Improvements at Bassetlaw's Rampton Hospital but 'more work to do' say inspectors

Rampton Hospital is one of three high secure hospitals in England and provides services regionally and nationally to people who are detained under the Mental Health Act 1983 and are classified as having a learning disability, mental illness or psychopathic disorder, or both.

The rating for how well-led the hospital is has improved from inadequate to requires improvement. The ratings for how effective, caring and responsive the hospital are remain as requires improvement and the rating for how safe the hospital is remains as inadequate.

Following this inspection, CQC served Rampton Hospital with a warning notice to focus its attention on reducing the use of restrictive practices, improving how they were managing medicines, as well as people’s physical health after rapid tranquillisation was used.

The warning notice also requires the hospital to maintain safe staffing levels.

Amanda Lyndon, CQC deputy director of operations in the Midlands said: “I was pleased to see an improvement in how Rampton Hospital was being run since our previous inspection. Our experience tells us without good leadership, progress in other areas that improve people’s experiences, can’t happen.

“However, while the culture of the service had improved, and leaders were more effective, people still weren’t always receiving safe care or treatment.

“While people were generally treated by kind and compassionate staff, we also found restrictive practices were overused, confining people to their bedrooms during the day. Their own trust policy only allowed confinement at night time.

“Additionally, the service still hadn’t addressed a concern raised at our last inspection, which was to improve how they monitored people’s physical health after rapid tranquillisation.

"We have issued a warning notice to the trust for these two areas in order to focus their attention on quick improvement.

“More must be done to mitigate the impact of low staffing levels. People couldn’t take part in activities or attend health appointments without staff cancelling tasks or closing part of the ward to support them and maintain safety. On occasion, there was only one nurse on a ward at night.

“With the improvement in leadership, the trust should take this feedback and use it to build on what’s already improved.

"We will continue to monitor the hospital closely, and if improvements aren’t made we won’t hesitate to take further action to keep people safe.”

Inspectors found:

The trust didn’t ensure adequate staffing levels across the hospital or do enough to mitigate its impact. This led to people sometimes being cared for in wards without enough staff to monitor and supervise them. Staff didn’t always report patient-on-patient assaults as safeguarding incidents. The trust failed to assess and manage risk to people using the service or staff, which should be done to keep everyone safe. Staff were unable to quickly identify and respond to people’s worsening physical health conditions. The trust didn’t have effective systems and processes in place to review people’s mail and telephone contact in line with the Mental Health Act 2005.

However, inspectors also found:

The service was more well-led and processes to help leaders have oversight had improved since the last inspection. Managers had worked to improve the culture of the hospital by completing cultural reviews on several wards. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.