• Norfolk and Suffolk FT upgraded from “inadequate” to “requires improvement”
  • CQC says progress has been made but it is not yet clear if it is sustainable
  • But Healthwatch Suffolk says there is a “disparity” between CQC’s verdict and the “very little improvement” seen by patients

A troubled mental health trust’s quality rating has been upgraded from “inadequate” to “requires improvement” but it remains in special measures, inspectors have announced.

The Care Quality Commission rated Norfolk and Suffolk Foundation Trust “requires improvement” for whether services were safe, responsive, effective and well-led and “good” for whether services were caring.

But Healthwatch Suffolk said there was “a disparity between what the trust reports, the outcome of this inspection and the experiences of service users and carers”. The local service users champion said it had noticed “very little improvement in peoples’ recorded feedback”. 

NSFT, the only mental health trust in special measures, has been responsible for multiple patient safety failings in recent years and has been viewed as one of the NHS’ most troubled trusts.

The inspection report is the first since East London FT was appointed NSFT’s “buddy trust” in January 2019, amid calls the trust should be put in the failure regime, and the appointment of chief executive Jonathan Warren in March. Marie Gabriel has also taken on the chair role, while retaining her position as chair of outstanding-rated ELFT.

Inspectors judged the “foundations had been laid to improve the direction of travel [but that some stakeholders had warned it] did not feel that changes had positively impacted all patients,” the report said.

It called on the trust to make a number of improvements, from keeping facilities clean to completion of patient risk assessments and medical audits (See box below for further details).

CQC chief inspector of hospitals Ted Baker said: “At our inspection in 2018, we had significant concerns about the safety, culture and leadership of the trust. Since then, there had been a change in leadership.

“We saw early improvements in almost all areas and a feeling of optimism from staff, but there had not been enough time to judge if these changes would be sustained.”

Professor Baker highlighted that “most staff… felt more listened to, empowered and believed the trust is moving forwards”.

He added: “Whilst governance processes had improved, they had not yet fully ensured that performance and risk were managed well. For instance, waiting lists remained high in the specialist children and young people community mental health teams.

“Some stakeholders did not feel that changes had positively impacted all patients, with feedback advising that some still did not feel listened to, with poor communication being a key feature of feedback from patients and their families.”

Healthwatch Suffolk added in a statement: “Simply put, in the time that has passed since the 2019 inspection of the trust, we have noticed very little improvement in peoples’ recorded feedback.

“High levels of dissatisfaction with access to services remain and people frequently reflect upon the difficulties they face when seeking care.

“Many of the improvements specifically highlighted by CQC relate to trust strategies, newly implemented quality improvement programmes and changes to the way that the quality of services are monitored.

“We believe that, roughly six months after this inspection took place, it would be reasonable to expect that service users and carers will be noticing improvements to the quality of services and their access to them.” 

The trust was first rated “inadequate” overall and placed into special measures following an inspection in 2015. The trust was, however, removed from special measures in 2016, before being swiftly placed back into special measures in 2017.

NSFT chief Mr Warren said: “This is a move in the right direction and is down to the hard work and dedication of staff. We are also starting to see some of the improvements we are putting in place come to fruition.

“However, we are under no illusions and recognise that the next 12 months and beyond are crucial in not only fully embedding changes already made, but in building upon them so that next time we are inspected, we have shown further significant improvement.

“Our ambition remains for NSFT to deliver high-quality and effective services for our patients and be in the top quarter of mental health trusts nationally for quality and safety by 2023, and the CQC confirms we have made a good start.”

The CQC told the trust it must make the following improvements:

  • Ensure internal and external environments of the learning disability inpatient service were clean, secure, maintained and suitable for the purpose for which they are being used;
  • Review their systems to ensure patients have risk assessments and care plans in the children and young person service;
  • Ensure adequate staff resources are available to reduce the patient waiting lists for triage, assessment and treatment in the children and young person service and for attention deficit hyperactivity disorder patients;
  • Ensure contemporaneous records are kept for people who use health-based places of safety;
  • Ensure medicines audits are robust, and all medication errors are reported and investigated as per trust policy; and
  • Ensure there are enough staff to safely manage the health-based places of safety and to meet emergency referral targets.

 

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The HSJ Provider Summit, taking place at the Crowne Plaza, Stratford-upon-Avon from 22-23 April 2020, unites 120+ board members from provider trusts across the country with those shaping national policy, to share best-in-class initiatives in delivering cost-effective and high-quality care for their local populations.

Held under the Chatham House Rule, attendees will co-develop solutions to their local challenges with colleagues from across the country. The summit is free to attend for board-level NHS leaders.