Sherwood Forest Hospitals NHS Foundation Trust was formed in 2001, and achieved foundation status in 2007. Sherwood Forest Hospitals is the main acute hospital trust for the local population, providing care for people across north and mid-Nottinghamshire, as well as parts of Derbyshire and Lincolnshire. The trust employs 4,300 members of staff working across the hospital sites.

There are four registered locations King’s Mill Hospital in Sutton-in-Ashfield, Newark Hospital and Mansfield Community Hospital.

Mansfield Community Services provided three medical wards with a total of 64 beds.  It is a rehabilitation service and has a range of outpatient and diagnostic services. There is a dedicated therapy team for Oakham and Lindhurst wards.Chatsworth ward has a dedicated therapy, psychology, dietetics and speech and language services and a small outreach service. Nurse specialists for Osteoporosis and Parkinson’s disease were based at the hospital and the Geriatric Medicine team offered dedicated outpatient clinics for these services.

In February 2013, the trust was identified as being one of the 14 healthcare providers in England which had higher than expected mortality rates. This led to the trust being reviewed by Professor Sir Bruce Keogh, NHS Medical Director for England and the trust was subsequently placed into “Special Measures” by Monitor, the independent regulator of NHS foundation trusts. CQC undertook a first comprehensive inspection of the trust in Spring 2014. Although some improvements had been made CQC recommended a further period in special measures and gave an overall rating of ‘Requires Improvement.’

We carried out an announced inspection visit from 16 to 19 June 2015 and three unannounced visits on 7, 9 and 30 June 2015. We held focus groups with a range of staff in the hospital and we also spoke with staff individually.

Overall, this trust was rated as "Inadequate." We made judgements about 13 services across the trust based on the five key questions that we ask. We rated safety, leadership and effectiveness as Inadequate, responsiveness as "Requires Improvement" and caring as "Good."

At Mansfield Hospital we rated the medical service as requires improvement but the effectiveness of the service was inadequate. Safety, caring, responsive and well led were rated as requires improvement.

Our key findings were as follows:

• Overall the hospital was clean, hygienic and well maintained. There had been one case of clostridium difficile infection and three cases of Escherichia coli (or E. coli) at Mansfield Community Hospital for the period April 2013 – March 2014. Infections by clostridium difficile and E. coli bacteria affect the digestive system.

• Nursing staffing levels had been reviewed and the numbers of staff had increased. There were some nursing vacancies but staffing levels were maintained by staff working extra shifts or the use of bank nurses. Bank nurses underwent induction. The planned staffing ratios were met and there was an escalation process in place if the acuity of patients increased.

• Medical staffing arrangements were different for each ward, depending on the speciality. Two of the wards used a local GP service to provide out of hours cover. There was no formal agreement in place for how quickly the GP service would respond for requests to review patients. Locum medical staff were used extensively due to difficulties recruiting permanent medical staff. Locums underwent induction.

• Care and treatment did not always reflect current evidence based guidance, standards or best practice. The care for patients living with dementia did not meet current guidance and recognised good practice. There were no learning disability care pathways in place to inform staff how to support patients with a learning disability. Generally, Care plans did not reflect people’s individual needs or preferences.

• The risk of inadequate nutrition was assessed for all patients. Not all of these assessments were accurate. Where patients needed assistance to eat and drink it was done in a sensitive manner but we saw the meal service on Oakham ward was fragmented. Ward dining rooms were used to promote independence and aid rehabilitation.

• We found limited evidence of how the service was monitoring clinical outcomes of patients so they could be certain they were providing effective care and treatment. Some staff were concerned with the types of patients being admitted to the hospital because rehabilitation was not realistic but this was not being monitored.

• staff felt their local leadership was good and they worked in effective teams. There was no clear vision or strategy for the hospital and some staff felt disconnected from the rest of the trust.

There were areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Mansfield Hospital

• Ensure staff have opportunities to learn from incidents across the trust.
• Ensure medicines are safely administered to patients in line with local policies and procedures and current legislation.
• Ensure care plans are individual and specific to the patient to ensure staff are aware how to deliver care to patients which meets their needs.
• Ensure the care of patients living with dementia is in line with current guidance and recognised good practice.
• Ensure patients’ mental capacity to make decisions is assessed in line with current guidance and legislation.
• Ensure the sepsis care pathway is followed so that patients with sepsis are identified and treatment is delivered.

Professor Sir Mike Richards

Chief Inspector of Hospitals