Nottinghamshire Healthcare NHS Foundation Trust

Ratings - High secure hospitals

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Requires improvement

Our view of the service

We completed a fully comprehensive assessment of Rampton High Secure Hospital with a site visit on 14, 15, 16 and 21 April 2026.

This assessment included both visiting the services early in the morning and during the night.

We conducted this assessment in response to concerns raised by whistleblowers and patients who had contacted the Care Quality Commission (CQC). We received concerns regarding patient safety and staff wellbeing due to low staffing levels. Through our regular engagement with the hospital, we became aware of an increasing number of occasions where patients were experiencing daytime confinement as a result of staffing shortages.

Rampton High Secure Hospital is run by Nottinghamshire healthcare NHS Foundation Trust. The hospital has 5 directorates that include 3 National services. At this assessment we visited every ward on each directorate and visited all the patient’s facilities within the hospital.

The directorates are:

• Personality Disorder directorate- Brecon ward, Cotswold ward, Hambleton ward, Malvern ward, Eden ward, Cheviot ward
• Mental health directorate- Carlise ward, Cambridge ward, Canterbury ward, Adwick ward, Quantock ward, Evans ward, Erskine ward
• National Deaf service- Grampian ward
• National Women’s service- Emerald ward, Ruby ward, Jade ward, Coral ward, Topaz ward
• National Learning Disability service- Kempton ward, Cheltenham ward, Newmarket ward, Aintree ward

Our assessment of Rampton High Secure Hospital was unannounced. As part of the assessment, we also carried out 2 visits which were during the night and early morning.

During the assessment we were able to speak to patients, staff and leaders of the hospital. We looked at various documents related to how the hospital was being managed and information related to the care and treatment of patients. We attended meetings and observed activities.

At this assessment, we rated the hospital as Requires Improvement. We identified 7 breaches of regulations relating to staffing, safe care and treatment, dignity and respect, person centred care, premises and good governance.

Hospital leaders did not consistently ensure that sufficient staff were in place to deliver effective care and treatment. Staffing shortages routinely resulted in the cancellation of patient activities, impacting the delivery of care and the patient experience.

Leaders did not always ensure that staff possessed the necessary training, skills, and competencies to meet patients' needs safely and effectively. As a result, care and treatment were not always delivered in a safe manner, and the management of medicines did not always follow safe practices.

The hospital environment was not fully accessible for disabled patients, and appropriate equipment for bariatric and physically disabled patients was not always available. These shortcomings meant that care and treatment did not consistently meet the needs of all patients.

In addition, leaders did not have effective systems and processes in place to identify, share, and embed learning from concerns raised by external bodies. Systems for recording and monitoring staff movement were also not effective, limiting oversight and assurance regarding workforce deployment.

The hospital had a vast and well-maintained range of off ward facilities. For example, several gyms, swimming pool, workshops, library, horticultural area, sports halls, patients’ food shop, clothing shop, place of worship and each directorate had their own day service facility.

When patients moved from different wards their care records and information went with them to enable a smooth transfer.

Ward teams who were supporting patient with advanced directives supported them with kindness, dignity and care. They had worked with patients to enable their wishes were taken on board and respected.

However, we observed improvements in person-centred care within the National Women's Service alongside embedded improvements in the National Deaf Service.

Within the National Women’s Service, they had developed a person-centred approach to support menstrual health and cancer screening.

The hospital had implemented several changes into improving the quality of care at the hospital. For example, changes to food offered to patients to support a healthier lifestyle and a project in the National Women’s Service named Dynamic Environmental Risk Management (DERM). The project aimed to reduce reliance on enhanced observations by adopting a more dynamic approach to risk management, focusing on the interaction between patients, staff, and the ward environment rather than increasing staffing levels to manage risk. However, this work was at the beginning stages of deployment and was not embedded at the time of our assessment.

We have asked the trust for an action plan in response to the concerns found at this assessment.

Mental Health Act and Mental Capacity Act Compliance Summary

Staff were trained in and had a good understanding of the Mental Health Act 1983, the Code of Practice and the guiding principles.

The trust had relevant policies and procedures that reflected the most recent guidance.

We saw evidence that staff informed patients of their rights under the Mental Health Act and the service provided appropriate access to advocacy.

Patients had easy access to information about independent mental health advocacy. Patients knew who their advocate was and how to contact them. We saw the advocacy team on wards meeting with patients during our assessment.

People's experience of this service

During our assessment we spoke to 76 patients.

One patient told us that it’s hard being at Rampton, but the staff make it better.

Patients we spoke with told us that they found the staff, kind and caring and good at what they do.

Patients were dissatisfied that their activities were constantly being cancelled. They felt demotivated and frustrated. A patient told us that they had no reason to get out of bed as there was nothing to do. Another told us that due to the frustration of having their activities cancelled they self-harmed.

Most patients were concerned over the welfare of the staff. Patients told us that they can see staff don’t get breaks, that staff don’t get a chance to go to the toilet or have food.

Most patients were unhappy that staff were not regular and that made them sometimes feel unsafe as they didn’t know them well enough.

Patients enjoyed the food but sometimes felt the portions were too small.

Patients told us that they knew staff were there to care for them and they felt comfortable speaking to staff.

Patients who required interpreters told us that if the hospital couldn’t get interpreters, then their visits were cancelled, which was disappointing.

Patients told us about the variety of things to do at the hospital and the importance of being able to access these. A patient told us that they most enjoyed having their hair straightened at the salon as it helped them relax but they were upset as they haven’t been able to do this due to lack of staff.

We were told by patients that they liked going to the church within the hospital. They told us that they liked the social events when they happen.