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 hospital involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has stayed the same. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

Staff did not always respect patients’ privacy and dignity. They did not always understand the individual needs of patients and did not support patients to understand and manage their care, treatment or condition.

However, most staff treated patients with compassion and kindness.

The hospital is in breach of legal regulations in relation to privacy and dignity.

This service scored 40 (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 some shortfalls. The service was not always treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

At the time of our visit, patients in the women's service had to dispose of sanitary products in paper bags and either hand them directly to staff or find a member of staff to unlock a restricted disposal area. Patients expressed mixed views about this process. One patient told us there was "no shame" in doing so. However, other patients felt that the arrangement lacked privacy and made their menstruation visible to others. One patient described it as a "walk of shame", while another told us, "It feels embarrassing giving pads to staff."

Female patients also told us they felt disadvantaged compared with male patients because essential items such as bras counted towards their property allowance. Patients explained that they often required additional underwear during menstruation and felt that hospital policies had not adequately considered the specific needs of female patients. The trust's policy permitted patients to have a maximum of 120 items of property, 70 items being for clothing and footwear. Leaders of the hospital explained that patients have access to their property which is based in a central storage area so that they can rotate what they have.

A patient with physical disabilities showed and explained to us how the layout and lack of accessibility within their bedroom meant they had to use a communal bathroom on the ward. To transfer onto the toilet, the patient had to hold onto the toilet bowl for support. The patient told us they could not be sure whether it was clean when doing so. Because staff respected the patient's privacy when using the bathroom, they were unaware of the difficulties the patient experienced when transferring. This situation exposed the patient to a potential risk of infection through contact with the toilet bowl and negatively affected their dignity. We raised this concern with hospital leaders for investigation.

Patients on the deaf service ward told us that staff listened to them. However, they expressed frustration that staff who were trained in British Sign Language (BSL) had been redeployed to other wards to cover staffing shortages.

Despite these concerns, we observed many positive interactions between staff and patients.

Staff demonstrated discretion and treated patients with respect. During our visits to the wards, we observed staff treating patients with kindness, compassion and care. Patients consistently provided positive feedback about staff. One patient described staff as "friendly", while another said they were "amazing". A patient on one of the personality disorder wards told us it was the "nicest and calmest ward" with the "best staff".

Patients on the women's wards also spoke positively about staff. They described them as "lovely" and said that "staff are great". One patient told us that the hospital chaplain was very kind, caring and "helps me relax". Although one patient raised concerns about staff swearing, feedback about staff was otherwise positive.

Patients using the learning disability service told us that most staff were friendly and kind. They also said that, although not all staff demonstrated these qualities consistently, regular staff did the "best they can". One patient told us, "Staff are nice, and you can talk to them about things."

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. The service did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

During our last assessment of the hospital, we raised concerns about the treatment of patients with physical disabilities. These concerns remain.

The hospital had a dedicated ward for patients with physical health needs; however, it was not located on the ground floor. Although most patients could manage the stairs, the ward lift was a service lift and was visibly dirty. Staff told us they could use a lift on another ward if required. However, this would require patients to access a different ward, which could create risks associated with mixing patients from separate areas.

We found that access between the Personality Directorate and the main hospital was not always safe for patients with restricted mobility. The route was uneven and contained potholes and raised kerbs, requiring wheelchair users to be lifted over some areas.

However, we heard that bariatric wheelchairs were available when required, representing an improvement since our last assessment.

The hospital considered patients' requirements for larger beds; however, it did not always provide them in a timely manner. One patient told us they were waiting for a larger bed but did not mind because they preferred sleeping on the floor.

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

During our assessment, we were not assured that the hospital consistently enabled patients to experience independence, choice and control. We understood that staffing constraints contributed significantly to these limitations. Leaders acknowledged these challenges and described the actions they continued to take to improve patients' experiences and increase opportunities for independence.

Patients told us that these limitations negatively affected their wellbeing and resulted in boredom and low motivation. One patient told us, "We sometimes feel like there's no point in getting out of bed because there is nothing to do all day." Another patient, who had been at Rampton for many years, told us that the lack of activities had led them to self-harm out of frustration. They described an incident where they self-harmed and required treatment after staff cancelled a planned activity.

Patients frequently described frustration when they could not access activities that were important to them, such as horticulture or the library. One patient told us that visiting the salon to have their hair straightened was one of their favourite activities because it helped them relax. However, staff frequently cancelled these appointments.

Patients throughout the hospital spoke positively about the importance of activities and the difference they made to their wellbeing. However, many told us that staffing shortages often prevented them from accessing these opportunities. One patient told us they had started a gardening project but had been unable to continue because of staffing shortages. Another said, "I can't go to the main gym as much as I want to. Sometimes there's a delay getting to the shop, but there isn't really enough staff to take us off the ward." A further patient explained that when staff cancelled sessions, they lost opportunities to socialise with other patients and participate in activities that supported their recovery. They felt ward-based activities were limited, stating, "You can only play football on the Switch so many times."

Another patient told us, "I want to do cooking. I'm waiting for OT to assess me, but they are busy." One patient said, "When there are staff, we get to do exercise," while another explained, "If there are enough staff, we can go outside, but if not, we can't." One patient described feeling "sedentary" and bored.

Staff from both the Therapy, Education Services (TES) and Active Lifestyle teams understood the importance of activities and recognised the benefits they brought to patients' mental health and recovery. Most staff expressed disappointment and frustration when they had to cancel activities. One staff member told us that repeated cancellations had affected their relationship with patients because patients were beginning to lose trust in them when planned activities did not take place.

Staff also reported that patients were losing motivation to engage in activities because opportunities had become infrequent. They described supporting a patient to improve their literacy skills; however, repeated cancellations had resulted in the patient losing some of the progress they had made.

We reviewed records maintained by Active Lifestyle staff that detailed occasions when leaders redeployed them to cover ward duties between 1 August 2025 and 1 January 2026. Staff explained that they kept their own records because the trust did not record redeployments of four hours or less. During this period, leaders redeployed Active Lifestyle staff on 280 occasions, amounting to 1,358.6 hours. Redeployments ranged from one hour to 12.5 hours in duration.

We also reviewed TES data, which showed that between December 2025 and the date of our assessment, staff lost 926.65 hours of activity sessions because they cancelled planned sessions.

The hospital had effective arrangements in place to help patients keep in touch with family and friends. Staff facilitated patients' access to ward telephones so they could make calls. However, patients within the personality disorders directorate told us they felt that the ward telephones did not always provide a fully confidential space for patients to speak with their loved ones. Patients understood that staff monitored some calls for safety and safeguarding reasons when necessary.

One patient told us, "It's hard to be at this hospital, but the staff make it better." Patients understood that being in hospital restricted some aspects of their lives. One patient told us, "The hospital should be mindful about confining people early because it winds people up and we can't call family."

The hospital facilitated family and carer events that enabled relatives and carers to engage with hospital staff. Leaders spoke positively about the success of these events. The hospital also recognised that some relatives and carers travelled long distances to visit patients and therefore provided accommodation close to the hospital.

Patients could send and receive post. Staff monitored correspondence when necessary for security reasons, and patients understood the reasons for this.

We saw that staff recorded patients' interests and what was important to them within their care records. For example, one patient with a keen interest in motor racing displayed posters in their room, and staff regularly engaged them in conversations about the sport.

The hospital operated a small shop on the hospital grounds that patients could access to purchase products. Patients valued this facility because it reflected a community experience and provided a sense of normality. The shop operated like a small supermarket and stocked a range of items, including snacks, drinks and beauty products. Patients spoke enthusiastically about the shop and told us it provided a valued connection to everyday life. We saw staff making efforts to ensure patients attended planned shop visits.

Leaders had made significant improvements to help deaf patients remain connected to the Deaf community. The hospital had installed technology within each deaf patient's bedroom area that enabled patients to access Deaf culture programmes and view their care plans in an accessible format. Patients frequently used the Deaf channels available to them and spoke positively about them.

The hospital also operated a Deaf club for deaf patients. We had previously raised concerns that one deaf patient on another ward could not attend. Leaders explained that identified risks prevented the patient from mixing with the group and that they had offered video-link access as an alternative. Despite this, the patient continued to feel excluded and isolated because they could not interact directly with their community.

During our assessment, we visited every area available to patients across the hospital. The range of facilities was extensive and included a library, general shop, clothing shop, swimming pools, gymnasiums, multi-use sports halls, an events hall, places of worship, and a variety of skills-based activity areas such as woodwork, reprographics, cookery and horticulture. We were also introduced to one of the hospital's guinea pigs, which patients clearly regarded as a valued and treasured member of the hospital community.

Staff recognised that these activities and facilities played an important role in supporting recovery, wellbeing and quality of life. The TES and Active Lifestyle teams demonstrated commitment, motivation and passion in delivering these services. However, the trust's reliance on TES and Active Lifestyle staff to cover ward duties, rather than deliver planned activities, reduced patients' access to meaningful activity and negatively affected both patients and staff.

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.

Whilst reviewing seclusion records within the mental health service, we found that staff placed a patient in seclusion following an episode of distressed behaviour. Staff identified that the patient may have sustained an injury during the restraint. They documented visible signs of injury and recorded that the patient reported pain. Staff sought advice from the duty doctor, who agreed that the patient should attend the local Accident and Emergency (AE) department for assessment.

Records showed that physical healthcare staff reviewed the patient, this included ward doctor and consultants. However, documentation showed that due to a lack of transport and staff available there was a delay of 24 hours for this patient to receive treatment

Staff noted swelling extending from the mid-forearm to the mid-hand. They could not check the patient's pulse, and the patient could move their fingers only minimally within the documentation covering the approximately 24-hour period between the incident and the patient's transfer to AE, we found no recorded evidence that staff offered or administered pain relief. We also found no evidence that staff provided the intermittent ice packs clinicians had recommended to reduce swelling. Leaders told us that duty of candour was applied following this incident and that a meeting involving the patient, their responsible clinician, clinical manager and advocate to discuss the incident, where a formal apology was offered.

We found staff had used inappropriate terminology in a patient record whilst describing a distressed behaviour. Staff recorded one patient with a learning disability who was awaiting a sensory assessment as carrying out a "dirty protest" when they smeared faeces. There was no evidence of staff reviewing if this patient had an un met sensory need.

Despite these concerns, we found examples of staff identifying and responding appropriately to risks affecting patients and risks posed by patients.

Staff had completed training in de-escalation techniques to reduce the need for physical intervention when patients' behaviour became heightened. We confirmed that the hospital made this training available to staff who were not based directly on the wards, and training records showed that these staff had also completed the training.

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

We spoke with more than 52 members of staff working across a range of roles and departments within the hospital. Despite the concerns they raised, staff consistently described their commitment to patients and their desire to provide high-quality care.

However, despite the actions being taken by leaders, these improvements had not yet become embedded across the hospital at the time of our assessment.

The most consistent feedback we received from staff related to staffing levels and workforce pressures. Staff described feeling "broken", "demotivated" and "struggling". They told us that the frequent movement between wards and uncertainty about their work location at the start of shifts caused significant frustration and anxiety.

We saw evidence that Therapy, education staff (TES) staff and Active Lifestyle staff were regularly redeployed from their substantive roles to support ward staffing requirements. Staff told us that this affected their ability to carry out the duties for which they had been employed. Some staff had altered their working hours in an attempt to undertake their contracted roles rather than routinely covering staffing gaps on wards. Staff also shared examples of difficult situations they had experienced on wards, which they said had a lasting emotional impact on them.

Staff described the benefits of workplace wellbeing plans, which are based on the Health and Safety Executive (HSE) Management Standards and are intended to identify measures that promote psychological wellbeing at work. Staff told us these plans had been important in supporting their wellbeing. However, they expressed increasing anxiety because some plans were coming to an end and others had been informed that managers had been advised not to complete any new plans. As a result, some staff felt uncertain about what support remained in place to protect and promote their wellbeing.

Leaders told us that wellbeing plans were not a mandatory requirement and were managed locally by individual line managers. However, the organisation did not maintain a central record of how many wellbeing plans were in place. Consequently, we were not assured that senior leaders had effective oversight of staff experiences, concerns, and wellbeing across the hospital.

Staff provided examples of situations where colleagues were not included in break allocations, resulting in staff remaining on observations for extended periods without access to food or toilet breaks.

Although leaders had identified the causes of staffing pressures and had implemented measures to address them, staff continued to report significant strain. Many told us that they did not feel their wellbeing was being adequately considered. Several staff had submitted incident reports in the hope that senior leaders would better understand the impact that ongoing staffing pressures were having on staff morale, wellbeing, and their ability to undertake their substantive roles.

Throughout the assessment, patients across all directorates shared concerns about staff wellbeing. Patients recognised that staff were not always able to take breaks and worried that some staff were missing meal and toilet breaks.