- SERVICE PROVIDER
Norfolk and Suffolk NHS Foundation Trust
This is an organisation that runs the health and social care services we inspect
Assessment report published 15 August 2025
Contents
Ratings - Community-based mental health services for adults of working age
Our view of the service
We carried out an inspection of the community mental health services for adults of working age on 18, 19 and 20 March 2025. This inspection was completed as part of the CQC's Adult Community Mental Health Programme. We also inspected mental health crisis services and health-based places of safety. The programme of inspections contributes to CQC's commitment to inspect the standard of care in community mental health services across the country. We undertook a short notice announced, comprehensive inspection of this service, looking at all 5 key questions to assess if services were safe, effective, caring, responsive and well led.
The trust has community mental health services across Suffolk and Norfolk.
The inspection team comprised of 4 CQC inspectors, 1 CQC senior specialist in mental health, 3 CQC pharmacist specialists (also referred to as medicines inspectors), 2 specialist advisors, and 1 Expert by Experience (people who have experience of using, or caring for someone who uses, services).
In Norfolk and Suffolk, we inspected 6 community mental health teams. These were the community mental health teams (CMHTs) West Norfolk in Kings Lynn, Great Yarmouth and Waveney in Great Yarmouth, Coastal Suffolk in Ipswich and Bury South in Bury St Edmunds. These teams support working age and older adults who need a specialist mental health service. Staff in the Suffolk teams told us that the team names were changing from Integrated Delivery Teams to CMHTs. We also visited the Early Intervention in Psychosis Services (EIS) East Suffolk base at Wickham Market and Great Yarmouth and Waveney. The EIS team support people between the ages of 14-65 who are experiencing symptoms of a first episode of psychosis. We also spoke with staff working in the Young People’s Mental Health teams at Ipswich and Bury St Edmunds. These teams support younger people aged 14-25 who require specialist mental health treatment. Referrals to the CMHTs were processed by the Access and Assessment team. Referrals to the EIS and Young People’s Mental Health teams were triaged by the receiving team.
For our inspection, we looked specifically at the services provided to adults from 18 to 65 years old, in line with how we register assessment service groups.
The trust’s community mental health services are spread across Suffolk and Norfolk
Community Mental Health teams
- West Norfolk
- East Norfolk
- Central Norfolk City
- East Suffolk Ipswich
- East Suffolk Coastal
- Central Suffolk
- Bury St Edmunds North
- Bury St Edmunds South
- Great Yarmouth and Waveney
Early intervention teams
- West Norfolk
- West Suffolk
- Norfolk and Waveney
We spoke with 44 staff of various grades and roles. We spoke with 18 people who use services and 9 carers. We reviewed 21 care records for people who use services and observed a range of meetings and appointments including care and treatment being delivered. We reviewed a range of data including complaints, incidents and policies. We reviewed feedback and data from Norfolk Healthwatch.
We last inspected the service as part of an unannounced comprehensive inspection in November 2022 when we rated safe, responsive and well led as requires improvement and caring and effective as good, which led to this assessment group being rated overall as requires improvement. At our last inspection we found breaches in regulation relating to staff training, inconsistent recording of risk assessments, long waits for psychology and lack of contact whilst on waiting lists. We also found breaches relating to trust leadership forming partnerships with stakeholders to look at models of services to meet the needs of the population and data availability in a consistent format. The service had made improvements and is no longer in breach of previous regulations.
At this inspection we rated the service overall as good. We found a breach in relation to safe care and treatment. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning. We have asked the provider for an action plan in response to the concerns found at this assessment.
People's experience of this service
We spoke with 18 people who used services and 9 carers, this included 15 people from the community team and 3 people from the early intervention team.
Overall people who used services and their carers told us that it was a good service and met their needs effectively. Most carers were happy with the service and all carers spoke highly of the staff. Overall, carers felt updated and involved in care decisions. One carer said, “I am always included”.
People who used services felt safe using the service and did not feel discriminated against if they complained. People and carers were confident to complain if necessary. Complaints were resolved in a timely manner. People could request home visits; this was particularly helpful for those who suffered from anxiety.
Most carers and people who used services described the service as effective and some people said the service was “amazing”. Carers said that the service offered a range of treatments and staff were helpful and that care and treatment including medicines were clearly explained during appointments.
People who used services and carers built a strong relationship with the care co-ordinators. People told us that staff were helpful and provided continuous care with open dialogue. People told us they saw the same staff member on a regular basis and the care co-ordinators were able to recognise when early intervention was needed. People told us they were given regular reviews of their care and staff referred people to other services such as physiotherapy and dentistry when needed. Regular physical health checks were carried out by the GP and communicated to the relevant CMHT. Some people told us they were given personalised treatments and therapies.
Most carers and people who used services commented that the staff were professional, caring and friendly, with one carer stating “they go above and beyond”. Most people and carers felt listened to and treated with kindness, compassion and dignity. Carers told us there was good family support. Some people and carers told us the service encouraged people to make decisions for themselves and the staff promoted independence and provided a ‘helpful and positive patient experience’.
Some people who used services told us the service was responsive to phone calls and e-mails and provided clear updates about individual’s care.
However, care plans and risk management plans were not always given to people and there had been a case of ‘lost paperwork’ which affected discharge. Some people told us what therapy they were to receive and how frequently was not clear.