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NSFT out of special measures as CQC publishes its ‘significant improvement’ report
14/10/2016

The Care Quality Commission (CQC) has today published its inspection report into NSFT’s services and our Trust’s overall rating has positively moved to ‘Requires Improvement’ out of ‘Inadequate’.

Commenting that our Trust had made ‘…significant improvement’  England's Chief Inspector of Hospitals, Professor Sir Mike Richards recommended to NHS Improvement (NHSI) that special measures now be removed.

NHSI has confirmed that this will take place, saying: “Today’s removal of the Trust from special measures reflects significant improvement at the Trust and a confidence in the leadership.”


The inspectorate and the NHS trust regulator said that additional support from NSHI will remain in place for the immediate future, as our Trust continues to improve and move towards a ‘Good’ overall rating, and that measures were being removed on condition that the Trust addresses outstanding safety issues. 


Professor Richards continued: “Our return to Norfolk and Suffolk NHS Foundation Trust showed significant improvement had taken place…The Trust’s staff and leadership should be proud of their achievement so far…”
 “The Trust leadership knows what it must do now to ensure those changes take place.”

Michael Scott, Chief Executive of NSFT, said: “This is great news for our Trust, it is a real testament to all of the hard work and commitment of our staff, and it’s reassuring for our patients. To have made this positive shift in just over a year-and-a-half is a real achievement and we are incredibly proud of the progress we have made together in all parts of our Trust.”

Michael went on to say that although our Trust’s ‘Inadequate’ ratings had dropped by 55% in the Trust’s core service areas (across all CQC inspection domains), it was of much concern to the Board that NSFT had seen an increase in the number of ‘Inadequate’ ratings in service areas within the CQC’s ‘Safe’ domain by 1.

“Our overall rating makes it clear that we still ‘Require Improvement’. This puts us alongside the majority of other NHS mental health trusts in England where 64% of mental health trusts the CQC had rated as of July 31, 2016 ‘Require Improvement’ overall. (Out of 47 rated). *

*(As referenced in the CQC’s State of Healthcare and Adult Social Care in England 2015-16 report, also published 13.10.16).

“But there will be no complacency on our part. We fully understand that there is still a way to go and we welcome any continued support to help us continue on our upward path.

“These are our local services, for our local people, with our local NHS staff working extremely hard to deliver them. We all remain 100% committed to delivering the very best care and support that we can and safety remains our paramount concern and focus.

“I think today goes some way towards proving that, and that our regulators have faith that we will continue to improve.”

He added that when the CQC inspections took place, there were concerns raised about quality and safety in some very specific areas and that NSFT has immediately responded to these by drawing up clear actions to rectify any issues and making improvements straight away. Many of these have now been completed, or are well underway.

“In all of this we need to be balanced and ensure that as well as celebrating what we’re doing well for our service users, we must continue to improve wherever we can,” said Mr Scott.


CQC Ratings

The CQC report offers its findings as to whether the care provided by the Trust is Safe, Effective, Caring, Responsive, and Well Led. NSFT’s overall ratings in these domains were as follows:

• NSFT Overall   Rated as Requires Improvement (from Inadequate)
• Are services caring?   Rated as Good (from Good)
• Are services Well Led?  Rated as Requires Improvement (from Inadequate)
• Are services Effective?  Rated as Requires Improvement (from Requires Improvement)
• Are services Responsive?  Rated as Requires Improvement (from Requires Improvement)
• Are services Safe?  Rated as Inadequate (from Inadequate)

Positive highlights

There are many positive highlights within the detailed report following the NSFT inspection in July 2016, including that since the last inspection in 2014:

• NSFT has doubled the number of ‘Goods’ in its overall ratings
• The Trust has received no ‘Inadequate’ overall ratings in service areas
• Four service areas - or a third of those inspected - have achieved ‘Good’ overall ratings
• NSFT’s ratings have improved in 14 service areas
• ‘Good’ ratings in service areas increased from 17 to 31 between 2014 to 2016 – an increase of 14 or 82% in the number of ‘Good’ ratings in service areas
• Forensic Services made the huge leap to a ‘Good’ overall rating from ‘Inadequate’
• Norfolk Recovery Partnership (NRP) (substance misuse services) and CAMHS Inpatient services (Child & Adolescent Mental Health Services) achieved a full run of ‘Good’ ratings in all of the CQC domains
• NRP and the Long Stay / Rehabilitation Service (Suffolk) – were both inspected for the first time – and both achieved a ‘Good’ overall rating
• ‘Inadequate’ ratings dropped from 11 to 5 (decreased by 55%) between 2014 to 2016
Once again, NSFT staff achieved an overall ‘Good’ rating in the CQC’s ‘Caring’ domain, and the report described staff as ‘…kind, caring and compassionate, treating patients with respect and wanting to provide high quality care…’

CQC commented that since its last inspection of NSFT:

‘…staff morale has significantly improved…’ with staff appearing ‘…happy in their roles and proud of the service they worked in…’

‘…most staff told us that the Trust encouraged openness…’ and that ‘…the majority of staff were aware of the Trust’s values and shared them…’

On speaking to NSFT service users and carers, CQC inspectors reported that:

‘…patient satisfaction (with services) had improved...’
‘…the majority of people we met were positive about their care, treatment and the service they had received…’
‘...most felt involved in their care planning…’

NSFT’s overall ‘Well Led’ rating also positively moved to ‘Requires Improvement’ from ‘Inadequate’ and inspectors commented that the Trust had:

‘…a clearer vision…’
and that they had ‘…found a revitalised energy…with a spirit of stronger leadership…’


Continuing to improve

Ten out 19 of the CQC improvement recommendations (‘must dos’) fall within this ‘Safe’ domain and the CQC said it had:

‘…a number of concerns about safety and these included unsafe environments…’
‘…. insufficient staffing levels to safely meet patients’ needs…’
‘…inadequate arrangements for medication management…’
‘…concerns regarding seclusion and restraint practice…’

It went on to say it was concerned about bed numbers and early discharge.

The inspectors highlighted the need for an ‘…immediate review into clinical information handling and systems so that risk can be identified in order to protect patients’ safety…’

The report commented that NSFT needs to ensure that ‘…there are systems in place to monitor and learn for quality and performance…’ and to ensure there are ‘…governance processes to capture and learn from adverse incidents…’

Care Plans and Risk Assessments were also raised as an issue, with comments about these needing to be regularly updated and developed with service users, and there needed to be full and proper compliance with the Mental Health Act guidelines.


For further information:

You can read the full reports relating to NSFT at: http://www.cqc.org.uk/provider/RMY

And you can read the national State of Healthcare and Adult Social Care in England 2015-16