The boss at Northampton-based NHS mental health provider St Andrew's Healthcare has admitted the organisation must downsize to ensure its survival.
The UK’s biggest independent charitable provider of mental healthcare plans to close 100 of its 860 beds in an attempt to streamline its operation.
Chief executive Katie Fisher told The Guardian St Andrew's suffered because it grew too fast and spread its care too thinly.
She also confessed they made a mistake with FitzRoy House, the 110-bed 'purpose-built' adolescent care unit which opened at the Billing Road hospital site in 2017, as it is too big to manage.
A spokesman for St Andrew's, which was founded in 1838, said: “There is going to be a tectonic shift within the charity in order for us to continue for the next 180 years."
St Andrew's was criticised by the Care Quality Commission (CQC) last week for not fully acknowledging the repeated and systemic failings in the organisation.
The child and adolescent mental health service (CAMHS) was rated inadequate in June 2019, while two third of St Andrew's Healthcare's services are rated 'good'.
Ms Fisher, who was appointed 18 months ago, believes the necessary changes are being made thanks to her leadership team but progress is slow.
“It got far too big too quickly,” she told The Guardian.
“What we did was stretch some of our most brilliant clinical minds too thinly across too great a spread of services, which has then allowed this inconsistency in terms of outcomes and service provision. Without any shadow of doubt.”
St Andrew’s provides specialist mental healthcare for patients with some of the most complex mental health needs in the country, with bases in Northampton, Birmingham, Essex and Nottinghamshire.
Services include CAMHS, neuropsychiatry, autistic spectrum disorder and learning disability, with the majority of its 900 patients referred from the NHS.
St Andrew's is expecting to receive a CQC report on FitzRoy House, which was also deemed 'inadequate' with patients being kept in regular seclusion for months.
Ms Fisher told The Guardian she expects the latest findings to be 'critical' while acknowledging some improvement.
“It’s not going as fast as we would like it and need it to,” she added.
Ms Fisher also defended her £300,000-a-year salary, one of the highest in the charity sector but almost £100,000 less than her predecessor as it was benchmarked against public rather than private contemporaries.
“I am paid well for what I do, but I do carry a big burden of responsibility for the role … and for the type of patient we care for,” she said.
“It was recognised by the board that they were heading in the wrong direction; they were pitching themselves in the wrong marketplace and they needed to go right back to the charitable purpose and its roots. I am extremely comfortable with that.”