Rampton Hospital

Updated 26 October 2016

Rampton hospital is one of three high security hospitals in England and Wales and is part of Nottinghamshire Healthcare NHS Foundation Trust.

Rampton hospital provides services for approximately 350 patients requiring care and treatment in conditions of high security, through six clinical services.

•Mental Health Service (128 commissioned beds)

•National High Secure Learning Disability Service (54 commissioned beds)

•National High Secure Deaf Service (10 commissioned beds)

•National High Secure Healthcare Service for Women (50 commissioned beds)

•Personality Disorder Service (55 commissioned beds)

•The Peaks Unit (60 commissioned beds)

Patients are only admitted to Rampton hospital if they are referred by a health professional and assessed by the hospital as meeting the criteria for admission.

All patients admitted to the hospital are detained under the Mental Health Act 1983 (MHA) and classified as having a learning disability, mental illness and/or a psychopathic disorder.

Patients will have been assessed as requiring treatment under conditions within a high secure environment, meeting the criteria of posing a grave and immediate danger to themselves or the public. Many will have come via the criminal justice system.

Most admissions are under Part III of the MHA, either from the court, from prison or a medium security unit.

Those patients who have not committed a criminal offence are a civil admission under Part II of the MHA and will usually have come from a lower level security hospital setting and have been assessed as potentially a serious danger to others.

The average length of stay in the hospital is approximately five years, but a very small number of patients are likely to remain at Rampton hospital for a significantly longer period of time.

CQC inspected Rampton Hospital in 2013 and found that it met the standards reviewed. CQC undertook a comprehensive review of Nottingham Healthcare NHS Foundation Trust in May 2014. The forensic service, of which Rampton is a part of, was rated overall as good for safety, effectiveness, caring, responsiveness and for being well led. A focussed inspection was carried out in March and April 2016 and a warning notice was issued for the four wards inspected.

We visited the same fours wards as part of this inspection:

• Emerald ward is a 12 bed purpose built intensive care for vulnerable women primarily with learning disabilities and personality disorders. The ward was divided into A and B sides with six bedrooms each side.

• Jade ward is a 12 bed female assessment and treatment ward for patients with a primary diagnosis of mental illness.

• Ruby ward is a 14 bed female treatment ward for patients with a primary diagnosis of personality disorder.

• Alford ward is a high dependency 16 bed rehabilitation and treatment ward for men with complex mental illness.

Updated 26 October 2016

Following a focussed inspection carried out in March and April 2016 where a warning notice was issued, we found that:

• The hospital had made improvements and progress occurred against the requirements of the warning notice on how the observations had been carried out. All four wards had an observation policy that had been reviewed in June 2016 and the general observations across the hospital were now carried out every 30 minutes.

• The hospital monitored and had a system in place to ensure that staff had read the policy and signed it. Staff followed the policy and demonstrated a good understanding of the policy. The hospital carried out audits to monitor that staff were carrying out observations in line with the trust’s policy. The manager regularly reviewed closed circuit television (CCTV) to ensure that staff followed good practice.

• The hospital provided us with information that showed that they were monitoring staffing levels. The information demonstrated that the hospital was above their budgeted staffing levels. Patients and staff told us that they felt safe. The hospital reviewed staffing levels daily and used bank staff when necessary.

• The hospital offered patients 25 hours a week of planned meaningful activities. The hospital monitored the uptake of all patients. Those that achieved less than 25 hours of activities were monitored closely with a view to increasing uptake of activities.

However:

• Staff on Jade ward used additional codes that were not on the policy forms to specify certain locations or activity. Staff on Alford ward omitted to use the location codes on a number of occasions particularly at night. Three clocks on Emerald ward showed different times.

• Two staff from women’s services reported that they did not get breaks from observations when on night shifts.

• Eight patients and seven staff across all four wards told us that low staffing levels occasionally led to activities being cancelled and staff moved around wards. The management deployed therapeutic involvement workers from the resource centre on the wards to cover for staff shortages.