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 requires improvement. At this assessment the rating has remained the same. This meant people did not always feel well-supported, cared for or treated with dignity and respect. Patients told us staff were kind and caring and we saw staff being respectful and discreet when interacting with patients. However, we also observed staff loudly shouting patient’s names to alert them to come for their medicine. This showed a lack of privacy and dignity. We found breaches in regulation under dignity and respect, premises and equipment and safeguarding. Managers did not always safeguarding patients from inhumane or degrading treatment for patients in long term segregation, patients were not always treated with dignity and respect, premises were not always accessible for disabled or bariatric patients, and equipment was not always available for patients who were bariatric or physically disabled. We asked the trust to address these concerns within an action plan.

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.

Patients told us staff were kind and caring. Patients told us ‘No one swears at us’. Transgender patients told us they were supported with kindness and to were able to be themselves. Patients on two separate wards told us that they heard swearing between staff, a patient told us ‘I don’t like it’. A patient on Brecon ward told us ‘Staff listen, they take notice if you are struggling’. We did however have patients tell us that some staff weren’t good, and they wouldn't interact with them and pushed them out of conversations. Patients commented that due to staff shortages they had staff with them that may not know them as well as regular routine staff. A patient told us ‘Different staff work differently and different rules’.

Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. We observed many interactions between staff and patients that showed an understanding, compassion and staff taking the time to listen to patients. However, whilst on Jade ward and Newmarket ward we observed staff loudly shouting patient’s names to alert them to come for their medicine. This showed a lack of privacy and dignity. We were aware that this action was due to low staffing, but it lacked awareness by staff to respect the privacy of patients.

Staff who we spoke with told us the importance of relational security at Rampton. This is having knowledge and understanding of the patient, the environment and themselves and the translation of that information into appropriate responses and care.

Staff said they could raise concerns to leaders and managers at ward level. They felt supported to raise concerns, but some staff told us they did not feel listened too by wider management.

Patients we spoke with told us how they understood how to complain. We observed ward advocates on the ward speaking to patients.

There were accessible documents for patients with a learning disability. Improvements had been made on the ward for deaf patients with the implementation of accessible information technology in each patient’s bedroom.

Improvements were shown in the further development in staff trained in British Sign Language. This included a member of domestic staff who works on the ward for deaf patients. Managers ensured that staff and patients had access to interpreters for patients whose English is not their first language.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups. Patients who were about to observe Ramadan told us ‘We have a special menu and staff support to observe this’.

Staff ensured that patients had access to appropriate spiritual support. We saw in care plans we reviewed that patient’s religious beliefs were documented and thought of.

However, the service did not always make adjustments for disabled patients. At the time of our assessment there were 7 patients who were medically classed as obese and did not have access to bariatric beds. This meant that their current beds were too small. We observed patients who required wheelchairs being supported to go the patient shop. An overweight patient had to utilise a standard size wheelchair which appeared uncomfortable. The patient told us ‘It’s so tight I hope I can get out’. Access to the ward for patients with a physical disability was problematic. We were shown the lift access for the ward, which was a service lift, this was dirty and would often break. Access to the main hospital from Brecon ward was not always safe for patients who used a wheelchair.We found it to be uneven, had potholes and lips on the curbs for wheelchairs to be lifted over. We observed a patient nearly tip out of their ill-fitting wheelchair due to the wheel getting caught in a pothole.

Staff did not always promote independence, choice and control. Patient care plans did not always include all areas of care needs. We found a patient’s shoulder pain and treatment was not included within their plans, meaning staff would not always be aware of the risks when supporting this patient. The trust updated this after we raised this with them. A patient told us that their choice of beverage had been changed recently, and they were not sure why as it had been agreed by their multi-disciplinary team 3 years ago. We saw evidence of this in their care plan. Staff told us it was a health and safety risk, but the patient was still frustrated by the decision as it had been accepted for the past 3 years.

Patients who we spoke with told us that activities were being cancelled due to short staffing. A patient told us ‘I haven’t had a walk on the grounds for 4 weeks. I want to see the flowers and have some fresh air’. A patient on Adwick ward told us that it took 4 staff to support them to exit their room and there had not been enough staff so sometimes this did not happen. Another patient on that ward told us ‘I’m going crazy in this room’.

There were patients at Rampton that were cared for in long term segregation (LTS). On Adwick there were 9 patients on LTS. The code of practice in the Mental Health Act states patients should have access to bathroom facilities and a suitable lounge, activities and fresh air. When patients couldn’t exit their room to access a lounge, fresh air and a shower (as only 3 bedrooms had ensuites with showers in them) due to staff shortages the code was not being adhered to. We reviewed when a patient had time out of LTS between the dates of 1 January 2025 and 26 February 2025. Out of those 55 days the patient only had 7 hours and 20 minutes out of LTS. Records showed the reasons why the patient did not go out of LTS, 3 occasions were due to staff shortages, 8 related to patient presentation and 7 occasions where they had chosen not to. We saw no evidence in the records to see if staff made more than 1 attempt to support the patient out of LTS.

Patients who we spoke with told us if they needed any immediate help, they had access to the physical health care team. A patient told us ‘If I feel ill, they come within a click of my fingers’. Patients we spoke with gave us of examples where appointments had been made to see different healthcare services including dentists and opticians.

We observed staff reacting immediately to deterioration in a patient’s health, through regular monitoring. Emergency out of grounds leave was organised and the patient was supported to a general hospital within hours of detection.

We saw how staff responded to alarms when additional staff were required to support patients’ behaviours that posed as a risk.

We observed the physical health team on wards we visited. We saw information on how staff could contact the ‘urgent care team’ for support. However, when speaking to staff on 1 ward they were not fully aware of the role of urgent care team and their role.

We observed a complex ward round for a patient with complex health matters. We observed how the multi-disciplinary team were taking a best interest decision in the patients welfare and how they could continue to support their wishes.

Staff and leaders are supporting a patient on end of life with compassion and kindness. We reviewed the patient’s care plan and saw how the care was being wrapped around their individual needs, wants and wishes.

We observed staff using de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened.

Staff did not always feel respected, supported and valued. Staff told us employment changes were occurring at Rampton hospital which had left them feeling de-valued and not listened to. Leaders of the hospital informed us that communications including emails and drop-in sessions had been made available, but staff felt more could be done.

Staff felt positive and proud about working for their base wards and felt supported well at ward level. However, staff who spoke to us told us that they didn’t feel that from the wider management team.

Staff told us that debriefs were offered after incidents. Sometimes these were after a long time since the incident occurred. Staff told us they witnessed a significant incident of severe staff assault a year ago and they still hadn’t received a debrief over it. However, we were told and saw examples of reflective practice on wards. These sessions were cancelled if staffing was low, but staff told us they valued this time.

Staff told us that when they were back to work following sickness, they did not always receive back to work interviews. A staff member told us how they were dealing with an ongoing illness with no support from occupational health or a risk assessment in place for working on the wards.

Staff told us that morale at the hospital was very low. Staff prepared to move wards daily to support other wards. Staff told us due to low staffing numbers, sometimes they didn’t get time allocated to have a break or even time to get to the toilet.

Staff who worked night shifts told us sometimes they were lone working. Part of the role of night team leader was to go onto each ward during the shift to check in with the staff on duty. We reviewed data on Evans ward and from 1 to 26 February 2025 the night shift leaders only came 9 nights over the 26. Staff told us that when they were lone working, they couldn’t have a break or go to the toilet.