Special review of mental health services at Nottinghamshire Healthcare NHS Foundation Trust

We have had ongoing concerns about the quality of care at Rampton Hospital for nearly 5 years.

Since July 2019 we have inspected the hospital 5 times, the last of which was in June 2023. During this time the hospital has not received a rating above requires improvement. Previous inspections have identified a pattern of concerns and breaches of regulations, including:

• not enough staff to meet patient needs. This included a lack of staff trained in British Sign Language (BSL) to communicate with patients in the deaf service.
• therapy staff being used to increase staff numbers on the wards, which led to reductions in patients' therapeutic programmes and meaningful activity.
• confinement being used during the daytime due to lack of staffing. In addition to this we noted an increased level of early nighttime or late unlock from nighttime confinement.
• poor medicines management, including the application of the Mental Health Act consent to treatment forms and mental capacity assessments.
• concerns around mandatory training and clinical supervision of staff, with rates of completion varying over the 5-year period.
• repeated issues of staff not always safeguarding patients from abuse.
• poor access to physical healthcare, lack of physical healthcare plans, and staff not using the National Early Warning Signs (NEWS) to monitor signs of deteriorating physical health or take the required action to improve a patient's physical health.

Throughout this section of the report we take a focused look at issues raised in previous inspections of Rampton Hospital and discuss both areas of improvement and continuing areas for concern.