Government ministers are facing fresh calls to take over the region's mental health trust, after its own doctors penned an extraordinary letter branding its services as "unsafe".
In a letter sent to its chairman Zoe Billingham, a committee representing its 140 doctors voiced eye-opening concerns about the way the trust has been run - describing some services as "unsafe" and clinicians as feeling "demoralised".
Campaigners say the Norfolk and Suffolk NHS Foundation Trust (NSFT) needs to be disbanded and replaced with a new organisation while Labour MP Clive Lewis says the government should step in and take control of it.
And a Tory MP has become the first to add his voice to calls for Whitehall to step in and put the service into special administration.
Mrs Billingham welcomed the letter, but said she was confident the leadership team would take the feedback on board and change this culture.
It comes four months after the trust was placed into special measures for the fourth time since its inception a decade ago.
What did the letter say?
The letter, which was sent to the NSFT, describes shattered morale among its medical staff and major concerns around the approach of its executive board.
It reads: "There is some concern that the organisation does not prioritise clinical work or engage effectively with frontline clinicians.
"Doctors are, by and large, regarded as clinical workhorses, many carrying huge caseloads and holding unacceptable clinical risks."
It adds: "Many medical consultants and speciality doctors have expressed that they are routinely excluded from key discussions when significant decisions are made pertaining to patient care, both at local and senior levels.
"Our expertise is not utilised. There is widespread demoralisation of the medical staff with regular resignations; ‘NSFT’ is often cited as the reason for leaving.
"In some circumstances, the clinical services are both unable to provide good basic care and are unsafe."
How did the chair respond?
Mrs Billingham responded to the letter by offering its signees - NSFT's medical staffing committee (MSC) - an "immediate meeting", which was held on Wednesday evening.
Mrs Billingham, who started her role in January, said: "I am glad the MSC has come forward to talk about its concerns and to solve the deep-rooted issues we have will take all of us working together.
"I have been in organisations dealing with struggles before and have been that person who encourages people to come forward with these things so know sometimes things will get worse before they get better."
In the letter, doctors expressed feelings of being "marginalised" - something Mrs Billingham insisted would be addressed.
"I want to hear what they think and how they think we can break down the silos we have built in the past," she said.
"Medical staff will not be marginalised - not on my watch."
Calls for government intervention
The letter has amplified calls for the trust to be taken into special administration by the government - with Tory MPs joining calls for the first time.
Duncan Baker, Conservative MP for North Norfolk, said: "A month ago I listened to concerns from campaigners and if 140 doctors are willing to put their names to a letter making the same points you can be sure many more of its staff feel the same way.
"This letter and the information we have had from the inquest of Eliot Harris, one of my own constituents, have proven what the campaigners have been saying to be true.
"I now see no other option than the government taking direct control of the trust and putting it into special administration."
Fellow Conservative MPs in Suffolk have made similar comments, with Central Suffolk MP Daniel Poulter saying the NSFT was "past the point of no return".
It echoes calls made by Labour MP for Norwich South, Clive Lewis, immediately following the CQC report's publication.
He said: "I think this letter is unprecedented - I do not know of any other health trust that has had its own clinicians so comprehensively declare they have no confidence in their leadership.
"They have been very clinical in their dissections of the failings of the trust - which has been a slow-motion disaster unfolding.
"I think this will be seen as a major milestone in how the trust is perceived."
What do campaigners say?
Mark Harrison, of the Campaign to Save Mental Health Services in Norfolk and Suffolk, said: "This has to be the final nail in the NSFT coffin. Surely NHS England will have to act decisively and put this dysfunctional trust into special administration?
"When the medical staff has lost confidence in the senior managers and governors, surely they have to be sacked if they do not do the right thing and resign?"
Mrs Billingham, however, said she was confident changes already made by the trust would see things improve.
Since her chairship began, the NSFT has brought in three new executive leaders - deputy chief executive Cath Byford, chief operating officer Thandie Matambanadzo and chief medical officer Alex Lewis, who have all come from outside of the trust.
Mrs Billingham said: "We have really refreshed our executive team and we need to give this new team time to make changes.
"We have been inadequate four times in six years and MPs want the very best for their constituents and it is what we want too.
"Splitting the trust will offshore the issues we already have into two organisations - the challenges will still be there."
How else has NSFT responded?
Cath Byford, deputy chief executive at NSFT, said: “We share the concerns raised by our medical colleagues. We value their views and are committed to working closely with them as we continue to make improvements on behalf of our service users and their families.
“One of our new chief medical officer's top priorities is to engage fully with our medical staff to make sure they are given every opportunity to make a valuable contribution to these improvements.”
Stuart Richardson, the trust's chief executive, was on annual leave when the letter was made public but is understood to have returned early to respond to the latest concerns.
What do the authorities say?
Any further action against the trust would need to come from either the Care Quality Commission, NHS England or the Department of Health.
A CQC spokesman said: "This letter has not been sent directly to the CQC but any information we do receive is used to inform our monitoring services.
"We took enforcement action against NSFT after our last inspection and recommended the trust remain in section four of NHS England's recovery support programme, as part of their oversight framework.
"If a trust has not met the requirements set out in the warning notice, CQC could consider imposing conditions on their registration."
When a trust is placed into special measures, it receives an unannounced re-inspection within six months of the results being published. It is expected the trust will be re-inspected in either September or October.
An NHS East of England spokesman said: “The trust remains in the recovery support programme and continues to receive intensive and targeted help and resources from NHS England.”
A Department of Health spokesperson said: “We are working with the NHS, CQC and local partners to ensure the best outcomes for patients at the Norfolk and Suffolk Foundation Trust.
“Patient safety remains our top priority and it is vitally important we learn from any mistakes made to improve care across the NHS and protect patients in the future.”
What has happened since the latest CQC report?
April 28: A CQC report is published placing the NSFT into special measures for the fourth time. Bosses insist changes will be made
April 29: Norwich South MP Clive Lewis calls for the government to take direct control of the trust
May 11: Campaigners call for a public inquiry into deaths at the trust
May 24: Crunch talks are held over the trust's future, including local health leaders, the CQC and Healthwatch Norfolk
June 2,: The trust submits an action plan to the CQC outlining how it would address specific concerns raised in November
July 4: A meeting between health ministers, MPs and campaigners to discuss a public inquiry is held in Westminster
August 8: In inquest into the death of Eliot Harris concludes, revealing that the trust had a "culture" of falsifying records
August 9: A letter signed by around 140 doctors to the NSFT's chair is made public - it was agreed at a meeting of its medical staff committee in June
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