One year on from mental health trust's damning review - what's changed?
PUBLISHED: 05:30 28 November 2019 | UPDATED: 13:16 28 November 2019
Campaign to Save Mental Health Services in Norfolk and Suffolk
Today marks a year since the Norfolk and Suffolk Foundation Trust (NSFT) was rated 'inadequate' for the third time in a row.
Speaking to patients, watchdogs, campaign groups, and the trust itself, we look at what's changed - how has it improved, and what challenges is it still facing?
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.
At a board meeting last Thursday, the NSFT's chief executive Jonathan Warren said some improvements had been made, and that initial CQC feedback indicated this was the case - though many challenges remained.
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.
MORE: People waiting more than a DAY for emergency mental health treatment
It has seen progress in other areas - such as bringing down the number of bed days spent out of area, from 1,212 in August to 574 in September.
"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.
So what is happening now?
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.
MORE: Harrowing stories of mental health patients highlighted ahead of under-fire trust's inspection
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.
MORE: Mum speaks of battle for support for autistic son
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."
What is the trust's view?
Stuart Richardson, NSFT's chief operating officer, said: "Our current performance on waiting times is strong in some areas, such as Improving Access to Psychological Therapies [IAPT] and Early Intervention in Psychosis [EIP], but we accept that in others we need to improve considerably.
"We have made improvements in the past 12 months and we demonstrated this to the CQC during their inspection last month.
But he added: "We fully accept there is still so much to do to ensure we perform at a consistently high level across all services, in all locations."
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."
Some patients praised communication by the trust.
One person, who self-referred at a time of "near crisis", said NSFT's response was prompt, and "made me feel okay for the first time in months - such empathy, kindness and understanding".
Overall, of the 62 responses to the Healthwatch Suffolk survey on this topic, 95% were negative, while 5% were positive.
What is the trust's view?
Mr Richardson said that next year, the trust will engage with patients, carers and staff to develop a new care plan, which they aim to bring in next October.
"This will improve the communication between health professionals and service users and, through that, outcomes of mental health," he said.
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".
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.
MORE: Our pain must never be repeated, say families of tragic Ipswich couple who died in stabbings
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."
What is the trust's view?
Mr Richardson said the trust remains focused on continuing to improve the quality and safety of the services they provide.
Recently, the trust appointed a specialist family liaison officer to increase the support provided to people who have been bereaved by suicide.
And new funding from commissioners also means mental health teams at Ipswich and West Suffolk Hospitals will next year operate 24/7.
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.
What is the trust's view?
Mr Richardson said people receiving community mental health services have experienced some improvements in their care in the last year, according to the results of the CQC's Community Mental Health Survey 2019.
The improvements are in key areas such as involvement in medication, taking account of personal circumstances, seeing professionals enough and involvement in agreeing care, he added.
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.
"People on Twitter have been horrible to staff who are caring and working hard. I thought the NHS had zero tolerance. Have some respect for the staff, we need them."
Others said NSFT carers are fantastic, and go "above and beyond".
However, others have had different experiences, with one patient adding: "The coordinators do not have the time to speak to me, they make snap judgements in the short time they have while their mind is on the next patient."
What is the trust's view?
Mr Richardson said there have been important changes in their senior leadership team since the 2018 CQC inspection, including new chair from the 'outstanding' East London mental health trust and Jonathan Warren.
"We are implementing a quality improvement plan, have 53 quality improvement initiatives and have developed a new structure which focuses on senior leadership," he said.
"This structure has introduced new posts for 'people participation leads', who are responsible for ensuring that service users and carers are involved in shaping the care we provide.
He added: "We know there is still much more work to do and many of the challenges we face, such as rising demand and recruitment issues, apply to many parts of the NHS."
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.