Meltdown: Working as a community nurse at NSFT

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“I work as a Community Mental Health Nurse for Norfolk & Suffolk NHS Foundation Trust (NSFT) and each week at work becomes more unbearable for so many reasons.

Caseloads are unmanageably high with constant pressure from managers to take more cases that are being referred in on a daily basis. There is pressure to take cases that are currently unallocated and cases that are considered ‘health only’ and are held by colleagues now working for Norfolk County Council (NCC).

My recent experience when taking cases that have been allocated for some time is that the service user has not been seen or contacted for many months, so when they are finally seen the situation is almost always in crisis, with the service user having no professional input for many months, the family or carers have been left to pick up the pieces. I have seen several people recently, that, had they been seen regularly, would not have reached crisis point. Their needs are severe, they need intensive, sustained input for a number of weeks or months, in order to recover, which is just not available in our current CMHT resource.

The recent split with Norfolk County Council has impacted in many ways. Trying to get a social care service for current service users is incredibly difficult, it may be as simple as organising a contract for home care, but as a nurse I am now unable to do this. Trying to get a social worker allocated to a case is difficult, clearly there are not enough social workers to provide the service needed for the number of cases identified. The social workers are having to manage a high number of cases who have complex health needs, but NSFT does not have the resource to take these cases and provide care coordinators. NSFT and NCC aren’t even able to agree a date at which all transfers between health and social care can take place. NCC says it happens by 31st December 2014, NSFT says by March 2015!!!!!

We have gone from a team where nurses, doctors, and social workers would meet regularly, make plans for those service users who required input from other disciplines and required intervention to manage risk to an office where NCC staff and NSFT are very separate teams. This results in lack of communication, no MDT discussions about how to help those with complex and often presenting with high risk difficulties. Staff feel very ‘alone’ with high caseload numbers, complex cases and now the added stress of finding a way through the NCC process of trying to get a social worker for individual service users.

We are asked regularly about our discharge plans for our patients in hospital by our manager. This is almost impossible to manage. To visit and review an inpatient now takes a whole day. Virtually none of the inpatients in my team are located in a local bed. We now see it as the norm that when we have someone admitted it will be in some far away place. A day out on one patient is just unmanageable and means cancelling other visits and not attending to CPA paperwork that we are told needs to be updated. In reality CPA paperwork in many cases are either outdated or non-existent, because many of us prioritise face to face contact with service users. Clearly this is not acceptable to anyone, but it is the choice we have to make on a daily basis.

Clients requiring psychological assessment or therapy are on a long waiting list due to lack of resource. This can mean that treatment is delayed resulting in a more unwell service user and then requiring more input from CMHT nurses/support workers.

Staff morale, I feel is at an all time low, with no prospect of it getting better. Although we have been told we have recruited more band 4 and 5 nurses in the near future, we still have huge numbers of cases to take from NCC staff. We still have many service users that require a care coordinator and not a lead care professional. I fear that means band 6 nurses will have massive caseloads and will never actually meet those service users, but will provide ‘coordination’. How can you do this effectively when you don’t actually know the person you are talking about?”

4 thoughts on “Meltdown: Working as a community nurse at NSFT”

  1. Lay people are generally unaware that having a patient sent out of area means the CC has to travel out of area also, to remain involved in their care., This definitely needs clarification and explanation so that the public get the fullest picture about what OATs mean for the service as a whole, let alone the poor patient and their social context.

    Education about the remit of MHP’s is needed to ensure the full impact of the cuts is understood. A lot of people think that the same ‘rules’ and processes apply as in physical health. Get treated for something like cancer at a regional centre and your care team/community nurse etc doesn’t have to physically go to see you. They think the same applies to mental health when it does not.

  2. Good point.. and when you consider that the rationale for not opening Thurne ward was that the cost analysis dictated that by raising the bar to admission and continuing to use OOA beds would result in a cost saving versus opening Thurne. Sadly this is the new normal in the NHS – management by spreadsheet – people and their lives are meaningless to these bureaucrats it is simply a numbers game.


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