Inspectors find seven breaches of regulations in visit to high security Rampton Hospital

The Care Quality Commission (CQC) has rated Rampton high secure hospital run by Nottinghamshire Healthcare NHS Foundation Trust as ‘requires improvement’ again, following an inspection there in April.

The mental health hospital cares for people detained under the Mental Health Act.

An inspection was made of the hospital service after whistleblowers and people using services raised concerns about their safety and staff wellbeing, linked to low staffing levels.

CQC had also become aware of occasions when people faced daytime confinement because of staffing shortages through its ongoing engagement with the trust.

Inspectors identified seven breaches of regulations relating to staffing, safe care and treatment, dignity and respect, person-centred care, premises and overall management.

CQC asked the trust to submit an action plan setting out how it will address the concerns identified, which the trust has since developed with a set of measurable actions agreed with CQC.

CQC has downgraded the rating for how responsive it is from good to requires improvement. How effective it is remains rated good, and how safe, caring and well-led it is remain rated requires improvement.

Victoria Green, CQC's deputy director of mental health in Nottinghamshire, said: “When we visited Rampton Hospital, we found staff shortages were affecting almost every part of people’s care, despite this being a long-standing concern. It was disappointing the hospital hadn’t always learned from issues we’d raised before.

“We had concerns about the way the service restricted people’s choices, recorded these restrictions, and shared rules in this area with people.

"The hospital also wasn’t consistently meeting the needs of autistic people and people with a learning disability, including not adapting ward environments to their sensory needs.

“However, we saw staff who cared deeply about the people they support and some genuinely person-centred work, particularly in the women’s service.

"Leaders were open with us about the challenges they faced and had already made some improvements since our last visit.

“We will continue to monitor the hospital closely to make sure people get safer, more responsive care.”

Inspectors found: The trust didn’t always learn from previous concerns, including from independent reviews of care for autistic people and people with a learning disability.

Staff didn’t always follow medicines management processes consistently, increasing the risk of error.

The hospital had one person wait more than 24 hours to get treatment for a fractured wrist because they couldn’t arrange secure transport quickly.

However, it was also noted leaders had introduced new approaches to reduce reliance on staff-intensive observation and support people’s recovery, though these were in the early stages.

Staff spoke with dedication and compassion about the people in their care, and the hospital’s reducing restrictive practice team had helped some people spend less time in long-term segregation.

In response to the report, Mark Axcell, chief executive, Nottinghamshire Healthcare said: “The safety, wellbeing and experience of our patients will always be our highest priority. Inspections are an important opportunity to understand what we are doing well and where we need to improve.

“We accept the CQC’s findings and recognise where we need to do better. We are fully committed to addressing each area identified for improvement through a detailed action plan with clear accountability.

“We have already made significant progress. For example, we have introduced ‘Activity First’, to help ensure patients can access and engage in meaningful activities, as part of business continuity and reducing restrictive practice. Patients have told us how much they value this and the feedback has been overwhelmingly positive.

“Since April, we have appointed 19 staff nurses and 29 healthcare assistants to our high secure services. Some will work flexibly across wards, enabling us to respond more effectively to changing patient need and levels of dependency.

"We continue to recruit every month, including newly qualified nurses who will join us later this year.

“Alongside this we have enhanced training for colleagues in learning disabilities and autism, developed plans to improve our specialist learning disability ward environments, and introduced innovative approaches to patient observations, reducing restrictive care and segregation wherever possible.

“I want to thank colleagues at the Hospital for their dedication, professionalism and compassion. Caring for patients in a high secure environment can be incredibly challenging and I am particularly proud that the report acknowledges the compassion and person-centred care delivered by colleagues, often in difficult circumstances.

“I am confident that positive changes already made provide a strong foundation for further progress.

"I want to reassure patients and their families that we are listening, learning and taking action to ensure we provide the safe, responsive and high quality care they deserve.”

The full report will be published on CQC’s website in the coming days.