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

Overall, we found the wards that we assessed were well-led. However, managers did not have oversight of staff's compliance with the trust's observation policy. We found that although checks were completed according to observation levels, additional "welfare checks" were carried out between observations, which deviated from policy. We provided this as feedback to the provider, and we were told that action would be taken to explore this matter further to ensure that therapeutic engagement observations are carried out in line with local and national guidance.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke described the hospital’s vision and values to work together to help young people and their families to feel empowered, take back control and promote recovery. Along with the aim to ensure a safe and supported discharge back into the community with the appropriate support in place.

Managers told us they were proud that young people were involved at every stage of the recruitment process for new staff.

Staff we spoke with said matrons and local managers were visible and supportive, but they did not see or know the names of senior leaders.

Managers we spoke with said they felt supported by the Senior Management Team (SMT) and Executive team, and their understanding of ward functioning and staff wellbeing.

We saw all staff we spoke with had an individualised wellbeing plan.

We saw managers had introduced a staff wellbeing ticket, by which young people nominated staff and the winner who was drawn at random received additional time added onto one of their planned breaks.

Staff we spoke with described the freedom to speak up process and said they would be happy to access it if required.

Staff we spoke with said they could access specific specialist training such as cognitive behaviour and trauma informed therapy.

We looked at community meeting minutes and “you said, we did” notice boards. Both described improvements following feedback and suggestions from young people.

We saw evidence that staff received monthly supervision as well as reflective practice sessions and peer supervision groups.

Managers did not ensure nursing staff completed daily environmental checks to identify and mitigate risks in the ward environment. We provided this as feedback to the provider, and were provided with assurance that the leadership team would take appropriate action to ensure that a system is in place which allows for improved oversight of environmental checks on the wards.

Managers did not ensure staff followed the trust’s observation policy, whereby additional “welfare checks” between scheduled observations were undertaken. This could be open to misinterpretation if a staff member was asked to complete welfare checks between scheduled observation intervals and was outside the policy. We provided this as feedback, and we were assured that the service will take steps to explore this area further and ensure that therapeutic engagement observation practices were being carried out in line with local and national guidelines.

However, staff also told us about the ways in which the wards respond to the changing needs of young people by implementing new governance systems. For example, managers had reviewed the “named nurse” system where a specific nurse was assigned responsibility for a young person’s care. They had introduced care teams whereby a group of staff were allocated, ensuring continuity, accountability, and a stronger relationship with an increased number of staff and young people.

We saw staff effectively communicated with other providers such as local authorities, integrated care boards and other NHS providers.

Staff worked with the onsite education team to ensure young people could continue to access their education.

Staff told us that planned reflective practice sessions were held every 2 weeks which they found very helpful in managing an increasingly acute group of young people.

There was a strong emphasis on wellbeing for both young people and staff, ensuring that everyone's health and wellbeing are prioritised.