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Mental health trust pledges to improve services following critical report
03/02/2015

Health chiefs at Norfolk and Suffolk NHS Foundation Trust have vowed to put patients and staff first and focus on improving services following a critical Care Quality Commission (CQC) report.

The CQC report arising from inspections in October last year has looked at whether the care provided by the Trust is safe, effective, caring, responsive, and well-led. The CQC assessment is that, overall, the Trust is rated 'inadequate'.

Results of the October 2014 CQC inspections (click here for a detailed breakdown):

  • Are services caring?                     Rated as good

  • Are services safe?                        Rated as inadequate

  • Are services effective?                  Rated as requiring improvement

  • Are services responsive?              Rated as requiring improvement

  • Are services well-led?                   Rated as inadequate


The CQC has now recommended to Monitor - the sector regulator for health services in England - that it places the Trust into special measures. If Monitor agrees with the recommendation these special measures would be likely to include:

  • The appointment of an Improvement Director attached to the Trust

  • The Trust to develop and be monitored upon the delivery of a Quality Improvement Plan (action plan)

  • For the Trust to be buddied with another Foundation Trust

 

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." 

The CQC report highlights the need to improve staff morale, staffing levels, bed availability, staff training and visible leadership across the Trust.

The inspections took place in the late October 2014 and immediate actions relating to safety in specific locations (not Trust-wide) included full reviews of issues raised by the CQC around privacy, same sex accommodation, and ligature risks and, where needed, remedial work has already been carried out.

The Board of Directors has recently seen extensive changes including a new Medical Director, new CEO, new Director of Nursing, new Directors of Operations for Norfolk and Suffolk, two new Non-Executive Directors, and responsibility for workforce development has been moved following the departure of the previous HR director.

Chair Gary Page said: "The issues raised by the CQC report reinforces what we, as a Board, have been clear on and are already working to remedy.

"Last year, we commissioned an external review of Board governance and leadership. As a result of that we have refreshed the Board, made staff recruitment, engagement, and morale a top priority, and streamlined our Board committee structure so there is much clearer line of sight between the Board and the rest of the Trust.

"This report is disappointing but the issues raised by the CQC are known to us and are being remedied by the new team."

Quality and safety improvements which are underway, include:

  • Reduction in number of Out of Area placements (49 to 16 as of 02.02.15)

  • Staff appraisal rates are now higher than 70 per cent     

  • Vacancy rates in clinical services are now below 10 per cent

  • 16 new doctors have been recruited to improve services and reduce locum use

  • New mental health assessment ward opening in March (Thurne Ward, 12 beds)

  • Mental health crisis line introduced in partnership with MIND (January)

  • Safe staffing review for inpatient areas completed and £2.6m investment made into recruiting more staff

  • Planned reduction in community caseloads and investment into community staffing

  • Local teams of quality staff to be embedded into services to support and escalate issues and concerns

  • Seclusion policies, restraint and medicines management policies urgently reviewed and additional staff introduced

  • Removed number of ligature risks; estates review ongoing for other risk areas with immediate actions being taken

  • Review of learnings from incidents, complaints and concerns to ensure emerging trends or issues are more speedily recognised, escalated and dealt with and whole Trust can respond and make necessary changes

  • Increase in mandatory training rates

 

In its report, the CQC has also highlighted areas of good practice, 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 multi-disciplinary team working within the child and adolescent community teams in order to meet young people's needs

  • 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

 

Michael Scott added: "We know our priorities, we understand where we got it wrong and we are putting it right. We know that being truly visible leaders who are ready to listen and respond, as well as lead, has to be our approach moving forward.

"But there can be no complacency and we need to continue to listen to service users, carers, and colleagues and engage with them all to continue to improve and raise the bar on quality."