The Care Quality Commission (CQC) has rated Norfolk and Suffolk NHS Foundation Trust inadequate, following an inspection undertaken in November and December.
CQC inspected the trust to assess whether improvements it previously identified were needed to meet standards people have a right to expect had been made. The decision to inspect the trust was also made in response to concerns about the quality of its care and patient safety.
The trust provides mental health and learning disability care for people across Norfolk and Suffolk.
Although the latest inspection found some areas where people received better care compared to the previous inspection, there were more areas where deterioration in quality and safety were noted. In some cases, this exposed patients to risk of harm.
This led CQC to considering taking urgent enforcement action while the inspection was underway. However, CQC had enough assurance this was not necessary after its initial feedback prompted the trust to close two wards to admissions, take other immediate remedial action and continue with a decision taken prior to inspection to not admit patients to another ward.
Following the inspection, CQC’s overall rating of the trust dropped from requires improvement to inadequate.
CQC also rated the trust inadequate for being safe, effective and well-led. It rated it good for being caring and requires improvement for being responsive to people’s needs.
Further to this, CQC served the trust a warning notice requiring it to make several improvements to ensure patient safety within a legally binding timetable.
CQC also recommends the trust remains in segment 4 of the system oversight framework, which is the recovery support programme for NHS trusts facing the toughest challenges. This means it will continue to receive intensive support from NHS England and NHS Improvement (NHSEI).
The trust knows it needs to turn its isolated examples of improvement into a culture of better care embedded across all its services. It has new leaders who are working closely with CQC and in collaboration with NHSEI to address the issues.
CQC will inspect the trust again within the coming months to determine whether improvements have been made. If there is insufficient progress, CQC will use its enforcement powers further to ensure people are not exposed to poor quality care.
Craig Howarth, CQC head of inspection for mental health and community services, said:
“Although the quality and safety of patient care in most of the services we inspected at Norfolk and Suffolk NHS Foundation had deteriorated since our previous inspection, there were areas where we found improvement.
“A significant factor behind the trust’s shortcomings was its lack of enough staff to meet patient need, a problem many mental health trusts are encountering. The trust needs to ensure its leaders have effective processes to consistently monitor teams, ensure compliance with training targets, understand issues affecting patient care and do more to support staff on the frontline.
“However, we found staff were more engaged, compared to our previous inspection, driven by a vision of what the trust wanted to achieve for its patients.
“This impetus had improved patient care on its wards for people with a learning disability or autism. The trust must embed this culture of improvement to turnaround its worse performing services.
“We also found better use of de-escalation techniques to reduce the trust’s reliance on restraint of people when they exhibited behaviour endangering themselves and others. However, we are concerned restraint was used too frequently and incorrectly on child and adolescent mental health wards, which were providing significantly worse patient care compared to our previous inspection.
“Due to our findings, we have served the trust a warning notice so its leaders are clear about what must be done to improve patient care and safety. They have a legal obligation to deliver this.
“Since the inspection, we have engaged regularly with the trust’s leaders through our ongoing monitoring. They have worked constructively with us, recognised improvements are required and shared their aspiration to improve the trust’s services for the benefit of patients.
“If our next inspection finds insufficient improvement, we will take further enforcement action to protect people from the risk of avoidable harm and hold the trust’s leaders to account.”
Inspectors found:
- In several of the eight core services inspected, lack of oversight from leaders contributed to poor management of people’s medicines and records. Insufficient management also led to patient observations which did not comply with national standards, long waiting lists and a lack of action to mitigate ligature points.
- Three services fell well short of standards people have a right to expect and were consequently rated inadequate. These are:
- child and adolescent mental health (CAMHS) ward
- community-based mental health services for working age
- adults acute wards for working age adults and psychiatric intensive care.
- Severe deterioration was found on the trust’s inpatient ward for children and young people experiencing an acute mental health disorder, which was previously rated outstanding. This service – known as the dragonfly unit at Carlton Court, Carlton Colville – relied on agency workers and lacked a permanent doctor. Its staff did not have appropriate training to protect young people from avoidable harm or build care around their individual needs, leading to high use of restrictive interventions which inspectors were unassured were undertaken safely or correctly
- Safe patient care was not being ensured in four core services rated requires improvement:
- long stay or rehabilitation mental health wards for working age adults
- specialist community mental health services for children and young people
- mental health crisis services and health-based places of safety
- wards for older people with mental health problems.
- There had been improvement on the trust’s wards for people with a learning disability and autistic people. This service had enough staff with the right training to meet people’s needs, refurbished premises and well-maintained clinical equipment – leading to its rating improving from requires improvement to good
- The trust must make several improvements to comply with the warning notice CQC served. These include:
- Maintaining safe staffing levels and ensuring training is completed
- Supervising and appraising staff to support safe and effective patient care
- Mitigating all ligature risks and learning from incidents where patients were exposed to harm or the risk of harm
- Embedding good governance to oversee performance and communicate priorities.
Full details of the inspection are given in the report published on our website.
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