Mental Health Matters: Last chance saloon

Given its difficult history, which last month culminated in a grim report from the Care Quality Commission, calls for major reform at Norfolk and Suffolk Foundation Trust should come as little surprise. 

Since merging into a single organisation in 2013, NSFT has been rated “inadequate” by the CQC four times. When the watchdog’s most recent assessment was published, long-suffering families tied hearts to railings outside the trust’s Hellesdon headquarters, each representing a life lost to service failures, as they led calls for a public inquiry.

Grieving relatives were joined by campaigners rallying to disband the organisation, while Labour MP for Norwich South Clive Lewis made an impassioned parliamentary plea for NHS England and Improvement officials to take it over.

Is this the end of the road for NSFT? Is it time to finally consider more drastic action?

The trust has received a lot of help already. During its repeated returns to special measures it has fallen under the NHS failure regime, receiving intensive support from NHSE/I. 

Improvement directors and buddy systems have come and gone, the most recent loaning directors from the “outstanding” East London FT – an arrangement which has now all but faded with Jonathan Warren’s retirement in April 2021 and chair Marie Gabriel’s exit eight months later.

‘Real sense of optimism’

One woman who could significantly influence the trust’s future trajectory is Ms Gabriel’s replacement – former chief inspector of police and fire services, Zoë Billingham, who joined 16 weeks ago.

While optimistic, Ms Billingham told Mental Health Matters the trust had very much reached the last chance saloon. 

“Personally, I think, at this moment in time, to reorganise us [through special administration or leadership change] would be a distraction. We have got one last chance to make this work,” she said.

“The conclusions from the [CQC] report are very grim. But there is a real sense of optimism that this time it can be better, it can change.”

She noted the relatively new addition of Stuart Richardson as CEO from his three-year tenure as chief operating officer, alongside the recent appointments of clinical commissioning group chief Cath Byford as deputy CEO and Thandie Matambanadzo as substantive COO.

Ms Billingham said she was “100 per cent confident” in the top team’s ability to drive improvements.

The former HM Inspector of Constabulary said right now she wants all activity funnelled into making wards safe, improving patient care and building relationships with staff to address immediate concerns.

But she did not rule out reorganisation entirely: “Of course, there could be a reorganisation if others wanted that, but my job at the moment is to absolutely focus on improving services.”

National support to continue

Last month, the CQC recommended the trust remained in segment four of the NHSE/I system oversight framework and served it with a warning notice requiring it to meet 109 legal requirements.

CQC bosses told HSJ in April special administration – where national officials would take over the trust – was not being considered at this stage.

The NHS East of England regional team told Mental Health Matters it was unable to comment on alternative options for running the trust.

Instead, regional commissioners said they had seen evidence of improvement previously at NSFT and support will be structured around contents of the trust’s action plan.

The plan, required within 28 days of the 28 April report, “will continue to ensure further progress and concentrate on fixing issues for patients”, it added. 

The Department of Health and Social Care was also approached for comment but has not yet responded. 

Clinical input needed

Former health minister Dan Poulter, an MP in the area since 2010 and NHS mental health doctor, called for the organisation to be split into three in 2019. But he believes now is the wrong time for that.

“You’d end up focusing on reorganisation rather than delivering better patient care,” he told Mental Health Matters. However, he added he was not surprised services had deteriorated following a “constant churn” of leaders since Mr Warren retired.

CEO candidate Mason Fitzgerald withdrew his leadership bid in spring 2021 after an investigation into falsified qualifications while interim GP leader Adam Morris only led the trust for six months.

Dr Poulter, who works at a London mental health trust, said one thing he is calling for is greater clinical representation on the board – currently, none of the non-executives have a clinical background.

Ms Billingham said adverts are out now for a new clinical non-executive director, which she said would help ensure the team had a “proper line of sight” on clinical assurance matters.

Read HSJ’s full interview with the new chair later this week