Cambridgeshire NHS Trust Leadership: Improvement Needed.

The Cambridgeshire and Peterborough NHS Foundation Trust has received a concerning report from the Care Quality Commission (CQC), resulting in its leadership rating being downgraded from ‘good’ to ‘requires improvement’. This decision follows a thorough assessment of the trust’s leadership, conducted between the 10th and 12th of February, focusing on frontline mental health services.

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The inspection specifically examined acute wards for adults, community health services for adults, and crisis services, including health-based places of safety. The CQC initiated these assessments due to serious concerns raised through whistleblowing, which highlighted potential risks to patient safety and a troubling culture within the trust’s services.

Key Concerns Raised by the CQC

The CQC report identifies several critical areas where the trust needs to make significant improvements. These include:

• Training and Supervision: Inadequate mandatory training, supervision, and appraisal processes for staff.
• Staffing Levels: High staff vacancies and sickness rates, placing undue pressure on existing employees and potentially impacting patient care.
• Learning from Incidents: A failure to effectively embed learning from past incidents to prevent future occurrences.
• Leadership Visibility: A lack of visible leadership from senior management, leading to staff feeling unsupported and unheard.
• Staff Morale: Concerns about a culture of bullying and harassment, making staff hesitant to raise concerns.
• Environmental Issues: Unspecified environmental issues requiring attention.
• Record Keeping: Deficiencies in record-keeping practices.
• Data Management: Inconsistent data accessibility and usability across different directorates.
• Patient Safety Concerns: Many staff members struggled to articulate the trust’s top patient safety concerns, and the pace of addressing identified risks was variable.
• Corporate Support: Variable support from corporate services (finance, HR, data, and insight) for individual directorates.
• System Working: Directorate leaders require the capacity and capability to actively participate in developing local services to meet population needs.
• Freedom to Speak Up: Significant numbers of staff did not feel safe speaking up and were not assured about the independence of the speak-up guardians.
• Equality, Diversity, and Inclusion: Continued concerns about racial and disability discrimination at work, requiring meaningful changes to improve equality and equity for staff and service users.
• Co-Production: Co-production with service users and carers was at an early stage and not embedded across the trust.
• Complaint Response Times: Responding to complaints was taking longer than stated timescales.
• Quality Improvement: Quality improvement efforts appeared to have slowed.
• Leadership Development: Inconsistent uptake of leadership development opportunities, especially for frontline staff.
• Environmental Sustainability: Concerns about environmental sustainability being taken seriously by leaders, requiring further embedding within the organisation.

Specific Directives from the CQC

The CQC has issued several directives to the trust to address these shortcomings:

• Leadership Stability: The trust must ensure the stability of its leadership team.
• Executive Support: The executive team must receive tailored support to develop in their roles.
• Stakeholder Relationships: The trust must reset its external stakeholder relationships and agree on short and medium-term priorities with system partners.
• Clinical Strategy: The trust’s refreshed strategy must clearly articulate the clinical strategy for physical and mental health services.
• Freedom to Speak Up Processes: The trust must take action to ensure Freedom to Speak Up processes are effective and demonstrate that it has acted on concerns.
• Engagement Plan: The trust needs an engagement plan, and board member visits to services need to be embedded.
• Equality Act 2010: The trust must ensure meaningful changes take place to improve the equality and equity of staff and people who use services related to their protected characteristics under the Equality Act 2010.

Positive Aspects Highlighted by the CQC

Despite the serious concerns, the CQC report also acknowledged several positive aspects:

• New Chief Executive: The new chief executive has been well-received both internally and externally, with staff and stakeholders describing him as open and responsive.
• Staff Commitment: All staff encountered by the CQC were enthusiastic, committed, and focused on the people who use their services.
• Openness During Review: Most staff felt able to be candid and open during the review.
• Research and Innovation: The trust’s research and innovation programmes were considered inspirational.
• High-Performing Services: The CQC heard about high-performing and innovative services across the trust, with staff taking pride in their work.
• Partnership Working: The trust works successfully in partnership to support the urgent care pathway for people with physical and mental health needs.
• Mortality Team Progress: Significant progress has been made by the mortality team on learning from deaths.
• Equality, Diversity, and Inclusion Team: The equality, diversity, and inclusion team were passionate and engaged in their work.
• Green Plan: The trust is making progress with its Green Plan.

Trust’s Response

Steve Grange, the chief executive officer of the trust, acknowledged the CQC’s findings and stated the organisation’s commitment to improvement. He emphasized that the report represents a “point in time” and that, while there are encouraging signs of progress, much work remains to be done. He thanked the dedicated staff for their efforts in delivering care to patients and service users, and expressed confidence that, with the support of partners, the trust will continue to grow and improve for the communities it serves.

The Cambridgeshire and Peterborough NHS Foundation Trust provides a range of mental health, physical health, specialist, learning disability, and neuro-rehabilitation community hospital services to approximately 950,000 people across the East of England, with main hubs in Cambridge, Huntingdon, Peterborough, and Fenland. The CQC’s findings underscore the urgent need for the trust to address the identified issues and implement sustainable improvements to ensure the delivery of safe, effective, and compassionate care to its service users.