Nottinghamshire Healthcare NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement: This meant patients did not always feel well-supported, cared for or treated with dignity and respect. Staff did not treat all patients with kindness, compassion and dignity, staff did not always treat patients as individuals, staff did not always promote patients’ independence, choice and control, staff did not always respond to patients’ immediate needs, and the trust did not ensure workforce wellbeing.

The service is in breach of legal regulations in relation to dignity and respect.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed significant shortfalls.The service did not treat all patients with kindness,empathyand compassion, or respect their privacy and dignity.

Patients were not always treated with kindness, compassion and dignity in their day-to-day care and support. Patients at Sherwood Oaks shared that some staff are “gentle, some people are not”. We reviewed patient daily notes whilst on Willows ward within which we found staff using concerning and subjective language to describe patients’ behaviours. Examples included staff describing some patients as “being demanding” and staff writing disrespectfully when describing a distressing incident for another patient. We observed an interaction between staff and a patient that was not respectful with their use of language and tone. During our visit on Willows ward we experienced staff discussing a patient’s religion in a disrespectful way which showed lack of compassion and understanding regarding what the patient and their family were experiencing. We raised our concerns about these 2 observations with senior leaders at the trust who advised they would investigate.

Patients did not always feel that staff listened to them and communicated with them appropriately, in a way they could understand. One patient on Willows ward were told to speak to staff when unsettled but said “the staff tell me to talk to them, but when I do they shut me down”. We observed Elm ward staff speaking to each in a language other than English in front of patients.

However, some patients experienced staff being nice and caring for them. A patient told us “A staff member sees me as a person and not as a number” patients told us that some staff would speak to them in a respectful way and behave respectfully. An example given was that some staff will knock on the bedroom door before entering. We received feedback from patients on Rowan 1 who told us they felt the staff were kind and caring and were available when they needed them. They also told us that staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Whilst on Rowan 1 we observed staff sorting out a birthday cake for a patient, we were told that birthdays were always celebrated. However, this was something that the staff paid for personally as there was no budget on the ward to pay for this.

The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Patients’ personal, cultural, social and religious needs were not always understood and met. We reviewed care records for a patient who identified as a gender different to that of their birth and we found no reference to this in the patient’s care plans. We were not assured that staff were aware of all patient’s religious beliefs and how to support them.

The trust provided a generic multi faith leader for staff but they did not have specific religious leaders. This meant that patients would not be able to access specific faith leaders. We were also not assured that staff took individual religious beliefs seriously. Staff described religious materials as “religious thingy’s”. We reviewed daily notes for a patient on Willows ward. The notes indicated that the ward only had a copy of the Quran in English and staff had not been able to provide versions in different languages. This had been requested by a staff member 2 days after the patient had been admitted onto the ward. At the time of our visit which was 8 days after the patient admission date this had still not been resolved.

When reviewing this patient’s seclusion records dated 25 January 2026 staff referenced difficulties “due to the language barrier and the fixation on religion”. Staff highlighted that this patient had “limited English” and required an interpreter. We found that throughout the patient’s episodes of seclusion staff had not requested an interpreter. However, by the time of our visit to the ward the patient was being offered 2 sessions a day with an interpreter.

We observed a pastor visiting another patient at their request during our inspection visit. Staff on Fir ward were respectful of a patient’s gender identity and used their preferred pronouns.

The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Patients were not always supported to maintain relationships and networks that were important to them. Not all patients had access to their friends and family while they were using the service. On Willows ward there was no flexibility offered to family and friends to enable them to visit their loved ones. The ward, which had 9 patients at the time of our assessment, only allowed visitors between 6pm till 7.30pm. There was only 1 meeting room available, for the 9 patients on the ward at the time of the assessment to have visits. This resulted in patients not always being able to see their family and friends. A patient told us of their dissatisfaction of having their family members turned away from the ward.

Patients did not always have access to activities to promote and support their independence, health and well being. At the time of our assessment, we observed informal activities on Redwood 1 and on Rowan 1, but we didn’t see any activities taking place on Willows ward. On Fir ward we observed that staff did not offer any activities and patients were all in their individual bedrooms.

However, patients were supported to have choice and control over their own care. Patients were able to access outdoor space, drinks and snacks. Patients were allowed their own phones, unless there was a specific risk. We observed patients utilising leave off the ward on each ward we visited. On Redwood 1 we observed family members supporting their loved one for off ward activities in the local community. On Rowan 1 we saw a range of activities being utilised by patients. Staff were supporting patients to play a game of cards and to play ping pong. Staff told us that the activities equipment, for example, the ping pong table, the basketball net and a games console were all purchased with funds raised by staff due to lack of trust funding available to improve facilities for patients. On other wards leaders raised concerns that they had no control over finances to purchase items, for example, outdoor furniture that would enhance patients’ experiences.

The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff did not always quickly recognise when patients needed help or support. We observed patients having to knock many times of the staff office on Fir ward, Elm ward, Redwood 2 ward and Willows ward to get the attention of staff who were inside the offices. On Elm ward we observed a patient in distress and asking for help who was ignored by 2 staff. A patient told us that staff ignore you until you “kick off”. However, On Willows ward we observed staff responding quickly to a distressed patient.

However, staff were alert to patients needs and took time to observe, communicate and engage people in discussions about their immediate needs. They found out how to respond in the most appropriate way to respect their wishes. Staff on Fir ward provided personalised interventions for a patient when they experienced distress. Staff on Rowan 1 included coping strategies in patients’ care plans.

The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Patients did not always receive safe, effective and person-centred care as the trust did not always recognise and meet the wellbeing needs of staff. Multiple staff told us they often worked 14 hour shifts with no break.

Patients did not always benefit from staff who had regular opportunities to provide feedback, raise concerns and suggest ways to improve the service or staff experiences. Staff tried to raise concerns about unsafe staffing levels and received no response from local or senior leaders. Elm ward had their baseline staffing establishment was reduced with no consultation. Nurses told us they used to have protected time to complete 121 sessions with patients and update patient care records, but this had been taken away by senior leaders, which impacted on their ability to complete these tasks and caused stress.