• We rated effective, caring, responsive and well-led at this hospital as good and safe as requires improvement.
• We rated all services inspected at this hospital as good overall.

• Staff worked together as a team to deliver effective, patient-centred care and improve patient outcomes. Treatment was planned and delivered in line with current evidence-based guidance and patients were supported by staff to take ownership of their own recovery.

• Staff treated patients with kindness, dignity and respect. Patients were involved as partners in their care and were supported by staff to make decisions about their treatment. Feedback from patients confirmed that staff treated them well and with kindness.

• There was a strong culture of openness, transparency and teamwork within the organisation. Staff felt well supported by managers and told us that they encouraged effective team working across the hospital. Senior staff were visible, approachable and supportive.

• The needs and preferences of different people, including the local population, were taken into account when designing and delivering services. There was a proactive approach to delivering care in a way that met the needs of older people and people living with dementia.

• The hospital had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

• The service had suitable premises and equipment and looked after them well. Staff kept themselves, equipment and the premises clean. They used effective control measures to prevent the spread of infection.

• The trust had implemented a number of innovative services and developed these to meet patient needs. The trust was committed to improving services by learning, promoting training and innovation.

However:

• The trust needed to take action to ensure that patients were protected from the risk of avoidable harm. We were not assured that there were effective systems and processes in place to prevent avoidable patient safety incidents from reoccurring. For example evidence of completed actions in response to serious incidents, was not always robust.

• Opportunities to share key safety information relating to patient risk were sometimes missed. For example, there was no system in place for staff to escalate to the safeguarding team and risk assesses patients that left the Urgent Care Centre before being assessed.

• Staff told us they reported incidents infrequently and therefore opportunities to learn from near-misses were lost. We were not assured that there was a robust culture of incident reporting.

• Although records were clear, up-to-date and easily available to all staff providing care, in the Urgent Care Centre, patient records were not always stored securely and appropriately.

• Although the trust provided mandatory training in key skills to all staff, not all staff had completed it. Many staff told us they did not get time to complete training and had to do it in their own time.

• Although the staff generally followed best practice when prescribing, giving and recording medicines, we found some medicines were not stored in line with trust policy.

• Patients sometimes experienced delays in accessing care and treatment. Waiting times from referral to treatment was not in line with national standards for the endoscopy unit. Theatre lists often started late meaning patients sometimes had to wait a long time on the day of their surgical procedure. The service did not have oversight of the number of patients who left the Urgent Care Centre before being seen, including vulnerable children and adults.