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

The patients and carers we spoke with were overwhelmingly positive about the support they received from the team. Staff teams always involved patients and carers in the development of holistic person-centred care plans. Staff were always approachable and explained the side effects of medication to patients and cares. Staff knew how to identify and report and safeguarding concerns.

However, we found breaches in regulation under safe care and treatment, good governance and safe and effective staffing. Staff did not always administer medication in line with the trusts policy, managers did not have oversight of the impact of cancelling training on caseload management and leaders, managers did not ensure there were enough suitably trained staff to meet the demand on the service. We have asked the trust to submit an action plan to address these.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients and carers we spoke with told us they were involved in the development and review of their person-centred, holistic care and treatment plans.

Staff we spoke with told us they felt “forgotten” by the trust as its focus was mainly on mental health services. We were told that managers had cancelled both mandatory training and caseload management time to focus on clinical visits as referrals had risen by over 20%. Local teams had co-produced a vision for the service which included workforce, partnership, involvement and quality priorities however managers told us they thought very senior managers did not see their services as core to the trusts' vision and values.

We saw learning from incidents was a regular item on team meeting agendas and during the handover process.

The service had submitted data to the trust under the policy to identify “red flags” which were an indicator that the quality of care given to patients may have declined. Examples of the red flags were the cancelling of mandatory training, high sickness rates and deferral of planned work.

We saw managers had reported 71 instances where training had been cancelled between 10 July and 2 December 2024 due to staff shortages, sickness and lack of capacity due to high demand. Although staff had continued to report this as an issue, this had not been resolved in the 5 months and managers did not appreciate the impact this had on staff.

The patients and carers we spoke with told us the teams were very responsive, and they could call them for advice at any time. We were told the team made onward referrals for physiotherapy and occupational therapy to give specialist support where appropriate.

Staff told us they were very frustrated as they were seeing patients who were not housebound which is outside the operating procedure of the team. Managers told us they had raised this but had not received a response from senior leaders. They also told us the teams did a significant amount of clinical activity which should be undertaken by the urgent response team. This was mainly but not exclusive to catheter care, managers were told the urgent care team did not have the skills or competencies to carry this work.

Within the care and treatment records we reviewed, we saw staff worked with and liaised with others to ensure continuity of care. These included General Practitioners, community rehabilitation teams, specialist teams and local authorities.

We saw although managers had raised concerns with leaders about staff seeing patients outside the operating procedure of the team they had not been responded to.

The patients and carers we spoke with were overwhelmingly positive about the support they received from the team.

The staff we spoke with were able to demonstrate how they would identify and raise a safeguarding issue. We were told there was a safeguarding lead at the trust that they could contact for advice.

Within the care and treatment records we reviewed, we saw staff and completed a holistic assessment which identified any safeguarding issues. We saw these were dealt with in a timely manner and recorded appropriately. We saw safeguarding posters displayed in office and reception areas.

We saw the trust had a safeguarding assurance framework along with a safeguarding assessment tool which managers completed. This identified any actions to be taken or opportunities for learning.

Patients and carers we spoke with told us they were told they were included in the holistic assessment process, which considered their individual needs.

The staff we spoke with told us they supported patients to reach decisions about their treatment and to plan care around their wishes. This included use of medicines and end of life, palliative care planning.

All care and treatment records we reviewed were comprehensive, had updated risk assessments in place and showed patient and carer involvement.

Patients and carers we spoke with told us staff always assessed the environment before initiating treatment to ensure the safety of the patient. This included clearing space to accommodate equipment.

Staff we spoke with told us how they “worked with what they had” whilst in the patient’s home. This meant they adapted equipment to ensure the environment was as appropriate as possible for treatment required. They told us they often had to ensure family pets were controlled during the appointment.

We attended one leg ulcer clinic which was modern, bright and fit for purpose.

We saw staff completed regular environmental audits of clinic rooms.

Patients and carers we spoke with told us staff were very hard working and were often rushing from 1 appointment to another. We observed staff being very caring but also working extra hours to complete tasks.

Managers we spoke with told us whilst vacancy rates were low within the teams, several posts had been frozen to accommodate staff from other areas undergoing organisational change and would potentially need redeployment. They told us the referrals to the teams had increased by almost 30% but staffing did not reflect this. Managers told us they had submitted several comprehensive staffing reviews to leaders, the last one being in April 2024 which included national benchmarking information. They had yet to receive a response. Managers told us the teams did a considerable amount of clinical activity which should have been undertaken by the urgent response team. This was mainly but not exclusive to catheter care, managers were told the urgent care team did not have the skills or competencies to carry this work. This significantly impacted the capacity of the team to complete their work.



Staff told us they were very tired and frustrated, and this was leading to burnout. They told us local managers were very supportive however they felt very senior managers did not understand the issues.



Managers told us about specific staffing issues within the evening and night service. They reported staff shortages on a weekly basis to the trust safer staffing meeting and at the quality and risk meeting.



Staff told us they did not always take their breaks and often worked additional unpaid hours to meet the clinical need.

We reviewed data submitted by the trust, this indicated there had been a fourfold increase in the number of incidents due to reduced staffing levels leading to deferrals of care in the 12 months prior to the onsite assessment.

Patients and carers told us staff always wore aprons and gloves during their visit and often used hand sanitiser gel.

Staff we spoke with described the challenges they faced when treating patients in their own homes. They told us they had to be creative about clearing a space to carry out aseptic techniques. We attended 13 home visits where staff followed infection control procedures.

We attended one leg ulcer clinic and saw staff adhered to the trust infection, prevention and control.

We saw managers completed regular audits of infection, prevention and control compliance and displayed these for patients to see.

Patients and carers we spoke with told us staff gave them advice on side effects of medication and how to store and take them effectively. However, there were several medication errors attributed to poor documentation and human error by nursing staff.

Staff we spoke with told us the trust was in the process of implementing an electronic medicine prescribing and administration system.

We saw staff administering medicines according to trust policy, during the visits we observed. However, incident data we reviewed showed a number of medication errors attributed to poor documentation and human error by nursing staff.

We looked at data submitted by the trust relating to medication errors for the period 2023/24 where 214 incidents had been reported. We saw 60 of these, were due to third party errors, however the majority reported were attributed to poor documentation and human error by nursing staff. Staff we not always administering medication in line with the trusts policy, leading to medication errors.