Written evidence submitted by Campaign to Save Mental Health Services in Norfolk and Suffolk (CMH0119)
Parliamentary Committee Inquiry into Community Mental Health Services Call for Evidence
This evidence is submitted to the Parliamentary Committee Inquiry into Community Mental Health Services on behalf of the Campaign to Save Mental Health Services in Norfolk and Suffolk.
Established in 2013, our campaign was set up in direct response to the radical redesign of the Norfolk and Suffolk NHS Foundation Trust (NSFT), which faced severe cuts under the austerity program. The impact of these changes was both immediate and devastating: the loss of experienced staff, the dismantling of critical services, and a profound effect on the people in most mental distress, making them more vulnerable members of our community. At the time, regulatory bodies expressed their concerns over the harm this redesign would cause, however it went ahead chaotically anyway. This led to a completely needless rise in unnecessary and preventable deaths and the first of many failures of CQC inspections.
Over the past 12 years, our campaign—comprising staff, patients, carers, and bereaved relatives—has witnessed the alarming deterioration of mental health services at NSFT. This decline has led to widespread harm and, tragically, death across Norfolk and Suffolk. NSFT has never recovered from the events of 2012/13. Deaths have kept on escalating and every organisation who has had responsibility to regulate, scrutinise, intervene and take action have remained in a position of inaction despite our calls for changes. We resorted to calling for an independent statutory public inquiry and still believe this is the only way forward.
We submit this evidence to emphasise that the problems identified within the Essex region, which are central to the Lampard Inquiry, are not isolated just to Essex. Whilst we understand that this inquiry is focussed on Essex, we believe that the challenges faced by NSFT illustrate the broader failures in mental health care provision that are now rippling throughout other counties too, much like campaigners in Essex have also highlighted. We hope this information will support a more extensive understanding of the current national picture.
In compiling this evidence, our focus has always been on the wellbeing of those in need of mental health care. It is our sincere hope that the Inquiry will consider the picture we present and use it to drive the reform urgently needed to prevent further harm and loss of life.
Community Mental Health Services Inquiry Terms of Reference
• What does high-quality care look like for adults with severe mental illness and their families/carers?
Inpatient beds available when needed.
Access available 24/7 to qualified, knowledgeable, empathetic staff.
Restore Assertive Outreach, homeless team and properly fund and integrate drug and alcohol services.
Restore an effective and resourced Crisis Team. In the event of a crisis 9-5 confidence that your phone call is private and conforms to data protection, followed by prompt transfer to a qualified practitioner. In the event of a crisis out of hours phone call answered promptly and real help available in a timely manner, not just an instruction to “go to A&E”.
Information given is accurate, phone numbers exist, carers are not gaslit.
Carers views listened to and included in Service Users’ (SU) care
Regular care coordinator appointments, to have a named, allocated social worker.
Community and crisis teams functioning to support people in the community to reduce the need for inpatient beds.
End unsafe discharge due to lack of beds and reinstate good quality, therapeutic step down provision
Mental Health Act (MHA) assessments carried out based on need rather than the availability of beds.
Integrated and joined up services are trauma informed and wholistic, addressing childhood and other trauma, sexual abuse, domestic violence, neurodiversity
Section 117 reviews happen annually with professionals who know the patient/service user and with carers & 3rd sector attending where appropriate.
Communication between Service User (SU), Carer, Care Co, 3rd sector.
3rd sector involvement appropriate, regular and reliable. It is none of those at present.
The Foundation Trust model is not working. NSFT have spent 12 years defending the Trust’s reputation and those of its (rapidly changing) executives. The needs of SUs have been totally negated. Governors either toe the line or are bullied out.
Integrated and joined up services are trauma informed and wholistic, addressing childhood and other trauma, sexual abuse, domestic violence, neurodiversity are readily available.
Services are autism informed and actually provide a service to neuro-diverse people
Coproduction with users and survivors of mental health services in line with NHS guidelines – replace tokenistic user participation as currently exists in most areas
https://www.england.nhs.uk/always-events/co-production/
◦ How could the service user journey be improved both within community mental health services and in accessing support provided by other services/agencies?
Reduce waiting lists for assessments and services.
Listen to Service Users’ (SUs) voice through meaningful co-production
Timely triage and assessment with no gap to receiving a service if required
SUs and carers live in fear of unsafe discharge particularly when SU has a “well” period
Provide enough beds to meet needs whilst resourcing community services/support to reduce the need for beds.
Ensure mental health act assessments are based on need and carried out in a timely way. At present the lack of beds is distorting practices and assessments are not being carried out because there are no available beds.
End the practice of ‘parking’ people assessed as needing a bed at home until one becomes available.
https://www.edp24.co.uk/news/23889102.former-wymondham-teacher-38-dies-hit-train/
Other agencies are underfunded and understaffed. Preventive and step down services, valued and needed, have closed over the last decade (Ashcroft and Omnia) which has increased the revolving door in and out of hospital.
Qualified, experienced staff have been lost during austerity and replaced with people with good intentions but a lack of training, experience and knowledge.
◦ How could this be measured/monitored locally and nationally?
By monitoring deaths and Prevention of Future Deaths (PFD) Notices issued by coroners and ensuring changes promised to coroners are actually carried out.
By learning from complaints.
By examining the experience of those who are sectioned.
Having national information and data standards that Trusts must meet.
• What is the current state of access for adults with severe mental illness to community mental health services?
Unacceptable – what community mental health services?
A&E or police often the route in
Referrals often declined from GPs
Lack of inpatient beds driving unsafe practice such as “being sectioned at home”.
Insufficient beds nationally. Phone calls not always answered. Many PFDs have been issued to Trusts, NHSE and DHSC saying this.
Lack of SU engagement should NOT be grounds for discharge but interpreted as an indicator of the person’s mental ill health.
Please see our Prevention of Future Deaths Report which has been submitted with this document.
https://norfolksuffolkmentalhealthcrisis.org.uk/statement-on-the-mortality-review/
the Grant Thornton review, commissioned by the ICBs to investigate excessive deaths at NSFT and published in 2023
https://improvinglivesnw.org.uk/~documents/route%3A/download/679/
and Forever Gone, written in response to Grant Thornton, by bereavement campaigners. It is available from
◦ What progress has been made in implementing waiting time and access standards for community mental health services?
Any paper improvement at NSFT has been made by discharging patients unsafely.
People are moved from one waiting list to another but few ever access services. Our members report unsafe discharges which we fear are carried out to reduce waiting lists.
GP Referrals are also often declined
◦ How could access be improved across the country?
Parity of funding/esteem with physical health
By offering the same care wherever you are – get rid of the postcode lottery
By making preventative services available to support people in the community so needs for beds will decline.
• Has the Community Mental Health Framework been an effective tool for driving the delivery of more integrated, person-centred community mental health services?
We have had no evidence reported to us by our members or others to indicate any of the aims of the Community Mental Health Framework have been put into practice in any way in Norfolk or Suffolk. The exception is physical health checks, which are completed by GPs and the results are then shared with NSFT. However, due to lengthy waits for GP appointments these results are often not available to psychiatrists when meeting patients.
We understand this Framework is now being abandoned, “NHS England mental health targets to be stripped back 'with no clear plan’," ITV News understands January 28th 2025.(ITV news 28.1.2025).
• How can community mental health services work with social care, the third sector and local government to better address service users’ health and wider social needs that are wider determinants of mental health outcomes?
End austerity for social care – social workers are as rare as hen’s teeth!
Restore community and preventive services closed or hollowed out due to 14 years of austerity cuts.
Commissioned services need continuous monitoring and evaluation to ensure delivery
Using co-production to improve services and to employ adequate qualified staff.
◦ How could the funding system be reformed to more effectively drive transformation in the delivery of integrated and person-centred community mental health services?
Mental health services have not modernised – they are stuck in 20th century models of care. Use funding based on coproduction principles to drive change and improvement. Austerity has forced all statutory agencies to retreat to statutory duties and beyond – most are not able to meet these with the current budgets available.
To fund MH services the same as physical health.
• What blockers or enablers should policy interventions prioritise addressing to improve the integration of person-centred community mental health care?
Implementing the UN Convention on the Rights of Persons with Disabilities (CRPD).
Lack of inpatient beds
Diminished social care provision
Staff shortages
Senior managers protecting the organisational reputation above the needs of SUs.
Poor access and communication.
Lack of inpatients beds implements on all community services as staff try to support those who need inpatient treatment at home. This reduces the services available to others.
Not providing good quality community services which prevents hospital admissions and step down and respite care supports people to reduce multiple admissions.
Tokenistic service user involvement programmes. Each area should have a user-led organisation to coproduce services and support.
Please also see our Unmet Needs report submitted with this document.
• What are the examples of good or innovative practice in community mental health services?
None we know of in Norfolk or Suffolk
◦ What needs to happen to scale up the adoption of these practices across the country?
More funding for both adult mental health and adult social care.
Make recommendations of PFDs enforceable by law, then improvement may be seen not the continuous repetition of the same mistakes.
For more information contact:
norfolksuffolkcrisis@gmail.com
February 2025