The health watchdog has highlighted “ongoing concerns” at the trust where Valdo Calocane was treated before he killed Grace O’Malley-Kumar, Barnaby Webber and Ian Coates in Nottingham last year.
The Care Quality Commission (CQC) said that Nottinghamshire Healthcare NHS Foundation Trust must improve “to protect patients, families, and the public from the risk of harm”.
And it raised concerns that mental health trusts around the country face similar “challenges”.
Health Secretary Victoria Atkins called for a rapid review of the trust in January after Calocane was sentenced to a hospital order for the killings.
Calocane, who had been diagnosed with paranoid schizophrenia, admitted manslaughter on the grounds diminished responsibility due to mental illness.
The CQC has published two parts of its review – an assessment of patient safety at the trust and an assessment of progress made at Rampton high-security hospital since it was last inspected.
A third part of the view – on Calocane’s care from the trust – will be published in the summer.
Inspectors reported “enduring areas of concern” at the trust, including problems with staffing; leadership and demand for services and access to care.
CQC said that over the last five years it has raised “ongoing concerns about the quality of community and inpatient mental health services at NHFT and has taken enforcement action including restricting admissions to Rampton Hospital”.
The review into patient safety and quality of care at the trust found:
– People struggled to access the care they needed when they needed it, “putting themselves and potentially members of the public, at risk of harm”.
– The quality of care and treatment across the trust “varied” and “care provided did not always meet the needs of individuals”.
– High demand for services and staffing shortages meant that patients were not always being kept safe.
– Action to address safety concerns was often “reactive”.
On Rampton Hospital – the high-security facility which has been inspected by the CQC five times between 2019 and 2023 – inspectors raised concerns about a number of issues, including: “pockets of poor culture”, poor communication between staff and patients, particularly for those in long-term segregation; and concerns over staffing levels.
Inspectors said the hospital should be given a 12-month licence, rather than the usual five-year licence period “to allow for improvements”.
Chris Dzikiti, CQC director of mental health, said: “While we found some improvements, our review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) highlights ongoing concerns around people’s care and safety.
“We have set out clear recommendations for action the trust needs to take so that services provide safe care and treatment, and to protect patients, families, and the public from the risk of harm.
“The concerns around demand for services and access to care, staffing and leadership at NHFT must be addressed – NHS England will be supporting improvement and we will be working with them closely on this.
“However, the findings of our review must also be a starting point to look more closely at the gaps in community mental health services so that real improvements can be made nationally to quality of care, patient safety and public safety.”
Inspectors said many other mental health services across the country are experiencing high and increasing demand and warned that the “high level of unmet need means that more action is needed” to improve care.
Commenting on the review, Brian Dow, deputy chief executive of Rethink Mental Illness, said: “Given the tragic and preventable loss of life in Nottingham which sparked this review, its findings remind us of the imperative to ensure mental health services have the resources they need to provide safe and timely care.
“For the minority who are a threat to others, but also the much larger number of people who when unwell only pose a threat to themselves, either though neglect or self-harm, recommendations from this review must be processed and implemented at speed in Nottinghamshire, with other NHS trusts across the country taking note.
“What’s also clear is that mental health services in some parts of the country are stretched dangerously thin and are struggling to meet demand.
“Until the Government puts them on a more sustainable financial footing, they will be unable to provide the safe, timely, high-quality care which the public expects and deserves.”
Ms Atkins said: “The Care Quality Commission has found failings in the Nottinghamshire Healthcare NHS Foundation Trust’s ability to manage demand for services, access to care, staffing, and issues of leadership. This is not acceptable, and action must be taken.
“Since I commissioned the review, an improvement director has been appointed, and a plan is being developed with the trust and NHS England to improve services. The trust will now have the highest degree of national oversight.
“I want to see rapid, significant improvement and have asked to be updated regularly on the ongoing work to dramatically improve standards at the trust.”
Ifti Majid, chief executive of Nottinghamshire Healthcare NHS Foundation Trust, said: “We are committed to providing high quality, effective and safe care to those people who need it most, and that is why this report makes difficult reading because it is clear that sometimes we have let down patients and their families and for this, we are truly sorry.
“External inspections are an important way of helping us learn and make the improvements that are needed.”
He said the trust set out to make a number of improvements even before the special review was commissioned, adding: “We welcome the additional support that we are now receiving as part of the national Recovery Support Programme, including the support of our improvement director.
“We are currently developing our integrated improvement plan and we will ensure that every recommendation within the CQC’s rapid review report is implemented so that those who use our services receive the high quality care they deserve.
“Once again I want to reaffirm our commitment to improving the quality and safety of our services. We will work relentlessly to ensure all of our patients and their families receive the high quality care they deserve.”