Four months ago, Mark Taylor, chief executive of North Norfolk CCG, on behalf of all the central Norfolk CCGs, promised:
“Although the numbers are small, we want it to end by April. As commissioners we do not want people to go out of area and we want to stop that as soon as possible.”
Similarly, Andrew Hopkins, acting Chief Executive of Norfolk & Suffolk NHS Foundation Trust (NSFT) said:
“We know at the moment that we are extremely pressured on beds in central Norfolk and we are making a number of out-of-area placements. We have done a lot of work to reduce delayed discharges. There is a plan to have more beds that are alternatives to admissions and we have nursing home beds in west Norfolk and Great Yarmouth and Waveney. We feel that we should be able to get beds under control and not have to make out-of-area placements.”
This week, Kathy Chapman, Operations Director of NSFT, and the Norwich health commissioner, Jonathon Fagge, let slip on BBC Radio Norfolk that they have failed, despite having four months, to deliver on their promises. In fact, the beds and community crises have become worse. Rather than admit that they have failed and address the causes, be they lack of resources, incompetence or a mixture of both, they now simply say the bed crisis will be addressed sometime this year. There is no acknowledgement that they have failed or explanation of the reasons. So we are left none the wiser as to why this is happening or when and how this emergency in mental health care is going to be solved. Do Chapman and Fagge mean this calendar year or this financial year (which could mean the end of March 2015) for a resolution and how will it happen? Should we have any confidence that they will deliver?
When Kathy Chapman was questioned at the most recent NSFT Board of Directors meeting, a discussion which was supposed to last fifteen minutes but went on for an hour and a half, Kathy Chapman was indicating that community teams would continue to have unallocated cases into 2015. Are people in crisis really going to be shipped off like cattle to Somerset and Manchester for another year too? We already know that the alternative-to-admission arrangements in the East have broken down in dubious circumstances and that at least some of the additional beds of which Jonathon Fagge spoke are actually a reallocation of respite beds. How is removing access to beds which stop people being admitted going to improve the beds crisis? NSFT overspent by £2.4 million last year on external placements.
When you listen to the audio clip, note that Jonathan Fagge of Norwich CCG claims that demand for mental health services has only increased by 1-2% in Norwich, that the commissioners have provided additional funding and that the entire NHS faces cost challenges. Jonathon Fagge also appears to hint at the return of the vital link workers which disappeared from Norfolk in the radical redesign, which we would warmly welcome. Contrast Fagge’s claims with those of Kathy Chapman, who says that the problems are due to increased demand and reduced funding. Yet as they, and Norman Lamb, blame each other, crucial mental health services continue to fail.
The radical redesign has been a disaster, both in terms of design and implementation. NSFT was warned repeatedly but it arrogantly charged on relentlessly with devastating results. The Director of Operation’s biography on the NSFT website describes how she ‘led strategic work on the redesign of services’ and ‘As director of operations, Kathy heads all Trust services that deliver health and social care directly to patients.’ For how much longer can the NSFT Board allow the Director of Operations to fail to deliver vital services, squander millions and destroy service user, carer, public and staff confidence? As Gary Page, NSFT Chair, said:
“Operational delivery is absolutely key to rebuilding trust and confidence in NSFT. There are real signs we are making progress but also examples of where there seems to be a culture that it’s ok not to deliver what is expected. I feel it’s really important that we have to role model the behaviours we expect to see at Board level.”
Norman Lamb, the CCGs and Monitor also need to share in the blame and in the cost of putting things right. They heard and read the warnings, were told what was happening, yet allowed the senseless radical redesign, with its many ‘transition plans’, to charge over the cliff. Jonathon Fagge has written that ‘Innovation is an act of courage that accepts the risk of failure in the pursuit of success‘ but the users of mental health services in Norfolk and Suffolk should not have been allowed to be used as guinea pigs in an arrogant experiment in hubris. Innovation cannot ‘take the blame’ and is not an end in itself.
Listen for yourself: