Patient-on-patient assaults were found not to have been properly reported by staff at Rampton Hospital. The Care Quality Commission (CQC) made the finding during an an inspection of the secure Nottinghamshire psychiatric hospital last September.
A number of other concerns were identified in the report, released on Friday, February 24, however the health watchdog lifted its overall rating from 'inadequate' to 'requires improvement'. The CQC said it was pleased to see an improvement at the hospital -particularly in the culture and leadership - but said patients "still weren’t always receiving safe care or treatment".
Nottinghamshire Healthcare NHS Foundation Trust (NHF), which runs the hospital, said it was "really pleased" with the improved rating and said it had put in place a quality improvement plan.
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Inspectors raised concerns with the fact that staff did not always report patient-on-patient assaults as safeguarding incidents. They said 68 of 110 actual assaults on patients were not reported between February and August last year.
"Staff should record all incidents where a patient has been physically assaulted as safeguarding incidents," reads the report. Restrictive practices were also being overused at the hospital, with patients regularly being confined to their bedrooms during the day to maintain safety on the words, according to the report.
Trust policy says this should only be done during the night. Amanda Lyndon, CQC deputy director of operations in the Midlands, said: "Additionally, the service still hadn’t addressed a concern raised at our last inspection, which was to improve how they monitored people’s physical health after rapid tranquillisation."
She said the trust had been issued with a warning notice for those two areas. Whilst staff were praised for being "kind and compassionate", NHF were accused of failing to ensure adequate staffing levels.
"People couldn’t take part in activities or attend health appointments without staff cancelling tasks or closing part of the ward to support them and maintain safety," said Ms Lyndon.
"On occasion, there was only one nurse on a ward at night." Rampton is one of three high security hospitals in England and Wales, where all patients admitted are detained under the Mental Health Act and are classified as having a learning disability, mental illness or psychopathic disorder.
The CQC said the hospital was more well-led and processes to help leaders have oversight had improved since the last inspection. It added that ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
'Difficulties recruiting and retaining staff'
Ifti Majid, Chief Executive of NHF said: "We welcome this external scrutiny to highlight these areas and the opportunity to improve our services for patients. The safety and wellbeing of our patients is always our priority.
"A quality improvement plan was put in place and significant changes have been implemented which continue to be monitored and evaluated. These include more training and supervision of staff, improved monitoring and recording of patient observations, greater awareness and understanding of procedures and auditing of compliance in all areas to quickly identify where further support is needed.
“As is the case with the NHS nationally, the Trust is not alone in experiencing difficulties recruiting and retaining staff. We recognise the impact of these difficulties on staff and patients at Rampton and are doing all we can to address this including more development opportunities for colleagues and recruitment drives for new members to join our team.
“We have some fantastic colleagues at Rampton Hospital who work incredibly hard to provide the best care and treatment to patients and their families and carers. I would like to recognise their contribution to the improvements made at the hospital and would like to thank them all for their continued dedication and commitment, in often difficult circumstances.”
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