Norfolk and Suffolk NHS Foundation Trust rated as ‘requires improvement’ by CQC

Leadership at the Norfolk and Suffolk NHS Foundation Trust (NSFT) has been rated 'requires improvement' following an inspection by the Care Quality Commission (CQC) carried out in May.

The trust provides specialist mental health services for children, adults, autistic people and people with learning disabilities. It supports a population of around 1.6 million people and employs more than 5,000 staff across inpatient, community and primary care settings.']#

Teams operate in five geographic care groups, covering:

• West and south Norfolk
• North Norfolk and Norwich
• Great Yarmouth and Waveney
• West Suffolk
• East Suffolk

Focus on leadership and governance

The latest inspection focused on how well-led the trust is overall, looking at leadership and governance across the organisation.

It followed earlier assessments of two NSFT services, community mental health services for adults and crisis services and health-based places of safety, which had both shown improvements in care since previous inspections.

The CQC said it had also found “notable improvement at the trust level” during the latest inspection, but added that “further work is needed to embed and maintain those improvements”.

Under the regulator’s new approach, each NHS trust now receives a single trust-level rating focused on leadership and culture, which replaces previous overall trust ratings. Individual services and hospital locations will continue to be inspected and rated separately to capture how people directly experience care.

Areas of progress and concern

Stuart Dunn, CQC deputy director of operations in the East of England, said inspectors found NSFT leaders “had started to make significant progress in areas such as board stability, management and engagement with people who use services”.

However, he added:

“More is needed to ensure improvements are embedded and delivered consistently across the organisation.

"Staff told us they felt services were starting to improve. However, many also said senior leaders weren’t always visible or approachable, and they didn’t always feel confident that concerns would be listened to or acted upon.

"We continued to hear about some poor experiences of workplace culture, including issues around discrimination and feeling unable to speak up. Trust leaders were aware of this and were taking action in response.”

Mr Dunn said inspectors saw “passionate and committed staff working hard to support the people they care for” and praised the trust for prioritising work with people who have lived experience of services to help design and improve them.

He also noted that the trust had been through a period of “prolonged instability” within its executive leadership team, but that recent board appointments had brought greater stability and experience from high-performing organisations.

“We saw a significantly improved governance system in place, with clearer lines of accountability and stronger oversight of risks and performance. The board is now more stable, but this stability needs to be maintained so that relationships and confidence can continue to be rebuilt,” he said.

Findings from inspectors

Inspectors also found that:

• Leaders had not provided enough pharmacy support to community teams, which remained a gap in safe and effective service delivery.
• Freedom to speak up processes had been strengthened, but some staff still lacked confidence in using them.
• There was limited positive engagement between the trust and some of its governors, with not all governors feeling confident or empowered in their roles.
• Delays in responding to complaints and completing patient safety investigations meant opportunities for learning were sometimes missed.
• The trust acted quickly when identifying issues such as staff skill mix, but needed to improve its understanding of the cultural factors behind them.
• Work had begun to address health inequalities, but this was still at an early stage and needed to be embedded across all services.

The CQC said it has told NSFT leaders where further improvements are needed to ensure the trust is “led successfully” and that it will continue to monitor progress through future inspections.

The full inspection report will be published on the CQC’s website in the coming days.

What the NSFT say about the findings

"Caroline Donovan, Chief Executive Officer at NSFT, said: “This well-led assessment highlights several key areas of sustained improvement and shows the large-scale transformation which is taking place at NSFT is beginning to reap positive results.

“We are particularly pleased that the inspectors have once again recognised the hard work and dedication of our staff and their commitment to the individuals and communities we serve.

“We know we still have much more to do to deliver consistent good quality mental health services, and we are already taking action to address many of the areas for focus highlighted by the CQC.

Improving our culture is one of our strategic priorities, while we have renewed our commitment to enhancing the experiences which staff from an ethnic minority background have when they come to work.

"In addition, we are also taking positive steps to ensure we respond to more complaints within our target timeframe while making it easier for staff to raise concerns.

“We look forward to working closely together to continue to drive these improvements and build on the solid foundations which we have already put in place so that we can consistently provide safer, kinder, better services for our communities.”

Zoë Billingham, NSFT Chair, said: “This is a strong report for the Trust whic contains some real positives. It recognises significant areas of improvement, and we are on the cusp of being rated good.

“I am delighted that the CQC recognised the significant improvements in partnership working as well as the progress we have made involving service users, carers and families across our improvement programme. On behalf of the Board, I would like to thank our staff for their hard work.

“We are not complacent, and we continue to work closely with our service users, families, carers and partners across Norfolk and Suffolk, to make sure our local communities receive the safer, kinder and better mental health services they rightly deserve."

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