Nottinghamshire Healthcare Trust: Section 48 statement by ICB

Today we welcome the publication of the Care Quality Commission’s (CQC) special review into Nottinghamshire Healthcare NHS Foundation Trust. The review was ordered by Health and Social Care Secretary Victoria at the end of January.

It was carried out by the CQC under section 48 of the Health and Social Care Act 2008 to “provide further answers for the families affected by the horrendous and tragic killings of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates in Nottingham in June 2023.” The review also focused on wider issues in mental health care provision in Nottinghamshire, including at Highbury Hospital and Rampton Hospital. 

The full review is on the CQC website. It has reported back on the following areas:

An assessment of the improvements made at Rampton Hospital:

• Communication between staff and patients was still poor, particularly for those in long-term segregation. The CQC saw improvements for patients who are deaf, with greater access to staff who are trained in British Sign Language.
• The safety of patients had improved, but issues around the prescribing of medicines and monitoring of people’s physical health meant that people were not always being kept safe.
• Staffing levels had improved but they did not always meet the needs of patients on the wards. Despite confinement being used less, this was still part of the culture of a small number of staff in the hospital.
• Leaders had addressed many of the issues identified on previous inspections and recognised ongoing concerns with the culture need to be scrutinised, but small pockets of poor culture remained.

An assessment of patient safety and quality of care: 

• People struggled to access the care they needed when they needed it, putting them, and potentially members of the public, at risk of harm.
• The quality of care and treatment across the trust varied and care provided did not always meet the needs of individuals.

• High demand for services and staffing shortages meant that patients were not always being kept safe.

• Leaders were aware of risks and issues faced by the Trust, but action to address safety concerns was often reactive and leaders were not always prioritising engagement with people who use services.

• At a system level, the CQC found issues with communication between services, which affected continuity of care for people. While the integrated care board was taking steps to oversee and improve quality, changes weren’t happening quickly enough.

The CQC will report back on the review into the care and treatment of Valdo Calocane at a later date.

We will continue to work with the Trust to ensure that quality and safety concerns are fully addressed as rapidly as possible.  The quality oversight and improvement arrangements detailed in the report, have been increased and a tailored, intensive support programme put in place with the Trust, focussing on the issues that need to be addressed to achieve rapid and sustainable improvement. This also supports NHS England’s placing of the Trust in Segment 4 of the National Oversight Framework and the support this releases through the Recovery Support Programme. 

We have set up an Improvement Oversight and Assurance Group (IOAG), jointly with NHS England’s Midlands regional team, to monitor Nottinghamshire Healthcare NHS Foundation Trust’s response to the current quality and governance concerns.

IOAG will oversee actions being taken by the Trust to address and mitigate risks to ensure sustained delivery of safe services. The group will also provide scrutiny for operational and quality risks and provide stakeholders with a single forum to support and challenge the improvements as set out in the Trust’s quality improvement plans.

We continue to offer support to the Trust to deliver its improvement objectives, including its the financial position, and will help to coordinate and support any other requests from the Trust as needed.