The Lowdown is publishing a slightly abridged letter sent to CQC chair Ian Trenholm by the Campaign to Save Mental Health Services, which is focused on the Norfolk and Suffolk NHS Foundation Trust, which covers Matt Hancock’s West Suffolk constituency. We agree that the concerns they raise about the conduct of the CQC need to be shared – and answers need to be demanded.

For more than five years, the mental health services provided by Norfolk and Suffolk NHS Foundation Trust (NSFT) have been substandard and unsafe. As you know, NSFT has been rated ‘Inadequate’ by Care Quality Commission (CQC) inspectors three times and placed into Special Measures twice, where the trust remains.

We believe that people have died as a result of NSFT’s failings and that NSFT is mental health’s equivalent of Mid Staffs.

Until recently, CQC was one of the few parts of the NHS ‘system’ which genuinely wanted to listen to, indeed sought out, the voices of patients, carers and staff: the very people who use, rely upon and provide NHS services. The CQC met with us and others during the inspection process and took our experiences seriously, which NSFT, NHS England and the CCGs did not. For this, which we believe resulted in balanced inspection reports, we are extremely grateful.

However, since the last inspection and the appointment of a new Chief Executive at NSFT who was previously an employee of CQC, which has been followed by the appointment of one of the new NSFT Chief Executive’s closest friends and former colleagues as CQC Deputy Chief Inspector of Hospitals and Lead for Mental Health, we and others have witnessed a worrying change of approach from CQC.

Previously, CQC maintained a professional distance and remained largely silent, quite properly as a regulator, between inspections: now the CQC Team Leader publicly praises the NSFT management, even when the trust’s performance has deteriorated rapidly, as empirical evidence and patient and carer experience clearly confirms. …

More worrying has been CQC’s changing attitude to engagement with those with experience of using or providing NSFT’s front line services, which Sir Robert Francis said was key to preventing future scandals such as Mid Staffs. …

Prior to every previous inspection, we and other stakeholder groups were invited to meet CQC in the inspection period, usually during the inspection itself.

During the last inspection period, for instance, about thirty of us met CQC staff at the Maid’s Head Hotel in Norwich, with similar meetings held with others. These meetings were arranged by the CQC Inspection Manager, who, we believe, is sadly no longer involved in the inspection process at NSFT.

We expected similar opportunities to be heard before the inspection currently underway and the CQC Team Leader indicated on 16 September 2019 that there would be such opportunities. She explained that these meetings had not been arranged in advance as:

‘There will be opportunity to speak. We are doing the inspections on an unannounced basis so we have not announced when for obvious reasons’.

So, imagine our surprise when the timing of these so-called ‘unannounced inspections’ became widely informally known to NSFT staff several weeks ago and when the dates of these so-called ‘unannounced inspections’ were announced to NSFT staff by the Chief Executive of NSFT and former adviser to CQC, in the week before the inspections in Suffolk and a further week before inspections began in Norfolk and, indeed, before we and other stakeholders were told. 

What about our promised ‘opportunity to speak’ that could not be arranged because of the ‘unannounced inspections’?

Since the ‘unannounced inspections’ were announced, we have heard nothing and neither have any of the other stakeholders who made submissions to whom we have spoken.

We submitted a thirty page report to CQC in July 2019 but have received not even an acknowledgement, never mind any follow-up.

We have spoken to other stakeholders who made submissions and they have not received acknowledgements or follow-ups either.

Since the promise of ‘opportunity to speak’, CQC appears to have changed its mind. 

We and other stakeholders to whom we have spoken have been invited to not a single ‘focus group’. We have heard about a very limited number of internal NSFT focus groups at which CQC has referred to NSFT directors on extremely familiar terms and those raising genuine and important issues have been allowed to be shouted down by NSFT ‘supporters’ but that is all. The claim that ‘we always want to hear all views’ appears at best disingenuous.

We also note that that at the end of every previous inspection, there has been a feedback meeting for stakeholders and the local NHS ‘system’.

Unlike previous years, those who would have expected to attend such an event have heard nothing from CQC.

Trusted sources from within the ‘system’ tell us that the NHS’s regulators (NHS England, NHS Improvement and CQC) do not want to hear, indeed refuse to listen to, ‘bad news’ about NSFT.

We find these reports deeply disturbing, again with echoes of Mid Staffs. We wish to put on record our belief that NSFT being released from Special Measures before the evidence says so, is dangerous and has happened before at NSFT, with disastrous consequences.

We believe that such a decision would be at odds with the submissions received by CQC about NSFT. We challenge CQC to publish the various submissions it has received for the public to judge.

If CQC is unwilling to publish voluntarily, please consider this a request under the Freedom of Information Act for disclosure of stakeholder (not individual) submissions received regarding NSFT.

With the greatest of regret, it appears that the NHS ‘system’, including CQC, has decided that the best way to solve the serious problems at NSFT is to ignore the evidence and experiences of patients, carers and staff, to pretend that there are no serious problems and to release NSFT from Special Measures, which now appears predetermined, even before the inspection is completed. Indeed, we have heard this is the case from several independent sources. This is a shameful and dangerous situation.

From having almost complete confidence in CQC’s impartiality and integrity, we now have virtually none.

We look forward to a full and prompt written response to our concerns. In the interests of transparency, we will be publishing this email.

Yours sincerely,

Committee of the Campaign to Save Mental Health Services in Norfolk and Suffolk

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