Emily Townsend of the East Anglian Daily Times reports:
Today marks a year since the Norfolk and Suffolk Foundation Trust (NSFT) was rated ‘inadequate’ for the third time in a row.
The toleration of the underperformance of NSFT is a national scandal.
The Norfolk and Suffolk Foundation Trust (NSFT)’s most recent Care Quality Commission (CQC) report, which uncovered a “litany of failings” in key areas, was published on November 28 last year.
Major issues included access and waiting times, communication, staff shortages, crisis support and discharge from services.
Inspectors went back to NSFT in October, and their findings are due to be published in January 2020.
Yet campaign groups feel the trust has failed to make said improvements, noting a “sea of red and downward arrows” in the trust’s latest performance figures, which revealed patients in crisis were waiting more than a day for emergency treatment.
“We are at a loss to understand how the mental health trust’s continuing deterioration can be tolerated, when in January of this year NSFT was told it had just weeks to improve, and it clearly has not,” said a spokesman for the Campaign to Save Mental Health Services in Norfolk and Suffolk.
Patient watchdog Healthwatch Suffolk, which this summer published hundreds of damning stories from people under the trust’s care and sent them to the CQC, is eagerly awaiting the results of the next inspection.
However, bosses said that through their work with the CQC, the watchdog is continuing to hear stories that reflect ongoing issues at the trust, particularly about waiting times, access, and communication problems.
Access and waiting times
Trying to get an appointment, and being put on waiting lists, still form a major part of people’s experiences of mental health support.
According to a recent Healthwatch Suffolk report, of nearly 200 comments, 97% described negative experiences of access and waiting times at NSFT. This document was submitted to the CQC ahead of their re-inspection of the trust.
One person, responding to the watchdog’s call for feedback, claimed a single mum faced a 12-week wait for treatment, despite being told she was an “urgent priority”.
Meanwhile, a recent prevention of future deaths report sent to the trust highlighted the plight of a patient who faced an 11-week wait for eating disorder treatment.
And at last week’s NSFT board meeting in Ipswich it was revealed patients in crisis, particularly in Norfolk, are waiting more than a day for emergency treatment.
In October Toni Smith, from Felixstowe, said she feels “100% let down” after having to wait a year for support for her autistic son.
Mum to Teddy, 13, Mrs Smith highlighted the long wait from an initial referral to seeing someone from the youth autism diagnostic service, run by the NHS.
The average waiting time in October was 32 weeks, double the target of 18 weeks.
Earlier this month Mellie Plummer, 19, spoke out about her difficulties accessing eating disorder treatment.
She said long waiting times can lead to a patient’s health deteriorating even faster, adding: “It seems like no one is doing anything about it and with eating disorders when you’re waiting for weeks the deterioration can be insane.”
The Chief Operating Officer of NSFT, Stuart Richardson, makes his usual lame and misleading excuses for underperformance which we are not going to repeat here. If you can bear to, you can read them on the EADT website.
Richardson needs to take responsibility for his failures and the disgraceful appointment of Amy Eagle as his deputy.
During their September 2018 visit, CQC inspectors said they particularly heard about delays in accessing services, describing communication as “poor” during these waits.
Some patients had harmed themselves while waiting for contact from clinical staff.
People who have been under the trust’s care in recent months say communication issues have persisted.
One patient said: “Left a message on crisis phone when I was in crisis (and) suicidal, that was five months ago, I’m still waiting for a call back.”
Andy Bowes, from Sudbury, said: “It’s a poor service. It takes forever to get appointments and while you’re on waiting lists nobody contacts you to let you know what’s happening. It feels like you’ve been forgotten about for months.”
Overall, of the 62 responses to the Healthwatch Suffolk survey on this topic, 95% were negative, while 5% were positive.
Support in a crisis
At the last inspection, experts were not assured that NSFT responded appropriately to emergency or urgent referrals.
The trust’s recent performance in this area has declined, with the percentage of emergency referrals being assessed within four hours falling from an average of 92%-93% in the months before the 2018 CQC inspection to 74% in September this year.
In April, following an inquest into the deaths of Thomas and Katherine Kemp, chief nurse Diane Hull pledged to carry out a thorough investigation of its crisis response, adding they had a “duty to do this for the sake of future service users and their families”.
You learn all you need to know about the rotten values of the executives at NSFT from the fact that all of them refused to appear on the BBC to account for the failing that led to the deaths of Thomas and Katherine Kemp.
Coroner Jacqueline Devonish ruled at the end of a week-long inquest that the pair were sent home from hospital just hours before their deaths in a “distressed and hopeless” state after seeing a mental health crisis team, run by the NSFT. Mr Kemp, who had a long history of mental ill health, told police officers he wanted to harm himself just hours before he killed his wife, and then took his own on August 6 last year.
Mrs Kemp literally cried for help for her husband.
A few hours later, both were dead.
The 32-year-old died from self-inflicted stab wounds to the neck, torso and limbs outside the flat he shared in Siloam Place, near Ipswich Waterfront, with his wife Katherine, 31, who died from stab wounds to the chest.
According to Healthwatch Suffolk, feedback sent to them about support during a mental health crisis in recent months has been predominately negative in sentiment.
Another added: “Our (nearest) hospital has no powers to stop (patients in crisis) from leaving. This often gives a very small period of time for mental health services to provide crisis support – however most patients just tend to self-discharge and walk out. This leaves very vulnerable individuals, who have just attempted suicide, with little to no mental health support post-discharge.”
Discharge from services
In the November 2018 report, inspectors warned that some people had been moved, discharged early, or managed within an inappropriate service.
The 21-year-old took his own life after being released from a mental health unit run by NSFT. He was found dead in London days after being released.
Since Henry’s death, and in recent months, the trust said it has strengthened the handover process between different shifts so all staff are immediately given all relevant information about each patient.
The trust accepted some aspects of care were below the standard they aspire to, and apologised to his family for this, paying out a settlement for an undisclosed sum.
Recent experiences of discharge arrangements suggest patients are continuing to face problems.
One person said: “My daughter was being treated under the mental health team at Walker Close and was gradually improving. The team discharged her earlier than I felt was appropriate, with absolutely no support post-discharge. She has swiftly relapsed and I have contacted the team but I cannot get her re-admitted. I simply get told to call the crisis team – who also do not help. I have tried other avenues but with no success – I feel like I am on my own.”
Of the 41 comments on this topic sent to Healthwatch Suffolk, 2% were positive, while 98% were negative.
There continue to be inappropriate discharges.
There appears to be an alarming and unsafe correlation between decisions to assess and detain under the Mental Health Act and bed availability.
In the unlikely event that a bed is available, the patient is much more likely to be detained.
If there isn’t a bed, they are much less likely to be detained.
Bed availability should not be influencing decisions made under the Mental Health Act. But it is.
Extremely ill people are being discharged by NSFT to sleep in churchyards, cemeteries and doorways in the winter.
People have frozen to death in churchyards or been found dead in bins at the back of Prince of Wales Road in Norwich.
At the last CQC inspection, it was widely reported that staff treated patients with kindness and compassion.
However, there was widespread low morale across the trust. Much of this was attributed to a “do unto” attitude staff felt came from senior management and directors.
At a recent board meeting, it was reported that voluntary turnover had reached the highest number of leavers since the 12 months to the end of February 2019.
But chief nurse Diane Hull said progress had been made in hiring more nurses, with 34 posts filled by UEA graduates last week.
Of the responses to the Healthwatch Suffolk survey, unlike the other categories, feedback is mixed with 31% positive, 22% mixed and 47% negative comments.
“I like my nurse, she helps me, I have no complaints,” said one patient.
We have continually said over the past six years that front line staff do their best in impossible circumstances.
Our issues are inadequate funding and the rotten management culture of the mental health trust.
Front line clinicians remain alienated by the cronyism of the rotten management.
NSFT is not clinically-led.
Co-production with service users is tokenistic and shallow.
The radical restructure has simply entrenched the rotten management.
What happens next?
Campaigners are urging the next government to find more radical solutions to the situation facing the NSFT.
Health groups are waiting for the results of the CQC report, after which they will decide which actions – if any – to take.
After the 2018 CQC report, there were calls for ‘special administration’, which would see a parliamentary representative parachuted in to take over.
Earlier this year, there were also talks of splitting the trust, into Norfolk, east Suffolk and west Suffolk.
The next full CQC report is expected in January 2020.
So much for ‘weeks to improve’.
So much for ‘green shoots’.
Click on the image below to read the special investigation in full on the EADT website. The graphs are particularly illuminating: