The Norfolk and Suffolk Foundation Trust (NSFT) is England’s worst performing mental health trust, and remains bogged down in ‘special measures,’ although these measures have done nothing to address the deeply flawed management regime, or prevent it receiving a third ‘inadequate’ rating from the CQC last November, and again being branded as unsafe.
The chronic failure of the trust comes despite (or possibly as a result of) it having a massively inflated proportion of managers: and this is getting worse.
In 2017 the local Eastern Daily Press (EDP) revealed that while the number of doctors and qualified nurses at NSFT had fallen by more than twenty per cent over the last five years as a result of cutbacks, the number of managers had risen by more than fifty per cent.
Angry campaigners have pointed out “NSFT has 67 per cent more managers than the Norfolk and Norwich, a university teaching hospital with three times the turnover, nearly twice as many qualified nurses and more than five times as many doctors. …. NSFT employs 1.3 doctors for every manager, while the Norfolk and Norwich employs 12.25 doctors for every manager.”
However repeated CQC reports since 2013 show clearly that this proliferation of managers are not delivering results that justify the resources they consume.
The BBC has reported that numbers of disruptive out of area placements of mental health patients for whom there are no local beds have trebled in the past 12 months, with some Norfolk and Suffolk NHS Foundation Trust patients are being cared for hundreds of miles away. The number of bed days for out-of-area placements in April 2019 was 1,911, three times the April 2018 total.
Campaigners argue that the beds crisis has been caused by a meltdown in community services, and the closure of more than 140 beds by the mental health as part of the disastrous ‘radical restructure’ in 2013 aimed at cutting spending by a massive 20%.
“Two of the three city adult community teams have been closed to routine work due to lack of staff.
“Nurses carrying caseloads of 60+ who routinely work until seven o’clock in the evening are being followed around by expensive management consultants to see how they spend their time.”
An EDP report this month on their findings from a Freedom of Information request reveals Norfolk police are now dealing with an extra 10,000 mental health incidents each year compared with 2014, with over 6,000 a year coming through emergency 999 calls.
Andy Symonds, chairman of the Norfolk Police Federation, told the EDP: “The system is broken. We are filling the gap in mental health services that do not really exist.”
Earlier this year an EDP Freedom of Information request revealed people in Norfolk had been detained in police stations for more than 40 hours awaiting assessment or transfer to hospital.
According to the most recent CQC reports, high staff turnover, vacancies, staff away on courses and sickness all contributed to an unmanageably high case load for staff at the Ipswich home treatment team, juggling the needs of 50 patients.
Not surprisingly this care was care that was “variable and at times poor” said the CQC after an unannounced inspection.
The inspectors were told that in Norwich the crisis and home treatment team was not consistent in providing safe care, and that staff failing to visit patients as planned was a “daily occurrence”.
A separate unannounced inspection of the trust’s community-based mental health services for adults also rated it inadequate.
The trust was rated inadequate in the summer of 2017, and an interim inspection last August raised significant unresolved concerns.
After each of these inspections the current chief executive has tried to find positives, while clearly failing to address the underlying issues. Last August, then chief executive Antek Lejk said it was “heartening” the report had acknowledged the trust’s improvements, but insisted some issues “cannot be resolved overnight.”
Six months later having repeatedly failed to resolve the same problems he departed for a senior post at the East London Foundation Trust, with a generous severance package.
Campaigners have been critical of what they see as ineffective CQC intervention over the five years of more since serious concerns were flagged up in 2014.
It’s clear services have been struggling as a result of staff shortages and under-funding by CCGs, but things have been made much worse by consistently poor senior management which redesigned services in 2013 as a response to a 20% cut in its budget, cutting staff and frontline teams. In four of the following five years there were further cuts in funding.
In 2017, having failed to address serious concerns raised by the CQC three years earlier, NSFT was placed again in special measures, after a previous spell from 2015-2016, with the CQC again calling for a host of improvements.
CQC’s chief inspector of hospitals Ted Baker said:
“It is extremely disappointing that on our return to NSFT we found the board had failed to address a number of serious concerns. The trust leadership… must ensure it takes robust action to ensure improvements are made and we will continue to monitor the trust closely.”
Six years ago officers of the UNISON branch covering the Trust wrote to the joint Health Oversight and Scrutiny Committee to express their concerns over the planned cutbacks and their impact.
They warned that
“Whether you euphemistically call it “Radical Pathway Redesign” or “Service Strategy” the reality is that this is a significant cut to local mental health services, and should be described as such. To not do so causes confusion and ambiguity in the minds of the public.”
UNISON noted that the proposed reduction of 502 whole time equivalent staff represented a reduction in 24% of front line clinical staff, so that the same number of patients would be seen by this 24% reduced clinical workforce. They went on:
“We find it incredible that providing care to this number of people, with 24% fewer staff can be done in such a way that does not affect the quality or safety of patient care. There is no evidence that teams or clinicians currently have 24% spare capacity, or that clinicians’ time and skills are underutilised.”
UNISON also warned that the risk register for the cuts was inadequate, and not sufficiently up to date, and suggested the HOSC request to see the risk register, and any plans in place to mitigate against gaps in service provision and risks. They endorsed the concerns raised by both the RCN and BMA that the proposed measures for monitoring the risk of these changes focuses too heavily on “safety” rather than “quality”.
Nine months later, early in 2014 the Campaign to save Mental Health Services in Norfolk & Suffolk also issued a detailed call for the HOSC to press for a change of course, asking What has gone wrong with the radical redesign?
Sadly all this prescient good sense went unheeded by councillors, CCGs and a trust board seemingly intent upon multiplying highly-paid management jobs at the expense of front line care.
The latest failure is therefore a combined failure of trust board, along with a proven failure of CQC special measures to make NSFT services safe, along with the chronic failure of local commissioners to allocate adequate resources to mental health services, and of governments since 2010 to provide adequate funding for the NHS.
How much longer will the agony go on for mental health patients in Norfolk and Suffolk?
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