Insufficient staff numbers and a lack of training are among the reasons why a mental health trust has been returned to “special measures”, according to regulators.
On Friday, the Care Quality Commission recommended that Norfolk and Suffolk NHS Foundation Trust be placed back into its special measures regime for struggling providers for a second time.
“It is extremely disappointing that we found the board had failed to address a number of serious concerns”
It was first rated “inadequate” and put in special measures after an inspection in October 2014, but was judged to have made sufficient improvements to exit the regime after a follow-up visit last year.
However, during the CQC’s latest visit in July this year, inspectors found the trust had not maintained standards and significant improvements were required, and was again rated as “inadequate”.
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The trust was told it must ensure action was taken to remove ligature anchor points, mitigate risks from poor lines of sight and follow national guidance on seclusion and restraint.
It was also told it must ensure sufficient numbers of staff were available “at all times to provide care to meet patients’ needs”.
In addition, the trust must ensure all relevant staff have completed statutory, mandatory and, where relevant, specialist training, particularly in suicide prevention and life support, said the CQC in its report.
Meanwhile, the regulator told the trust that all risk assessments, crisis plans and care plans must be in place, updated consistently and reflect the full and meaningful involvement of patients.
People must receive the “right care at the right time” via placements that meet their needs, give access to 24-hour crisis services and ensure that discharge arrangements are effective, said the CQC.
Data about what is happening at the trust must be used to inform practices and policies that bring about improvement and ensure that lessons are learned.
“We apologise to our staff, to our service users and carers, and to our stakeholders”
In contrast, the inspectors also highlighted several examples of good practice at the trust. These included a peer support worker role that was embedded into community teams and a new “peer support navigator” role being trialed in adult community teams.
The trust had continued to develop “The Compass” centre, which provided a therapeutic education service for young people who might otherwise be placed in schools out of area.
Norfolk and Suffolk was rated “inadequate” overall, “inadequate” for whether services were safe and well-led, “requires improvement” for being effective, responsive and “good” for being caring.
CQC chief inspector of hospitals Ted Baker said: “It is extremely disappointing that, on our return to Norfolk and Suffolk NHS Foundation Trust, we found the board had failed to address a number of serious concerns; some of which we first reported on in 2014.
“The trust board had not taken the action required to ensure that all its wards were safe environments for patient care, that clinical teams had a sufficient number of staff or that staff assessed and managed risk adequately,” said Mr Baker.
He said: “People did not always receive the right care at the right time due to a shortage of beds and sometimes people had been moved, discharged early or managed within an inappropriate service.
“Our concerns were compounded by the fact that the trust board did not have the information it needed to assure itself that the care provided was safe or of a good quality,” he added.
edward ted baker
Mr Baker warned the trust leadership, including its new interim chief executive, that it must take “robust action” to ensure improvements were made.
Trust chief executive Julie Cave said her board had actioned an “urgent response” to the report and its findings, and that work was already underway.
Ms Cave noted that “anyone who cares about mental health services in Norfolk and Suffolk is going to be disappointed in these results”, but said the trust remained focused on improving.
“In short, we have not made enough significant improvements over the past year and that has resulted in this retrograde step in our CQC ratings and in our progress,” she said. “For that we apologise to our staff, to our service users and carers, and to our stakeholders.
“We know our dedicated staff will offer their continued support in helping us to put things right and to achieve the improvements we need to make at a greater pace over the coming months,” she said.
She added: “Our teams have been working incredibly hard to continue to keep our services safe and of high quality for our service users and we should note that today’s report does not mean we have made no improvements.”
Ms Cave highlighted that the CQC report also commented on how caring the trust’s staff were.
The trust joins North Lincolnshire and Goole Hospitals NHS Foundation Trust and United Lincolnshire Hospitals NHS Trust as providers that have been placed in special measures twice. Both Lincolnshire trusts re-entered the regime in April, having exited in July 2014 and March 2015, respectively.