Norfolk and Suffolk NHS Foundation Trust
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Norfolk and Suffolk NHS Foundation Trust Evidence appendix Hellesdon Hospital Date of inspection visit: Drayton High Road 7 October to 6 November 2019 Norwich Norfolk Date of publication: NR6 5BE 15 January 2020 Tel: 01603 421421 www.nsft.nhs.uk This evidence appendix provides the supporting evidence that enabled us to come to our judgements of the quality of service provided by this trust. It is based on a combination of information provided to us by the trust, nationally available data, what we found when we inspected, and information given to us from patients, the public and other organisations. For a summary of our inspection findings, see the inspection report for this trust. Facts and data about this trust The trust had 13 locations registered with the CQC (on 3 September 2019). Registered location Code Local authority Carlton Court RMY13 Suffolk Chatterton House RMYWF Norfolk Fermoy Unit RMYWA Norfolk Hellesdon Hospital RMY01 Norfolk Juilan Hospital RMY02 Norfolk Lothingland RMYNP Suffolk Northgate Hospital RMY03 Norfolk Norvic (now called Northside) RMY04 Norfolk St Catherines RMY55 Norfolk St Clements Hospital RMYMV Suffolk Walker Close RMYMW Suffolk Wedgwood House RMYNR Suffolk Woodlands RMYNG Suffolk Page 1 The trust had 394 inpatient beds across 26 wards, 12 of which were children’s mental health beds. The trust also had no acute outpatient clinics, community mental health clinics or community physical health clinics per week. Total number of inpatient beds 394 Total number of inpatient wards 26 Total number of day case beds 0 Total number of children's beds (MH setting) 12 Total number of children's beds (CHS setting) 0 Total number of acute outpatient clinics per week 0 Total number of community mental health clinics per week 0 Total number of community physical health clinics per week 0 The methodology of CQC provider information requests has changed, so some data from different time periods is not always comparable. We only compare data where information has been recorded consistently. Is this organisation well-led? Leadership The trust board of directors consisted of six non-executive directors (NEDs) and seven executive directors (ED’s). Two additional NED posts were being recruited to which would then bring the total NEDs to eight. Following our last inspection at the trust several key staff left the organisation. A new chair was appointed and took up post in January 2019. The chief executive officer left, and the new chief executive took up post in April 2019. A substantive director of nursing started in post December 2018. The chief operating officer was in post just prior to the 2018 inspection and an interim director of HR has recently joined the executive team. The chief medical officer was still in post at the time of this inspection but was retiring in November 2019. A replacement had been appointed to this post and a period of transition had commenced. The executive board had no black and minority ethnic (BME) background members and one (14%) woman. The non-executive board had one (17%) BME background member and two (33%) women. The board had begun to form, and early indications were that the trust board had the appropriate range of skills, knowledge and experience to perform its role. Board members modelled leadership behaviours and demonstrated the values of the organisation. The board was unitary, and non- executive directors (NEDs) were beginning to provide the right level of challenge to the board. There was a formal agreement with an external trust which forms part of the trusts ongoing plan for future improvement. The executive leadership team had begun to form but was still in its infancy. Work had begun to ensure the non-executive directors and the board of governors provided the appropriate level of challenge, but this needed further development. Medical, operational and corporate leadership teams supported the directors. This included clinical directors, directors and associate directors. Page 2 Medical, nursing and allied health professional roles had access to professional leadership structures. Recruitment files demonstrated all appointments to the board had been completed in line with fit and proper person guidelines. More recent appointments demonstrated the improved involvement of governors in recruitment and there had been efforts to involve people who use services in the recruitment process more recently. Appraisals had been completed for the non-executive directors (NEDS) with clear objectives set. Newly appointed NEDS attended the NHS Improvement induction programme and links were created with an external trust to provide mentorship. Improvements had been made in creating stronger links with the board of governors so that they contribute and inform the strategic decision making of the board. However, further work was required to fully engage this essential group and ensure all views were listened to. Board development days had been established and were taking place. There had been further change to the leadership and management structure. The trust created five care groups in September 2019, geographically located across Norfolk and Suffolk. Each care group had a four-way management team comprising of a people participation lead, clinical director, operational director and nurse lead. This was the first phase of the restructure and was in the early days of implementation. The care groups had devolved autonomy and responsibility for decision making and reported directly to the executive team. Phase two of the management restructure was due to commence in November 2019. There was a 6-month plan in place for each care group with a clear list of priorities and actions to address. The trust provided learning and development opportunities to staff, of all grades, through a leadership and development programme. Staff had access to a variety of leadership courses commensurate to their roles. Staff had access to and had undertaken leadership courses such as Leading Myself, Leading My Organisation programmes focussed on emotionally intelligent and resilient leadership training, Institute of Leadership and Management Levels 3 and 5, East of England leadership training and access to the on-line Edward Jenner programme. Staff aspiring to become directors were supported to complete the Nye Bevan programme. The trust also supported the Stepping Up and Ready now programmes for Black, Asian and Ethnic Minority (BAME) staff. Following our inspection of 2018, we had raised significant concerns about the safety, culture and leadership at the trust. We told the trust that they must urgently address concerns and meet regulation. The leadership team prioritised addressing these concerns as key to improving the quality of care. At this inspection, we found that progress had been made in all these areas although all actions had not been fully addressed. Changes had begun to take effect; however, further work was required to improve the leadership, culture and safety of services. The board placed focus on visibility. The Chief Executive Officer (CEO) carried out 33 service visits in the 6 months from April 2019 when he commenced in post. The Executive Directors (ED’s) and Non-Executive Directors (NED’s) also visited services. In addition, joint EDs, NEDs and governor service visits took place monthly. Feedback from services was largely positive, with many staff noting an improvement in visibility, however, some failed to recall when they had been Page 3 visited by senior leaders. Those that had seen the executive team described them as warm, patient centred and approachable and told us this was in contrast to the previous board who many staff felt had been distant and focussed on ticking boxes rather than truly working to improve the quality of care. Vision and strategy The trusts values are: Positively, Respectfully, Together: Positively: Be proactive…Look for solutions, think creatively and focus on what we do Take pride…Always do your best Take responsibility… Plan ahead, be realistic and do what we say we will Support people to set and achieve goals…And be the best they can Recognise people…Their efforts and achievements and say thank you Respectfully: Value everyone…Acknowledge people’s unique experiences, skills and contributions Step into other people’s shoes…Notice what’s actually happening Take time to care…Be welcoming, friendly and support others Be professional… Respect peoples time and be aware of our impact Be effective… Focus on the purpose and keep it as simple as possible Together: Involve people…Make connections and learn from each other Share…Knowledge, information and learning Keep people updated…With timely, open and honest communication Having two-way conversations…Listen and respond Speak up…Seek, welcome and give feedback There was no Vision identified on the trust website. Staff knew the values of the organisation and demonstrated this in their day-to-day work. Staff gave examples where they felt their teams reflected the values of the organisation in their work with patients and carers. Managers and staff discussed the vision and values at interviews to ensure the right people, with the right values, worked for the organisation. The trust embedded values across the organisation; managers displayed values information in all the services we visited. The trust strategy for 2016 to 2021 was revisited in October 2018 and included three key strategic priorities. These were: • improving quality and achieving financial viability • working as one trust Page 4 • focussing on prevention, early intervention and promoting recovery The new trust board had revisited this and had developed a draft people strategy which was presented to the board in July 2019. The aim of this strategy was to support people to live their hopes, dreams and aspirations and to be in the top quartile of mental health trusts for quality and safety by 2023. The focus was on transforming the culture of the trust to enable continuous improvement of services and service user experience.