Our rating of services went down. We rated it them as requires improvement because:

• We rated safe and responsive at this hospital as requires improvement and we rated effective, caring and well-led as good.
• We rated three of the four services inspected, during this inspection, as requires improvement overall.
• Many of the issues identified during the previous inspection, which impacted on the safety and responsiveness of the service and had not yet been addressed by the hospital’s leadership team.

• Mandatory training for staff in key skills, including safeguarding, fell below the trust’s target

  for compliance. However, staff we spoke with were aware of their responsibility to protect vulnerable children and adults.

• Medicines were not always stored in accordance with published guidance. Although many aspects of medicines were managed safely, storage of medicines, and intravenous fluids, was not always safe or secure. Staff did not always monitor storage temperature accurately to ensure it was not harmful to medicines. In some areas there was a risk, due to lack of security measures, that unauthorised persons might gain access to, or tamper with medicines intended for patients.

• Best practice guidelines for care and treatment of patients with mental health needs were not consistently followed. Not all staff understood how and when to assess whether a patient had the capacity to make decisions about their care. The trust policy on restraint was out of date and did not follow current best practice guidance.

• The hospital did not always have sufficient numbers of staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment. In some areas, there was a high turnover and vacancy rates amongst nursing staff and not always enough staff to ensure shifts were safe at all times.

• People did not always have prompt access to the service when they needed it. Waiting times from referral to treatment and decisions to admit patients were not always in accordance with best practice recommendations. There were a high number of patient bed moves and discharges at night. Overcrowding in A&E was a regular occurrence due to lack of space and lack of capacity to meet service demand.

• Whilst the trust had effective systems for identifying risks and planning to reduce them, risks were not always being dealt with in a timely way. Some department level risks had not been identified or adequately addressed. Not all risks identified during our inspection were on the hospital’s risk register; therefore we were not assured that senior leaders had appropriate oversight of these issues.

However:

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

• The hospital generally controlled infection risk well. Staff kept themselves, equipment, and the premises clean. They used control measures to prevent the spread of infection.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers monitored the effectiveness of care and treatment and used findings to improve them.

• Staff cared for patients with compassion, kindness and respect and provided emotional support to patients to minimise their distress. Patients and those close to them, were involved in decisions about their care and treatment.

• Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The hospital engaged with patients, staff, and local organisations to plan and manage services.

• The trust was committed to improving services by learning, promoting training, research and innovation.