Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question Good. At this assessment the rating has remained as Good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. Staff demonstrated a clear understanding of the Trust’s vision and values, and how these are reflected in their team’s work. Executive leaders were more visible across both sites, which had been positively received. Managers expressed passion and commitment to their work. Patients, staff and managers felt confident in giving feedback on services without fear of any repercussions. The service celebrated contributions of international nurses and leaders emphasised the importance of understanding and embracing different cultures. Clear systems were in place for the flow of information between executive leadership and frontline staff.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Both Wathwood Hospital and Arnold Lodge are part of the Trust’s Forensic Care group. Recent changes had been made to the management structure of this division, including the introduction of key leadership roles. Staff at both locations were aware of these changes and understood the strategic direction being taken.

Staff demonstrated a clear understanding of the Trust’s vision and values, and how these are reflected in their team’s work. Executive leaders were more visible across both sites, which had been positively received.

However, some staff expressed concerns that the senior leadership team did not always effectively communicate the Trust’s vision and values to frontline staff. While weekly emails were sent and generally welcomed, staff often lack the time to read them. Despite this, local leaders at both sites described how information from the Trust was cascaded to frontline teams.

We received positive feedback regarding the recent ‘Big Conversations’ led by the Chief Executive Officer. Staff felt these sessions provided a valuable opportunity to raise concerns and contribute to discussions about service strategy, particularly during periods of change.

Leaders reported ongoing work to strengthen the culture within the Care group, driven by a shared commitment to delivering high-quality care. However, staff also highlighted that budget constraints had made their work more challenging and had impacted patient care. Despite these challenges, staff felt confident in raising concerns with local leaders and believed these issues would be communicated to senior Trust leadership.

Leaders demonstrated the skills, knowledge, and experience necessary to perform their roles effectively. We spoke with ward managers and leaders at both locations, who spoke confidently and knowledgeably about their wards and services. They expressed passion and commitment to their work. All were able to articulate their understanding of the patient group and how they managed associated risks.

Leaders were open about their learning journeys and improvement plans, which was evident at both sites. Despite the geographical distance from the Trust’s base in Nottingham, staff at both locations embraced and embodied the Trust’s values. During supervision sessions, staff were encouraged to provide examples of how they upheld these values in their daily work.

In our 2024 assessment, staff primarily identified with their hospital rather than the Trust. While this sentiment remained to some extent, we found that significant progress had been made to address this. Executive leaders were now regular visitors to both locations, reinforcing the connection to the wider Trust.

Leaders were visible and approachable to both staff and patients. During our assessment, we attended a learning event led by a senior Trust member, which reflected a culture of openness and transparency.

Leadership development opportunities were available and accessible to staff. For example, members of the leadership team at Wathwood Hospital were supported in applying for the clinical director role. We also spoke with ward leaders who had progressed internally into leadership positions.

Both locations actively supported student placements. During our visit to Arnold Lodge, we met a student doctor on placement, which highlighted the service’s commitment to training and development. Staff development was also encouraged, with in-house team members supported in their career progression.

During our assessment of both locations, staff and leaders described various methods for patients to provide feedback on their care.

At Wathwood Hospital, we observed a patient forum that demonstrated how patients were encouraged to raise questions, concerns, and suggestions directly with leadership. This forum appeared to be an embedded practice, with action points recorded at each meeting and reviewed regularly. Leaders were held accountable for following through on these actions.

At Arnold Lodge, we attended a ‘ward away day’, which offered another opportunity for patients to participate in decision-making processes.

Across both locations, we saw patients attending their ward rounds, which served as an additional platform for providing feedback on the service.

Leaders shared examples of how they supported patients in speaking with them directly to discuss any issues or concerns.

When discussing the "freedom to speak up" initiative, most staff reported that leaders at both sites actively promoted this culture, which resulted in positive outcomes. One staff member told us they felt “confident to speak up without any fear." However, some staff expressed concerns, particularly regarding the experiences of bank staff and those from ethnic minority backgrounds, suggesting that not all felt equally supported.

There were designated Equality and Diversity Champions within the service, representing groups such as LGBTQ+ and BAME communities. At each location, we saw display boards, which celebrated equality and diversity, reinforced the hospital and trust’s commitment to inclusivity.

Arnold Lodge is located within the culturally diverse area of Leicester. We found the staff composition at this location reflected the diversity of the surrounding community.

Across all locations, ward activities were designed to promote equality and diversity among patients and staff. Both sites celebrated the contributions of international nurses. For example, an international nurse at Wathwood shared that they had delivered a presentation to their team about their background and experiences. Leaders emphasised the importance of understanding and embracing each other’s cultural backgrounds.

At Arnold Lodge, 1 former international staff member had taken a proactive role to promote inclusion, an example of this was orientating new staff to the surrounding area to familiarise them with where to go for food, finding a local GP and local religious groups. Leaders from Arnold lodge had acknowledged the importance of this and have developed a well-being team which included the nurse mentioned. We were told a mandatory training package was now in place for all staff called, ‘Allyship’ to fully support and embed equality and diversity.

Staff were encouraged to apply for flexible working arrangements to accommodate personal circumstances, such as caring responsibilities or health conditions. One staff member shared, “When I came back from maternity leave, I was fully supported. I have flexible working in place.” We were also informed that returning mothers were supported in continuing breastfeeding, with time allocated for expressing milk that did not impact their break time.

Both locations actively supported men’s and women’s health. Posters which promoted health screening checks were visible throughout the sites. Staff reported that leaders were supportive of their health needs, including menopausal health.

Managers implemented reasonable adjustments to help staff perform their roles effectively. The Trust had an established Health and Wellbeing Guide, which outlined available internal and external support services. Staff confirmed they were well-informed about these resources and had access to personalised “Wellbeing – How Are You Doing?” plans. These tools helped identify and address physical or mental health concerns, which supported staff to remain well at work.

There was a clear framework outlining the topics to be discussed at ward, team, and division levels during meetings. This ensured that essential information, including learning from incidents and complaints was consistently shared and reviewed. We were shown practical examples of how information was disseminated, reviewed, and acted upon.

Leaders clearly explained the systems in place for the flow of information between executive leadership and frontline staff. Staff members we spoke with demonstrated an understanding of what information needed to be recorded and how it was used.

Leaders also described the audit process and noted the implementation of a new system designed to enhance oversight. While the current system was sufficient to provide assurance, staff were responsive to audit outcomes and took appropriate action when necessary.

The forensic care group maintained an up-to-date risk register, along with local risk registers for each site, which were regularly reviewed by leadership.

Staff understood the collaborative arrangements with both internal teams and external partners to meet patient needs. We were given examples of effective collaboration with commissioners, advocacy services, and other internal departments.

Emergency preparedness plans were in place at both locations, including protocols for adverse weather. These plans were supported by partnerships with local emergency services.

Recent changes to the governance structure of the forensic care group had been implemented, and both leaders and staff expressed a positive outlook on these changes. Leaders at Wathwood Hospital explained how they managed current leadership gaps. However, some leaders expressed concerns about communication, which had been acknowledged by management and was currently being addressed.

During our visit to Wathwood Hospital, we found leaders worked closely with commissioners from outside the trust, as the hospital provided funded beds for patients from other areas. Regular collaborative meetings were held with all stakeholders, and bed management was actively monitored to ensure efficiency.

The hospital also maintained a strong partnership with a local forensic ward managed by another trust. This relationship was built on a culture of shared learning and mutual support.

Leaders at both Wathwood Hospital and Arnold Lodge highlighted well-established relationships with local general hospitals and police services. Each location had a designated police lead, and these partnerships were considered vital for enhancing patient care and safety.

Wathwood Hospital had also developed a meaningful connection with the surrounding community. For example, theCourtyard Café, located on the hospital grounds. This was managed by the horticulture team during the week and open to the public on weekends, the café featured animals such as pigs, goats, and donkeys, and sold flowers, plants, and crafts. Patients were actively involved in running the café, and gained valuable skills in food hygiene and horticulture.

The café was also used during the week by a local community service for adults with learning disabilities. It had become a popular weekend destination, and promoted the hospital’s mission of“reducing the stigma in mental health.”

Staff were given time and support to explore opportunities for improvement and innovation, which led to meaningful changes in practice. Staff we spoke with reported that regular team meetings provided a platform to discuss and implement these changes.

There were also opportunities for staff to engage in research. Medical leaders in the Forensic Care group shared examples of how the Trust supported 2 medical academics to pursue research aimed at enhancing patient care. This included collaboration with Nottingham University.

Innovation was evident across the service. Leaders highlighted several initiatives, such as allyship training and the involvement of external psychologists to support staff who experienced racism. Quality improvement projects were also underway, including patient co-production of ward round presentations and initiatives focused on restrictive practices and transitions from high-secure to low-secure hospitals.

During our assessment, staff described the need for shift patterns to adapt minute by minute to meet patients' needs. They expressed a willingness to embrace change when it benefited patients. However, some staff voiced frustrations about the Trust’s communication around changes. For example, a recent directive to remove plastic bags from ward environments was implemented immediately, but without guidance on suitable alternatives. Although this issue had since been resolved, staff felt disappointed by the lack of clear communication and rationale from executive leadership.