Norfolk and Suffolk NHS Foundation Trust

Debate between Dan Poulter and Duncan Baker

Tuesday 7th March 2023 Commons Chamber

[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.