Judy Terry is a marketing professional and a former local councillor in Suffolk.
For the fourth time since its inception a decade ago, Norfolk & Suffolk NHS Foundation Trust has been rated ‘inadequate’ by the Care Quality Commission (CQC) and remains in Special Measures, first imposed in 2015.
Following inspection in November/December 2021, the latest report was published on 28th April, highlighting further deterioration since previous excoriating assessments.
The CQC’s Head of Mental Health Inspection confirmed that ‘we have served the Trust with a Warning Notice, setting out a legally binding timescale for compliance, so its leaders are clear about what must be done to improve patient care and safety, which they have a legal responsibility to deliver’.
Crucially, governance processes failed to identify or address all risks leading to significant patient safety concerns, including illegal substances on a ward. In the two years to September 2021, there were 115 ‘unexpected or potentially avoidable’ deaths. Over 1000 complaints were received between April 2019 and March 2021.
Whilst local authorities have avoided comment (although Norfolk County Council made a statement to Cabinet), two MPs acknowledged that this is the worst mental health provider in England, demanding action: Labour’s Clive Lewis and Conservative, Tom Hunt. Good for them! Suffolk County Council’s Health & Wellbeing Board doesn’t even have the report on its May meeting’s agenda.
Meanwhile, as activists and bereaved families, who are always patronised and ignored, continue to campaign for the Trust to be split into two, with services tailored to each county, one has to wonder whatever happened to the local Healthwatch and Clinical Commissioning Groups’ report, ‘Mental Healthcare & Emotional Wellbeing 2019-29’. Recommending a fresh, joined up, approach, it was rushed out in draft a few days before the previous damning CQC report was released, noting 61 breaches of legal requirements.
But, to the present: Norfolk & Suffolk Mental Health Trust employs 4,227 staff (and is recruiting more) with a £305m budget (up from £227m a couple of years ago).
Here is a summary of the CQC’s key findings following its latest inspection, most of which repeat previous issues not resolved. ‘Inadequate’ was the outcome for whether services were safe, effective, and well led, whilst whether services are rated ‘requires improvement’:
Inevitably, the Trust “chair”, whose predecessor jumped ship prior to the last CQC report’s publication, responded with:
“We are deeply sorry and have already taken action to help us improve.
‘We now have a leadership team with clear and ambitious plans… we are determined to make the required changes with pace and focus.”
Amid calls for the Chief Executive to resign, a spokesman for the Campaign to Save Mental Health Services in Norfolk & Suffolk said:
“This current Chief Executive was the chief operating officer from August 2018, so this has happened on his watch and he has to fully accept his part in this.”
But he’s not going anywhere. In an interview with the East Anglian Daily Times, he defended his position, insisting he is the right man for the job and only formally took up his current post in September 2021, just two months before the latest CQC inspection:
“As operations officer I made sure operations were managed in the Trust, now my responsibility is much greater and I can help make a greater difference. I believe I have the right team around me and my background is as a clinical nurse. My entire career has been built around working in the NHS and mental health services. I am fully committed and want to be here to ensure we can embed the changes we need to make to improve.”
He fully accepts the CQC findings, but rejects campaigners’ demands to divide the Trust, saying it would take 18 months and ‘detract from what we are trying to do to turn things around. With integrated care boards coming in, we have a different opportunity to look at how we configure the system and make sure we can meet the needs of both counties.’
One of the biggest learnings he takes from the report is the need to pay closer attention to the fears and concerns of his own staff. ‘We need to take a more bottom-up approach, where staff feel they are being listened to’. What about those campaigners, who are uniquely sensitive to issues affecting patients, their families, and the wider community?
With a further inspection pending, to ensure action has been taken to comply with the Warning Notice, the Chief Executive notes that the Trust will not meet its goal to be in the top quarter of mental health trusts next year! Instead, ‘we need to make sure we meet the requirements of the report’s action plan and make continuous improvements.’
Campaigners want an independent inquiry into why the Trust is allowed to go from crisis to crisis, without anyone – past or present – being held to account for its serious failings. There have been eight Chief Executives in 10 years, contributing to management instability, following a radical redesign of services in 2013.
I have repeatedly asked why Norfolk and Suffolk county councils don’t each have a senior councillor on the Trust board, with support from a small joint panel to monitor progress, regularly reporting back to Cabinet and Full Council.
With such a poor record, surely it’s time for Jeremy Hunt to investigate through his Parliamentary Health Select Committee. One question which doesn’t appear to have been addressed is ‘what happened to the Improvement Director appointed by NHS Improvement to assist the Trust after CQC’s previous report?’ He seems to have disappeared without making any contribution to ‘improvement’ of this failing Trust.