During our visit on 12 July 2011, patients were very positive about their experiences of care and treatment.

People commented that care was ‘second to none’ and ‘excellent’. Patients outlined that they had received good nursing and medical assessments and that these were regularly reviewed. They reported that staff communication was good, procedures were well explained and they felt involved in decision making processes. Communication with consultants and senior house officers was reported to be good.

Most patients stated that while staff were often busy they felt there were enough staff on duty to meet their needs.

During this inspection we inspected the core services of gynaecology and surgery. We rated the gynaecology services as requires improvement and the surgery as good. In reaching our final rating for this location we have taken in to account the ratings for the core service medicine and end of life care also provided at this location, which were not inspected on this occasion.

Our rating of services stayed the same. We rated them as good because:

• Incident reporting systems were in place and there was a culture of reporting, investigating and learning from incidents.
• Staff kept detailed records of patients’ care and treatment. Detailed risk assessments were carried out for patients who used the services and risk management plans were developed in line with national guidance. There were effective arrangements in place to safeguard patients from abuse and mitigate the risk of it happening.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients said they were involved in decisions about their care and that staff considered their emotional well-being, not just their physical condition.
• The service followed best practice when prescribing, giving and recording medicines and patients received the right medication at the right dose at the right time.
• Staff assessed and monitored patients regularly to see if they were in pain and had enough to eat and drink.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services.

However

• In general, services provided care and treatment based on national guidance and managers monitored the effectiveness of care and treatment and used the findings to improve them. Most leaders had the skills, knowledge, experience and integrity they needed to fulfil their roles.
• However, recent organisation changes meant there were new leaders at directorate and divisional levels for the gynaecology service. While these teams were working to ensure there were clear reporting structures and a sustained level of scrutiny to ensure they were delivering a quality service where risk were known and managed this was still under development. Therefore, it was not possible to fully assess the effectiveness or impact of the governance and risk management processes.
• There were structures, processes and systems of accountability to support the delivery of the strategy and sustainable services. However in the gynaecology services audits and quality outcomes conducted at a local and divisional level to monitor the effectiveness of care and treatment were not always effective in identifying areas for improvement.
• Evidence was not provided to show staffing levels were always planned, implemented and reviewed to keep people safe.
• Staff did not always receive training identified as necessary for their role.