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 well-led as inadequate. At this assessment the rating has improved to a rating of good. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected and analysed data about outcomes and performance. They used this to identify improvements.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff consistently demonstrated an understanding of the provider’s vision and values and described how these were embedded in their team’s daily work. They spoke with compassion and pride about the care they delivered.

The senior leadership team had effectively communicated the provider’s vision and values to frontline staff. Service leaders reported that they met quarterly, they held team meetings to reflect on their shared vision and discuss any updates. They used a variety of communication methods, including face-to-face meetings and emails, to ensure staff were kept informed.

Staff told us they were encouraged to contribute to strategic discussions, particularly during periods of change. They generally felt that communication from their service leaders was good. However, some staff highlighted areas for improvement, citing the refurbishment of Cherry Ward as an example. They explained that the plans were co-produced with input from both staff and patients, and there was strong support for the proposed changes. Staff expressed disappointment that the refurbishment had been halted without clear communication or rationale. While they did not attribute this to service-level leaders, they felt the executive team at the trust had failed to communicate effectively.

Staff were able to articulate how they strived to deliver high-quality care within the constraints of the available budget. However, they expressed frustration about the trust’s financial position and its impact on service quality. The halted refurbishment of Cherry Ward was again raised as a concern. Staff noted that patients continue to reside in dormitory-style accommodation, and the lack of dedicated space for staff meetings is affecting team operations. They felt these limitations were having a negative impact on both staff and patient experience.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders within the service demonstrated the skills, knowledge, and experience required to perform their roles effectively. During the assessment, we spoke with all members of the senior team, each of whom showed passion and dedication to delivering high-quality care and support to patients. Several leaders shared that, despite the complexities of the patient group, they had been motivated to work in this area since their early careers as trainee nurses.

Ward managers also demonstrated relevant experience and a deep understanding of the patient group. Like their senior colleagues, they expressed enthusiasm and commitment to their roles.

Leaders had a clear understanding of the services they managed and were able to articulate how their teams worked to deliver high-quality care. Their commitment to excellence was evident, even when discussing challenges such as increased patient acuity. These discussions were approached with empathy and a strong sense of responsibility.

Leadership visibility was a notable strength. Leaders were regularly present within the service and were described by staff as approachable and supportive. This visibility was observed throughout the assessment and confirmed by staff feedback.

Opportunities for leadership development were available and extended to staff at various levels. Staff told us that leaders actively supported professional growth and described a culture of “growing their own,” where internal development was encouraged and nurtured.

Leaders also highlighted the availability of opportunities for student nurses, noting that they were welcomed and supported within the service.

3. We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers were provided with opportunities to give feedback in ways that reflected their individual needs. Managers and staff had access to this feedback and used it to inform service improvements.

On Silverbirch ward, patients could access a free, confidential, and independent support service available to both patients and their families or carers.

The redesign of Cherry Ward was co-produced with staff and patients, which demonstrated meaningful involvement in service development. Although this work was on hold at the time of our assessment, it remained a positive example of collaborative decision-making.

The trust supported patients in using platforms such as‘Care Opinion’to share their experiences and feedback.

During our assessment, we observed staff wearing‘Freedom to Speak Up Champion’ badges. Staff told us there are 13 champions who worked across the wards, and that the initiative was actively used. Staff reported feeling confident to raise concerns without fear of detriment, which reflected a culture of openness and psychological safety.

The service demonstrated a strong commitment to equality, diversity, and inclusion (EDI). Designated EDI Champions were in place, who represented groups such as LGBT+ and Black, Asian, and Minority Ethnic (BAME) communities. At each location, we observed display boards that celebrated diversity, and reinforced the hospital and trust’s vision of inclusivity.

Trust-wide EDI leads regularly visited services and contributed to the trusts EDI strategy, which was aligned with both the business and people plans. The trust had also committed to increasing representation of staff from BAME backgrounds in leadership roles.

Across all locations, we observed a diverse staff mix that reflected the local communities. International staff members were encouraged to share aspects of their culture with their teams, fostering mutual understanding and inclusivity.

Staff were supported to apply for flexible working arrangements to accommodate personal circumstances, such as caring responsibilities or health conditions. One staff member shared how they were supported to adjust their working hours to meet caring needs and described being treated with kindness and understanding when their child was unwell. Another staff member spoke positively about their experience returning to work after illness, and noted that reasonable adjustments were made to support their role.

However, some staff reported they had experienced racism from patients. While the service did not tolerate such behaviour and encouraged staff to report incidents to the police, some staff expressed hesitation, believing that patients may not be fully responsible due to their health conditions. We raised this with service leaders, who emphasised the importance of reporting—not only to safeguard staff but also to ensure appropriate support for patients. Leaders committed to reinforcing this message across the service.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear framework in place to guide discussions at ward, team, and care group levels, which ensured essential information such as learning from incidents and complaints was consistently shared. We observed this in practice during handover meetings, safety huddles, and ‘ward to board’ meetings across the wards we visited.

Since our last assessment, the trust had further rolled out a new system called‘Safe Now’, designed to provide oversight of audits. Most services had implemented this system, including the service we assessed. Ward managers reported that while they were still familiarising themselves with the system, they had already seen its benefits. Feedback on its functionality had been positive.

At the time of our previous assessment, improvements were needed in governance. We found that significant progress had been made in this area. The governance structure was functioning well, and systems for managing risk were more embedded. During safety huddles, we observed that managers were held accountable for actions, and leaders acknowledged the increased workload at ward level, expressing efforts to support their teams.

Learning from serious incidents was embedded in practice. Following a recent patient death, new risk assessments were introduced for any patient using a physical health bed, demonstrating responsive and proactive risk management.

Staff had access to the risk register at both ward and directorate levels and could escalate concerns when necessary. One example on the register was the refurbishment and removal of dormitory beds. Staff expressed disappointment that this work had not yet been completed, citing negative impacts on patient care. Patients also shared that they disliked having to share sleeping spaces.

On Cherry Ward which is the last ward with dormitory-style accommodation, we observed limited space for staff breaks. The designated area was cramped and located adjacent to a toilet. Staff told us they often resorted to taking breaks in their cars due to the lack of suitable facilities. While staff were able to raise concerns, the delay in refurbishment left some feeling unheard.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Leaders from the service actively engaged with external stakeholders, including commissioners and Healthwatch. They described strong working relationships with local acute hospitals, which were reported to have a positive impact on patient care. Effective information sharing and a shared understanding of bed pressures across services were key benefits of this collaboration.

During our assessment, we attended a‘Red to Green’meeting, where each patient’s discharge plan was reviewed. These meetings aim to identify opportunities for timely discharge, helping to free up beds for patients in both the community and acute hospitals. Staff also shared that they continued to support patients who were admitted to acute wards for medical treatment, to ensure continuity of care across settings.

Patients and staff had opportunities to meet with senior leaders and commissioners to provide feedback. Staff told us that senior leaders regularly visited the wards. While some patients were not familiar with who the leaders were, we observed leaders engage with patients and staff in a meaningful way. In one instance, a senior leader spoke with a patient about a complaint. The conversation was respectful and demonstrated care and kindness.

We scored the service as 2. The evidence showed some short falls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service had embedded practices that supported continuous learning. We were told that reflective meetings held on the wards fed into governance discussions, and that issues were regularly addressed through the Clinical Effectiveness Forum.

On Robin Ward, the trust’s‘Positive Behaviour Support’workstream was being actively used to enhance patient care. It helped staff to analyse behaviour and to support staff to understand and care for their patients. Leaders spoke positively about how improvement initiatives were discussed and supported across teams. They emphasised the importance of sharing learning and fostering a culture that celebrated success.

We were informed that each Wednesday, the service held a‘clinical case discussion’session, which focused on areas such as falls, nutrition, and hydration. These meetings provided teams with the opportunity to raise concerns about individual patients and receive input from the consultant therapists for falls prevention and nutrition and hydration. Where concerns were identified, the head of nursing or matron liaised with the team to provide additional support.

During our assessment, patient acuity was high across all wards, with the most significant impact observed on Silverbirch Ward. Although the ward was designed as a specialist unit for people living with dementia, 9 of the 20 patients had diagnoses of general mental health conditions. This affected the ward’s ability to function as intended. During our visit, we observed a distressed patient who exhibited challenging behaviour, which visibly upset a visiting family member who subsequently left the ward.

Staff expressed concern about the mismatch between the ward’s intended purpose and the current patient mix. One staff member told us, “It’s not sustainable,” while another said, “I’m experienced in working with people living with dementia, not general mental health.”

When we raised this with service leaders, they acknowledged the impact of high acuity on both patients and staff. The issue had been added to the service’s risk register, and plans were in place to reduce the number of general mental health patients on Silverbirch. The opening of Blossomwood ward was expected to support this transition. Leaders demonstrated openness and a willingness to hear ideas from staff, reinforcing a transparent and inclusive approach to problem-solving.