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

Staff understood patients' individual needs and patients felt safe on the wards. Staff were always available to support patients and supported them with daily tasks. Staff encouraged and supported patients to partake in activities. Patients were involved in their care and treatment and had an active voice in their ward rounds, where they were able to voice their opinion on their care and treatment and their preferences. Patients had access to advocacy services and were also encouraged to voice their opinion at regular community meetings. Staff felt supported by managers and leaders actively sought the opinion and views of staff and patients in the development of the service.

This service scored 75 (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 Kindness, compassion and dignity during this assessment. The score for this quality statement is based on the previous rating for Caring.

Patients told us staff understood them and understood their history. They told us staff supported cultural and spiritual needs. A patient with impaired vision told us they were frustrated that they didn’t have glasses (as they were broken), staff explained to the patient how they were going to organise advocacy to support them due to an issue with getting a new pair. The patient was listened to and was thankful for the staff understanding their needs. They told us staff supported them around the ward, so they were not at risk of falling. A patient told us after their behaviour was unacceptable towards another patient “I was not met with feeling judged but met with kindness, support and compassion”. However, a patient told us staff had told them “They should be in a care home” and they felt they annoy staff with the physical needs they have.

We spoke to a student nurse who told us their induction to the hospital and the wards was ‘very good’, and time was spent being told about each individual patient and what made them who they are. Staff showed an example of how they had created a personal pictorial document ‘blob people’ so they could communicate with a patient who was autistic. They explained that the patient engaged with it very well and how it was made for them and no one else.

We observed staff supporting patients on each ward with activities that were suited for them. We saw patients producing diamond art. One patient told us how much they enjoyed doing this type of art and how they found it helped with focus. Their art was displayed, and we also saw staff interacting with the activity. A patient with impaired vision was supported to take part in a card game with large print. Although the activities were restricted due to the patient’s vision staff supported them to take part to keep them engaged. We saw staff using patients preferred names and saw this reflected in documents. We observed a patient had changed their name due to their religious beliefs and we saw staff talking to them using their preferred name. However, there were inconsistencies with how staff referred to this patient within documentation. We raised this with staff and leaders and documentation this was addressed immediately.

We saw evidence in care plans of how staff recorded patients’ needs, likes and how they wanted to be cared for. Leaders told us about the implementation of a patient involvement support worker, who has supported patients to voice how they want to be treated. The role has also supported patients be involved in co-producing pieces of work to support learning for new staff coming on to the wards.

Patients told us they were supported to call family and friends, choose activities, meals and do their own laundry. They were given the opportunity to speak at ward rounds around their care and support and their preferences. We were given examples of how patients had spoken up regarding their concerns about how Coniston ward was being closed. The patients told us that although they hadn’t been told an exact date they felt informed throughout the process.

Staff we spoke with told us how they support patients to have choice and control over their care and treatment. They told us patients were supported to have their choices heard through ward rounds and other ways, including community meetings. We were told about the work being done by the patient involvement support workers and how this was supporting patients to speak up about how they wanted to be supported. We were told on the day of the assessment a coproduced video was shown to new members of staff during their induction. The video was to help staff understand how to support people with mental health needs, specifically in the service.

We saw patients on Connack ward getting ready for a game of monopoly, an activity that the patients had chosen to do. A patient told us ‘This afternoon we have decided to play a game of monopoly together’. We saw other examples on the other wards where patients were choosing what they wanted to do in terms of activities. We saw on each ward there were facilities for patients to complete their own laundry and support in place if they needed it. Whilst on Coniston ward we saw how a patient requested to change the time of their ward round due to how they were feeling at the time, this was listened to and altered as per the patients request.

Forums and community meetings were being held regularly on each ward where patients could speak up about their care and treatment. The work with the patient involvement support workers was supporting patients to co-produce information, experiences and focus staff awareness on specific patient needs. The service supported advocacy to be available for the patients and patients had access to social workers to supported them.

Patients told us staff were available if they needed them and they felt comfortable in asking for support. A patient told us they had been experiencing dental pain and after a recent dentist appointment was cancelled the staff offered the patient alternative pain relief to support them as they knew the patient may have been in more pain due to the wait to be seen by a dentist. The patient told us they felt cared for.

Staff told us that due to knowing and understanding their patients, they felt confident in recognising when patients needed urgent help. Staff told us how relational security was very important in understanding patients’ needs and anticipating further support when needed.

Whilst on Coniston ward we observed staff manage a medical emergency. The situation was managed quickly and effectively. The ward remained calm by the support being given to patients by staff around them.

We reviewed care plans on each ward and found examples of how staff recorded needs and preferences with how patients wanted to be treated. Ward rounds, forums and community meetings were held regularly for patients to engage in how they want to be treated.

Staff we spoke with told us supervisions happened regularly, and they felt they could speak about any issues with their line manager. The service had had a period where some wards had been without ward managers. The leaders of the service placed interim measures, so staff were supported. Staff told us these were successful, and they felt things had been managed well during this time.

We were informed that Coniston ward would be decommissioned next year and transformed into another ward type. Staff told us this was a worrying time. However, leaders of the service had met with staff regularly to speak about developments and patient meetings had also been developed to include this. Staff told us in house away days had been devised house to discuss learning. Patients on Coniston ward also had ‘in away days’ too. Although staff told us they felt nervous of the changes coming they felt supported, and leaders had provided ample opportunities to discuss and gather feedback about the process.