Exclusive: Trust CEO drafted in to advise crisis-hit neighbour

East Suffolk and North Essex Foundation Trust boss Nick Hulme will spend two days a week for at least the next three months advising Norfolk and Suffolk FT and local system leaders on reviving the mental health provider’s fortunes.

HSJ revealed last week that senior figures are concerned an imminent Care Quality Commission well-led inspection of NSFT could prompt the provider to be broken up.

Mr Hulme, who will remain ESNEFT chief executive, was chosen for the role in part because he led the turnaround of Colchester hospital, which came out of special measures in November 2017 after four years –  a record length of time to have been in the regulatory regime. He is also a senior figure in one of the health economies served by NSFT. 

The long-serving chief told HSJ there were “clearly no easy answers” on how best to tackle NSFT’s problems, which are so grave and long-standing they resulted in the trust being rated “inadequate” for the fourth time in April.

Breaking up trust ‘should be the absolute last resort’

Mr Hulme stressed his role was advisory, with no executive authority. However, his views are likely to carry significant weight with local and national leaders tackling the trust’s monumental challenges.

Asked about the possibility of the trust being broken up, he said all options were rightly on the table, but structural change was “not a panacea [and] should be the absolute last resort”.

He said: “Unless there is a very clear and demonstrable evidence that organisational change will improve the care that we’ll provide to patients then I think it’s something which should be the absolute last resort.”

He added it “seemed counterintuitive to go for a smaller organisation” at a time when most of trusts were merging into bigger organisations or forming collaboratives. 

He added: “The other thing is to never underestimate the amount of disruption that any organisation change has.”

The trust’s chair Zoe Billingham admitted earlier this year April’s CQC inspection report’s findings had been “very grim” and the organisation has “one last chance to make this work”.

Some local MPs, including former health minister Dan Poulter, are already calling for a structural change.

Mr Hulme said it was “above his pay grade” to comment on what the bare minimum requirements were for the well-led inspection for the trust not to be broken up, and that was a “decision only the CQC and regulators can make”.

But he admitted that if inspectors found there was “no progress, then that’s a really difficult conversation”. However, he hoped that if they found “some progress, and that the right people are doing the right things to see sustainable long-term improvement”, that the trust would be given a realistic timescale for progress. 

‘Status quo is not an option’

The former Croydon Health Services Trust CEO urged regulators and local system leaders to be “realistic” about the pace of improvement, and for the focus to be on a path concentrating on delivering sustainable long-term improvements, rather than short-term solutions to “turn red to green” on RAG rating score charts.

Suffolk and North East Essex Integrated Care Board chair Will Pope, and Norfolk and Waveney ICB chair Patricia Hewitt and NSFT chair Zoe Billingham all welcomed the appointment.

They said in a joint statement: “Nick has agreed to support us on this vital work and [we] are very grateful to him and ESNEFT for enabling this to happen.

“Despite the huge efforts of dedicated frontline mental health staff, and the real improvements that have been made in some services, we have a long way to go before our mental health services reach the standard that all our residents are entitled to expect.

“The status quo is not an option. This is not just an issue about NSFT; it involves the whole health and care system including, crucially, the voluntary and community sector.”