Nottinghamshire Healthcare NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement: This meant people’s needs were not always met. The service did not always ensure care provision, integration and continuity, it did not always listen to and involve patients, it did not ensure equity in experience and outcomes for all patients, and it did not support all patients to plan for the future.

However, the service ensured care was person centred, provided information and enabled equity in access.

This service scored 61 (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 a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff regularly involved most patients and those close to them (including carers and dependants) in planning and making shared decisions about their care and treatment, so it was centred around them and their needs. We found positive examples of staff involving patients and their loved ones in care and treatment plans. These included staff inviting families to ward rounds and patients’ views being sought. However, on Fir ward, staff had not created a person-centred care plan for 1 patient.

The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Patient’s care and treatment was not always delivered in a way that met their assessed needs. On Fir ward staff had not developed specific physical healthcare plans for 2 patients assessed as requiring these and staff were also unable to describe how they would support an autistic patient. Staff advised discharges were sometimes delayed due to a lack of appropriate support in the community.

However, there was continuity in patient’s care and treatment because services were flexible and joined up. Staff worked with local partners in the health and social care system to support continuity of care for patients. Staff were able to assert the need to continue to support patients’ whose discharge was delayed due to a lack of appropriate onward placement.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients, their family, friends, and carers were provided with information that was accessible, safe and secure and supported their rights and choices. Staff ensured that patients could obtain information on treatments, local services, patients’ rights and how to complain. Staff made information leaflets available in languages spoken by patients. Staff ensured carers, families and commissioners were regularly updated about the patient’s progress. Families were invited to attend ward rounds if the patient gave consent to this.

Patients could expect information to be tailored to individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who did not speak English as a first language. We saw evidence in care plans of staff accessing interpreters for patients who required this.

Patients could get information and advice that was accurate, up-to-date and provided in a way that they could understand and which met their communication needs. Most patients were aware of the section of the MHA they were detained under and said staff explained their rights to them.

Patients individual needs to have information in an accessible way were identified, recorded, highlighted and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. The trust reported that they produced a bank of easy-read information to support understanding of being under a section of the MHA, and other key information relating to legal frameworks such as, tribunals, deprivation of liberty safeguards (DOLS),community treatment orders (CTO’s), and advanced directives. They reported producing easy-read summaries for patients following the outcome of MHA assessments.

Information about patients that was collected and shared met data protection legislation requirements. We found all wards we visited had Information governance systems included confidentiality of patient records. All patient records were password protected and offices were not accessible to patients. Wards displayed patient information on white boards for easy access, this included mental health act status, observation level and any risk information. Staff kept this information out of view.

The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

Not all patients knew how to give feedback about their experiences of care and support including how to raise any concerns or issues and could not always do so in a range of accessible ways. On Elm ward patients raised concerns about the frequency of community meetings and how they were run. We reviewed records for community meetings between 1 October 2025 and 28 January 2026 and only 4 meetings had taken place, with staff recording in a previous meeting that patients wanted more frequent meeting. A patient told us staff did not control the meetings and patients would sometimes be running around. However, on other wards, patients told us they did have access to community meetings.

Patients, their family, friends and other carers felt confident that if they complained, they would be taken seriously and treated compassionately. The trust reported they received 15 complaints between 15 December 2025 and 29 January 2026. Of these, the trust reported 6 were upheld or partially upheld. The most common complaint theme was nursing care with 3 complaints received about this. However, 1 patient told us they did not know how to complain. The trust received 1 compliment for Rowan 2 ward during the same period.

Patients felt that their complaint or concern would be explored thoroughly and they would receive a response in good time because complaints were dealt with in an open and transparent way, with no repercussions. The trust advised there was a close working relationship between senior leadersand the PALS and complaints department, with regular meetings to discuss open complaints. Senior leadersregularly met withcomplainants to hear and resolve their concerns.

Learning from complaints and concerns was seen as an opportunity for improvement. We were told by leaders that the trust had brought in a model called ‘Triangle of care’ that supported receiving feedback from patients and carers. The Triangle of Care is a partnership model designed to ensure that carers are recognised as essential partners in mental health care. It involves three key participants: the person receiving care, their carers, and the mental health professionals supporting them. This approach emphasises collaboration, communication, and shared responsibility to improve outcomes for individuals with mental health conditions and their support networks. The trust advised they had commissioned an external complaints review to improve how they captured patients and carer’s voices when investigating complaints.

The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Patients could access care, treatment and support when they needed to. The trust advised they provided inpatient care for adults aged 18 and over who were experiencing a period of significant mental ill health and needed support or treatment that could not be safely offered at home or in the community. The trust said they would explore community based support first and only admit when it was safest and most helpful place for the patient to receive care.

Physical premises and equipment were accessible. Patients were given support to overcome barriers to ensure equal access. All the wards apart from Elm ward at Sherwood Oaks were on the ground floor, allowing good access for any patient with physical disabilities. Sherwood Oaks had a working lift that patients with physical difficulties could utilise when leaving the ward. We found each ward to be spacious and there was no visible hazards allowing easy access to each area on the wards. However, patients on Elm ward expressed concerns that they were not able to access the outdoor space easily.

The evidence showed some shortfalls. Staff and leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Patient’s care, treatment and support did not always promote equality, remove barriers or delays or protect their rights. We reviewed records for a patient whose first language was not English. Staff stated in the records that communication was difficult due to the language barrier. A senior leader made a dismissive comment about a patient’s religious practices to the inspection team. At Highbury hospital patients who required it could not access an Imam as there was only a multi faith leader available. This had a negative impact on Muslim patients and their families as this did not align with the requirements of their faith. We also observed a ward round for a Muslim patient, with their family and staff displayed a dismissive attitude to their faith in relation to how it impacted on the patient’s mental health. We spoke to a patient with a disability who told us staff didn’t support them to understand an upsetting incident that was occurring. However, this patient told us staff had supported them well to orientate themselves when they were admitted to the ward. High use of temporary staff impacted on consistency in the experiences of care patients received.

Staff on Rowan 1 ward were alert to discrimination and inequality impacting on patients and would actively seek ways to improve patient’s experience and outcomes. For example, meeting patients’ religious needs and supporting a patient with an asylum application.

Leaders were alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, organisational processes and culture or from individuals. They sought out ways to address these barriers to improve patient’s experience. At the time of the inspection the trust had recently implemented their Patient and Carer Race Equality Framework (PCREF) plan. PCREF is a national NHS England requirement for all mental health providers to co-produce a framework of actions toeliminateracial disparities in care.The objectives of the trust’s plan between 2025-2027 were to; establish PCREF governance with a fully functional steering group, deliver cultural competency improvements trust-wide, embed lived experience through feedback and co-production, monitor and evaluate delivery and meet NHS England expectations as required by March 2026.

The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Patients were not always supported to make informed choices about their care and while they had the capacity to do so. Staff had not completed advanced directives for all patients. Advance directives are about making/recording views and decisions on health care in preparation for a time in the future when a person may lack the capacity to consent to or refuse treatment. In mental health, this means that a person’s wishes can be taken into account if he/she ever becomes mentally incapable of making informed choices during a crisis.

When patients’ future care preferences were for greater independence and fewer care interventions that were likely to benefit them, professionals worked together to support them to achieve their goals. We found staff completed discharge planning for most patients and involved professionals from community teams and social care to support with this.