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Provider: Nottinghamshire Healthcare NHS Foundation Trust Requires improvement

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We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 10-12 March 2020

During an inspection looking at part of the service

  • Security was a key priority on the wards. Staff spoken with knew the security procedures well. We saw each ward had an allocated security lead daily who was responsible for the environmental security checks.
  • The trust had established the staffing levels required to meet the needs of the patients. Ward managers had the autonomy to increase staffing levels if required. Staff training was all above 75% compliant. There was suitable medical cover and on call cover throughout the week.
  • Staff held regular and effective multidisciplinary meetings. Clinical staff completed a comprehensive review of patient needs and reviewed progress made. Staff understood their roles and responsibilities under the Mental Health Act and the Mental Health Act Code of Practice.
  • Patients knew the complaints process and had access to an independent mental health advocate if requested. Staff were aware of the trust’s whistle blowing policy and knew their responsibilities in relation to safeguarding. Staff told us they felt confident to raise concerns to senior managers without repercussions.
  • The manager had oversight of the hospital. Ward performance was monitored by completing regular audits and the outcomes were recorded and monitored over time to ensure the ward continuously improved. Leaders were visible in the service and supported staff to develop their skills, take on more senior roles, and responsibilities.
  • Patient feedback was positive. Most patients told us they felt safe on the ward. Patients spoken with told us that staff were kind and friendly. Patients told us they enjoy the activities on offer at the hospital and that they really liked playing on the computers or going for walks around the grounds.


CQC inspections of services

Service reports published 23 September 2020
Inspection carried out on 19 to 29 July 2020 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 25 March 2020
Inspection carried out on 12 February 2020 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 24 January 2020
Inspection carried out on 13 November to 14 November 2019 During an inspection of High secure hospitals Download report PDF (opens in a new tab)
Service reports published 16 October 2019
Inspection carried out on 2-4 July 2019 During an inspection of High secure hospitals Download report PDF (opens in a new tab)
Service reports published 24 May 2019
Inspection carried out on 22 Jan to 07 Mar 2019 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 22 Jan to 07 Mar 2019 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 22 Jan to 07 Mar 2019 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 22 Jan to 07 Mar 2019 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 22 Jan to 07 Mar 2019 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 22 Jan to 07 Mar 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 24 May 2019
Service reports published 14 August 2018
Inspection carried out on 28 June 2018 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 8 June 2018
Inspection carried out on 20th-22nd March 2018 During an inspection of High secure hospitals Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 8 February 2018
Inspection carried out on 9 Oct to 14 Nov 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 9 Oct to 14 Nov 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 9 Oct to 14 Nov 2017 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 8 February 2018
Service reports published 15 June 2017
Inspection carried out on 6 - 10 March 2017 During an inspection of High secure hospitals Download report PDF (opens in a new tab)
Service reports published 14 February 2017
Inspection carried out on 11 November 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 23 December 2015
Inspection carried out on 18 August 2015 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
Inspection carried out on 11th August 2015 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)
Inspection carried out on 18 August 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
See more service reports published 23 December 2015
Service reports published 30 October 2015
Inspection carried out on 01 September 2015 During an inspection of Reference: not found Download report PDF (opens in a new tab)
Inspection carried out on 01 September 2015 During an inspection of Reference: not found Download report PDF (opens in a new tab)
Inspection carried out on 22 Jan to 07 Mar 2019

During a routine inspection

Inspection carried out on 9 Oct to 14 Nov 2017

During a routine inspection

Our rating of the trust stayed the same. We rated it as good because:

  • We rated effective, caring, responsive, and well led as good for the trust and safe as requires improvement. We rated 15 of the 19 core services provided by the trust as good. Our rating for the trust took into account the previous ratings of services not inspected this time.
  • We rated well led for the trust overall as good.
  • There was good leadership at corporate level. The board understood the challenges the trust faced and made sure that plans were in place to manage these, while planning for the future. The board members challenged each other to make sure the right implementation of decisions occurred. Leaders at service level were visible.
  • Good partnership working continued with other organisations to help plan and meet the needs of the local people. Stakeholders were positive about the trusts contribution to the local health economy planning.
  • There was good multidisciplinary working within clinical teams and with external partners.
  • Patients and carers could still contribute to service planning and delivery through the involvement centres. Patients were positive about the care and treatment provided by staff.
  • Patients were still at the centre of the trust culture, which involved them through a range of initiatives. Patient needs were assessed, and care and treatment were planned;- with outcomes to measure progress monitored. There was an established recovery college for patients to learn skills in in managing their physical and mental health.
  • Staff continued to have good access to training and development. Staff knew how to raise safeguarding concerns to protect patients. They knew how to report incidents and were open and transparent when things went wrong.
  • There were effective complaint management systems, and the trust had set up good processes to investigate and learn from deaths.
  • Learning from incidents, audits, complaints, deaths, was publicised through a variety of methods to improve practice. The trust carried out and shared the research it had undertaken.

However:

  • Medicines management practice in storage and recording and effective monitoring of action plans was not consistent.
  • Staff recruitment and retention was a challenge and nursing fill rates of shifts did not consistently meet the trust target of 90%.
  • Staff did not consistently assess record and monitor patients’ physical health needs.
  • The physical environment on some ward were not conducive to good quality care. On some wards patients had to share bedrooms and other wards did not have disabled access. On some wards staff found it difficult to observe all areas because there were no mirrors to help them see round blind corners.
  • The Mental Health Act Code of Practice was not followed in relation seclusion facilities, giving patient rights and copies of leave forms.
  • Representatives of Black and minority ethnic staff groups interviewed said they did not feel engaged. They reported a lack of career development and opportunities and they did not feel able to speak up.
  • Not all staff knew about the Freedom to Speak up Guardian role in the trust.

Inspection carried out on 29 April - 1 May 2014

During a routine inspection

Nottinghamshire Healthcare NHS Trust employs nearly 9,000 staff and provides a wide range of care services from many separate locations.  Despite this, the trust had a clear ‘brand’ with a set of values that was embedded and visible throughout the organisation.

We were impressed with the strong leadership from the Board, the executive team and senior managers.  There were clear lines of authority, responsibility and accountability, senior managers, the executive team and the Board demonstrated and encouraged supportive relationships, there was a culture of collective responsibility and teams had clear objectives and worked towards achieving them.  One of the vehicles to achieving this cohesion was the trust’s leadership programme that ran through all the directorates.  This encouraged staff to engage in discussions about the strategic direction of the trust and the challenges it faced. 

The trust demonstrated to us that people using services were treated with dignity, respect and compassion. The great majority of the service users and carers that we spoke with said that staff were kind and we observed many positive and respectful interactions between staff and service users.  We also saw examples across all services of the trust responding to people’s spiritual, cultural and ethnic needs; including at Rampton Hospital.

At all levels, the trust actively engaged and involved people who use services in their own care and in the development of the service itself.  With the exception of information about how to complain not being consistently provided in the Healthcare Partnerships division, the trust had mechanisms in place to hear and act on feedback from people who use services and the board itself received and monitored information from the analysis of complaints.  We were impressed by the Recovery College and the Involvement Centre; which are both national exemplars.

The trust had good systems in place to report, record and learn from incidents and ensured that this was embedded in practice at all levels across the three divisions. Staff used past incidents as a means of learning to ensure the safety of people using services. This learning was shared with all staff.

There were good and regular training opportunities (including induction and mentoring) and the content was appropriate to staff roles, responsibilities and areas of work.

The trust had clear safety related goals that the majority of staff understood and were working towards across all three divisions. There was a culture of openness and transparency and staff understood the need for investigations in order to learn from, and develop, improved practices.  The trust had identified a number of priorities in relation to safety and we concluded that they had developed after consistently reviewing data from a wide range of sources.  Despite this, we identified a number of safety concerns.  These included:

  1. the presence of ligature points that might pose a risk to people who are at risk of suicide on wards at Broomhill House, Newark Community Rehabilitation Unit, Mansfield and Thorneywood Mount;
  2. wards that did not adhere to national guidance on same-sex accommodation in the CAMHS Thorneywood service and in two of the acute admission wards; B2 at Bassetlaw and Orchid ward at Millbrook Mental Health Unit;
  3. poor medicines management in the Children’s Development Centre at Nottingham City Hospital campus and at Bassetlaw Hospice.

Across all of the divisions we found that care provided was evidence based and followed recognised national guidance. There were good examples of positive outcomes for people using services across the divisions. This included a significant reduction in acquired avoidable pressure ulcers, where the trust exceeded its own target.

Overall, trust staff adhered to the requirements of the Mental Capacity Act 2005 to assess capacity to consent.  We visited most of the wards at each location where detained patients were being treated. In the majority of the care records we reviewed, which related to the detention, care and treatment of detained patients, the principles of the Mental Health Act (MHA) had been followed and adhered to.  The long stay wards were an exception; here we found inconsistencies in the application of the MHA and a failure to undertake risk assessments of service users given leave under Section 17 of the Act.  We also found that the trust did not have a robust system in place to ensure that patients in seclusion at Arnold Lodge had a four-hourly review by a doctor.  There were systems and procedures in place to safeguard vulnerable people and to identify, assess and manage risks. However, the divisions varied in how they fed back safeguarding concerns and the outcome of findings from investigations.

We had a number of concerns about the learning disabilities service and concluded that they did not have a high profile within the trust.  We saw examples of restrictive practices, institutional environments at Alexander House and Hucknall House and a lack of physical health checks on the Orion Unit. 

In the majority of services we visited, people did not experience long waits for assessment or treatment.  However, some service users did report difficulty accessing crisis mental health services at night.  The crisis team offered only telephone contact at night.  Those who needed immediate assessment were directed to the Emergency Department at Queen’s Medical Centre; where they might have to wait a long time to be assessed by the liaison psychiatry team.

We saw that the trust had introduced night time confinement at Rampton Hospital. We concluded that its use was in line with the Department of Health High Security Psychiatric Services (Arrangements for Safety and Security) Directions 2013 and the associated guidance.  However, some people who used the service, and some staff, were concerned about the provision of physical healthcare during night-time confinement.  During our unannounced, night time visit to Rampton Hospital we observed two patients receiving treatment through the ‘hatches’ in their bedroom doors. One was given insulin for diabetes and one was provided with stoma care. We raised this with the trust which stated that it is not normal practice to provide physical healthcare through the hatch and undertook to investigate the circumstances of the care and treatment provided on this occasion.

Across the three divisions we identified that there were some concerns about the different clinical information systems, which did not enable information to be shared effectively and at the right time. This could lead to information regarding risks not being available to all staff. We found the trust recognised the difficulties and had plans in place to improve facilities and functioning of systems.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.