Patients told us they were treated with dignity and respect. They said they were able to make informed choices and their privacy was maintained. One patient told us “The staff nurses and doctors explained to me what was going on.”

Patients care records were written in a clear and easy to understand way. The assessments and care plans contained within each person’s record detailed how staff should support each individual in the person’s preferred way.

The provider had sufficient numbers of staff with the right competencies, knowledge, skills and experience to meet the needs of patients.

The provider had clear procedures in place, which were followed in practice, for receiving, handling and responding to complaints.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

The patients that we spoke to said that they were happy with the food they got. We did not get any comments from patients about any of the other outcomes that we reviewed during this visit.

Our rating of services stayed the same. We rated it them as requires improvement because:

• We rated safe and well led as requires improvement; effective, caring, and responsive were rated as good.
• Overall, urgent and emergency care, medical care and surgery stayed the same since our last inspection. Maternity services had improved.
• Seven never events had occurred between May and October 2016. The trust took actions to address this. However a further four never events occurred at the trust between November 2016 and May 2017. The trust took further action but despite this two further never events occurred after September 2017.
• The department was having difficulty meeting the four hour target. Between October 2016 and September 2017 the department had only met the monthly 95% four hour target once.
• The hospital did not meet targets for Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training.
• There were poor levels of overall compliance with mandatory training.
• Staff satisfaction was mixed according the staff survey. Staff did not always feel actively engaged or empowered. Equality and diversity were not consistently promoted and the causes of workforce inequality were not always identified or adequately addressed.

However:

• In most areas nurse staffing had improved.
• Care and treatment of patients requiring non-invasive ventilation (NIV) had improved since the last inspection.
• Staff investigated incidents quickly, and shared lessons learned and changes in practice with staff.
• Wards and department areas were clean and equipment well maintained. Staff followed infection control policies that managers monitored to improve practice.
• Staff provided care and treatment based on national guidance and evidence and used this to develop new policies and procedures.
• Staff cared for patients with compassion, treating them with dignity and respect.
• Patients, families and carers gave positive feedback about their care.
• The hospital escalation policy and procedure guidance was followed during busy times.