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.

Patients we spoke with said that they had plenty of choice of food and that the portion sizes were good. Most said that the quality of the food was good. Some patients we spoke with said they hadn’t been specifically asked about their dietary requirements. Patients told us that they had not been interrupted during mealtimes.

During our visit on 12 July 2011, most patients we spoke to were happy with the level of care they received and the responsiveness of staff. Patients and their relatives said that communication had been good and that they were involved in decision making processes. Staff were observed sitting with patients and taking time to talk with them. When call bells were rung, staff answered promptly. A few patients we spoke to raised concerns about the care they received and communication with staff.

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

• Most services had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, some risks which had a potential to have a high impact, were not considered as a risk and therefore were not captured on the services risk register.
• The services provided mandatory training in key skills to all staff but not everyone had completed their training. Nursing staff compliance was significantly higher than medical staff.

• There was a gap in the management and support arrangements for staff. Appraisals were significantly below the trust target of 90% for staff groups except medical staff.
• The trust had a recruitment program and was undertaking various initiative to encourage staff to stay. However, some services, such as surgery, gynaecology and midwifery did not always have enough nursing or midwifery staff, with the right mix of qualification and skills.

• Patients care records were not always stored in a way which protected patient confidentiality.
• Medicines were not always safely stored and managed at all times.
• Some services did not always control infection risk well. Staff did not always keep equipment and the premises clean. Control measures to prevent the spread of infection were not always in use in the main theatres.
• The environment was not always suitable for services provided. Areas in some of the main operating department and wards were damaged and in need of repair and posed potential risks to patient and staff safety.
• Privacy and dignity was compromised for some patients in the main operating department.
• National standards for care and treatment in some key areas were not always met. Referral to treatment (percentage within 18 weeks) and average length of stay for elective patients did not always meet the England average. The percentage of cancelled operations was higher than the England average.
• The trust’s responses to complaints were not always completed in a timely manner.
• A proportion of patients experience a delay when medically fit for discharge.
• 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.

However

• The services managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learnt. When things went wrong, staff apologised and gave patients honest information and suitable support.
• In general services provided care and treatment based on national guidance and monitored evidence of its effectiveness. Although we found the maternity service had not reviewed or updated some of the protocols and guidelines against best practice and national guidance.
• There was good multidisciplinary working. When people received care from a range staff, teams or services, it was co-ordinated.
• People were supported, treated with dignity and respect and were involved as partners in their care. People were treated with kindness during all interactions with staff and relationships with staff were positive.
• Reasonable adjustments were made and action taken to remove barriers when people found it hard to access or use services.
• Consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity Act 2005. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded.
• Most leaders were visible and approachable. Leaders modelled and encouraged compassionate, inclusive and supportive relationships among staff so that they felt respected, valued and supported.