Norfolk and Suffolk NHS Foundation Trust

Peter Aldous 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.