Norfolk & Suffolk's Mental Health Trust Facing 'Special Measures'

England's Chief Inspector of Hospitals has recommended that Norfolk and Suffolk's Mental Health Trust should be put into special measures.

Professor Sir Mike Richards has made the recommendation following a Care Quality Commission inspection rated the service as 'Inadequate'. 

The CQC found that Norfolk and Suffolk NHS Foundation Trust, which provides mental health and learning disability services to a large population across Norfolk and Suffolk, needed to make a number of improvements to ensure it was consistently delivering care which was safe, effective, responsive to people's needs and in services which were well led. The inspection was carried out in October 2014.

The concerns and the recommendation have now been referred to the health sector regulator -  Monitor.

The overall trust and individual services provided by the trust have been given one of the following ratings: Outstanding, Good, Requires Improvement, or Inadequate.

The trust was rated as Inadequate over whether services were safe and well-led, Requires Improvement on whether services were effective and responsive and Good over whether services were caring. Its overall rating was Inadequate

A full report on the trust, and on all the individual services inspected, can be found here

CQC identified several areas of concern where the trust must make improvements. These included:

  • Staff morale was very low across many areas of the trust and concerns were highlighted about the lack of senior leadership support towards staff.

  • Leadership from ward level and above must be more visible and accessible to staff. Staff told inspectors they did not feel engaged in the improvement agenda or any top level decisions.

  • Improvements are needed regarding safety at the trust. Areas of concern included; unsafe environments that did not promote patient dignity; insufficient staffing levels to safely meet patient's needs; inadequate arrangements for medication management and concerns regarding seclusion and restraint practice. 

  • A lack of availability of beds meant that people did not always receive the right care at the right time and sometimes people were moved, discharged early or managed within an inappropriate service

  • The trust must ensure that action is taken to remove identified ligature risks and to mitigate where there are poor lines of sight

  • Proper procedures must be followed regarding detention under the Mental Health Act. 

  • Wards managed by the trust must meet guidance on same-sex accommodation whilst promoting safety and dignity.

  • The trust must ensure that seclusion facilities are safe and appropriate and that seclusion and restraint are managed within the safeguards of national guidance. 

  • All staff including bank and agency staff must complete statutory, mandatory and specialist training where necessary. 

  • The trust must provide sufficient personal alarms for staff and visitors and carry out and document regular checks of emergency equipment.

Despite the overall rating of Inadequate, inspectors identified a number of areas of good practice across the trust, including:

  • The dementia and intensive support team have introduced an innovative helpline to assist carers and care homes with support and advice

  •  Inspectors found examples of innovative and multi-disciplinary team working within the child and adolescent community teams.

  • The dementia and complexity in later life team (DCLL) has integrated their collaborative working with GPs and social workers to improve outcomes for patients.

  • The trust has developed effective services such as the Compass Centre (a therapeutic and education service) and an intensive support team which have reduced the number of admissions of young people to hospital.

Dr Paul Lelliott, CQC's Deputy Chief Inspector of Hospitals (lead for mental health), said:  "We found a number of serious problems when we inspected the services run by Norfolk and Suffolk NHS Foundation Trust and we have made a recommendation to Monitor that the trust is placed into special measures. We have informed Monitor of the breaches and it will make sure these are appropriately addressed and that progress is monitored through the special measures action plan.

"We were concerned about the safety and quality of care provided by some of the trust's services. We were also struck by the low morale of many of the staff that we interviewed who told us that their voices were not heard by those managing the trust.

"Some of the management team at Norfolk and Suffolk NHS Foundation Trust are quite new in post. They must provide the leadership to bring about the urgent improvements needed to ensure care and treatment consistently meets the required standard.

"The trust managers have told us they have listened to our inspectors' findings and have begun to take action where it is required.  We have maintained close contact with the trust since the inspection and will undertake further inspections, including unannounced visits to check that the improvements needed have been made."

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team's findings

The report, which CQC publishes today, is based on a combination of its inspection findings, information from CQC's Intelligent Monitoring system, and information provided by patients, the public and other organisations.

Chief Executive Michael Scott said: “Our priority is to make sure we work with staff to improve the services we provide across Norfolk and Suffolk. The CQC report states that… ‘Overall, we saw that staff were kind, caring and responsive to people and were skilled in the delivery of care’. On behalf of the Board I’d like to thank staff for their support and dedication and underline our commitment to work with staff to improve our services.

“We are under new management, the new team is bedding in, and there is no complacency on our part about the need to continue to deliver improvements. I would like to assure our patients, staff and our partners that this is a turning point for the Trust and we will continue to do everything possible to address all of the recommendations the CQC has made.”  

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