CQC inspectors have found improvements are needed at Nottinghamshire Healthcare NHS Foundation Trust following an inspection in March and April.
CQC carried out the inspection as part of its programme of ongoing checks on the safety and quality of healthcare services.
Inspectors visited the following areas across the trust; long stay rehabilitation mental health wards for working age adults, wards for older people with mental health problems, community-based mental health services for older people, psychiatric intensive care unit and acute wards. The following community health services were also inspected; inpatients, end of life care, children young people and families and adults’ services.
Following the inspection, the trust’s overall rating remains as requires improvement. Caring has moved up from good to outstanding, effective has moved down from good to requires improvement. Safe, responsive and well led remain rated requires improvement.
Jenny Wilkes, CQC head of hospital inspection, said:
“When we returned to Nottinghamshire Healthcare NHS Foundation Trust, whilst we found some improvements had been made, further work was needed across the trust to ensure people receive safe and appropriate care.
“It was concerning that 80 patients were still in shared sleeping accommodation. Whilst the bed areas were separated by curtains, this didn’t promote people’s wellbeing, privacy or dignity. This issue was raised with the trust in 2019 and they had set deadlines to get rid of these areas, but this was delayed due to refurbishment elsewhere and still hadn’t been done.
“In long stay rehabilitation mental health wards for working age adults, the environment hadn’t been well maintained and repairs weren’t done in a timely way. For example, at Thorneywood Mount showers hadn’t worked properly for almost two years; managers had reported this issue repeatedly, but they were only ever fixed temporarily.
“In addition, within two mental health services and one community health service, there weren’t always enough suitably qualified staff on duty to meet people’s needs and keep them safe.
“However, the trust must be commended for achieving an outstanding rating for being caring. We saw several examples of staff going the extra mile to ensure patients felt involved with their care. For example, one patient said staff had helped them to find a nurse specialising in Parkinson’s disease and another said staff always provided full explanations about their medications which gave them a better understanding of their condition.
“Leaders identified that they needed to further develop the culture to allow staff to perform at their best, with a zero tolerance for inequality, discrimination and bullying. The trust had opportunities for staff development and career progression as well as providing health and wellbeing offers.
“It was positive that executive board members were proactive, open and responsive to feedback and passionate about improving the organisation.
“We will monitor the trust to ensure that any necessary changes are made to keep people safe, and we will expect to see sustainable improvements the next time we inspect.”
Inspectors found the following during this inspection:
- Governance systems and the strategy of the organisation had been extensively reviewed since our last inspection, but any positive changes haven’t yet been embedded into services.
- There were not always additional alarms for staff working in the wards for older people if staffing numbers increased. This meant staff could not get help quickly if there was an emergency.
- In two mental health services and one community health service, staff were not up to date with mandatory training. The compliance rates fell below the expected 75% compliance rate for specific training
- Whilst the trust had a robust appointment process for all board directors, they did not ensure that that the senior leaders personal files met General Data Protection Regulations (GDPR) and the fit and proper persons checks had not been reviewed as they should have been.
- Whilst managers ensured staff had access to regular, constructive clinical supervision of their work, clinical supervision compliance rates in four of the inspected core services did not meet the trusts target rate of 80%.
However:
- The trust had a clear vision and a set of values with quality and sustainability as the top priority. The strategy was aligned with the local health economy and considered the needs of the developing Integrated Care System (ICS).
- Senior leaders supported improvement and innovation work and there was a strong programme of staff training.
- The trust was committed to patient involvement and working with volunteers. The trust had an active volunteer network of around 185 volunteers.
- Since the last inspection the trust corporate governance structure had been reviewed, redeveloped and improved.
- The board recognised that that risk management was an essential and integral part of good management practice.
- The black and minority ethnic network was one of the most established staff groups in the trust with 285 members.