Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Staff and clinicians at the service did not always feel valued or listened to by senior leaders. Staff felt detached from the wider trust and questioned whether very senior leaders were aware of staffing issues at the hospital as they had planned to open an additional ward even though there were concerns around staffing.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with staff on women’s wards, described how they had been involved in a reconfiguration of the service, whereby both staff and patients were supported to move within the pathway to effectively meet clinical need.

Managers told us they were concerned about a plan to reorganise matron cover across the hospital. They had presented their comments and reservations regarding the proposals to the senior team; however, they were uncertain as to the impact of the plans on leadership on the wards.

Staff we spoke with told us there were plans to open an additional male ward, they were concerned as the ward was due to be staffed within current establishment levels which meant existing wards would be seriously depleted of staff. They also said that communication regarding the proposals had been sporadic which had an unsettling effect within teams.

We were told although listening events were held within Rampton hospital, staff were not able to attend due to low staffing.

Senior clinicians we spoke with told us they felt sidelined and undervalued, perceiving that Rampton Hospital was too operationally focused without a balanced approach between clinical and operational leadership. This had led to friction and frustration amongst the team. We were told there was a lack of strategic vision and concerns about Rampton Hospital not having its own governance structure.

Staff we spoke with said they felt detached from the wider trust and questioned whether very senior leaders were aware of staffing issues at the hospital.

Wards staff said matrons were generally visible and supportive, but they did not see or know the names of senior leaders.

Managers we spoke with said they felt there was limited visibility and oversight by the Senior Management Team (SMT) and Executive team, and their understanding of ward functioning and staff wellbeing. Whilst managers we spoke with knew how to escalate concerns to the SMT, they said their response felt very ‘detached, corporate, and political.’

We saw all staff we spoke with had an individualised wellbeing plan in place.

Staff we spoke with told us they were reluctant to raise concerns with the freedom to speak up team and that there was a lack of trust in how their concerns would be managed. This was because the hospital had a very close-knit staffing group who had worked together over many years. They reported that staff and managers were friendly out of work, went on holidays together and were often related to each other, which they told us deterred them from raising concerns. Two staff said they had raised issues but there had been no follow up and they felt snubbed by their peers following this.

Leaders told us they had reservations about directly raising concerns with the executive team. They felt that very senior leaders had a focus on self-preservation rather than addressing the bigger picture particularly regarding high secure services.

We spoke with 20 staff, 1 staff member stated that raising awareness about racism was not a primary focus for the senior leadership team.

One member of staff told us they had recently experienced racism and bullying from colleagues within the hospital. They said they were reluctant to report this as they felt this would affect their career progression prospects.

We requested themes of concerns raised to the trust from the freedom to speak up guardian and the unions over the last 3 months and we found no concerns specifically regarding racism had been raised. However, both bullying and harassment and discrimination were found as themes.

The hospital employed peer workers with lived experience to assist patients where appropriate.

All staff we spoke with had an individualised wellbeing plan. After the assessment the trust assured CQC they had a comprehensive Equality, Diversity and Inclusion and Racism project in place, which provided events, training, and support for staff.

We attended one forensic performance meeting where there were representatives across high, medium, and low secure services. Topics considered included quality, audits, workforce and training, staff engagement and wellbeing, staff redeployment and finance.

Although the number, risk, trends, and instances of staff redeployment to other wards at Rampton Hospital was referred to at the performance meeting there was no indication of escalation, mitigation, or management actions to reduce staff moves.

Whist some of the data discussed was specific to Rampton Hospital the majority referred to other forensic units within the trust. This meant that a further report was required for managers to have specific oversight of performance at Rampton Hospital.

Whist leaders told us they followed the trust policy and procedures regarding sickness they were unsure as to guidance regarding the management of staff who contacted the hospital with a variety of reasons for very short-term absences. Staff told us they thought this was acceptable if they “worked the shift back” within the month, however they said this caused significant challenges when the wards were left short of staff at short notice.

Staff told us they were concerned about the proposed restructure of the matron role across the hospital. They said they thought the role of the quality matron would be incorporated into the ward manager role which would significantly reduce their capacity to fulfil their role.

We saw staff effectively communicated with other providers such as local acute trusts, the prison service and NHS and independent providers of forensic in-patient care.

Staff carefully managed additional support to patients whilst they were inpatients in general hospitals, this included providing appropriate numbers of experienced staff to ensure safety.

Patients we spoke with said there were identified patient representatives from the wards to collate and give feedback to the hospital managers about a variety of topics for example food, restrictive practices, and service improvements.

Staff told us planned reflective practice sessions were frequently cancelled due to staff shortages.

We were told that timely completion of incidents was challenging and sometimes were missed as staff did not have the time to complete due to clinical and staff pressures on the ward.

Staff had developed a trauma-informed cervical screening pathway which had been integrated into the women’s service to ensure that all women have access to cervical screening.

Additionally, we were told there were plans for a mobile breast screening unit to visit Rampton, benefiting both patients and staff members. Furthermore, staff said there was a strong emphasis on menopause wellbeing for both patients and staff, ensuring that everyone's health and wellbeing are prioritised.