Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Patients were comfortable with staff and felt they could approach staff. Patients felt safe on the wards. Medications were stored, administered and managed well. The environment was safe, and appropriate environmental risk assessments were in place. However, not all areas of the wards were clean and there were insufficient showering facilities on Blake ward, with only 2 showers for up to 16 patients (at the time of the onsite assessment there were 12 patients on this ward). Wards were often working under optimal staffing levels. We found processes in place to manage and monitor staffing did not always record the intricate details of how staffing changed over a shift, meaning management did not have oversight of the true staffing levels on wards over a single shift. We found a breach in regulations under safe care and treatment. Staff did not always manage risks well. We found staff did not always complete and record appropriate checks when monitoring side effects of medications. We have asked the trust for an action plan to improve completing and recording appropriate checks when monitoring side effects of medications.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients we spoke with told us they felt that staff understood them and knew their needs. One patient told us ‘Staff helped me order a new comfier chair for my room, it’s much better’. Whilst another patient told us ‘I like to read books and staff support me to the library, I’ve got a book with me in my room and a copy of a bible which is important to me’. Patients on Eden Ward told us that they understood their pathway and objectives. Patients on Adwick due to their acuity were not able to understand their condition fully. Two patients were however able to tell us why the level of restrictive practice was happening for them and told us that staff had explained this to them. A patient on Eden was able to discuss how staff were supporting him through an illness and how they were putting things in place for him, he was complimentary about the staff on ward in how they were supporting him through a difficult time.

Staff we spoke with discussed patients with care and compassion on both wards. Staff were able to discuss needs on an individual level. We spoke to staff on Eden ward (this was a pre discharge ward) who spoke about the needs of patients being around how they supported each patient’s progression to be discharged from the ward. They discussed individual goals and how the multi-disciplinary team were fully involved in supporting each patients’ objectives to discharge from the hospital. We spoke to staff working on the Adwick ward (which was an intensive support unit) about the goals and objectives for patients. They told us about how they were working to reduce risk for people and to support people to regulate (become stable) and then progress to be discharged onto treatment wards.

Whilst we were on Eden ward, we saw positive interactions between staff and patients. Staff knew the patients well and were able to engage in meaningful conversations. On Adwick ward all patients on the ward were in long term segregation. We saw one staff member playing cards and positively interacting with the patient. We spoke to patients which was either through the door hatch (due to risk) or with their doors open. We saw staff spoke to patients on an individual level and with knowledge of them. One patient was able to discuss the heating in their room and staff listened and interacted well with them. However, we observed little verbal interaction between the staff and patient when they were carrying out prescribed enhanced observation checks. This was a missed opportunity for a meaningful interaction or conversation with patients.

We reviewed patient care and treatment plans on both wards we visited. On Eden ward they fully reflected their physical, mental, emotional and social needs and gave opportunities for staff to understand the objectives and goals for each patient. However, the care plans reviewed on Adwick ward were inconsistent in how they were completed. We found care plans to be person centred but not always goal orientated. We found examples where instead of goals and objectives staff had written the problems and issues. This would make it difficult for patients to know how to progress. We also found an example of where a patient’s allergy was not included in the last two care plan reviews. It was present on the patient’s medical card, but the information was not present on their care plan, and no one had noticed this and actioned on it. We informed the staff on the ward of this, and they immediately changed the information. In all the care plans we reviewed we did not see the active voice of the patient. We did see ‘I’ statements being used but no quotations of information written in the patient’s voice.

A patient we spoke with told us about how they were receiving specialist support due to their physical illness and a specialist nurse visited them weekly to see how they were and to discuss their illness with them. The patient told us ‘The nurse comes every week, and we can talk about how I am, they are really supportive’.

Staff we spoke with told us patients have access to a chaplaincy service and patients can access the service for their religious needs. We were told about the facilities on offer to support healthy eating and healthy lives on each ward. Eden ward had an on-ward gym, which staff were trained on and Adwick ward had access to a barber who also specialised textured hair and could meet the needs of all patients on the ward. Staff on Adwick ward told us how they managed the integration of patients due to racial tension between patients. At the time of our assessment all patients on the ward were in long term segregation, this meant that staff had to manage how to safely support these patients to access time out of their rooms to reduce risks. We spoke to staff on Eden ward who told us how they promoted a good transition for patients when moving from services. As Eden ward was a pre discharge ward we were told on how discharges occurred and how this was planned with the patient and the multi-disciplinary team. We were also told about the aftercare the team did to make the experience for the patient as smooth as possible.

Each patient on the wards we assessed had individual patient care and treatment plans. They included plans around daily living skills, managing mental health, physical health, managing risk and relationships with others. When we reviewed care plans on both wards, we saw diverse health or care needs had been identified. We spoke to staff, and they told us that handovers and ward rounds was also a place where this information was discussed along with recommendations on any changes to be made to support the patients.

A patient we spoke to told us about how they were receiving specialist support due to their physical illness and that this specialist nurse visits them every week to see how they are and to discuss their illness with them. The patient told us ‘The nurse comes every week, and we can talk about how I am, they are really supportive’.

Staff we spoke to told us that there is a chaplaincy service at the service and patients were able to access the service for their religious needs. We were told about the facilities on offer to support healthy eating and healthy lives on each ward. Eden ward had an on-ward gym which staff were trained on how to support patients to utilise this. Staff on Adwick ward told us how they managed the integration of patients due to racial tension between patients. At the time of our assessment all patients on the ward were in long term segregation, this meant that staff had to manage how to safely support these patients to access time out of their rooms to reduce risks. We were told that patients on Adwick ward have access to a barber who also specialised textured hair and could meet the needs of all patients on the ward from different cultural and ethnic backgrounds. We spoke to staff on Eden ward who told us how they promote a good transition for patients when moving from services. As Eden ward is a pre discharge ward we were told on how discharges occur and how this is planned with the patient and the multi-disciplinary team. We were also told about the after care that the team does to make the experience for the patient as smooth as possible.

Each patient at the wards we assessed have individual care plans. They included plans around daily living skills, managing mental health, physical health, managing risk and relationships with others. When we reviewed care plans on both wards we saw any diverse health or care needs had been identified. We spoke to staff, and they told us that handovers and ward rounds is also a place where this information is discussed and recommendations on any changes to be made to support the patients.

Patients we spoke with knew how to make a complaint and compliment the service. One patient told us ‘I have an ongoing complaint; I received a letter from the general manager and although it wasn’t the result I wanted I did feel heard’. Another patient told us how they felt listened to, and staff listen and take on board what they say. They told us they used care opinion which is an online service where patients can place complaints and compliments. A patient on Adwick ward who was being nursed in long term segregation asked the ward manager how they could complain and due to the restriction in place for his own safety the ward manager explained how they would support him to complain and access advocacy. Advocacy services came on the ward weekly to meet and speak to patients.

We spoke to staff who told us they felt with the therapeutic relationships they promoted; patients were able to tell them if they had any problems or concerns. They told us patients had an opportunity to access advocacy services, and they could discuss issues through different forums including ward round, community meetings and care opinion. Staff on both wards discussed ‘relational security’ and how important it was for both patients and staff. Relational security was about the knowledge and understanding of the patients and the environment and the translation of that information into appropriate responses and care.

We observed on each ward staff allowed time for patients if they wanted to speak to them. We saw these interactions were positive and supportive. However, when observing the prescribed observations by staff on Adwick ward they did not allow the chance for patients to discuss anything with them, as the checks were quick.

We saw minutes of multi-disciplinary team meetings in each patients care and treatment plan we reviewed. Each patient on both wards had opportunities to attend their ward rounds. It was discussed with us how they supported high risk patients on Adwick ward to attend these meetings, so they had a chance to voice their opinion.

Patients we spoke with told us how they could access their care and treatment in a way that worked for them. A patient on Eden ward told us how their physical health needs were being supported by specialist nurse who was coming to the ward each week. We spoke to a patient on Adwick ward who explained how they had recently experienced treatment that wasn’t timely and had caused them distress. The distress the patient experienced escalated their need for restricted practice which included the use of strong wear (clothing that is anti-tear proof) and lack of possessions in their room and reduced access to fresh air. The patient told us if they had had their needs met when they required, then the situation they found themselves in would not have happened.

We spoke to staff on Eden ward who told us how they supported a patient who had a diagnosis of autism. They had implemented measures in how they supported the patient’s communication needs, including the use of ear defenders and an appropriate service that meets their individual needs upon discharge. Staff on Adwick ward told us that the environment of the ward was accessible for patients with physical disabilities. At the time of the onsite assessment there were no patients on this ward that had physical disabilities. Both wards were on the ground floors of the service which aided in access. Staff on both wards spoke with knowledge of their patients and were able to tell us about individual needs and how they managed these. They spoke about how they supported patients with protected characteristics and how they supported them. Staff on Eden ward told us they had access to reflective time to speak to a specialist nurse regarding the patient with physical health needs. Staff told us that this space was ‘good, we can discuss things about the treatment on how to support them’.

We reviewed ward round minutes and how individual needs were documented in patient care and treatment plans. However, we found inconsistencies in the completion of the responsible clinician’s long term segregation reviews for a patient we reviewed. These reviews are to be done daily in accordance with the Mental Health Act Code of Practice. We found from the 1 October 2024 to 14 October 2024 the responsible clinician had reviewed this patient 7 times rather than 14 times in line with code of practice. In our review of the daily reviews, we found inconsistencies in what was being written, and we found information that was false in relation to the patients access to fresh air. The patient told us they hadn’t had access to fresh air for weeks where the responsible clinician stated that they had. The service was made aware of this, and action was immediately taken.

A patient from Eden ward told us how staff were supporting their physical health, and decisions were being made with him and not for him. However, on Adwick ward a patient told us about their experience on the ward. At the time of the onsite assessment, they were in long term segregation for their safety and for the safety of the staff. They were in strong wear and had placed the mattress which they slept on the floor near the window. They told us ‘I haven’t been out for fresh air for weeks so I put my bed here so I can get the fresh air from the gap in the window’. When reviewing this patient’s documents, we found that they had only 7 occasions where they had been able to access fresh air over a 36-day period. The patient was unable to explain how he would be able to achieve access to fresh air and we found no goals or objectives written in their care plan around this.

We spoke to staff on Adwick who were able to explain the rationale behind the restrictive practice on the patient who had only experienced 7 occasions over a 36-day period. They clearly explained this but were not aware that this was not in the patients care and treatment plan. They were going to amend this and update the patients care plan. They told us that outcomes were discussed in each handover of care and in each ward round.

Care plans were in place for each patient on both wards. However, we did find inconstancies in completion on Adwick ward. This was brought to the attention of leaders and was going to be immediately actioned. We found records of ward rounds for each patient’s care and treatment record, in which outcomes were discussed.

Patients we spoke with on Eden ward were able to explain their understanding of their pathway on the ward and how they were moving on. They spoke about outcomes and goals of what they wanted to achieve. Patients we spoke to on Adwick ward were unable explain their pathway and one patient told us what he thought was happening to him ‘I’m here forever’. The acuity of the ward at the time of the onsite assessment was high.

Staff on Eden ward discussed the pathway options for patients and patient involvement in this. They told us how it was a team effort, and the multi-disciplinary team approach worked with patients. Part of planning for the future was how they could support the patients during trial leave and after discharge. We were given a recent example of how staff had contacted a patient at another service that was previously on Eden ward, who was able to do a video tour of the ward to support a peer that was planning to go there.

Discussions and meetings regarding the journey of each patient was found in patients care and treatment plans along with meeting minutes. Although objectives and goals were inconsistently completed for patient on Adwick ward.