This is shocking. How could Norman Lamb even consider handing ownership of mental health services in Norfolk and Suffolk to these people?
Leadership, morale and staff engagement
The board had some significant changes over the past year. There was a relatively new chair who had been in post just over a year. The chief executive was appointed four months prior too our inspection and the director of nursing also had only been in post just over a year. There had also been some other internal movements to provide more leadership to the Norfolk area. The medical director had announced his intention to step down after 14 years. The finance director had resumed his position after a year in post as interim chief executive. There were also fairly newly appointed non-executive directors in post.
Since 2013 the trust has been undergoing a programme of service transformation which has led to some service closures, mergers and reorganisation. The trust told us that this strategy had been developed in partnership with staff, patients and other stakeholders following detailed consultation. At a presentation from the trust prior to this inspection they stated that staff engagement was a key priority.
Ahead of the inspection we were aware that staff and patients at the trust had not all been welcoming of the changes and some had been campaigning to stop service closures. Some staff, patients and stakeholders told us that the programme has been designed around cost saving rather than quality improvement, and had compromised patient safety.
We heard from board members that out of area placements were reducing, but we saw little evidence that this was a sustained reduction. Bed occupancy was very high and this bore out staff fears about the quality of the service that could be provided.
Some staff told us that they had no confidence in senior management and felt they had been let down. Others told us that they had been worried about speaking openly with us for fear of victimisation. We had sight of a letter from a senior manager that instructed staff to only give information to CQC that was requested. The urgent need for a workforce and operational development plan to deal with the issues of low staff morale was not prioritised or backed up with actions.
In the 2013 NHS Staff Survey, the trust scored within the worst 20% of mental health trusts for 21 key findings. These related to staff not feeling satisfied with the quality of work they are able to deliver, staff feeling work pressure, recommending the trust as a place to work or receive treatment, risks around managerial communication, believing patient care was not the trust’s top priority, believing the trust provides equal opportunities and staff experiencing discrimination. This is the second year running that the results had been poor, with this year showing a worsening in morale. There had been little action to address the staff survey results.
The trust told us they had recognised the need for improvement to ensure staff felt valued and fully
supported, and so had undertaken a number of initiatives to address this. The trust told us that data from the staff element of the Friends and Family Test from April 2014 indicated that there had been an increased level of staff satisfaction. We looked at the results from this and noted that the response rate was very low at 5%. Staff fed back to the trust that they felt that the survey was not confidential as they had to input an assignment number.
Staff were aware of their role in monitoring concerns and assessing risks. They knew how to report concerns to their line manager and most felt they would be supported if they did. However we found that some staff had been raising safety issues of concern with their managers without any action being taken.
We found very few examples of staff feeling that learning from past incidents was informing planning of services or service provision. Despite requests for information we saw little evidence that the trust could provide such assurance. Information was held in different places and was not easily accessible, even to the governance staff.
We looked at data available about staffing. Sickness absence rates had fallen slightly since the staff survey was completed however remained above target at 5.3%, with very high rates for absence due to stress at 26% of these.
The trust confirmed that they have a vacancy rate of over 11% and that staff turnover stood at over 17% in September 2014. Nursing vacancies were particularly high with over 65% covered by bank or agency staff.
We were concerned that there were low energy and action levels at board level. We heard no evidence to suggest that staff felt inspired by their leaders and saw no evidence that this was on the workforce agenda. We did recognise, however, that there were new board members and that there was will from the board to engage with staff.