Norfolk and Suffolk NHS Foundation Trust

Dan Poulter Excerpts

Tuesday 7th March 2023 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to bring some positive news and, I hope, some reasonable asks to the Minister regarding Norfolk and Suffolk NHS Foundation Trust. May I first declare an interest as a practising psychiatrist? I do not work for the trust, but I think it important to bring the House’s attention to that point.

Over the past few years, we have had many debates in this place and many meetings with Ministers about Norfolk and Suffolk Foundation Trust. The good news is that in the last few days, the trust has been taken off special measures and is no longer rated “inadequate”. The tremendous effort of the board and the staff has paid off, and, as a result, we have seen in the latest Care Quality Commission report a considerable improvement in the quality of patient care.

The background is, as we know, that Norfolk and Suffolk Foundation Trust, which serves roughly 1.6 million people across Norfolk and Suffolk, and has about 87,000 patient contacts a year, has been in difficulties for a number of years. Over the past eight years, the trust has been rated “inadequate” four times, which I think probably places it not just as an outlier but as historically the worst-performing trust in the country for both physical and mental health.

A tremendous amount of work has needed to be put in to turn things around. I am optimistic that the new leadership team at the trust, the board and the staff have done the necessary work and that they will now continue that work to ensure that the people of Norfolk and Suffolk with mental ill health receive the improved care that they need.

In its most recent inspection, the CQC conducted an unannounced comprehensive inspection of two core services: child and adolescent mental health wards and community-based mental health wards. That inspection took place towards the end of last year. The CQC highlighted in its report, which was published on 24 February, a number of areas of improvement. It awarded NSFT an improved overall rating. It still requires improvement as a trust, but that is much better than being inadequate. The trust is now rated “requires improvement” rather than “inadequate” across all CQC domains, with the exception of the caring domain, in which the trust continues to be rated “good”. On individual services, 60% of those inspected are now rated “good”, and the trust no longer has a legal warning notice relating to concerns about the quality and safety of its patient care.

The CQC reported:

“The trust has moved at pace to make the necessary changes and significant improvements could be seen at all levels”.

It also described largely positive feedback from patients and service users, who said that they

“felt safe and well cared for...staff were supportive of their needs and friendly and approachable…staff were kind, they felt listened to…staff helped them when they needed it”

and that

“they were fully involved in their care”.

That is positive feedback from patients.

Key areas of good care highlighted by the CQC included the NSFT’s child and adolescent mental health ward, Dragonfly, which achieved a significantly improved overall rating of “good”; acute wards and community-based mental health services, which support working-age adults and achieved positive improvements in overall ratings; and the community-based mental health services for adults of working age, whose Bury St Edmunds pilot programme for dialectical behavioural therapy—a type of therapy generally provided to people with personality disorders—was recognised for outstanding practice.

[Peter Aldous (Waveney) (Con)]

I congratulate my hon. Friend on securing the debate. He mentioned improvements on the acute wards, and I wanted to highlight that a recurring theme of my 13 years as an MP has been the lack of acute beds in the region, and how for so many people with real challenges beds have to be sourced out of region, which causes them a lot of stress and their families a great deal of anguish as well. I am aware that the trust has plans to address the deficit, but does he agree that this issue must be addressed as a high priority?

[Dr Poulter]

My hon. Friend is absolutely right. He has been a strong advocate for patients in his constituency receiving the care they need locally, which is something we all want for mental health patients. The trust has identified that out-of-area placements have been a problem, which is now being addressed at board level and throughout all services. Part of that work will be about improving and developing the mental health estate, improving the in-patient facilities available locally in Norfolk and Suffolk, and part of it will be about transforming the model of care, moving away from inappropriate in-patient admissions where people can be better cared for in the community. I will return to that subject, but my hon. Friend is right to say that the trust must continue to focus on reducing out-of-area placement, which is not good for patients or for their families, who want to support them while they are being cared for in hospital.

A key point that the CQC highlighted was strengthened leadership across the organisation, in individual services and particularly at board level. That was reflected in the trust now having a rate of mandatory training compliance among staff of at least 90%, and the trust rolling out accredited training in the prevention and management of violence and aggression, following a case in which restraint had been carried out incorrectly.

There has been significant change at board level, which I believe has been vital in driving the improvements in the quality of patient care. There has been a number of new appointments: trust chair Zoe Billingham, non-executive directors Dr Roger Hall and Sally Hardy, chief executive Stuart Richardson, deputy chief executive and chief people officer Cath Byford, chief medical officer Dr Alex Lewis, who is particularly impressive, and chief operating officer Thandie Matambanadzo have all brought significant experience and qualifications to the trust. It is by bringing in that external expertise that the trust has been able to understand what good looks like, and to begin to transform services and patient care.

The trust’s clinical and other governance processes have been strengthened. The number of board sub-committees has been reduced to streamline systems of assurance. External stakeholders have become more active participants through committee memberships. An evidence assurance group has been introduced to ensure that progress-monitoring data is accurate. The strengthening of a ward visit quality assurance team has also been important to driving up standards; this team carried out 100 comprehensive visits between March and October 2022. The introduction of a new digitised and simple method of completing clinical audits is another key element of driving up standards at the trust.

[Tom Hunt (Ipswich) (Con)]

My hon. Friend has great expertise in this area, so when he speaks his words carry weight. I welcome some of these improvements, but does he agree that, such is the extent of the failure over such a long period, a huge job for the new leadership is to regain the trust of families throughout Norfolk and Suffolk who have lost trust in the organisation, who think it is broken, and who believe a new organisation is the only way forward?

[Dr Poulter]

I agree with my hon. Friend and neighbour about the importance of rebuilding trust. The CQC highlighted a lot of the work done over the last year as good because the NSFT has rebuilt trust with both staff and the patients who use the service. The patient feedback, which was highlighted by the CQC, has been overwhelmingly positive in that time. That area has been addressed. It is an ongoing piece of work for the trust to focus on. It is also important, before we think about reorganisation—I understand why my hon. Friend has highlighted that—to understand what the consequences of that might be, and I will come to that in my later remarks. My view would be that we now need to get behind and support the new leadership team and recognise that for the first time in eight years we have a trust that is moving in the right direction and now needs to show consistent progress. Reorganisation would be a distraction from continuing that progress and could be detrimental to patient care. Whereas I might have agreed with my hon. Friend a year ago that reorganisation could be a viable option, at this stage, given the progress made and for a number of other reasons that I will come on to, I believe that the solution does not lie in breaking up the trust, but in supporting the board and staff to do the job that they have started and to get the trust not just to “requires improvement”, but to “good” and then to “outstanding”, which is what they would like to do.

The trust has recognised that it has needed to bring forward work to align its strategy with the plans in the broader health and social care system. One of the problems in the past was that the trust was often operating in isolation and not joining up the focus of its care with the work done by other healthcare partners. If we are talking about preventive care and upstream early intervention, a lot of the work going on between NSFT and primary care partners has meant that there is more focus on early intervention and preventing people becoming unwell, and hopefully therefore reducing inappropriate hospital admissions, and that is an important ongoing piece of work.

However, improvements still need to be made. A key area that has been highlighted for improvement by the Care Quality Commission and internally by those who work at the trust is that trust data is not as unified as it could be. While the trust has a large amount and range of data, it is not brought together effectively to focus on patient care and reduce risk in the way it needs to be. The effect is that struggling services are not always identified quickly enough to be provided with the necessary support, and I know that that will be a key focus over the next year to 18 months. Essential environmental improvements, for example on in-patient wards, do not always happen fast enough within the trust to address patient safety concerns. There is variation in the abilities and confidence of ward and team managers and middle management in clinical care groups, and managers do not always escalate concerns quickly enough to gain the necessary support. The strategic leadership team at the trust has recognised that and is now focusing in particular on ensuring that quality improvement is embedded in everything that everyone at the trust does so that it becomes everyday business, rather than an aspect of clinical audit, as may have been the case in the past.

[Duncan Baker (North Norfolk) (Con)]

I thank my hon. Friend for bringing this debate to the House. I think we should give credit where credit is due, and it is positive that we now have some green shoots at the Norfolk and Suffolk NHS Foundation Trust moving forward, but my concern is that those should be sustainable green shoots and that this is not a yo-yo where the trust goes back into special measures. It should be on a sustainable footing going forward. I know that the chair has reassured many of us that she feels it is a good platform from which to move forward.

One of the points to address is culture and the improvements that need to be made. Does my hon. Friend agree that one of the key statistics is that 41% of staff leave within the first two years? The trust has to improve on that. People who need a lot of mental health support must form relationships with those who are treating them. The number leaving within those first two years is something that the trust has to improve.

[Dr Poulter]

I agree with my hon. Friend. A key issue faced by a lot of mental health trusts, but which is particularly acute at Norfolk and Suffolk, has been a high rate of staff turnover, and that is not good for continuity of patient care. It is not good when we are talking about embedding a culture of safety and quality improvement. It does not help. It is undoubtedly the case that one of the key challenges going forward that has been identified by the trust and the CQC as well as by NHS Improvement, which has been providing external support, is the need to improve staff recruitment and retention. Some of that is a national challenge, but effective initiatives have been introduced at a local level. The new chief medical officer, for example, has introduced staff recruitment and retention initiatives, some of which are financial and some of which relate to improved job planning, which can help to make the trust a more attractive place for staff, not just to work, but to remain for the longer term. We need to see that kind of work being built on and continue in the months and years ahead. The same is true across nursing and all other staff groups.

Other areas to highlight where things are going well include investment. The trust has invested £3.2 million in digital improvements, £1.6 million in improvements in clinical areas, £1.3 million refurbishing bungalows for people with learning disabilities, £1 million to address safety issues, and £600,000 to improve the pharmacy at Hellesdon Hospital in Norwich. There are new services, including 95 new primary mental health nurses working across the trust directly with primary care, offering more than 80,000 appointments in GP surgeries across Norfolk and Suffolk. There is a 22-strong rehabilitation team and a new armed forces veterans wellbeing service in partnership with Walking with the Wounded and Outside the Wire to help to improve mental health support available to veterans across Norfolk and Suffolk —we have many veterans living in our constituencies.

The trust still has a lot to do, but it has achieved a lot in the past year under new leadership. I should like to put on record my thanks to the board and all the staff for the work they have done in turning things around so effectively and quickly. Key challenges, as we have outlined, remain the recruitment and retention of staff. The trust has launched programmes to address that, but there is still more to do. The CQC report recognised that the NSFT is changing at pace, but it needs to do more than show improvement over a year—it needs to embed the changes, sustain them and secure not just “requires improvement” but “good”. The NSFT needs to continue its work with system partners across Norfolk and Suffolk to improve commissioning and the delivery of mental health services across the patient journey.

The trust requires ongoing support, and I have some brief asks of the Minister. First, the trust requires from the Government another £3 million of funding to complete the £54 million needed for a new campus at Hellesdon Hospital, which would secure the development of three new wards. That is a key aspect of addressing the problem that my hon. Friend the Member for Waveney (Peter Aldous) outlined, so that there is less reliance on out-of-area beds. We need more wards to treat more local patients in Norfolk and Suffolk, and less reliance on out-of-area placements. I hope that that £3 million of funding can be secured, and I would be grateful if the Minister outlined how we can go about that.

Secondly, the trust has made inroads into issues associated with its estate, but it needs significant and urgent capital investment in addition to that £3 million to help to develop those new wards and modernise Hellesdon Hospital. More generally, can the Minister outline what capital programmes are available to support the trust in those ambitions?

Thirdly, funding for mental health services has been constrained despite increased needs and patient demand, and, when we are talking about parity of esteem when funding increases for the NHS, my general plea—I would say this as a practising psychiatrist—is for greater funding for general adult and other mainstream psychiatric services.

The next area of asks for the trust is from NHS England. The trust has benefited from strong and experienced outside support from NHS Improvement and from experienced leaders such as Nick Hulme from East Suffolk and North Essex NHS Foundation Trust, who was seconded to support the trust. Now that the trust is out of special measures, I hope there is still an opportunity for some of that external support to be maintained, even in a more informal capacity. I look to the Minister to perhaps outline how that may continue or whether she may be able to give some direction to help with that ongoing support, which the trust has found very helpful during these difficult times.

On local decision makers and stakeholders, the trust supports a new model of care for Norfolk and Suffolk, and ensuring that local ICBs work effectively with it to deliver more preventive upstream care and more care in the community. Reducing inappropriate and unnecessary in-patient admissions is a key priority in the trust’s ambition to transform services and improve patient care, and any support the Minister can offer to encourage or enable the local ICBs to be more effective at doing that would be gratefully received by the trust.

On the issue of breaking up the trust, I would urge the Minister to give a commitment at the Dispatch Box today that, given the progress that has been made by a very effective new board—a group of individuals with a good skillset—and given the commitment that has been shown to staff and to turning around the trust and moving it away from special measures and away from “inadequate” towards “requires improvement”, the threat of the trust being broken up can be taken off the table at this stage so that the trust can focus on caring for its patients. Breaking up the trust now would be very disruptive to patient care. It also would be financially inefficient and would lead to a worsening of the retention and recruitment challenges, which have been outlined by my hon. Friend the Member for North Norfolk (Duncan Baker), with staff feeling that their jobs are insecure.

To sum up, we are asking for support with capital projects, particularly around Hellesdon Hospital. We are asking for ongoing support, be it informally from NHSI or key national stakeholders. And we are asking for some encouragement to be provided to the local health and care system to support the trust’s service transformation model. Finally, I hope the Minister can give a commitment this evening that there is no threat of the trust being broken up, so that it can get on and continue to deliver the improvements that have been put in place.

I will cease my remarks, Mr Deputy Speaker. I look forward to hearing the Minister’s response, but I will put on record once again my thanks to the board and the staff for turning around what was the worst-performing trust in the country and, I hope, putting us in a place where we can be proud of our local NHS mental health trust and where patients will receive a much better quality of care not just today but in the future.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for bringing forward this important debate about the Norfolk and Suffolk NHS Foundation Trust, and for highlighting the progress that has indeed been made. The difficulties at the trust have been well documented, and there have been performance and quality issues for many years. Those have been highlighted on behalf of their constituents by many Members of the House, including my hon. Friends the Members for North Norfolk (Duncan Baker), for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt), many of whom are here this evening. However, all the MPs in Norfolk and Suffolk have worked constructively to make progress and to support the trust, patients and staff.

To understand the root causes and to ensure that effective plans are in place to improve patient outcomes, I and many of my ministerial predecessors have met right hon. and hon. Members from Norfolk and Suffolk collectively on several occasions, alongside NHS England, the CQC and representatives from the trust and the newly formed ICBs, to review progress and to ensure that there was an effective plan to achieve the quality of care that patients and families clearly deserve.

I am pleased that the latest CQC report recognises some key progress in areas that need improvement. The leadership team and staff across the trust should be congratulated on their hard work on that, and on the fact that the trust’s overall rating has moved from “inadequate” to “requires improvement”. Many elements of the report were found to be “good”, however, which indicates that things are moving in the right direction. The CQC also reports that

“the trust had moved at pace to make the necessary changes and…significant improvements could be seen at all levels”,

which is encouraging.

I understand that my hon. Friend the Member for Central Suffolk and North Ipswich and other hon. Members from Norfolk and Suffolk were invited to attend a briefing on 23 February, prior to the publication of the inspection. I hope that those who could attend found that session constructive; it sounds as though there is collective agreement that progress has been made. I had a similar session with the CQC the day before and I found the progress encouraging. I was reassured that many of the issues raised previously are being addressed, but there are clearly still significant challenges at the trust that must be addressed, which my hon. Friend outlined well this evening.

I welcome the progress that the trust and its leadership team have made and the fact that they have set out a realistic improvement delivery plan and a commitment to take it forward. I am pleased to hear from the CQC that the trust and all its partners are clear that they cannot take their foot off the pedal. Now is the time to double down on their efforts and not just assume that the progress of the last few months will continue.

I am pleased to confirm that NHS England will continue to provide the existing level of support to the trust. A full-time improvement director is in place, with representation at the trust’s governance meetings, so they have full visibility of the latest data and improvements needed. They will continue to work closely with the trust and key stakeholders to ensure that they continue to build on the recent progress. As part of the next steps, a rapid quality review meeting between the trust and its partners will take place on 27 March.

I will continue to watch closely and to ensure that any concerns that arise are dealt with quickly and at pace. Alongside NHS England, I am keen to ensure that the joint meetings that we were having continue to take place. I intend to hold a follow-up meeting with the relevant Members of Parliament and our system partners in early May, once the rapid quality review meeting has taken place on 27 March and the options review work has concluded. I hope that gives my hon. Friend some reassurance about how seriously we are taking the issue.

On mental health more generally, on 23 January I announced that we were commissioning a rapid review into mental health in-patient settings, with a focus on how we use data and evidence to look at the quality of in-patient services in mental health across England more broadly, including complaints and whistleblowing alerts, to identify risks to safety. The review is being chaired by Geraldine Strathdee and will run for eight weeks. We will shortly get her report and I am keen to implement her findings. That relates to the point that my hon. Friend the Member for North Norfolk made about the culture in mental health and how we change that to improve outcomes for patients. NHS England recently announced a new in-patient quality transformation programme to support cultural change in mental health and to develop a new, bold, reimagined model of care for all NHS-funded mental health services, particularly in an in-patient setting.

In the minute or so I have left, I will touch on a couple of key asks. Capital funding is available for mental health services. A few weeks ago, we announced funding for crisis centres, community support teams and mental health ambulances, so that they can respond more quickly to those going into crisis, in order to try to avoid admissions. More generally, record levels of funding are going into mental health—£2.3 billion extra each year. I encourage the local trust to speak to its integrated care board, which has access to that funding, if it is interested in capital programmes. That is a whistlestop tour of the support that we can give.

[Dr Poulter]

Will the Minister give way?

[Maria Caulfield]

I have only a few seconds left.

In conclusion, I hope that reassures all hon. Member across Norfolk and Suffolk that we take the issue seriously. I am delighted that progress is being made across the trust.

Question put and agreed to.