Archived: HMP Nottingham

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed three quality statements under the safe key question at this inspection. We found that the learning culture had improved with robust oversight of incidents. We found improved staffing levels which had reduced the waiting times for people to access services.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

At our last inspection we found that the reporting and management of incidents was not in line with the providers policy. At this inspection we found there was an improved reporting culture across all aspects of incident reporting. Staff now recognised the importance of reporting missed appointments and the reasons why. Staff told us that these incidents were discussed at team meetings and any learning shared. The number of incidents reported had increased, and investigations into incidents took place in a timely manner. We found the provider was following their policy to manage incidents effectively.

At the time of inspection, there were no overdue incident investigations. Manager oversight of incidents had improved with matrons carrying out prompt reviews of those reported. Matrons identified learning from incidents and shared this with the wider healthcare team during daily handover meetings. The head of healthcare completed a weekly report for senior managers to highlight the number of incidents reported, common themes identified and any outstanding actions. Managers we spoke with understood how to escalate any concerns identified from incidents.

At our last inspection we found patient applications to see healthcare staff were not reviewed in a timely manner, meaning some people experienced a delay in accessing the service they needed. This time we saw improved oversight of the applications system.

Although the service received a very high number of applications from people each day, we found they were consistently reviewed by a clinician within a maximum of 5 days and referred to the appropriate pathway. A nurse was allocated to triage the applications each day and managers checked with staff during the daily handover that applications in the last 24 hours had been reviewed to address any urgent need. Data was now shared with senior managers weekly for assurance the process was being well managed. This meant people’s applications to the healthcare team were safely managed to ensure timely access to treatment.

5 people were waiting to be triaged during the inspection. We saw an appropriately skilled nurse triage the list and allocate the concerns to the most appropriate clinician for assessment and treatment. Once people had been triaged into the appropriate nurse led clinic they waited no more than 48 hrs, and we found many were seen much sooner.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

At our last inspection we found staffing capacity was a concern with significant numbers of shifts unfilled and staff reporting that low staffing levels were the norm. Managers were having to respond to inadequate staffing levels regularly and make decisions that impacted negatively on the regular running of the service, such as planned clinics.

During this inspection, we found staffing levels had improved and was a standard agenda item within daily clinical handover and team meetings. Staff we spoke with during the inspection felt that issues relating to suboptimal staffing were now managed more proactively than reactively. Staff felt this has led to better clinic planning and more appropriate consideration of which clinics can be moved to limit the impact on people. We saw evidence that when there were issues around low staffing, this was escalated locally and regionally.

There was now a weekly oversight meeting to discuss vacancies within the service; HR representatives shared data for the number of vacancies advertised, recruited to and staff in vetting. A weekly roster meeting had also been introduced to provide scrutiny of the number of shifts filled and agency or bank staff usage levels. This meeting included local and senior managers so that additional resource could be found if needed and managers were held to account for ensuring all shifts were filled.

Staff we spoke with reported feeling supported by their peers and supervisors. Data provided shows an improving trajectory for completion of clinical supervision rates.

At our previous inspection we found staffing issues were impacting the delivery of mental health services and in particular there was no senior psychologist in post due to difficulties in recruiting. This time we found a much-improved picture and a more comprehensive range of treatments for people. People referred to the mental health service were seen within the 5-day timeframe for a routine assessment, or much sooner for urgent referrals. This meant people had timely access to assessment and treatment for mental health issues.

Although some vacancies remained, the 20% vacancies were covered by regular agency staff and interviews for mental health nurses were scheduled during the week of our inspection. The mental health lead attended the weekly roster planning meeting alongside other healthcare managers to report and resolve any staffing deficits in the coming months. A lead psychologist was in post and supervised the assistant psychologists. A number of new groups had been established by the team to increase the psychology offer to people.

We found an experienced mental health matron who was supported by a regional clinical lead. A wide range of interventions were now available to people including psychology, therapies and group work such as coping with stress and trauma. Staff told us that caseloads were manageable, and they were happy with the workload. Staff felt supported by their manager and reported having regular supervision. A weekly multi-disciplinary team meeting provided an opportunity to review new referrals and any concerns from staff caseloads. We observed good treatment planning for people through this meeting. The mental health well-being centre was seen as a positive treatment option to support people and was well utilised despite some challenges with regular officer support.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

The judgement for Medicines optimisation is based on the latest evidence we assessed for the Safe key question.