Nottinghamshire Healthcare NHS Foundation Trust

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• 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 requires improvement. At this assessment the rating has remained requires improvement. This meant the service management and leadership was inconsistent. Staff were able to have reasonable adjustments in place, allowing them to work flexibly to suit their personal circumstances. However, the trusts senior leadership team did not always involve staff in discussions around service re structure. Learning was not always shared at a service level. Leaders did not always have oversight of how the service was run. The trust did not have good governance oversight to manage environments, patient outcomes, restrictive interventions or treatment model of the service. We asked the trust to address these and produce an action plan in relation to this.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The trust’s senior leadership team had not always successfully communicated the provider’s vision and values to the frontline staff in this service. Staff told us they had not been given the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. The trust had recently implemented structural changes with the care group and the staff and managers on the wards had not contributed to these changes. They had been told of the changes, but due to a lack of service manager they were unsure who was supporting them.

Leaders did not always have a good understanding of the services they managed. They could not always explain clearly how the teams were working to provide high quality care. They team at Bracken House had clear audit processes and knew the treatment plans in place for patients. However, the managers at Throneywood Mount, did not know why they had stopped using clinical outcome measures. They did not have oversight of the treatment model and clinical outcomes in place.

Leaders were visible in the service and approachable for patients and staff. Staff and patients told us the ward manager or acting ward managers were approachable and present on the ward areas.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. There were regular patient community meetings in place and all staff we spoke with knew who their freedom to speak up guardian was and how to approach them.

Staff had approached the freedom to speak up guardian at Thorneywood Mount and as a result changes had been implemented during mealtimes and the trust chief executive officer had also visited the service. No further freedom to speak up requests had been made in the last 12 months for the service.

Staff were able to apply to work flexibly and flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. One staff member we spoke with told us after a recent health issue as a result ofshift work which affected their health, managers accommodated shifts and gave them a week of early shifts and week of lates to suit their health needs.

The trust had an established Health and Wellbeing Guide, which outlined available internal and external support services.

There was a clear framework of what must be discussed at a ward, team or care group level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. We reviewed team meeting notes, and these included standard agenda items including learning from incidents and complaints. However, staff had not always implemented learning at a service level. We found learning from one location had not always been implemented at another. We found changes had been made to the restrictions in place at mealtimes at Thorneywood Mount however, these had not been shared and implemented at Bracken House. We found trust wide learning following and incident at another service included a ban on bin liners and plastic bags. However, consideration had not been made of the impact and appropriateness of this depending on service type, in particular these rehabilitation services.

Staff undertook local clinical audits. However, these did not always identify areas of improvement. For example, the audits in place had not identified staff had not used clinical outcome measures when to assess and evaluate patients at Thorneywood Mount and had not identified the unnecessary restrictions in place at Bracken House.

The maintenance log at Thorneywood Mount had several jobs that needed attentions, but the manager did not have oversight of when job requests had been dealt with or had been met. For example, Thorneywood Mount did not have a working tumble dryer, but the manager did not know when this was going to be fixed or whether it would be replaced. Also, the TV in the games room at Thorneywood Mount had not been working since April 2025 and the manager did not know when this would be fixed. We raised this with leaders at the trust, and they confirmed the manager now had oversight of the relevant oversight dashboards. Managers told us they could escalate risk if they needed to but currently there were not items on the risk register for this service.

This showed managers did not have good governance oversight to manage environments, patient outcomes, restrictive interventions or treatment model of the service. Although leaders put appropriate actions in place to address the immediate concerns we have asked the trust to develop an action plan to address this.

Directorate leaders engaged with external stakeholders such as commissioners. Managers had a good working relationship with local clinical commissioners and worked well with social services including housing teams, when required.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Staff at Thorneywood Mount told us senior leaders had visited the service, and they found them approachable. Managers had a good working relationship with the service’s matron.

All wards did not participate in accreditation schemes as the current accreditation scheme required a clinical registered clinician, and Thorneywood Mount had a non-clinical registered clinician. However, managers told us they had regular meetings where they looked at best practice from AIMS (AIMS accreditation isa quality assurance framework, often used in UK mental health services, where inpatient units undergo a self-review, a peer review, and a final assessment by the Royal College of Psychiatrists accreditation committee.The goal is to ensure high standards of care, patient safety, dignity, and therapeutic activities, improving patient and carer experiences by involving service users and carers in the review process) and apply to their service.

However, the service had regular quality and risk meetings where they discussed learning and improvement. Thornywood Mount was the only open-door level 1 unlocked rehabilitation service. The staff at the service were able to assess the needs of patients before they came in the service to confirm suitability to the service as it did not have a locked door.

The service also had regular staff development days to offer specific training and learning was shared.