Improvements still needed at high-security hospital

A high-security psychiatric hospital has been told it still needs to improve after whistleblowers raised concerns about safety and low staffing levels.

Rampton Hospital, run by Nottinghamshire Healthcare NHS Foundation Trust, has been rated "requires improvement" by the Care Quality Commission (CQC) following an unannounced inspection in April.

Low staffing levels at Rampton had been a "long-standing concern" which the CQC said leaders had not got on top of after two previous inspections.

The healthcare watchdog said the NHS trust had since submitted an action plan setting out how it would address the concerns, as it was requested to.

Rampton provides services to people who are detained under the Mental Health Act 1983 and are classified as having a learning disability, mental illness or psychopathic disorder.

The hospital was given the rating "requires improvement" following an inspection in March 2025.

During that inspection, staff told inspectors about incidents in which hospital wards had not met "safe staffing levels".

Before that, in January 2024, Rampton had been rated "inadequate".

The trust was under close scrutiny at the time over its care of Valdo Calocane, who carried out the Nottingham attacks in June 2023.

The CQC said it had become aware of occasions when people had faced daytime confinement because of staffing shortages.

Victoria Green, the CQC's deputy director of mental health in Nottinghamshire, said: "When we visited Rampton Hospital, we found staff shortages were affecting almost every part of people's care, despite this being a long-standing concern.

"Leaders hadn't got on top of it and it was disappointing the hospital hadn't always learned from issues we'd raised before."

Green said leaders sometimes moved staff between wards at short notice, which meant some people were cared for by staff who did not know their needs well, while people were also missing planned activities and therapy sessions due to shift changes.

The inspection report said between 1 January and 29 April - a 119-day period - 303 therapy sessions were cancelled because of staffing pressures.

One patient told inspectors they had "no reason to get out of bed as there was nothing to do", while another patient said the frustration of having their activities cancelled led them to self-harm.

On one occasion, a person was left waiting for more than 24 hours to get treatment for a fractured wrist, because the hospital did not arrange secure transport quickly enough.

Inspectors identified seven breaches of regulations relating to staffing, safe care and treatment, dignity and respect, person-centred care, premises and overall management.

The CQC said patients also raised concerns for the welfare of staff.

"Patients told us that they can see staff don't get breaks, that staff don't get a chance to go to the toilet or have food," inspectors recorded.

The CQC downgraded the rating for how responsive Rampton was from "good" to "requires improvement", how effective it was remained rated "good", and how safe, caring and well-led it was remained rated "requires improvement".

Green said: "We had concerns about the way the service restricted people's choices, recorded these restrictions, and shared rules in this area with people.

"The hospital also wasn't consistently meeting the needs of autistic people and people with a learning disability, including not adapting ward environments to their sensory needs.

"However, we saw staff who cared deeply about the people they support and some genuinely person-centred work, particularly in the women's service."

The CQC said leaders were "open" about the challenges they faced and had made "some improvements".

Mark Axcell, the chief executive of Nottinghamshire Healthcare NHS Foundation Trust, said: "The safety, wellbeing and experience of our patients will always be our highest priority.

"We accept the CQC's findings and recognise where need to do better.

"We are fully committed to addressing each area identified for improvement through a detailed action plan with clear accountability."

Axcell said since April, the organisation had appointed 19 staff nurses and 29 healthcare assistants and continued to recruit "every month", and that it had "enhanced training" for colleagues in learning disabilities and autism.

He added: "Whilst we know there is more work to do, I am confident that the positive changes already made provide a strong foundation for further progress.

"I want to reassure patients and their families that we are listening, learning and taking action to ensure we provide the safe, responsive and high-quality care they deserve."

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