What can we learn from England’s ‘worst-performing mental health trust’?

Today a report from inspectors has revealed Norfolk and Suffolk NHS Foundation Trust is the country’s ‘worst-performing mental health trust’, with more than 100 patients dying under their care over a two-year period. What can we learn from this Care Quality Commission report and what does it say about the state of mental health services in the UK today?

Written by Bryony Porteous-Sebouhian

What does an ‘Overall Inadequate’ rating by the Care Quality Commission (CQC) mean?

Published today, the CQC’s report on Norfolk and Suffolk NHS Foundation Trust (NSFT) paints a bleak picture at a glance. CQC inspection ratings fall under 5 different levels, ranging from ‘Outstanding’ and ‘Good’ at the top, to ‘Requires improvement’ in the middle and finally ‘Inadequate’ and ‘No rating/under appeal/rating suspended’ at the bottom.

The CQC rates functionality of a service/trust and specific services within that trust under these banners. For NSFT, the functionality ratings were as follows:

• Safe: Inadequate
• Effective: Inadequate
• Caring: Good
• Responsive: Requires improvement
• Well-led: Inadequate

This latest inspection was reviewing the period between the 2nd of November 2021 to the 29th of December 2021 and has seen the trust fall from an overall rating of ‘requires improvement’ to ‘inadequate’ and is now under special measures.

A service or trust will usually fall into a rating of ‘Inadequate’ when they have been given a series of recommendations from the CQC to bring themselves out of the ‘Requires improvement’ rating, and at the time of the following inspection, work towards achieving those recommendations has not been sufficient.

The next step after a rating of ‘Inadequate’ will be a deadline to have improved services by, or to face enforcement action by the CQC.

What does the CQC report on Norfolk and Suffolk NHS Foundation Trust say?

There are, unfortunately many damning findings in the CQC report of NSFT, the worst of which is possibly that ‘115 unexpected or potentially avoidable deaths were reported over a two-year period’.

Others include the fact that a long stay unit for adults was relying on one consultant psychiatrists who only worked half days, and one locum junior doctor who was being shared between that service and another.

The CQC also found that Norfolk had the largest rise in referrals from children and adolescents to community services in the country over the period of August 2020 to July 2021.

The report found that 15 people in contact with the trust, though not hospitalised had died by suicide in the three months prior to the inspection.

Local MPs have been calling for the government to take action in light of the CQC report. Norwich South Labour MP Clive Lewis, has called for immediate and direct government control.

Speaking to the BBC, he said: “The inadequate delivery of mental health services puts lives and wellbeing at risk. Given this, it is even more imperative that the Government steps in to take over failing trusts, like NSFT.”

The report from the CQC especially highlights the source of many of these issues being staffing problems. The trust has an annual nurse vacancy of more than 17%. However, the report did find that the contact many service users and family members had with the trust indicated a workforce who deeply care about the patient they do care for.

Patients and carers across services for children and adolescents to crisis teams said staff were polite and ‘interested’ in their patients wellbeing as well as being ‘respectful, compassionate and caring’. And services for autistic people and those with learning difficulties were contrastingly rated as ‘Good’.

So, how has a trust with positive patient feedback ended up in special measures?

The somewhat juxtaposing nature of the patient feedback and how caring staff are, versus how the service itself is functioning on the basic levels of safety, effectiveness, responsiveness and how well-led it is indicates a problem rooted in something much deeper than a simple ‘the staff don’t care enough to do a good job’.

In the BBC report on the CQC inspection, reporter Nikki Fox states that in 2013, “a total of 136 beds were cut and a large number of experienced staff were lost following a 20% cut to its budget over four years”.

Since then, Fox reports, staffing has gotten consistently worse and alongside this, management has seen extreme instability with eight different chief executives leading the trust over 10 years. A lack of clear direction – which often comes with consistent management – has resulted in a service that is not prioritising staff with the right skills, not joining various services together and is continuing to see consistent vacancies.

What is the solution?

The easy action to suggest here is simply, more staff, more nurses, more specialist lead practitioners. However, with more professionals leaving or simply walking out from NHS mental health services than ever before, convincing new and passionate professionals to join the ranks is looking harder by the day.

It falls with policy and decision makers in government and local authorities, to find a way to encourage what is needed: a huge influx of workers in mental health services.