Revealed: Damning contents of staff report into problems within Norfolk and Suffolk’s mental health trust
- Credit: Archant
Mental health staff told of feeling 'helpless', 'disempowered' and described their department as being 'in chaos' in a damning report, which raised serious concerns about the safety of patients they treat.
Norfolk and Suffolk Foundation Trust (NSFT) had tried to block the release of the highly-critical staff survey - leading Norwich South MP Clive Lewis to challenge David Cameron over it in yesterday's Prime Minister's Questions.
However, we have obtained the 40-page document - and it lays bare the devastating impact of a shake-up and staff cuts within the trust.
Today, bosses at the trust, which still faces financial problems, insisted many lessons had been learned since the report and that a 'lessons learned' paper from it was being used as a check-list to ensure they didn't make the same mistakes again.
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The NSFT report, written in 2014 following surveys of staff within the recently formed Norwich-based Central Adult Service Line, reveals:
- An increase in fatalities, with over-worked staff feeling they would be blamed if things went wrong
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- Excessive caseloads, with some staff having to cope with more than 60 patients on their books at a time
- Hundreds of unallocated cases, meaning needy mental health patients are going un-assessed and untreated
- Concerns the use of agency staff was hindering the service
- Low staff morale, motivation, high stress and a bullying culture
The report's author, Marie Alexander, acting clinical education lead for the trust, concludes: 'It was clear that a number of staff did not feel able to function effectively.
'They were largely disengaged, disempowered and believed that clinical and service-user safety was being compromised and that no-one with the ability to affect change was listening to them.'
The trust has faced several years of upheaval following the launch of a service redesign in 2012.
This included cuts to the team in Norwich, with the new service discussed in the report operational in 2013 and comprising of five teams out of Hellesdon Hospital, in Norwich and Gateway House, in Wymondham
The service helps adults over 25 in central Norfolk with moderate to severe mental health needs.
One department saw the number of senior staff cut from 12 to two, the report reveals.
More than 30 members of that team took part in 45 hours of interviews and 300 pages of material was turned into the report called, 'Understanding the Impact of Trust Service Strategy on staff working in the Central Adult Service Line'.
Discussing the quality of service patients received, it said: 'Some respondents reported feeling that they needed to apologise to service users and carers for the poor quality of the service and letting them down, 'sorry I have to cancel another visit', 'sorry no-one's been to see you'. One reflected 'I almost want to add an apology when I say I work for the trust'.
'It was identified by a significant number of respondents that, although they enjoyed their job, they could no longer provide a comprehensive service. At its most extreme they worried about service users killing themselves.'
The report goes on to discuss the issue of 'people in crisis not allocated', a problem caused by the high case loads staff already had.
It adds: 'People were 'left to fend for themselves' because of the lack of capacity in teams. This was culminating in a reduced quality of life and' the most unwell service users were being let down'.
On caseloads it said: 'There were consistent reports of excessive or unmanageable caseloads...caseloads of 40+ were reported...with anecdotal suggestions that caseloads had reached 60+ for some staff. In some cases up to a third of allocated cases had not been seen and respondents reported 'always being in a state of catch up'.
Staff also raised concerns about a failure within management to listen to their concerns, leading to 'mistrust'. It was suggested change would only really happen 'when people start dying'.
In her conclusions, the report author highlights the needs for the concerns to be heeded and acted upon.
She adds: 'The report may illustrate a service not recognisable to decision-makers, respondents have repeatedly raised concerns over the quality of service delivery and the maintenance of staff and patient safety. It is essential remedial action is taken to prevent further deterioration and to develop a cohesive, resilient workforce, that can negotiate future changes.'
The trust had previously tried to stop the report from being made public, refusing our Freedom of Information request on the basis that publication would prevent staff from taking part in future surveys. It also refused a request from the Campaign to Save Mental Health Services in Norfolk & Suffolk to release the report.
Did you take part in the survey? Contact David Powles on 01603 772478 or email firstname.lastname@example.org
THE TRUST'S RESPONSE
Michael Scott, Chief Executive of Norfolk and Suffolk NHS Foundation Trust, said: 'We are very disappointed that this has been shared outside of the organisation. Not because its content is critical of the trust as it was in 2013, but because the trust gave its commitment to all of the staff involved that their input would remain confidential. With this assurance, they felt they were then able to speak opening and candidly about the issues as they saw them.
'Last week, we wrote to them asking for their permission to publish the report following the increasing interest, and we have been awaiting their response. We have now been able to publish this on our website, with any names redacted.'
He explained that the report released in late 2014 – often referred to as the Alexander Report – was commissioned by trust directors in early 2014 to look into the mistakes made in its change programme, called the Trust Service Strategy (TSS).
TSS was launched in October 2012 and completed last year. Since then, and as a result of the lessons learned, he said the new leadership has adopted a fresh change philosophy which engages with staff and protects clinical quality.
He added: 'The Board has subsequently heard and answered many of the issues raised by the report and other reviews, such as our CQC Report, in many other staff and public forums and conversations.
'Members of the Board have apologised publically and to staff about the mistakes we made in the past.
'In December, a summary report outlining the key issues and lessons learned from TSS, and informed by the Alexander Report, was discussed in public, at our Board meeting. So, we have been as transparent as possible while doing our best to honour our commitment to confidentiality for our staff.
'We now use the lessons learned paper as a checklist for change, to test out any proposed recent service changes we propose, to ensure we don't make the same mistakes again.
'We have discussed this with staff, carers, with our regulators, with the media, and in many public documents including our annual reports and quality accounts. No-one is denying or hiding from the issues that TSS caused our staff and service users. But confidentiality for staff is something we felt was important to honour.'
Immediate action by Board:
• To fundamentally change the way in which we manage change programmes
• Effective engagement and communication with staff around change
• Investment in community services – just under £1m – and inpatient units of £2.6m
• Developing the locality model to reduce travel time for staff
Staff issues addressed/ do staff feel the same?
'There are still issues for our staff and we are addressing these. We recognise the pressures on them and we are working together with them and the unions to make our trust a very different place to work in the future.
'I believe that the majority of staff members now understand that the new leadership is listening and working with them.
'But we all understand, it will take time, and we are in an ever-difficult environment of funding pressures. The fact our staff continue to work as hard as they do to is a testament to their commitment to make this trust stronger in the future.'
With current financial constraints will this happen again?
'We have committed to prioritise quality and we will do everything we can to protect frontline services.
'The focus for us is not only on balancing the books; it is on about maintaining safe and high quality services.
'But we would be naïve not to recognise that 2015-16 and into 2017-18 will be equally difficult for our trust and for other NHS trusts. We are all seeing a steady increase in patient numbers and pressures such as annual Cost Improvements Plan (CIP) savings that we have to make year-on-year.
'We are grateful for the support of Clive Lewis, and other local MPs, in raising the matter of mental health underfunding at the highest levels. Together we can put the issues trusts such as ours and many more around the country are facing on the national agenda where it needs to be.'
Caseloads and unallocated cases. Are these still a problem?
'Like any other health service, there is a waiting list for those provided by mental health trusts.
'It is regrettable that patients have to wait, but we have implemented a number of measures to ensure they have regular contact with our services.
'Each clinical team now has a daily duty worker whose role it is to support patients who may require additional support in the absence of an allocated worker or in circumstances where their allocated worker is not available.
'So while a patient is waiting as an unallocated case, they receive a letter with a duty worker phone number clearly listed; should their circumstances change, they can call the team where support will be provided.
'Caseloads are higher than we would like, but the aim of our extra investment into recruiting more staff is to reduce this figure and help us manage the increasing number of referrals and demands upon our services.'
Has the trust taken on board the concerns about the scrapping of the Assertive Outreach Team? If so what has been done?
'Following the integration of the assertive outreach function into our adult community teams we constantly review how best we can support those who have severe and enduring mental health problems.
'This has seen the introduction of the Flexible Assertive Community Treatment model (FACT) in our community services, which allows teams on the ground to increase, within hours, the support a patient receives if they appear to be escalating, to avoid a crisis and need for an admission.'