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

All locations we visited now had embedded learning culture within meetings with staff. Patients were involved in discussing risk and regular multidisciplinary meetings took place. Staff always informed patients of the impact of medication. We found Safeguarding was an embedded practice at all locations we visited. There was a consistent approach to risk management during weekly across all locations. We saw staff escalated risk in a timely way and how staff advocated on the best support path for their patients. All areas of the service were clean at the time of the onsite assessment. However, we found the clinic room cleaning checklists were not always completed as intended. The services based in the county were having difficulties with staff vacancies and increasing levels of staff sickness.

This service scored 56 (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 checked up on them regularly and discussed risk with them.

We spoke to staff and leaders of each service and patient risk and safety was an embedded culture. Staff told us how things had changed due to the section 48 review and how new strategies had been put in place to monitor risk and how waiting well calls were happening for patients waiting for assessments. Risk was on every agenda at each meeting and discussed within supervision as well. Trust wide emails were now being sent out discussing any learning. However, staff we spoke with told us they did not have time to read these. The services based in the county were having difficulties in staff vacancies and increasing levels of staff sickness. This affected one of the services we assessed, which meant other services were supporting caseloads and duty cover for that location. Staff and leaders, we spoke with told us this was a trust initiative to ensure risk oversight was in place and locations were not left when they were understaffed. However, staff told us of the pressure they were under and how to keep control of risk they would work over their hours and expressed their struggle with their own well-being. This was raised with leaders, and they told us they were working hard to support all their staff in these services.

The services had embedded learning culture within meetings with staff. This included daily risk meetings, huddles, team meetings and supervision. The trust would send out updates to all staff about any learning from incidents. We were told that specific incident meetings and debriefings would happen to discuss any points of learning. Although the trust told us they had many meetings and resources available to monitor the impact of workload on staff, staff we spoke with were very distressed when discussing the impact of their workload. This demonstrated that although processes were in place there were not effective.

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.

Patients we spoke with told us staff discussed their risks with them and support them if there were any safeguarding issues. One patient told us ‘When things get difficult, I know I can call them’.

Staff we spoke with told us about safeguarding with knowledge and understanding. They gave clear examples of their processes and how they had brought in local partners to support their patients. They knew how to take appropriate action when needed and what to look for. Staff fed back that safeguarding issues were brought up in daily risk meetings, allowing staff with an opportunity to bring up any concerns to discuss and escalate where appropriate.

We observed 2 daily risk meetings where safeguarding issues were discussed. Safeguarding was a permanent agenda point at these meetings, at every location we assessed.

When reviewing patient care and treatment plans, we saw how safeguarding was embedded into practice in all locations. We saw how staff identified potential issues and how with their understanding of safeguarding, they had taken appropriate action. We found the safeguarding systems in place in each location were making sure patients were protected from abuse. Each service had strong links with local safeguarding partners and worked collaboratively. Weekly huddle meetings were held with leaders of all of the locations. These meetings would discuss safeguarding and other items.

Patients we spoke with told us they felt understood by the teams. A patient told us ‘They know me, they picked up on things that I didn’t realise I was struggling with’. Each patient we spoke with told us that due to staff knowing them, they felt safe. They told us they could speak openly with staff and felt heard. Patients told us of instances where staff had explained any changes in medicines or approaches and how this was discussed with them. A patient told us ‘I was struggling, I knew I couldn’t get a GP appointment about my sleep. I spoke to my nurse as I was struggling, and they got me an appointment that day- amazing!’.

We spoke with staff who told us they attended daily risk meetings which was where patients at risk or are showing signs of being at risk were discussed and plans were arranged in their support. Staff also told us that separate multi-disciplinary meetings also occurred. This was found at each service location we assessed. Staff fed back in each team about how they felt these risk meetings helped prioritise those in need and to discuss those patients who were currently in inpatient services.

Managers and leaders from each location we visited told us about weekly multi-disciplinary team meetings held to discuss risk. This showed a consistent approach to risk management was in place. We saw examples with patient care and treatment records of how staff escalated risk. We saw the consideration of the support needs of the patients at risk and what plans and action were put in place. We also saw how members of the multidisciplinary team were involved when required. At the time of the assessment the trust was carrying out a piece of work looking at improving the way information is recorded in risk assessment following staff feedback in this area. Staff we spoke with knew their patients very well and spoke about them with care and compassion. We also saw this in patient progress notes on how knowing their patients they were able to pre-empt risk and put actions in place before any escalation. Where escalation of risk and need occurred, we saw how staff advocated on the best support path for their patients.

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

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

We spoke to patients from across all locations we assessed. Patients from each location told us the waiting rooms and clinic rooms they went to were always clean and tidy. A patient told us ‘It’s really nice there, very clean. The toilets are spotless and that means a lot for me’.

Staff told cleaners were employed to maintain the cleanliness of the locations we visited. They told us the team staff had responsibilities in the maintenance and cleanliness of the clinic rooms at each location. They told us personal protective equipment was available when needed and was available for when they completed visits in the community.

We reviewed each patient area at each location we visited. All areas were clean and tidy and free from hazards. Hand sanitiser was available for patients and staff and touch free points in some clinics were observed. All patient areas had sanitiser wipes available to wipe down surfaces when required. However, we found that at Newark and Sherwood some cupboards were not maintained effectively and were not able to close. There was no risk to patients or staff and action had already been taken to get them fixed.

We found cleaning charts in each clinic room. However, these were not always completed as intended. Although we found that the clinic was clean and organised in Newark and Sherwood staff told us they were prioritising patients at risk rather than completing the check list due to the pressure of keeping patients safe. Leaders were made aware of this.

Patients told us they had experienced no issues with accessing their medicines. Staff who supported them were helpful at organising ways to assist them to take their medicines, which included ordering their tablets to be put in dosette boxes (dossette boxes sort and store medication safely). Patients told us they were grateful for this support. When needed to go to the clinics, they found the care and support to be fine and medications and treatments were explained to them including what side effects they should look out for.

Staff we spoke with told us pharmacy teams attending the locations and reviewed all patient medications and are available and accessible for them to speak with for guidance. Staff gave patients information leaflets about their medicines and discussed side effects with them. These information leaflets were also available in different formats and languages if required.

We reviewed the clinic rooms at each location. We found them to be in order, clean and had all the equipment required in place. Medicines were stored correctly. However, in the clinic room at Newark and Sherwood we found there were some store cupboards that didn’t close correctly. There were no medicines stored in them and the trust acted quickly to get this resolved.

We found in each clinic room, room temperatures and fridge temperatures were being taken regularly. Clinic rooms had electronic recordings of temperatures for both the room and the fridge where medication was stored. Only 3 out of 4 clinics had this. We were told that alerts are sent to the team if a problem was reported by this electronic system. In the clinic at Newark and Sherwood we found inconsistent record keeping in cleaning checks. We were told that due to pressure on the staff and practising patient risk that sometimes clinic room checks are not completed every day. However, we found the clinic room to be clean and tidy. Medication audits were completed in clinic rooms at every location, to make sure medicines were being stored appropriately and equipment and the room itself were safe for patients and staff.