The Care Quality Commission (CQC) has upgraded Norfolk and Suffolk NHS Foundation Trust’s rating from inadequate to requires improvement, following an inspection undertaken between September and November 2022.
CQC inspected the trust to assess whether it had made improvements after the last inspection, in 2021, led to it being rated inadequate. At that inspection, CQC also served the trust a warning notice, requiring it to make improvements within a specific timeframe after inspectors found people were being exposed to the risk of harm.
The warning notice is no longer active following the latest inspection because the trust has started to take action in all the areas it covered.
While no current enforcement action being taken against the trust, progress with unresolved issues is being monitored against requirement notices. The trust is also required to detail how it will resolve these issues.
CQC inspected six of the trust’s core services at the latest inspection:
- Child and adolescent mental health wards
- Community-based mental health services for working-age adults
- Long stay or rehabilitation mental health wards for working age adults
- Acute wards for adults of working age and psychiatric intensive care units
- Mental health crisis services and health-based places of safety
- Wards for older people with mental health problems.
These inspections focused on the areas covered in the warning notice where improvement was needed.
As well as its overall rating improving following the latest inspection, the trust’s ratings for being safe, effective and well-led also improved from inadequate to requires improvement.
The trust was again rated good for being caring, and it was again rated requires improvement for being responsive to people’s needs.
Although the inspection found improvement overall, there were areas where more improvement is needed. There were also a small number of areas where there has been a deterioration in the quality and safety of care provided to people.
To ensure improvement that has been made is sustained, CQC recommends the trust continues to receive the intensive support it has had from NHS England.
Jane Ray, CQC deputy director of operations, said:
“While the trust has more to do to consistently provide high standards of care and treatment that people have a right to expect, it’s made welcome progress – even at what continues to be a difficult time for the NHS.
“Although our previous inspection found the trust’s care was very poor, we noted it had a more stable leadership team and board with the potential to drive improvement. This team needed time for its approach to deliver results, and our latest inspection found that improvements had been delivered at pace.
“This was particularly evident in the trust’s child and adolescent mental health wards, which had gone through a transformation programme. This included improving the physical environment and strengthening clinical leadership across the unit.
“Staff morale in the service was good, and young people using it described the unit as a safe environment where staff met their needs in a caring way.
“However, the trust hadn’t shown improvement in all areas, and there were some aspects of its care where quality and safety had deteriorated.
“This includes a few acute mental health wards and its wards for older people with mental health problems, where there continued to be ligature points – despite us previously telling the trust it needed to address these. However, there were plans for them to be removed.
“We also found some wards didn’t have enough staff who had completed mandatory training, and a few staff weren’t carrying out restrictive interventions – such as restraint or seclusion – appropriately. However, the trust was addressing these issues.
“This demonstrated that although changes to improve people’s safety had been introduced at pace by the trust since the last inspection, further refinement and embedding is needed to improve the consistency of its care.
“The trust must now ensure the progress it has made does not slip, and it must apply its commitment to improvement to areas that still don’t meet standards people have a right to expect. It is recognised that the trust will need the support of its system partners, including NHS England and local integrated care boards, to deliver this change.
“We will continue to monitor the trust closely, including through future inspections, to assess whether further improvement happens. If adequate progress isn’t made, we will use our regulatory powers to ensure people’s welfare and safety.”
Following the inspection, CQC reported its findings to the trust so its leaders know what they must address and where there is good practice on which they can build.
CQC found one core service, child and adolescent mental health wards, evidenced significant improvement – enabling its rating to progress from inadequate to good.
Four other core services also improved. These were:
- Community-based mental health services for working-age adults, which improved its rating from inadequate to requires improvement
- Mental health crisis services and health-based places of safety, which was rated requires improvement again, but its rating for whether it was safe improved from inadequate to requires improvement
- Long stay or rehabilitation mental health wards for working-aged adults saw its rating for being safe improve from inadequate to requires improvement
- Acute wards for adults of working age and psychiatric intensive care units improved its rating from inadequate to requires improvement. But it was rated inadequate again for being safe.
The final service inspected – wards for older people with mental health problems – evidenced improvement some areas, but deterioration in others. Its ratings for being effective and responsive to people’s needs progressed from requires improvement to good, however its rating for being safe deteriorated from requires improvement to inadequate.
In areas where the trust must make improvements, issues included:
- Data and information were not always brought together effectively. This meant struggling services might not be identified at an early stage to ensure they had adequate support
- Some essential building improvements had not happened fast enough to address safety concerns
- Some ward and team managers did not have adequate skills, experience, motivation, ability and confidence to deliver the best possible care to people. The trust had implemented leadership development opportunities, but managers needed to engage with these opportunities more
- Some clinicians, especially psychiatrists did not feel sufficiently engaged. But they were positive about the recently appointed medical director’s plans to give them opportunities to participate in planning future services
- The trust faces considerable challenges regarding its IT systems.
However:
- The trust had a clear and realistic plan to deliver improvement
- There were improved systems and training for undertaking observing, and for managing and reducing restrictive interventions
- Medicine management had improved
- The executive leadership team and governance arrangements had been strengthened. Executive leaders were clear about their responsibilities, and the quality and safety of care was the priority
- An improved staff induction had been developed
- The trust recognised it needed need to improve its culture to support its staff to provide good care to people. While many staff felt progress had been made, some reported discrimination and poor morale
- The trust was bringing forward work to align its strategy with those of the Norfolk and Waveney Integrated Care Board and the Suffolk and North East Essex Integrated Care Board. It was active in both systems, and its leaders recognised and supported partnership working to meet local people’s mental health needs
- Patient participation had increased, helping the trust understand and respond to people’s needs.
