Stepping forward: A review of Norfolk and Suffolk NHS Foundation Trust

Healthwatch Suffolk worked with the Suffolk User Forum o discover the current views of service users and carers on the Mental Health services in Suffolk provided by Norfolk and Suffolk Foundation Trust (NSFT). They surveyed 119 people.

People want many things from health care, including continuity of care and smooth transitions. These require planning and co-ordination with the service user. 

The findings from the Stepping Forward event highlight that by efficiently deploying multi-professional resources, co-ordinated care systems should be better able to deliver the other things patients require: fast access, effective treatment, respect for their preferences, support for self-care, and the involvement of family and carers. Thus it is no surprise that during the Stepping Forward Event “integration” was repeatedly mentioned by service users, carer and stakeholders alike. People understand that there are resource limitations for the Norfolk and Suffolk NHS Foundation Trust, Suffolk County Council and the NHS nationally. But they want to know clearly what their entitlements are - not just about care, but support and finance too. 

Service users that attended the Stepping Forward event want services to agree on these and not to argue between themselves. They want obvious efficiencies to be achieved – not least in use of their own time – for example, by making it possible for multiple appointments to happen on one day.

 Divisions into ‘primary’, ‘secondary’, ‘community’ and ‘social’ care are relatively meaningless to those experiencing declining mental health or those at a point of crisis. The people for whom integration is most relevant, especially those with long term conditions, have said that they are looking for the Norfolk and Suffolk NHS Foundation Trust to combine two things in one place: 

 Knowledge of the service user/carer as a person: This does not simply refer to the medical need of a service user or carer; a common discourse seen from the Stepping Forward event was that including home circumstances, lifestyle, views and preferences, confidence to care for themselves and manage their condition(s), as well as their health status and symptoms, among others, was a vital mechanism for service user and carer reassurance. 

Knowledge of the relevant condition(s) and possible pathways: Service users wanted to be able to clearly see and navigate the mental health services in Suffolk. 

At present many service users do not know what they are entitled to; it was widely voiced that all options should be presented to a service user at the first point of contact, including a list of all available support services. 

This report acknowledges that the Norfolk and Suffolk NHS Foundation Trust tries to implement this approach, but all too often service users are ‘falling between the cracks’. Being able to set, and be arbitrated by, patient-focused outcomes was mentioned by many service users and carers during the Stepping Forward event. Although the Norfolk and Suffolk NHS Foundation Trust has continuously worked to achieve this over the last four years with the implementation of reverse commissioning in The Trust Service Strategy 2012-2016, such outcomes are not readily available or quantifiable. The lack of quantifiable outcomes is, in part, due to the current mental health system, and the health and social care systems in tEngland, falling short of “good” integration. 

hose that attended the Stepping Forward event acknowledged that people do not want to fall through gaps, to be forgotten about, to have to explain themselves anew to every professional or service they encounter, and to face the fear of going around in circles when suffering from declining mental health. 

Lastly, the Stepping Forward event highlighted that recovery can mean services are withdrawn, leading to a ‘fear’ of getting better. People are discharged into primary care where the quality of mental health awareness and provision is patchy. Although their mental health needs may be dealt with, the other needs that underlie their unstable health may not be – including their physical health. Dual diagnosis patients can be excluded from services because of their addiction, and therefore go untreated. Yet, the coping mechanisms of addiction is self medication for the mental illness.