NSFT: What next for NHS trust after chief executive's exit

Stuart Richardson's departure from the under-fire mental health trust was confirmed on Tuesday, with his two-year tenure set to come to an end in October.

It is the latest chapter in the long-running saga of the trust, which has faced criticism ever since it was set up over the quality of care it offers to patients.

Mr Richardson's departure follows intense public scrutiny over a report into how the trust keeps track of patient deaths - and amid accusations the trust had critical language removed from it.

Hunting for a new chief executive is a task that has become far too familiar for the trust in the past decade.

Since it was formed by the merger of neighbouring NHS trusts, NSFT has had five permanent chief executives, as well as three interim leaders.

One recent search sparked red faces across the trust after it formally appointed Mason Fitzgerald to the role before discovering falsities in his CV, leading to his application being withdrawn before he could begin in the post.

The search resulted in the promotion of Stuart Richardson from his role as chief operating officer in September 2021.

What led to his departure?

During his two years in charge the trust has faced intense criticism and in early 2022 it was placed into special measures and rated inadequate by the Care Quality Commission.

However, earlier this year this rating was upgraded to requires improvements - although the trust does continue to be in special measures. 

The scrutiny of Mr Richardson and the trust's leadership reached new levels in June, following the publication of an independent review of the trust's mortality data.

From the report - carried out by auditors Grant Thornton - it emerged the trust had lost count of the number of people that died under its care.

His departure comes weeks after a BBC investigation claimed that critical remarks were removed from early drafts of the report - including referring to a "culture of fear " within the trust.

What will happen next?

Cath Byford, deputy CEO of NSFT (Image: NSFT)

The trust's search for a permanent replacement is already under way, but interim arrangements are expected to be confirmed in the coming days or weeks.

Mr Richardson's current deputy is Cath Byford, who joined NSFT in April 2022. Previously she had been chief nurse of the Norfolk and Waveney clinical commissioning group.

Her current role has seen Ms Byford placed at the forefront of trust communications in recent months.

Another option could see the organisation share a chief executive with a neighbouring trust in the interim - an approach taken recently by the Norfolk and Norwich University Hospital.

The current chief executive of the neighbouring Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) is a familiar face in Norfolk and Waveney.

Anna Hills served as chief executive of the James Paget University Hospital from December 2018 before taking on the role at CPFT in March last year. 

The trust is currently rated as good by the Care Quality Commission, but with Ms Hills still relatively new to leading a mental health trust it may be challenging to take on such a large organisation.

A new approach?

Campaigners, however, have called for a more drastic approach than simply finding a new chief executive - instead calling for NSFT to be disbanded and services in Norfolk and Suffolk to be split.

This is something that may be being considered, but would need to be enforced by NHS England and the Department for Health and Social Care.

It is an approach Mr Richardson previously spoke out against, describing the calls for splitting the trust as "misguided".

How has his departure been received?

While campaigners have welcomed Mr Richardson's departure, they say the issues at NSFT run much deeper.

Emma Corlett, Caroline Aldridge and Anne Humphrys co-wrote their own report into deaths at the trust titled 'Forever Gone'.

In a joint statement, they said: "Replacing the chief executive is something that has been done several times before and never makes a difference as it is ingrained organisational culture and lack of effective oversight at accountability that have led to these failings.

"This is just 'here we go again' on the magic roundabout of NSFT failures.

"Without this prompting root and branch change at NSFT, nothing will change.

"The two integrated care boards either need to work really well together in a proactive way to support NSFT or they need to split the trust.

"All those who are invisible need to step out of the shadows and start performing their public duties."

Mark Harrison, spokesman for the Campaign to Save Mental Health Services in Norfolk and Suffolk, said: "Stuart Richardson needed to go but the main challenge is getting NHS England and the Department for Health and Social Care to take meaningful action to remove the chairman and board, disband NSFT and set up an independent statutory inquiry into the 8,440 deaths since 2020.

"Their failure to safeguard the people of Norfolk and Suffolk is a dereliction in their duty of care.

"There have been too many deaths and too much harm to keep moving the deckchairs around on the Titanic.

"NSFT is an institutionally dysfunctional organisation and just appointing a new CEO hasn't worked over the last 10 years and won't work now."

Alex Stewart, chief executive of Healthwatch Norfolk, said: "We are very sorry to hear about the departure of Stuart Richardson.

"We enjoyed an open and constructive relationship with him.

"Equally, we recognise the trust is in a difficult place and has a lot of work to do.

"To achieve this and continue to make progress requires stability and a continual churn of chief executives and senior staff will not help.

"This is not just a concern within mental health - in just over 10 years at Healthwatch Norfolk I have worked with around 35 different chief executives of health and care organisations.

"I am concerned about these continual changes. For patients and those being looked after in the county, stability is key."

Zoe Billingham, chairman of NSFT. Picture: NSFT (Image: NSFT)

Zoe Billingham, NSFT's chairman, who will be tasked with appointing Mr Richardson's successor, said: "Stuart has led and delivered a number of significant improvements during his tenure over the past five years as both chief executive and chief operating officer.

"On behalf of the trust board, I'd like to pay tribute to his commitment and dedication to improving NSFT for our service users and staff.

"His focus on ensuring staff are looked after and valued will be a lasting legacy we are all very grateful for."

Analysis: organisation in a dangerous cycle

This is by no means an unfamiliar situation for NSFT - but one that is not at all welcome for the people who desperately need its care.

By the time Mr Richardson departs he will have been chief executive for just over two years - making him the third longest-serving boss since NSFT formed.

This kind of instability and constant changing of guards is worrying for any organisation, let alone one on which lives depend.

Since 2013, nine different people have been appointed to the role on either a permanent or interim basis - including one who never took on the role in embarrassing circumstances for the trust.

This is a staggering number for a single organisation and each time the person at the helm has changed, the deep set troubles at NSFT have not.

As the saying goes, those who do not learn from history are doomed to repeat it, which seems to ring true for the trust.

NSFT appears to be trapped in a dangerous cycle of shortcomings and a revolving door of leadership provides little more than sticking plaster - if that.

It is vitally important that whatever happens next can finally stop the rot - whether that is through new leadership or through a complete reorganisation of services.

Across Norfolk and Suffolk people are suffering and in the most extreme cases they are dying.

A solution desperately needs to be found - we can not afford to find ourselves in the same position yet again further down the line.

Lives literally depend on this mess being sorted.