Mental health trust should face special measures over ‘inadequate’ safety and leadership, says CQC

A mental health trust that has faced claims from social workers that cuts have led to unsafe care could be put into special measures after being rated ‘inadequate’ by the Care Quality Commission.

The CQC gave Norfolk and Suffolk NHS Foundation Trust an overall rating of ‘inadequate’ in a report issued today, following an inspection in October last year that found concerns over the safety and leadership of services. The CQC has recommended that health regulator Monitor puts the trust into ‘special measures’, a move that could see the watchdog appoint an ‘improvement director’ to oversee services. The trust has already faced investigation from Monitor over concerns with its finances.

Responding to the report, the trust’s chief executive vowed to improve services.

Previous warnings

Union officials said the CQC’s findings highlighted problems with care that staff have warned about for more than a year.

In November 2013, the Campaign to Save Mental Health Services in Norfolk and Suffolk – a campaign group of staff and service users – warned that cuts to services had made it ‘almost impossible’ to practise safely. In March 2014, social workers told care minister Norman Lamb – whose north Norfolk constituency is served by the trust – that a shortage of beds had left them unable to operate safely or legally.

Problems with community services and bed availability are both raised in the CQC report published today. Inspectors assessed the trust against five standards. On two of these – safety and leadership – services were given the CQC’s lowest rating. Improvements were also found to be needed on two other indicators – the effectiveness and responsiveness of services. The trust scored its only ‘good’ mark when assessed whether its services were caring.

The CQC findings

The CQC found that a number of the trust’s inpatient wards and community services had unsafe staffing levels and a lack of beds across the trust had damaged the care and safety of patients. Staff said that the bed shortage had led to patients being transferred to out-of-area hospitals, being discharged too early or being sent to inappropriate services. A shortage of psychiatric intensive care unit beds had also delayed admissions for people in need of intensive support.

On the issue of leadership, inspectors found that staff morale was “very poor across the trust”. People were not engaged in the board’s ‘improvement agenda’ and some staff told the CQC they feared victimisation if they spoke out. Inspectors were also shown a letter from a senior manager that “instructed staff to only give information to CQC that was requested”.

Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals, said: “We found a number of serious problems when we inspected the services run by Norfolk and Suffolk NHS Foundation Trust.

“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.”

Reaction

Emma Corlett, a mental health nurse and spokesperson for the trust’s Unison branch, said that the CQC had picked up on concerns that frontline staff had warned about for some time.

“It’s sad that it has taken the CQC inspection to get the extent of the difficulties facing our teams to be properly acknowledged,” she said.

“We’re pleased that the compassion and caring nature of staff – despite them trying to work without adequate resources – is acknowledged. People are going the extra mile in extremely difficult circumstances. But the problems the CQC have found is what happens when you impose savage cuts on a mental health trust budget. It impacts the quality and safety of care.”

Michael Scott, who was appointed chief executive of the trust in March of last year, said: “Our priority is to make sure we work with staff to improve the services we provide across Norfolk and Suffolk. 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.”