Report Reveals Top-Level Concerns Over Mental Health Services in Health Trust

Published on: 23 Aug, 2019
Updated on: 25 Aug, 2019

Abraham Cowley Unit at St Peter’s, Chertsey run by Surrey and Borders Partnership NHS Foundation Trust. Photo: Surrey Advertiser.

By Rebecca Curley

local democracy reporter

Concerns about accountability and a “breakdown of trust” at top level within the NHS Trust that provides mental health services in Surrey were identified just months before the county council terminated a contract with them, a report has highlighted.

An internal review of Surrey and Borders Partnership NHS Foundation Trust (SABP) found a “them and us” culture between the council of governors and the board of directors.

And a “dissatisfaction with the relationship” was recorded.

The review was done in November 2018 by Marie Gabriel, commissioned by the Trust chairman at the request of the lead governor and acting chief executive.

The Trust runs CAMHS (children and adolescent mental health services) for Surrey County Council (SCC) and was delivering the mental health support services for adults until the council terminated its contract with them in May 2019.

SCC said it wanted to bring back in house control of staff delivering its adult social care services, including work with people with learning disabilities and terminated the agreement held since 2012.

Under the Section 75 agreement, SABP managed the council’s social workers and staff to deliver the adult services, such as helping to draw up care plans and make sure residents have access to the proper health treatments.

But by serving notice on the contract SCC was taking back control to manage this.

A SCC spokeswoman said this week that the decision to terminate the Section 75 agreement was not related to the internal review in 2018 or concerns with accountability at the NHS Trust.

SABP has also been involved with concerns raised over the past two years about CAMHS assessment waiting- times and the safety of patients at the Abraham Cowley Unit at St Peter’s Hospital in Chertsey, both run by SABP.

The report released this week, after a Freedom of Information request by healthcare journal HSJ, identified problems with accountability had been identified in 2018 and recommended a more open relationship between directors and governors.

It said “root causes of the difficulties” in the relationship between the two groups were not being tackled, adding “this meant that unhelpful views and behaviours, perceived or actual, continued to occur with a ‘them and us’ environment being fostered”.

The report added: “Overall, there was a feeling there had been a breakdown of trust between the Council [of Governors] and the Board, although within this there were a number of Governors and Board members who reported positive individual relationship.”

The Council of Governors comprises elected volunteers appointed to represent members and the public and work on setting strategies and finding solutions.

The Board of Directors is made up of executive directors (senior employees of the Trust) and non-executive directors, independent of the Trust but in a paid role.

Recommendations from the report included finding a joint understanding of the two groups and how they can work together, more clarity on meeting agendas and reports, better communication and improving accountability.

Dr Ian McPherson, the Trust chairman, said the review had given them a fresh perspective on what was working well and where there were gaps.

He said: “It was conducted very much in the spirit of the building on what we were already doing to work more collaboratively and to develop the role of governors in our organisation.”

The Board and Governors has reviewed the recommendations together, he added, and they have identified priorities which includes “developing the role of governors as leaders in our Trust”.

Since the report was published in November 2018, Dr McPherson said, directors and governors now carry out joint service visits, the format of meetings has been changed and a governor-led newsletter is being shared with Trust members.

“Overall the review has been helpful and has helped create a better dialogue between the Board and our governors and facilitated some significant developments.”