• Trust sets up board with NHS England and national regulator representation to improve unhealthy staff culture at secure hospital
  • CQC rated Rampton Hospital inadequate and warned of staff condoning or using racist language towards patients
  • Executive director for forensic services left trust after report was published

A mental health trust has established a dedicated improvement board to try to “deal with cultural issues” at the “inadequate”-rated high-secure hospital which it runs.

Rampton Hospital, which is one of three high-secure hospitals in England, and is run by Nottinghamshire Healthcare Foundation Trust, was given an “inadequate” rating in October by the Care Quality Commission following an inspection.

The regulator raised numerous safety concerns including severe staff shortages, “an unhealthy staff culture”, and issues in the senior leadership team.

Following the highly critical report, executive director for forensic services Peter Wright left the hospital.

The trust confirmed the improvement board includes representation from “external partners”, including NHS England/Improvement, the General Medical Council, the Nursing and Midwifery Council, and the CQC.

Julie Hankin, interim director for forensic services, told HSJ the trust was “very disappointed” to receive an ‘inadequate’ rating for Rampton and that a “number of actions were taken in immediate response”, such as improving staffing and patients’ access to activities.

She said: “We fully accept the CQC’s concerns, we know there are problems. Some of it is the sheer nature of the hospital. It is a high-secure hospital, with all that entails.”

Dr Hankin said the improvement board – which HSJ understands has now met four times – was established to oversee further improvements and deal with cultural problems raised by the CQC.

“This board features strong representation from senior clinicians within the hospital, as well as broader representation from the trust and external partners,” Dr Hankin said. “We will work to improve relationships at the hospital and improve not only the care we deliver to our patients, but the work experience for our staff.”

Isolated staff

Dr Hankin said a lot of the cultural issues were due to staff feeling “isolated and out of touch” with some of the strategic decision making at board level.

“I think there has been some long standing issues between the medical staff group and senior management in [Rampton] Hospital,” she said. “They felt unhappy about some of the cost reduction plans [and] feeling they weren’t being listened to.

“There’s also a lot of patient-to-patient, patient-to-staff issues here,” she explained. “In a lot of hospitals you can say, ‘we’re going to have zero tolerance’ [but] we can’t refuse treatment as you would in a community or acute setting. But we take action where we can.”

Dr Hankin added: “We’ve had another [focused] inspection since and are expecting a full inspection early next year. We see the CQC as helping us to address issues and improve, it will make our services better.”

CQC findings in detail

The CQC said it carried out the inspection at Rampton Hospital in response to concerns from a range of sources, including consultant medical staff.

Following the inspection in July, the regulator change ratings for both its well-led and safe domains down from “requires improvement” to “inadequate”.

It found the hospital had miscalculated the number of staff needed to provide safe care and found this had a direct impact, resulting in “restricted practices and low patient and staff morale”.

The CQC also reported patients and staff raising concerns about some staff “using or condoning the use of racist and other inappropriate language towards and around patients”.

Issues surrounding the senior leadership team were also highlighted by the regulator. It reported staff did not feel able to raise concerns without “fear of retribution”.

“Staff who had whistle blown corroborated this and said the hospital had moved them to another ward because of whistleblowing,” the CQC report said. “They told us about a bullying culture in which there was little or no debriefs or support and they felt that the hospital did not take it seriously when they raised issues.”

In May this year, Nottinghamshire Healthcare FT’s overall rating was downgraded from “good” to “requires improvement”. The trust’s psychiatric intensive care unit was also rated “inadequate”.