Dear Mr Parsley,

Thank you for the Regulation 28 report to prevent future deaths dated 07/03/2024 about the death of Nicola Rayner. I am replying as Minister with responsibility for Mental Health and Women’s Health Strategy. Firstly, I would like to say how deeply saddened I was to read of the circumstances of Nicola Rayner’s death, and I offer my sincere condolences to her family and loved ones. I can only begin to imagine the effect that this will have had on her loved ones and, whilst I know that it will come as little comfort to them, I nevertheless hope they will accept my heartfelt condolences.

The report raises concerns over the lack of bed capacity for patients like Nicola seeking informal inpatient admission and that for the individual trusts, any measures that may have been taken, have neither adequately, or effectively, addressed the continuing local and national risk of future deaths occurring. In preparing this response, Departmental officials have made enquiries with NHS England and the Care Quality Commission. NHSE have informed us that the number of mental health beds required to support a local population is dependent on both local mental health needs and the effectiveness of the whole local mental health system in providing timely access to care and supporting people to stay well in the community, therefore reducing the likelihood of an admission being necessary.

In some local areas there is a need for more beds, this is being addressed in part through investment in new units, however, this should be considered as part of whole system transformation approach. This is supported by the NHS Long Term Plan (LTP), which is seeing an additional £2.3bn funding invested in mental health services from 2019/20 –

2023/24, around £1.3bn of which is for adult community, crisis and acute mental health services to help people get quicker access to the care they need and prevent avoidable deterioration and hospital admission.

NHS England’s 2024/25 priorities and operational planning guidance reinforces this focus on improving patient flow as a key priority – with systems directed to reduce the average length of stay in adult acute mental health wards and in order to deliver more timely access to local beds.

To address the wider system issues that impact on health services, a further £1.6bn has been made available via the better care fund from 2023-25. This funding can be used to support mental health inpatient services as well as the wider system which should help to reduce pressures on local inpatient services so that those who need to access beds can do so quickly and locally.

CQC continue to monitor the mental health sector and NSFT through their regulatory monitoring powers. The CQC will also continue to work with and monitor the trust on an ongoing basis and, if there are concerns about risk to patients, will not hesitate to take action. Access to mental health care and the quality of the care remain a key area of concern.

I would like to assure you that we take these concerns very seriously. The Government remains concerned about the prevalence of suicide. The Government’s new suicide prevention strategy for England is a five-year strategy which sets out the Government’s ambition for suicide prevention, together with over 100 actions that we think will deliver this. It is a multi-sector and cross-government suicide strategy, with actions from a wide range of organisations that will be delivered over the next few years.

The strategy is supported by a wide-range of activity the government is funding and that will support people’s mental health. Between 2018/19 and 2023/24, NHS spending on mental health has increased by £4.7bn (in cash terms). This is significantly above the £3.4bn cash terms growth ambition set out at the time of the Long Term Plan. As part of our plans to improve mental health facilities, we are investing over £400 million to eradicate dormitories and give patients the privacy of their own ensuite bedroom - over 600 beds have already been replaced across 34 sites (out of a total of around 1,400 beds across 50 sites).

The Department is also committed to ensuring that significant progress is being made in Norfolk and Suffolk to ensure that mental health services are of the high standard that patients and their families should rightly expect. This is why I met and will continue to meet with a range of campaigners, local stakeholders, the Trust and delivery partners to discuss progress on the Trust’s improvement plan, improvements in mortality recording, and how we can better understand the number of deaths, as set out in the Grant Thornton report.

Whilst some improvements have been made, as set out in the most recent Care Quality Commission inspection report, it is clear that vital improvements are needed to be made and embedded to address the very significant challenges that remain. The Trust must be transparent and engage closely with families and local stakeholders as it aims to continue to make progress with its partners in improving mental health support in the area.

It is critically important that we learn from patient safety incidents, so that the NHS can improve the quality and safety of the services it delivers. An inquiry is only one, but it is not appropriate in all circumstances. There are a range of mechanisms that the government can deploy to achieve this learning. The Trust is in the national Recovery Support Programme, which means it is subject to the highest degree of national oversight in segment 4 of the NHS Oversight Framework. NHS England is providing the Trust with focused and integrated support, with a full-time improvement director in place, and representation in the trust’s governance meetings so it has full visibility of the latest data on the improvements needed. It will work closely with the trust and stakeholders to ensure that the recent progress made continues and is built on.

I hope this response is helpful. Thank you for bringing these concerns to my attention.