unexplained or avoidable deaths”.
A further 27 deaths, reported to the CQC during their inspection, occurred between 1st April 2017 and 31st May 2017.
Immediately prior to that report’s official publication, the then-Chief Executive took early retirement, and two other directors also resigned in order to ‘work their contracted six months notice periods in the wider NHS’.
Following the publication of the 2017 CQC report, in an article for Conservative Home, I questioned the purpose of the Health & Wellbeing Boards. It consists of Norfolk County Council has a membership of 32, and Suffolk has 21. These also include representatives from Healthwatch and the Clinical Commissioning Groups, as well as councillors and officers from local authorities. Although both meet four times a year, there was no evidence that members had monitored the trust or examined its progress since the 2014 and 2016 reports. I was surprised that no councillors were on the trust board, reporting to Health & Wellbeing, and both Full Councils.
I suggested that the two county councils hold a joint emergency meeting to review the 2017 report, establish a small joint panel, agree on a strategic plan to monitor progress towards compliance with CQC’s recommendations, and liaise with NHS Improvement and its Improvement Director appointed to support the trust, whilst regularly updating Full Council.
This would have provided an opportunity to respectfully listen to campaigners who understand the issues from their own personal experiences, allowing them to share their ideas and knowledge. Too few public bodies, including national and local politicians, communicate with those of us they like to brand ‘ordinary people’ – instead, they choose to ignore and patronise, especially when someone challenges them. The trust was guilty of taking this approach.
Unsurprisingly, my proposal wasn’t pursued, so the latest CQC report, released this year, has been greeted with ‘surprise’, shock and outrage – by Healthwatch, the Clinical Commissioning Groups, councillors, and a (now former) trust governor, who calls for the trust to be broken up. How long would that take, and how much would it cost, whilst vulnerable people continue to suffer? It would simply mean the creation of yet more unaccountable bureaucracies doing their own thing.
So, where are we now?
This time, the Chair, who’d been in place since 2013, jumped ship, resigning with immediate effect, along with three senior executives (moving elsewhere in the NHS), prior to publication of the report, amid speculation that it would be less than flattering. Meanwhile, Healthwatch and the CCGs, no doubt also expecting a poor outcome, belatedly combined to produce a fresh approach: ‘Mental Healthcare and Emotional Wellbeing 2019-29’. Conveniently published in draft a few days prior to the CQC’s latest report (released to the media on 27th November,but embargoed until the 28th), leaving cynics to wonder why the plans to join things up couldn’t have been developed earlier, in co-operation with the trust, following the 2014, 2016 or 2017 inspections.
Also conveniently timed, attendees at the trust’s AGM received a full colour glossy magazine (goodness knows how much that cost) and various presentations designed to convince us that services were improving.
Sadly, that was not the case. The latest report, following the CQC’s September inspection, states the trust had ‘failed to make significant improvements’, leaving it in special measures amid ‘significant concerns’.
According to the CQC’s Deputy Chief Inspector of Hospitals who leads on mental health, Dr. Paul Lelliott, “at our inspection of 2017, we raised concerns about safety, culture and leadership and told the trust it must take urgent action to put things right. Some of these issues we first raised in 2014 and are very disappointed to find that they have still not yet been fully addressed:
“The trust leadership has not taken action at the pace required to bring about sustained improvement and to resolve failings in safety. The people who depend on this trust for care and support deserve better.”
Lelliot went on to identify specific failings, all of which had been raised previously:
- Some of the buildings in which wards and community teams are based did not provide a safe environment for patient care and staff did not assess and manage the risks they pose to patients in a consistent way;
- Key risks considered closed or mitigated were not fully addressed; in some cases, works had created new risks, including ligature points;
- Fire safety (patients smoking on wards) inadequately monitored, whilst there were significant issues with resuscitation equipment;
- Staff did not manage medicines and equipment safely;
- They did not undertake proper reviews of patients who were in seclusion; and
- There was insufficient staff to meet patients’ needs in some community services.
- There had also been further deaths since June 2018, and 2400 patients did not have a care coordinator;
- There were breaches of 61 legal requirements.
Dr. Lelliott added, “we were particularly concerned about the safety of patients waiting for assessment or treatment by the community mental health teams. Not all services were meeting their targets for assessment and the trust did not respond appropriately to emergency or urgent referrals. Inspectors found that staff were sometimes downgrading referrals from urgent to routine without ensuring that it was safe to do so. There were instances of people who had significant needs being denied a service and records showed some patients harmed themselves while waiting for contact from clinical staff.”
Managers did not learn and share lessons when things went wrong, to reduce repeats.
Once again, the trust’s leadership was called into question, with demands for robust action to ensure that improvements are made. CQC emphasised the strong link between quality of overall management and quality of services, calling upon NHS Improvement ‘to offer support to the Trust to make the immediate changes necessary to keep patients safe.”
However, staff were caring, but many are suffering low morale because of the poor management culture and, in many cases, inadequate resources to make patients’ lives better.
In response to the report, the new Chief Executive, who inherited what can only be called ‘a poisoned chalice’ when appointed to his unenviable role earlier this year, stated:
“We are obviously disappointed with the CQC’s findings, but fully accept their report and its recommendations. Although we have been working hard to make improvements, we recognise that the actions we have taken so far have not resulted in the rapid progress which both the CQC and our trust had hoped for.
“We have been taking action to address the immediate concerns and listening to our staff and service users to make sure we fully understand the deeper challenges faced by the trust. This will allow our new senior management team to make long term, sustainable, changes, based on their knowledge and experience, and draw on best practice from across the wider NHS.
“We are determined to get things right.”
Amen to that. It was clear from seeing him at the AGM that he is truly committed, and has already made welcome changes to the trust’s culture and deserves support. It would now be appropriate for two senior councillors, one each from Norfolk and Suffolk to join the board as Non-Executive directors, and for the two Health & Wellbeing boards to establish a specialist panel to work with – and challenge – the trust and its CEO. But I shan’t hold my breath.
In the meantime, Matthew Hancock, the Health Secretary and a Suffolk MP, promises to ‘get to the bottom of the problems facing the trust:
“We have to take more radical action,” he said, whilst not ruling out intervention via a special administration arrangement.”
Most important, he questions why mental health services are run completely separately from community services, hospitals and the rest of the NHS. That is the best argument to emerge – if the system were cohesive, outcomes for everyone would be vastly improved. As I said in my last piece for Conservative Home, Suffolk Community Foundation has already identified the necessity for a more joined-up approach and is working with local organisations, including the CCGs, to pilot change.