Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question require improvement. At this assessment the rating has remained as requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. Due to concerns raised by staff and patients during this assessment we reviewed the quality statement safe and effective staffing. Staff reported incidents where the wards were not meeting safe staffing levels and incidents where patient activities were cancelled due to low staffing levels. We found managers did not ensure there were sufficient staff deployed to ensure minimum levels were achieved. Although the service had systems in place to help safeguarding patients and staff some wards staff were lone working at night over 15% of the time, which did not allow them to take adequate breaks. We have asked the trust to submit and action plan to address the staffing concerns.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service did not always have enough nursing and medical staff, who knew the patients, or to deliver planned care.

Staff we spoke with said activities and therapies were frequently cancelled and patients were very frustrated, annoyed, and occasionally angry when this happened. There were 500 instances between 1 March 2024 and 27 February 2025 where staff had submitted incident forms where therapy and activities for patients were cancelled due to staffing issues. Patients we spoke with told us that activities get cancelled due to staffing. One patient told us ‘I have been waiting to do cooking; it’s been cancelled for 5 weeks due to staffing’. However, this equated to only approximately 2% of the total number of activities offered to patients.

Managers told us wards hardly ever had the number, experience and gender of staff required to keep patients and staff safe. During 1 March and 27 February staff had submitted 777 incident forms where the reasons stated were clinically unsafe staffing. A patient told us ‘We can see the red alerts on the tablets, I know that staff could be late to do observations, if I hurt myself, I’m scared they will be too late, it could be life or death!’.

Between 1 December 2024 to 5 March 2025 405 therapy and education staff were redeployed to the wards for 4 hours or over to support safe staffing fill rates and patient safety.

Data submitted by the trust showed that staff were lone working at night on the wards for 667 hours between 19 December 2024 and 2 March 2025. Managers we spoke with said staff felt anxious, isolated, and unsafe when working on their own.

There were 448 absences reported over the 3-month period from 1 December 2024 to 5 March 2025 reasons for absence included, other, did not attend, car problems, not disclosed, personal and childcare.

We spoke with 20 staff they told us they were regularly moved from their regular ward to support other wards; this was frequently in a different clinical pathway at the hospital. They told us they often felt a lack of confidence when working with different patient groups and sometimes unsafe.

Managers said they tried to ensure equity when staff were being moved however some staff were repeatedly moved.

After the assessment the trust leaders provided assurances around staffing measures that they had in place including pairing wards to minimise lone working at night and ensuring therapy, education staff were redeployed to wards they were due to support with activities on. The service was also in the middle of a large recruitment drive which included 34 Healthcare Assistants and 9 Registered Nurses in process of being onboarded to join the team.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.