Not enough staff, not enough beds - inspectors brand region’s mental health trust inadequate again
PUBLISHED: 08:05 13 October 2017 | UPDATED: 16:41 13 October 2017
The region’s mental health trust has once again been branded as failing as inspectors found serious issues first raised three years ago had not been fixed.
Inspectors found patients at Norfolk and Suffolk NHS Foundation Trust (NSFT) were unsafe and the service was inadequately led, as the Care Quality Commission (CQC) rated it as inadequate overall and recommend it be placed in special measures.
Julie Cave, the trust’s new chief executive, apologised to patients and said they were “determined” to improve.
In particular, they highlighted how:
• Failings first identified by inspectors in 2014 had still not been addressed;
• Data the board of directors relied on to assess performance was “flawed” and “unreliable”;
• There were not enough staff to meet patients’ needs;
• Unsafe seclusion and restriction practices continued;
• The trust did not have enough inpatient beds - although it maintains it has;
• Community and crisis team referral times were not being met;
• The IT system Lorenzo was having an impact on staff and patient care;
• Staff who work for the trust wanted to provide high-quality care, and were kind and compassionate.
Mrs Cave added: “We are determined to ensure that our local mental health services continue to improve in what we all recognise as an increasingly demanding environment in the NHS and in social care, with more people suffering mental ill health than ever before, and with more complex needs, while our resources remain under huge pressure.”
The trust was first plunged into special measures following an inspection in 2014. It was subsequently lifted out but looks set to go back in after recommendations from the CQC.
This time around inspectors found more patients were tranquillised, others were kept in unsafe seclusion, and in some instances staff had higher caseloads than levels recommended by the Royal College of Psychiatrists.
In the community, the trust told inspectors there were safe staffing levels but inspectors found this was not always the case. The report said: “In some older people’s teams core staffing levels had not been reviewed by the trust since 2014 despite the concerns of front line staff. Caseloads were an average of 60-70, with an average of 90 referrals a month.”
In crisis services staffing levels had improved but there were still issues. One consultant in Great Yarmouth was responsible for an acute ward, a rehabilitation service, and the crisis team.
The trust also still had “no overarching operating procedure for crisis services” despite this being required after the last inspection. And for those who were not already known to crisis services the “only option in a crisis had been to either telephone 111, wait to see their GP or attend Accident and Emergency departments.”
In 2016, the trust was told it had a beds shortage. But inspectors said: “The trust told us that they did not believe that they had insufficient beds.”
This is a position the trust maintains but this time around the CQC found bed occupancy rates were high, particularly in acute services, “leading to a large number of patients had been treated outside the trust, moved, discharged early or managed within an inappropriate service”.
This newspaper reported two weeks ago how NSFT has sent patients to the failing, private Mundesley Hospital.
When patients were kept within the trust they were often moved around. Between April last year and July this year, 472 patients had been cared for on more than two separate wards during a single admission.
One patient on Glaven Ward, in Norwich’s Hellesdon Hospital was “transferred between five wards in seven weeks, including out of area, as there had been no psychiatric intensive care beds available”.
Inspectors were also concerned about the monitoring of patients’ physical health after rapid tranquillisation had been used - the number of times the practice had been used had seen a “significant increase” since the last inspection.
When patients were secluded they were sometimes not reviewed by a doctor or nurse, and their food and drink intake was not monitored.
At Northgate Ward, at Wedgwood House in Suffolk, one patient was secluded because they threatened to self-harm, which is contrary to the Mental
Health code of practice requirements.
Inspectors laid much of the blame at the feet of the trust’s board of directors. They said trust chiefs had failed to tackle problems and had not performed quick enough to turn things around. Data collected by the board was contradictory, leading the CQC to conclude any future plans could not be determined.
The trust is expected to be put into special measures in coming days.
The shining light of the CQC report was the caring category, which mainly reflected the attitudes of NSFT staff - it was the only area rated as good.
Almost all patients and relatives told inspectors staff were “kind and supportive” - particularly in older people’s care, community learning disability services, and wards for children and adolescents.
The Dragonfly Unit, a ward for children and young people, treated patients “with exceptional care and respect and staff were passionate about their service”.
Inspectors said: “Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels in some services.
“We observed some very positive examples of staff providing emotional support to people across all services visited.”
Cultural and religious needs were met, and people’s personal boundaries and privacy were respected.
Mrs Cave, who was yesterday appointed as the trust’s new chief executive having formerly been deputy CEO and finance director, said the board had actioned an urgent response to the report and its findings
She said: “Anyone who cares about mental health services in Norfolk and Suffolk is going to be disappointed in these results, as we are at NSFT.
“In short, we have not made enough significant improvements over the past year and that has resulted in this retrograde step in our CQC ratings and in our progress. For that we apologise to our staff, to our service users and carers, and to our stakeholders.
“We know our dedicated staff will offer their continued support in helping us to put things right and to achieve the improvements we need to make at a greater pace over the coming months.
“Our teams have been working incredibly hard to continue to keep our services safe and of high quality for our service users and we should note that today’s report does not mean we have made no improvements.
“The CQC report also comments on how caring our staff are, stating that patients told them they felt ‘genuinely cared for’ and ‘supported’; that they ‘felt safe on our wards’; and that our community staff were ‘responsive to their needs, caring and treated them politely’
“Our board will remain focused. That is our responsibility and our commitment to our staff, to our service users and carers. We will continue to improve but we will do so with greater pace in order to deliver the quality of service that the people of Norfolk and Suffolk deserve.”
Meanwhile, a spokesman for the Campaign to Save Mental Health Services in Norfolk and Suffolk called the report “devastating and unnecessary but not a surprise”.
He said: “Since 2014, the board of NSFT has chosen to ignore its own patients, carers, staff and regulator. The board of NSFT was warned repeatedly to turn back by our campaign, the Royal College of Psychiatrists and Unison. Yet, it chose, and has continued to choose, to ignore us all, and the accumulating evidence of failure, with devastating consequences for patients and their families.”
“Neither the people of Norfolk and Suffolk nor the caring frontline staff can tolerate management failure on this scale any longer.
“Our politicians and the NHS bureaucracy must guarantee that the money and expertise necessary to provide high-quality mental health will be found. NSFT’s budget this year is less than when the trust was formed on January 1, 2012. Given increased demands and inflation, any management - competent or not - would be challenged.
“The increase in seclusion and restrictive practices indicates a trust at breaking point, which puts both staff and patients at risk.
“The claim made by the NSFT Board that it has enough beds is farcical, as shown by the millions wasted at the inadequately-rated hospital at Mundesley. We need investment in a mix of community and inpatients services which keeps as many people as possible alive and well.”
Former Liberal Democrat health spokesman, and North Norfolk MP Norman Lamb, previously called for better mental health care nationally. He said: “It’s very, very bad news and obviously we’ve got to treat the judgement of the CQC very seriously.
“It’s disturbing when you hear about ligature points not having been addressed as its been raised before.”
But he warned against hitting the morale of staff “who work so hard” on the front line.
Dr Adrian James, registrar of the Royal College of Psychiatrists, said: “It is appalling that patients and staff are being let down by misguided cuts to mental health services. When the trust was formed 5 years ago, my predecessor warned of the potentially devastating effects of the proposed cuts to services under the reorganisation plan. The CQC is now proposing to put the trust back into special measures - this is the latest chapter in this long and painful saga.
“It’s extremely disappointing that despite appearing to turn the ship around after coming out of special measures last year, the Trust appears to be back where they started because of not investing properly in its workforce and support services.
“That a new chief executive has been appointed is a step in the right direction. It’s scandalous that the apparent leadership problems which have bedevilled this Trust since its inception are still to be addressed.
“Since the trust came into being in 2012, operating income has declined by 7.5pc and according to official figures, the trust has seen a 19pc reduction in psychiatrists. Far from achieving parity of esteem, the trust has failed to invest enough in mental health services.”