Thread by @TownCloseEmma

Been on @BBCNorfolk this morning talking about NSFT (mental health trust) remaining in special measures. Can’t believe that some of the problems that we first raised the alarm about in 2013 still persist. Day to day I continue to see the fall-out in my community.

I can’t imagine how distressing it is for bereaved families who have been repeatedly fobbed off that “lessons will be learned” to see same problems persisting, & five areas of concern actually getting worse. Less than 50% of areas they are directed to improve have got better.

Over 25% of people requiring a four hour urgent assessment were not seen in time. Some of the “positives” cited are actually just good quality care that should be the norm and a basic expectation if you are referred to services, not cause for celebration. Shows how low bar is set

In my opinion there are still too many layers from “ward to board”. Too many opportunities to water down the message from frontline staff by senior managers wanting to give good news to board, over-optimism and bullying persists in some areas.

Jonathan Warren (NSFT CEO) says that “we need to develop primary care mental health services at a pace”. One of the service cuts that we campaigned vociferously about was the axing of primary care link workers from GP surgeries. Experienced nurses who were “too expensive”.

What “support” NHS trusts get when in special measures is worthy of further scrutiny @BBCNorfolk @BBCLookEast

You get no extra money. The quality of “improvement director” has been variable (Alan Yates the only one who “got it”. Others no discernible difference made)......

And given that five areas of demanded improvement actually got worse WHILE IN SPECIAL MEASURES you have to question who regulates the regulators and are they fit for purpose.

(& in 1st world problems update, the way the text butts up to the picture is agitating me!)

Ploughing through the detail of the report.... “our rating of safe improved” yet same concerns raised in 2018 were concerns at this inspection. Baffling. Internal audit hadn’t identified problems CQC found - yet they’d already been firmly pointed in right direction in 2018.

Not enough staff - especially in crisis teams.

The “improvements” highlighted (least restrictive practice & risk assessment) are just the basics of good and safe care. Should be a given.

ADHD “service” is one nurse with a caseload of 175.

175!

With a waiting list of 120.

I frequently see evidence of people being discharged too quickly, more often than not back to exactly same circumstances that precipitated admission. Readmission rates also something we flagged as concern at Health Scrutiny

Readmission reduced in 4 areas, but increased in 6!

Which sums up for me how endemic problems still are. Slight improvement in one area given specific attention, move attention elsewhere improvement not sustained. So it’s not embedded. This is not a sign of an organisation with the ability to master more than one thing at once.

& after all this time, all the feedback & suggestions given in good faith, often by bereaved families, and empty promises about “lessons being learned” this is the state of complaints system.

This sums it up in a nutshell really. Placed in special measures on three previous occasions, with very clear and specific direction on what needs to change. “Not all of the previous areas of concern had been addressed”. Five years since the original inspection. 5. Years.

A prime example of knee-jerk action solve one problem but create another. Get rid of waiting list by overloading already overloaded community staff. Average caseload of 47. When services were cut staff were ASSURED the community caseload would be 25. No idea how staff are coping.

& despite it being patently obvious to any manager providing supervision to community care co-ordinators that they’re overloaded with unmanageable caseload there’d been no review of capacity & demand. So not made argument for more resources, just expect staff to ‘get on with it’

I’ll be back with more later. This is making me feel too angry. Time for a tea break.

Yet to find a single concern that staff hadn’t raised themselves throughout 2012 & 2013 - at all levels. Internally. CQC. Every single Norfolk MP.