Norfolk and Suffolk NHS Foundation Trust rated 'inadequate' for the fourth time in damning report by CQC inspectors
A mental health trust has been rated 'inadequate' following an inspection by health watchdogs.
The Care Quality Commission (CQC) visited the Norfolk and Suffolk NHS Foundation Trust (NSFT) in November and December last year to assess whether improvements it had previously identified had been made - and in response to concerns about the quality of its care and patient safety.
In 2015, NSFT, based in Hellesdon, and which provides mental health and learning disability care for people across Norfolk and Suffolk, became the first NHS mental health trust to be placed in special measures.
It has been rated 'inadequate' on three occasions since then, and remained in 'special measures.'
Its last rating in January 2020, was 'requires improvement'.
CQC inspections rate trusts on five areas - safety, effectiveness, caring, leadership and responsiveness to people's needs.
Although the latest inspection found some areas where people received better care compared to the previous inspection, there were more areas where deterioration in quality and safety were identified, according to inspectors.
In some cases, health inspectors felt this 'exposed patients to risk of harm' and considered 'taking urgent enforcement action' while the inspection was underway.
However, they were assured this was not necessary after their concerns prompted the trust to close two wards to admissions, take other immediate remedial action and continue with a decision not to admit patients to further wards.
Following the inspection, CQC’s overall rating of the trust dropped from 'requires improvement' to 'inadequate'.
The report also rated the trust inadequate for being safe, effective and well-led.
It rated it 'good' however for being caring and 'requires improvement' for being responsive to people’s needs.
Inspectors served the trust a warning notice requiring it to make several improvements to ensure patient safety within a legally binding timetable.
It also recommended the trust remains in the recovery support programme for NHS trusts facing the toughest challenges.
This means it will continue to receive intensive support from NHS England and NHS Improvement (NHSEI).
CQC will inspect the trust again within the coming months to assess whether improvements have been made, and if not, will use enforcement powers to ensure people are not exposed to 'poor quality care and the risk of avoidable harm', with trust leaders held to account.
Craig Howarth, CQC head of inspection for mental health and community services, said: “Although the quality and safety of patient care in most of the services we inspected at NSFT had deteriorated since our previous inspection, there were areas where we found improvement.
“A significant factor behind the trust’s shortcomings was its lack of enough staff to meet patient need, a problem many mental health trusts are encountering.
The trust needs to ensure its leaders have effective processes to consistently monitor teams, ensure compliance with training targets, understand issues affecting patient care and do more to support staff on the frontline.
“However, we found staff were more engaged, compared to our previous inspection, driven by a vision of what the trust wanted to achieve for its patients."
Mr Howarth added: "The trust must embed this culture of improvement to turnaround its worse performing services.
“We also found better use of de-escalation techniques to reduce the trust’s reliance on restraint of people when they exhibited behaviour endangering themselves and others.
"However, we are concerned restraint was used too frequently and incorrectly on child and adolescent mental health wards, which were providing significantly worse patient care compared to our previous inspection."
NSFT leaders meanwhile have pledged to improve services and go 'above and beyond' the CQC recommendations, including a review of mental health support in the community, the demand for services and capacity, drawing up clear safety plans throughout patient care, improving the work place for staff, and providing strong clinical leadership.
The CQC rated care on wards for people with learning disability or autism, and community-based mental health services for older people as ‘good’.
It also recognised the positive impact people participation work has made over the past year.
Stuart Richardson, chief executive officer at NSFT said: “We fully accept the areas that the CQC say need to improve. The people of Norfolk and Suffolk deserve good quality mental health services and we are committed to achieving this.
"People have worked tirelessly to keep services open during the pandemic and I want to thank all my colleagues for their hard work.
We recognise that we have not made the expected progress in some key areas, and I am deeply sorry for this and the impact this will have had on people who need support with their mental health.
"We have already taken action that will help us improve, including increasing support and training for our staff, redoubling our efforts to recruit more nurses and doctors, and bringing services closer to people’s homes through our community transformation projects.”
Zoë Billingham, chair at NSFT said: “NSFT wants to provide quality specialist mental health care. Where we have made successful improvements, this has been in partnership with patients, services users and of course our staff – and we must now replicate this approach in all areas.
“We now have a leadership team with clear and ambitious plans and changes in how we work across the health and care system means we have an opportunity to provide mental health services differently. We are determined to make the required changes with pace and focus.”
Ed Garratt, chief executive of Suffolk and North East Essex Integrated Care System and Tracey Bleakley, chief executive, Norfolk and Waveney Integrated Care System said in a joint statement: “The two integrated care systems will offer increased levels of support to the trust so the necessary improvements can be achieved.
"Both systems are committed to and will continue to support the Trust on this journey of improvement.
While the rating is disappointing, it is vitally important that we acknowledge the huge efforts of frontline staff who have worked tirelessly throughout the pandemic and their care has been rated as ‘good’ by the CQC.
Howard Tidman, lead governor at NSFT, said: “Our patients, carers and staff deserve better. As a council of governors, we have seen how hard staff are working and just want to thank them for all they are doing.
"We will work with the trust board to make the changes needed, so that we move forward positively."