Nottinghamshire Healthcare NHS Foundation Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

Nottinghamshire Healthcare NHS Foundation Trust is an NHS provider of integrated care services, including mental health (inpatient community and high secure services) intellectual disability (learning disability) and physical health services. The trust employs over 11,000 staff to work at the trust and provide services in a variety of settings from over 257 different locations. The trust provides care to a population of around 1.1 million people.

The trust provides a range of community and home-based services for children, young people, adults of working age and older adults supporting physical and mental health needs as well as providing services for those with an intellectual disability. This includes community-based nursing and therapy teams and well as universal services such as health visiting and school nursing for children and families. Services are delivered from in-patient settings, children’s centres, local health centres, secure settings, GP practices and people’s homes. At the time of our assessment, the trust provided healthcare to offenders in prison services across the East Midlands but had made a decision to stop this service which will be led by another provider in the near future. National specialist services also sit with the trust, including the national high secure deaf service, national high secure service for learning disabilities and autism, and the Nottingham Centre for transgender health.

Since May 2024, we have undertaken a programme of assessments following the Single Assessment Framework (SAF). This was part of a recommendation made during a formal review of services (Section 48 review by the Care Quality Commission) which took place following the devastating attack on individuals in Nottingham in June 2023.

The SAF is a framework which allowed us to carry out short, targeted assessments, and we make judgements on the quality of care by assessing a number of quality statements at each site visit. In total, 39 assessments were completed between May 2024 and August 2025.

All 18 assessment service groups (ASG’s) of the trust were assessed. 57% of all quality statements across the trust were assessed in part or as a whole, and of those, 73% were re-rated in full which led to 3 ASG’s that had all 5 key questions assessed and 10 ASG’s (56% of the trust services), 7 mental health services and 3 community health services, which led to a change in their overall rating. Improvement was seen in the overall rating of 4 services, 12 remained the same and 1 service rating had deteriorated.

No services in the trust remained inadequate. 7 services were rated requires improvement overall (5 mental health and 2 community health services); 10 services were rated good overall (9 mental health services and 1 community health service); and 1 service was rated outstanding overall (1 community health service). 83% of all ASGs (15 of 18) had the key question of safe re-rated where 7 services showed an improved rating, 7 remained the same and 2 deteriorated. 2 services had 3 quality statements re-rated to an improved rating of outstanding (caring in perinatal services and safe and caring in community health services for children, young people and families). However, we have told the trust to take action in 10 services where we found breaches of regulation. The trust responded with action plans.

This trust wide well-led review was carried out to assess how ‘well-led’ the trust was following the programme of assessments of frontline services and as part of our commitment to carry out the recommendations of the Section 48 review.

We asked the trust to take immediate action to address the delay to complete the eradication of dormitories at the trust. In 2022 we asked the trust to make significant improvement to eradicate shared living accommodation. At the time of this assessment, dormitory style accommodation remained at one location at Highbury Hospital. The trust had no proactive or strategic appetite to elevate the importance of improving estate across the trust in relation to eradication of dormitories.

In addition, the trust had no proactive strategic plans that were confirmed, consulted with and in progress to elevate the importance of improving estate across the trust in relation to environments used for long term segregation of Service Users.

We have identified this to be a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 17, good governance.

Due to the level and nature of risks identified, we have taken enforcement action and asked the trust to make significant improvements and to work collaboratively with key stakeholders in the wider healthcare system to support significant improvement.

We also identified further breaches of regulation 17, good governance. We have asked the trust to provide an action plan to address the following areas:

• To embed and make progress to deliver its shared vision and strategy, based on transparency, engagement, equity and inclusion.
• To embed and make progress on strategic culture to deliver workforce equality and diversity, proactively engage with staff to improve culture where staff feel valued and recognise the impact a positive staff culture has on patient care.
• To fully deliver and embed the Patient and Carer Race Equality Framework (PCREF) across the organisation.

Details relating to our findings of these issues can be found in our report.

People's experience of this service

As part of this assessment, we reviewed feedback from people who used mental health services and results from the Community Mental health Survey 2024. All other feedback about the trust can be found in our service reports already published. The findings below aligned to feedback received from key stakeholders and this was also focused on mental health services.

There were both positive and concerning features to care and treatment. People were positive about some services and reported feeling well supported by staff and mental health services, particularly when they felt in control of their care and treatment. Overall, people were happy when they interacted with staff, with most people reporting positive experiences. People often named specific staff members they felt supported by, which often supported the feeling of being involved with their care and treatment. Specific areas of care that people highlighted as good, included involvement from occupational therapy, the perinatal team, attending recovery college and receiving specialised therapies such as psychodynamic therapy, Step4 and post-traumatic stress disorder (PTSD) support.

However, more people had poor experiences through not being offered treatment other than medication, no support in managing their mental health, and not being referred for therapy or some specialised services. Most feedback from people highlighted issues of not being able to access mental health services, raised concerns with long waiting times for appointments, assessments, and referrals to specialised services.

Many people reported they mostly had received positive experiences with staff interaction. Staff were described as “honest” going above and beyond”, “helpful”, “supportive”, and “knowledgeable”. A few people also told us that they were treated with respect and dignity and often thanked specific members of staff for their care and treatment. People reported that positive interactions was a “good thing” about their care, and being listened to and included in care decisions were a driver for people’s perception of positive interactions with staff. This had helped build trust with the mental health service and feeling safe.

However, there were a few negative experiences that raised concerns about some staff’s professionalism, communication skills, and compassion towards people seeking support from mental health services. Several people described staff as “dismissive”, “unprofessional”, “difficult to communicate with” and “rude”. Respondents felt staff should be more compassionate, less judgemental, and more reassuring to people who are seeking support when at their most vulnerable.

Several people told us about their experience of accessing mental health services. A few people felt they had immediate access to assessments and interventions, had regular appointments and were referred to specialised services. However, most people raised complaints of long waiting times for mental health support, including waiting for assessment, intervention and referrals. Having shorter waiting times was a frequent suggestion of ways the service could be improved. Many people complained about not feeling as if they had support in time and feeling left to manage their mental health alone. Other concerns around access included wanting to increase the frequency of their appointments, having shorter waiting times between assessment and treatment, and being able to get in contact with staff.

People told us they did not always feel involved in decisions around person-centred care, with many feeling they were not being heard or that their care plans were not suitable for them. When people did feel involved, they had positive experiences with their care and treatment.

Concerns that were highlighted of people’s experiences with crisis care included not feeling supported at their most vulnerable times as their calls were not returned, they were hung up on, inappropriate advice was provided, and some staff lacked compassion.

A few people expressed concerns with the service and staffing of mental health services, feeling they are underfunded and understaffed, and that services should implement training to increase staff’s understanding of neurodiversity and physical health impacts on mental wellbeing. Patients at Rampton Hospital told us that activities had been cancelled due to staffing shortages, and some patients who had been segregated did not have enough staff to help them safely exit their room.