Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained the same.

This meant the effectiveness of people’s care, treatment and supported patient to achieve good outcomes.

Staff did assess the health needs of all patients on admission. However, there was an inconsistent approach in the completion of patients care plans.

Although the hospital had a range of treatment and care for patient this was not always available to patients.

Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

This service scored 63 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We were not assured that staff consistently assessed, planned and recorded care in a person-centred way or that all patients received timely physical health assessments.

We reviewed the records of a patient admitted to the National Learning Disability Service and found that staff completed a comprehensive mental health assessment promptly. However, although the patient was admitted on 13 January 2026, staff did not complete their admission blood tests until 2 February 2026.

Records showed that staff made several unsuccessful attempts to obtain blood samples because the patient had a fear of needles. However, staff did not document any plans or reasonable adjustments to explain how they intended to support the patient or overcome this barrier to care. As a result, the patient waited 21 days to receive admission blood tests.

We also found that several patients had either not received a sensory assessment or were awaiting assessment. As a result, we were not assured that staff had sufficient information to consistently identify and respond when patients' sensory needs were not being met.

Within the Women's service, staff did not routinely develop care plans for patients who experienced menstrual-related physical or mental health needs. For example, one record identified that a patient experienced heavy menstrual bleeding, required additional sanitary products and felt embarrassed discussing the issue with staff. However, staff had not developed a care plan that outlined how they would support the patient. In another case, staff had not documented how they would support a patient during her menstrual cycle while she was subject to mechanical restraint.

Although most care plans within the Women's Service were comprehensive and up to date, we found examples where staff had not reviewed or updated documentation. For example, one patient's Positive Behaviour Support Plan had been implemented on 9 February 2025 and had not been updated since. We also found an alert within the care plan which stated that only patients with a learning disability diagnosis required a Positive Behaviour Support Plan. This created uncertainty about whether staff should have reviewed and updated the patient's plan.

We found inconsistencies in the quality of care plans across other wards. Within the Mental Health Directorate, care plans were not consistently holistic and did not always clearly reflect the patient's voice. For example, staff had recorded information about clozapine monitoring requirements across several sections of one patient's records rather than within a single care plan, which increased the risk of omissions.

Staff also did not always record contingency plans and early warning signs appropriately. For example, one care plan listed, "I will be encouraged to speak to a named nurse and supported in my religion," as an early warning sign. This described an intervention rather than an indicator of deterioration.

In another patient's risk management care plan, staff focused goals and objectives on risks rather than recovery-based outcomes. For example, the plan stated, "I can present as irritable and find it difficult to tolerate being around others" and referred to a history of assaults following deterioration in mental health. Similarly, within a long-term segregation care plan, staff described risk management actions as goals, such as, "I need to hand in certain risk items prior to time out of LTS," rather than identifying therapeutic or recovery-focused objectives.

We also found that care plans within the Learning Disability Service did not consistently reflect patients' voices. In several examples, staff wrote plans in the first person but used clinical language that did not appear person-centred. For example, one care plan stated, "I can present as a high risk of assaulting others when in close proximity."

During our assessment, we reviewed 55 patient care records across all wards within the hospital. We found several examples of detailed care plans where staff had comprehensively assessed patients' needs, reviewed them regularly and documented them clearly. We found the strongest examples within the Women's Service.

Staff on the women's wards developed relapse and crisis plans, as well as advance statements relating to restraint and seclusion. We saw evidence that staff incorporated patients' views into care planning. For example, one patient's advance statement regarding restraint and seclusion stated: "Sometimes talking helps, and staff who know me well can support me, as I work better with staff I get along with."

The evidence showed a good standard. The service planed and deliver people’s care and treatment with them, including what was important and mattered to them.

Each directorate within the hospital had a complementary multidisciplinary team that supported patients. These teams included consultants, specialist medics, occupational therapists, clinical psychologists, diabetes nurses and specialist nurses.

The hospital had a physical healthcare department on site. The department operated similarly to a general practice surgery in the community. It contained specialist rooms where general practitioners, specialist nurses, physiotherapists and dietitians could see patients, and where patients could attend clinics. The physical healthcare department also included a dentistry service and facilities for optician appointments.

Department leaders told us that ward staff referred patients who required physical healthcare interventions or access to a general practitioner and the referral entered a triage system. Physical healthcare staff triaged patients as follows -Immediate care: staff identified patients who required treatment at the accident and emergency department of a general hospital. Urgent care: staff prioritised patients for assessment within 24 hours. Routine appointments: patients could book routine appointments.

The department adapted appointments to meet patients' individual needs. For example, when the hospital nursed patients in long-term seclusion, healthcare staff visited them rather than requiring them to attend appointments if they needed them to. We saw evidence of this in patients' records.

We found the physical healthcare department clean, welcoming and representative of community healthcare settings. The department displayed information for patients to read and employed physical healthcare escorts who supported patients to attend appointments off the ward.

The department also supported care and nursing teams by providing education on specific topics, including cancer screening, menopause and obesity.

Department leaders explained the importance of recognising the relationship between physical health and mental health.

We were assured that patients had good access to physical healthcare, including specialist services when required.

During our assessment, we identified patients who required nasogastric feeding. We reviewed how staff provided this treatment and observed them delivering care respectfully and compassionately.

Some patients required additional support with nutrition and hydration. Staff monitored food and fluid intake and tracked weight gain or loss where necessary. The hospital used the Malnutrition Universal Screening Tool (MUST) to identify adults who may be at nutritional risk. When we reviewed training data, we found that 38% of nursing staff had completed MUST training. Leaders told us they had made MUST training mandatory from June 2024. They had also introduced additional training, ‘Nutrition and Hydration’, as part of the Fundamentals of Care Physical Health (FOC) programme. Since the programme commenced in March 2025, 500 hospital staff had completed FOC training.

Mental Health Act

The trust reported 88% of staff had received training in the Mental Health Act. This meant that 88% of staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

The trust had relevant policies and procedures that reflected the most recent guidance which staff had access to at the hospital.

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.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We saw staff documented this in patients’ care records.

The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

During our assessment, we met with 52 staff members across all directorates. Staff consistently spoke with dedication and passion about their work at the hospital. However, they also expressed frustration about staffing levels and the impact these have on their ability to deliver care.

During visits to wards across all directorates, as well as off-ward teams, we observed a strong understanding of the importance of teamwork. However, staff told us that the frequent movement of staff away from their established teams was both frustrating and challenging.

Staff reported that members of the TES and Active Lifestyles teams often felt disconnected from ward-based teams. They also described inconsistent handover practices, with some staff receiving limited or no handover information at all.

We observed shift handovers and found them to be effective in sharing relevant information about patients. We also reviewed patient care records and found evidence that staff held regular and effective multidisciplinary team meetings.

The evidence showed some shortfalls. The service did not always support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The hospital recognised that there were patients who were clinically obese and staff were developing new pathways to support those patients. As part of the assessment, we were able to discuss healthy eating with the catering department. Leaders in the department were passionate at adapting the menu to offer patients healthier options. They were spending time with patients on the wards to receive feedback on menus. Staff and leaders throughout the hospital knew and recognised the importance of good quality food for patients and how it is something they look forward to.

However, at the time of our assessment no action on changing the offer on food had been embedded and change was still in process.

During our assessment we found that patients were experiencing limited access to a variety of physical exercise provision at the hospital. For example, swimming, gym, sports hall, walking groups, football sessions.

During our review of patients records and visiting the physical health care department we found that patients were able to routinely have cancer screenings.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Through our review of 55 care plans, we found evidence that staff used recognised rating scales to assess, monitor, and record patient severity and outcomes.

For example, staff used the National Early Warning Score (NEWS2), where appropriate, to identify early signs of deterioration in patients' physical health.

Staff completed and regularly reviewed both seclusion plans and long-term segregation plans.

Patients who required Historical Clinical Risk Management (HCR-20) assessments had these in place and under regular review.

Staff completed assessments and reviews for patients who were at risk of falls or who had experienced a fall.

We found that staff used technology effectively to support patients, including providing access to test results.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. Patients understood that the hospital's security requirements meant staff needed to manage some decisions, such as access to the community, confining patients to their bed spaces at the same time each evening and unlocking their doors at the same time each morning. Exemptions to these arrangements were made where individual risks required a different approach.

We saw evidence that staff read patients their rights on admission. Staff also read and recorded patients' rights during regular ward rounds.

For patients who may have had impaired mental capacity, staff appropriately assessed and recorded their capacity to consent.

When patients lacked capacity, staff made decisions in their best interests while recognising the importance of the person's wishes, feelings, culture, and history.

Staff enabled patients to make advance decisions about their care. We reviewed the records of a patient who was refusing treatment and found that staff and the multidisciplinary team supported the patient to make informed decisions and understand the potential consequences of refusing treatment. Staff documented this work in a person-centred and respectful way that recognised the patient's views and preferences.