We rated Norfolk and Suffolk NHS Foundation Trust as inadequate overall because:
- We found that there was not a safe, effective or responsive service at this trust and the board needs to take urgent action to address areas of inadequacy.
- While the board and senior management had a vision with strategic objectives in place staff did not feel fully engaged in the improvement agenda of the trust. Morale was found to be very poor across the trust and staff told us that they felt let down by management.
- The trust had been involved in a number of initiatives to engage with staff. However, staff told us that leadership from above ward level was not visible or accessible to them. Staff told us that they did not feel engaged in the improvement agenda.
- Despite the trust collecting data there was little evidence of this being used to inform performance. The board could not assure us that it knew how the trust was performing and how decisions were implemented or impacted on quality. We found that while performance improvement tools and governance structures were in place these had not always facilitated effective learning or brought about improvement to practices.
- Throughout this inspection we heard from service users, carers and local user groups who felt that they had not been effectively engaged by the trust in planning and improvement processes.
- We had a number of concerns about the safety of this trust. These included unsafe environments that did not promote the dignity of patients; insufficient staffing levels to safely meet patient’s needs; inadequate arrangements for medication management; concerns regarding seclusion and restraint practice.
- We were also concerned that while the trust had systems in place to report incidents, improvement was needed to ensure learning or action.
- A large number of staff had not received their mandatory training and many staff had not received regular supervision and appraisal.
- A lack of availability of beds meant that people did not always receive the right care at the right time and sometimes people may have been moved, discharged early or managed within an inappropriate service.
- Overall we saw good multidisciplinary working and generally people’s needs, including physical health needs, were assessed and care and treatment was planned to meet them.
- We observed some positive examples of staff providing emotional support to people, despite the challenges of staffing levels and some poor ward environments.
It is our view that the trust needs to take significant steps to improve the quality of their services and we find that they are currently in breach of regulations.
Throughout and immediately following our inspection we raised our concerns with the trust. The trust senior management team informed us of a number of immediate actions they intended to take to address our concerns.
A spokesperson for the Campaign to Save Mental Health Services said:
“The regulator confirms what our campaign has consistently said for more than a year. NSFT has been providing an unsafe service due to: a lack of beds; inadequate community and ward staffing levels; superficial engagement with service users, patients and carers; poor leadership and a Board disconnected from the harsh reality on the frontline.
We are delighted that the CQC has recognised the hard work and dedication of clinical staff trying to do a great job in impossible circumstances. There is a £30 million black hole in funding at NSFT. Now, we need to see a genuine sense of commitment and urgency to put things right.”
In summary: “Caring lions led by incompetent donkeys.”