Norfolk and Suffolk NHS Foundation Trust’s mental health services still ‘require improvement’
Inspectors say that leadership at Norfolk and Suffolk’s mental health service ‘requires improvement’.
The Norfolk and Suffolk NHS Foundation Trust supports a population of around 1.6million people, delivering specialist mental health services for children, adults, autistic people and people with a learning disability.
A recent Care Quality Commission (CQC) inspection assessed how well-led the trust is overall, focusing on leadership and governance across the entire organisation.
It followed earlier assessments of two of NSFT’s services, community mental health services for adults, and crisis services and health-based places of safety, to ensure a thorough understanding of the trust’s leadership.
Both of these inspections noted improvements in the way care was delivered since the previous inspections of these services.
There was also “notable improvement” at the trust level identified during this inspection, although further work is needed to “embed and maintain those improvements”.
Overall, the CQC has again rated the trust as ‘requires improvement’ for how well-led it is.
Stuart Dunn, CQC deputy director of operations in the East of England, said: “During our well-led inspection of Norfolk and Suffolk NHS Foundation Trust, we found leaders had started to make significant progress in areas such as board stability, management and engagement with people who use services.
“However, more is needed to ensure improvements are embedded and delivered consistently across the organisation.
“Staff told us they felt services were starting to improve. However, many also said senior leaders weren’t always visible or approachable, and they didn’t always feel confident that concerns would be listened to or acted upon.
“We continued to hear about some poor experiences of workplace culture, including issues around discrimination and feeling unable to speak up. Trust leaders were aware of this and were taking action in response.”
Mr Dunn added: “We saw passionate and committed staff working hard to support the people they care for.
“We were also pleased to see the trust prioritised working with people that have lived experiences of services to help shape and design them.
“The trust had been through a period of prolonged instability within its executive leadership team. Recent appointments to the board had brought greater stability and experience from high-performing organisations.
“We saw a significantly improved governance system in place, with clearer lines of accountability and stronger oversight of risks and performance.
“The board is now more stable, but this stability needs to be maintained so that relationships and confidence can continue to be rebuilt, both within the organisation and with external partners.
“We’ve told leaders the areas where improvements are needed to ensure the trust is led successfully, and we will continue to monitor their progress, including through future inspections.”
Inspectors also found:
• Leaders had not provided enough pharmacy support to community teams, and this remained a gap in safe and effective service delivery.
• The trust strengthened its ‘freedom to speak up’ processes, but some staff still lacked confidence in using them.
• There was limited positive engagement between the trust and some of its governors, and not all governors felt confident or empowered to carry out their role.
• Inspectors saw delays responding to complaints and completing patient safety investigations meaning opportunities for learning were sometimes missed.
• The trust acted quickly in response to issues they identified, such as problems with staff skill mix, but further work was needed to improve their understanding of the impact of these issues and the cultural aspects associated with them.
• The trust had started work to address health inequalities, but this was still in early stages and needed to be embedded across all services.
Caroline Donovan, chief executive officer at NSFT, said: “This well-led assessment highlights several key areas of sustained improvement and shows the large-scale transformation which is taking place at NSFT is beginning to reap positive results.
“We are particularly pleased that the inspectors have once again recognised the hard work and dedication of our staff and their commitment to the individuals and communities we serve.
“We know we still have much more to do to deliver consistent good quality mental health services and were already taking action to address many of the areas for focus highlighted by the CQC.
“Improving our culture is one of our strategic priorities, while we have renewed our commitment to enhancing the experiences which staff from an ethnic minority background have when they come to work.
“In addition, we are also taking positive steps to ensure we respond to more complaints within our target timeframe while making it easier for staff to raise concerns.
“We look forward to working closely together to continue to drive these improvements and build on the solid foundations which we have already put in place so that we can consistently provide safer, kinder, better services for our communities.”
Zoë Billingham, NSFT chair, added: “This is a strong report for the trust which contains some real positives. It recognises significant areas of improvement, and we are on the cusp of being rated good.
“I am delighted that the CQC recognised the significant improvements in partnership working as well as the progress we have made involving service users carers and families across our improvement programme. On behalf of the board, I would like to thank our staff for their hard work.
“We are not complacent, and we continue to work closely with our service users, families, carers and partners across Norfolk and Suffolk, to make sure our local communities receive the safer, kinder and better mental health services they rightly deserve.”