Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found this service to be safe. All locations we visited had embedded learning culture within meetings with staff. Patients were involved in discussing risk and regular multidisciplinary meetings took place. We found safeguarding was an embedded practice at all locations we visited.

There was a consistent approach to risk management and risk review. We saw staff escalated risk effectively and in a timely way, whilst supporting patients and their families. and how staff advocated on the best support path for their patients. Risks within patient homes were shared effectively and reviewed regularly. Staff vacancies were low, and workload was shared fairly between the teams.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with told us how they shared safety concerns through the teams. Concerns had been raised about hot water bottles degrading over time, increasing the risk of burns to patients. Staff were made aware of this promptly and were able to act quickly by checking the condition and expiry date of patient’s hot water bottles. Any learning of incidents at team level or trust wide were discussed at regular meetings. Staff told us they received trust wide emails and communications.

Processes were in place to allow and encourage staff to raise any concerns. Each team had a consistent approach in how any learning was communicated to staff. Along with trust wide safety bulletins staff had regular supervision, monthly team meetings and weekly meetings where safety was mentioned. Safety and risk management was an embedded practice in all teams we visited.

Patients we spoke with that had experienced a change in teams told us how it was done well, and they had no issues. One patient who was residing in a residential home told us the team kept in touch with them, and they felt confident that if they needed them, they would be there for them. The patient told us, ‘They call me and check in on me’.

Staff we spoke with gave examples of recent admissions and discharges from the service. We were told about the process when a patient is discharged and how the care and treatment is transferred effectively. Staff from 1 team told us that a patient who was discharged many years ago kept in touch with the team informing them how they were. The teams participated in ward rounds if a patient became an inpatient at hospital allowing continuity of care. We were shown how this was recorded on patients care plans.

The teams we visited had both community and intensive support teams working alongside each other. This way of working created a continuous approach in care and treatment as the teams would come together regularly to discuss cases. Teams had access to online communication applications where they kept in contact with each other through online meetings and instant messaging in the treatment of the patients on their case load. We saw records of team meetings, multi-disciplinary team’s meetings, case discussions and recording of patient ward rounds. Each team leader utilised the tool set up by the trust to have oversight of each patient’s pathway. Leaders of each team used this process to ensure they had oversight of documentation being completed is effectively and in a timely manner.

A patient we spoke with told us when staff visit, ‘they always ask how I am’ and if anything has changed for them.

Staff we spoke with told us safeguarding was an embedded process in everything they did. They told us it was spoken about regularly in meetings and case reviews. They felt they were knowledgeable on signs to look for and knew what actions to take if there were any safeguarding concerns. Staff were able to talk through the process of alerting a safeguarding and how they contacted the trust safeguarding lead if they had any queries.

We observed a telephone call being taken by a duty worker in one of the teams visited. The call indicated to the duty worker that a patient on their case load was in urgent risk of harm. We observed how the staff member worked quickly in supporting the family and the quick response to alerting the emergency services whilst maintaining a supportive, kind and caring approach to the family in distress. We saw how the information was communicated promptly to management to keep them aware of the situation. Management then stepped in to ensure the duty worker was ok and if they needed any support.

The teams were able to show embedded processes in practice of safeguarding their patients and how managers had oversight of this. We found evidence of regular meetings and safeguarding involvement in patients care and treatment plans.

People we spoke with told us when staff visited ‘they ask if I’m ok’. One patient told us the staff were going to call them over Christmas to make sure they were ok, as they knew they found the Christmas period difficult.

Staff we spoke with told us how they put the patient in the centre of all that they do. When reviewing patient care and treatment plans, we saw how the staff team delivered person centred care. We saw the team recognised a patient’s pets being important to them and put an appropriate care plan in place to support them. This led to a positive impact on the patient’s mental health, showing the staff kept the patient at the centre of care delivery.

The service had embedded systems to ensure patients were involved in care planning and assessing risks. We found this in patients care and treatment plans, risk assessments, how the staff discussed risk factors in case discussions, team meetings and through regular supervision.

Staff we spoke with told us if any risks are noted regarding visiting patient homes, they were recorded as alerts in patient care plans. We saw records of this and how this was managed. This included indicating where pets were present for staff who were allergic to pet hair.

We were shown examples within each team we visited around how they recorded risks within patients’ home to support safe practices for when staff made visits. There was also a clear process in place for when new risks were identified. When this occurred the team discussed it, assessed it and recorded it in patients care and treatment plan.

People we spoke with told us they had not experienced any problems with appointments being missed or cancelled due to staff shortages. A patient told us they felt the staff ‘are knowledgeable’ and another patient told us ‘They are so supportive, took me shopping when I was struggling’. The patients we spoke with all told us ‘Never had an appointment cancelled’.

Staff we spoke with told us that although workloads could be a challenge they felt supported by management and leaders. Vacancies in the teams had been recently filled and there was a low vacancy rate within the teams. Staff told us caseloads were spread fairly throughout each team and if there were any issues they could raise them with their managers and the team. Training rates were compliant within the trusts policy, and we were told any specific training needed was supported by the trust.

Each team we visited had enough staff to manage the day to day running of the service. We observed staff having supportive conversations regarding their workloads for the day and how they could help each other. We were able to observe a team’s meeting where new patients were discussed and how the work was fairly disseminated.

Management had embedded process on how they managed the team’s caseload management and how work was shared between each team. We saw how management recorded case management numbers and how they monitored staff’s whereabouts during the day to make sure they were safe when lone working. Online team channels were set up to allow staff to contact each other for support and guidance.

Staff we spoke with told us if any concerns with infection prevention and control was identified on visits or through conversations with the patient this would be recorded on the patients care plan and notes and communicated with the team.

Staff had access to appropriate personal protective equipment, if required.

Management and leaders informed us if patients were at risk of having their medicine at home, the staff stored it at the trust office for a short period of time, until the risk had been reduced. We were assured that this was always temporary. We saw how medicine was stored in line with legislation and was recorded properly and monitored regularly.