Following the conviction of Valdo Calocane in January 2024 for the killings of Ian Coates, Grace O’Malley-Kumar and Barnaby Webber, the Secretary of State for Health and Social Care commissioned the Care Quality Commission (CQC) to carry out a rapid review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) under section 48 of the Health and Social Care Act 2008.
Today, CQC publishes two parts of this review - an assessment of patient safety and quality of care provided by Nottinghamshire Healthcare NHS Foundation Trust (NHFT) and an assessment of progress made at Rampton Hospital since the most recent CQC inspection. The remaining part, a review of the available evidence related to the care of Valdo Calocane, will be published in the summer on a date to be agreed with the Secretary of State.
The review published today draws on information gathered from onsite visits to NHFT, personal experiences from people who use services and their families and carers, and information including survey data and prevention of future deaths reports. The review’s findings and recommendations also take into account findings from CQC’s inspection activity at NHFT and Rampton Hospital over the last 5 years and our wider oversight of the challenges facing mental health services, including evidence from our statutory State of Care and Mental Health Act annual reports, and other thematic reviews.
Over the last 5 years, CQC has raised ongoing concerns about the quality of community and inpatient mental health services at NHFT and has taken enforcement action including restricting admissions to Rampton Hospital. During this time, all services, except forensic inpatient services, have been rated as requires improvement or inadequate. Previous inspections have identified a pattern of concerns and breaches of regulations.
While this rapid review of the care provided by NHFT found some evidence of improvement, it also found that:
- People struggled to access the care they needed when they needed it, putting themselves and potentially members of the public, at risk of harm.
- The quality of care and treatment across NHFT 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 NHFT, 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, there were issues with communication between services, which affected continuity of care for people. While the integrated care board was taking steps to improve quality, changes were not happening quickly enough.
CQC has inspected Rampton hospital five times between 2019 and 2023. While the review found that care at the hospital has improved since the last inspection in July 2023, concerns remain in a number of areas:
- Communication between staff and patients was still poor, particularly for those in long-term segregation – although there were 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 our previous inspections and recognised ongoing concerns with the culture need to be scrutinised, but small pockets of poor culture remained.
Commenting on the review findings, Chris Dzikiti, CQC’s Director of Mental Health, said:
While we found some improvements, our review of Nottinghamshire Healthcare NHS Foundation Trust highlights ongoing concerns around people’s care and safety. We have set out clear recommendations for action the trust needs to take so that services provide safe care and treatment, and to protect patients, families, and the public from the risk of harm.
The concerns around demand for services and access to care, staffing and leadership at NHFT must be addressed - NHS England will be supporting improvement and we will be working with them closely on this.
However, the findings of our review must also be a starting point to look more closely at the gaps in community mental health services so that real improvements can be made nationally to quality of care, patient safety and public safety.
The review published today makes a number of recommendations. The majority of these are specific recommendations for Nottinghamshire Healthcare NHS Foundation Trust, but there are also wider system-level recommendations for national bodies. One of these is that NHS England recommends that the Secretary of State relicenses Rampton Hospital for a period of no more than 12 months (rather than the full 5-year licence period), to allow for improvements to continue along with expected improvements at trust level. Throughout the 12-month period, CQC will monitor progress closely.