Regulators have said a mental health and learning disability trust should be placed in “special measures”, the support system for failing NHS organisations, after inspectors judged it to be “inadequate” and raised concerns about low staff morale.
The Care Quality Commission said Norfolk and Suffolk NHS Foundation Trust needed to make a number of improvements to ensure it was consistently delivering safe and effective care.
Based on an inspection carried out in October, the trust was rated overall to be “inadequate”, and specifically with regard to whether services were safe and well-led.
In addition, it was told it improvement was required with regard to whether services were effective and responsive. It was rated “good” with regards to whether services were caring.
CQC identified a raft of concerns, noting in particular that staff morale was “very low” in many areas and that there was a lack of senior leadership support towards staff.
“We were also struck by the low morale of many of the staff that we interviewed who told us that their voices were not heard by those managing the trust”
Leadership from ward level and above must be more visible and accessible to staff, the CQC said in its report, adding that staff told inspectors they did not feel engaged in the improvement agenda or any top level decisions.
Other areas of concern included care environments that did not promote patient dignity, insufficient staffing levels to safely meet patient needs, and concerns regarding seclusion and restraint practice.
The trust must ensure that action is taken to remove ligature risks and to mitigate where there are poor lines of sight, said the CQC, and wards must meet guidance on same-sex accommodation.
In addition, it said all staff, including bank and agency staff, must complete mandatory and specialist training where necessary, and the trust must provide personal alarms for staff and visitors.
However, inspectors did identify areas of good practice, including an innovative helpline set up by the dementia and intensive support team to assist carers and care homes with support and advice.
The CQC’s concerns have been referred to fellow regulator Monitor, which will decide whether to carry out its recommendation to place the trust in special measures.
Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health, said: “We found a number of serious problems… and we have made a recommendation to Monitor that the trust is placed into special measures.
“We were concerned about the safety and quality of care provided by some of the trust’s services,” he said. “We were also struck by the low morale of many of the staff that we interviewed who told us that their voices were not heard by those managing the trust.
“We have maintained close contact with the trust since the inspection and will undertake further inspections, including unannounced visits to check that the improvements needed have been made,” he added.
“We have refreshed the board, made staff recruitment, engagement, and morale a top priority”
In response, the trust’s chair Gary Page said: “The issues raised by the CQC report reinforces what we, as a board, have been clear on and are already working to remedy.
“Last year, we commissioned an external review of board governance and leadership. As a result of that we have refreshed the board, made staff recruitment, engagement, and morale a top priority,” he said.
“This report is disappointing but the issues raised by the CQC are known to us and are being remedied by the new team,” he added.
The trust provides services for adults and children with mental health needs across Norfolk and Suffolk, as well as services for people with learning disabilities in Suffolk.
It also provides secure mental health services across the East of England and a number of specialist services, including community-based services for eating disorders and drug or alcohol dependency.
The trust serves a population of approximately 1.5 million and employs approximately 4,000 people.