Norfolk and Suffolk NHS Foundation Trust

Debate between Tom Hunt and Dan Poulter

Tuesday 7th March 2023 Commons Chamber

[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.