Leadership at under-fire NHS trust 'must improve'

An under-fire mental health trust in Nottinghamshire has been told to "make significant improvements" following a review of its leadership.

A report into the Nottinghamshire Healthcare NHS Foundation Trust was published on Wednesday after it was inspected by the Care Quality Commission (CQC) in September.

While the service has seen change since previously being told to improve in November 2022, the CQC's recent assessment into the well-led category ordered the trust to draw up an action plan.

The trust said it accepted the findings, had "already made improvements" but admitted there was "still more to do".

Between May 2024 and August 2025, the CQC carried out a programme of 39 inspections at the trust.

This was part of recommendations the healthcare watchdog made during a formal, government-commissioned review of the trust in the wake of the Nottingham attacks in June 2023.

The review of the NHS trust's leadership was carried out in September last year, following these inspections.

It found breaches of regulation relating to how the trust was managed - and told the trust to submit an action plan showing what action it is taking in response.

The CQC report said: "Due to the level and nature of the risks, we have taken enforcement action and asked the trust to make significant improvements."

The healthcare watchdog said the action should address breaches in governance, including making progress to "proactively engage with staff to improve culture where staff feel valued".

Valdo Calocane was treated by the trust before killing students Barnaby Webber and Grace O'Malley-Kumar, both 19, and caretaker Ian Coates, 65, in the city centre.

The CQC said breaches of regulation were found in 10 services, which now had action plans in place by the trust, as well as a breach of the Health and Social Care Act's good governance requirements.

The inspection found there were "persistent" issues with racism, harassment and "blame culture" in parts of the trust, and the CQC ordered it to make progress on equality and diversity.

In addition, the trust has been continuing to use "dormitory‑style" accommodation in mental health settings at Highbury Hospital - one of the sites it runs - despite being told to stop in 2022.

It must also, the report said, improve areas used by patients in long-term segregation and ensure it adheres to the Mental Health Act.

The report said: "There was poor practice in maintaining dignity, upholding human rights and ensuring least restrictive actions were delivered."

Seven out of its 18 service areas are rated as requires improvement, including five mental health services. Ten services were rated good and one outstanding.

The review found issues with leadership, accountability and culture at the trust, including low morale, with surveys finding less than half of staff would recommend the trust as a place to work.

The watchdog said Freedom to Speak Up cases - a service which encourages staff to anonymously voice concerns - were up to 567 in 2024-25 from the previous year, with themes of staffing problems, patient safety, bullying, attitudes and behaviour.

Inspectors also found a "challenged" financial picture at the trust, with a forecast deficit of £46.8m at the end of the 2025-26 financial year.

The trust's plan to break even was now expected to end £7.5m short due to "slippage" caused by higher than expected numbers of temporary staff and the use of beds out of its area.

Ceri Morris-Williams, CQC deputy director of mental health in the Midlands, said: "In 2022, we told the trust to make significant improvements and remove shared living, dormitory-style accommodation. We've told them to take immediate action to remove this accommodation and prioritise improving the estate and environments across its services.

"Due to the level of concern, around this breach and others breaches we identified, we asked the trust to submit an action plan that addresses how they will embed and make progress.

"We have told the trust where they need to make immediate and widespread improvements, and we will continue to monitor services to make sure people are safe while this happens."

In a statement, the outgoing chief executive of the trust, Ifti Majid, who announced he will retire in June, said: "We are committed to providing high quality, effective and safe care to those people who need it most.

"External inspections are an important way of helping us learn and to make the improvements that are needed.

"We accept the CQC's findings and recognise where improvement is needed. We have already made significant improvements since the CQC's last inspection but fully appreciate there is still more to do. We will be addressing all areas identified in the report."

The trust's services will be reviewed once more when the findings of a public inquiry into the Nottingham attacks are published.

The inquiry, which officially started last year, will examine the management of Calocane's risk to others and the events on the day of the attacks.

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