The Care Quality Commission (CQC) has rated Rampton Hospital, run by Nottinghamshire Healthcare NHS Foundation Trust, inadequate following an inspection in June and July.
Rampton Hospital is one of three high secure hospitals in England. The hospital 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.
CQC carried out an unannounced focused inspection at the hospital to assess the quality and safety of care being provided to people. This was to follow up on the progress they were told to make after being issued with a warning notice following their previous inspection, in September 2022.
Following this latest inspection, significant improvements had not been made in the areas highlighted in the warning notice, therefore further enforcement action has been taken and conditions have been placed on the trust’s registration. These include the hospital not being able to admit anyone without prior written agreement from CQC. Also, the trust must ensure there are sufficient experienced staff trained in British Sign Language (BSL).
The overall rating for the hospital, as well as how effective and well-led it is, has dropped from requires improvement to inadequate. Safe has again been rated as inadequate, and responsive was inspected but not rated, therefore remains rated as requires improvement. Caring was not included in this inspection and also remains rated as requires improvement.
The overall rating for Nottinghamshire Healthcare NHS Foundation Trust remains requires improvement.
Greg Rielly, CQC deputy director of operations in the midlands, said:
“When we visited Rampton Hospital, it was disappointing to find the trust hadn’t made the significant improvements they were told to make after the previous inspection in September 2022, so people weren’t receiving safe care and treatment.
“We found the hospital didn’t always have enough nursing and medical staff to keep people safe. Staff regularly confined people to their bedrooms and limited their access to activities and leave from their room, due to low staffing numbers. This meant people weren’t having any fresh air, which wasn’t good for their health and well-being. This was identified at our last inspection, however the trust hadn’t made the required improvements which increased the risk of people coming to harm.
“Also, staff didn’t always use restraint and seclusion appropriately. It was disappointing that levels of restrictive interventions were so high, and often used to manage risks to people, due to low staffing levels.
“However, since the inspection, the trust has informed us they have made significant improvements around staffing, confinement, and having more people trained in British Sign Language to help support deaf people.
“We will continue to monitor the hospital closely and will return to carry out another inspection to ensure improvements are sustained and embedded. If this doesn’t happen, we won’t hesitate to take further action in line with our enforcement powers.”
Inspectors found:
- Managers had not ensured that wards had enough nurses to keep people safe and wards had high vacancy rates
- Managers did not always ensure that staff received regular formal supervision
- The hospital did not ensure that effective systems and processes were in place to correctly authorise medicines in line with the Mental Health Act
- Staff did not always observe people fully when in seclusion
- Managers did not ensure that there were effective systems and processes in place to monitor quality of care when staff were supporting people in distress
- The hospital did not have enough staff trained in BSL to meet the needs of deaf people. Staff on the ward for deaf people, communicated with each other verbally, and did not use BSL. This meant deaf people could not be included in the everyday sounds and noises of the ward and were excluded from social communication.
However:
- Staff had improved how they had managed people’s access to risk items on the wards
- Staff improved how they monitored people’s physical health after rapid tranquilisation was used
- The hospital had improved mail and telephone monitoring arrangements, in line with the Mental Health Act.