During this inspection a team of inspectors visited the Luton and Dunstable Hospital on 15 and 18 June 2012 and spoke with more that 45 people who were either in- patients or attending out patient appointments at this time.

Most people that we spoke with told us they were clear about the care and treatment options that were available to them and they felt that they had been thoroughly involved in making decisions about the treatment they had received. They said that the nursing and care staff in particular were very good at explaining their care and treatment options to them.

People spoke positively about their experiences in the A & E department stating that they felt safe, and had confidence in the staff to care for them appropriately. One person said. “Why wouldn’t I feel safe, everyone is so kind”.

Generally we found that people were very satisfied with their care, and had confidence in the nursing and medical staff. One person told us the care they had been offered was “very good and better than they had received from another hospital” And another said “If you had to go into hospital I would recommend this one. My treatment has been brilliant and the staff and the doctors have explained everything to me. I live 100 miles away and they have given me advice on what to do when I get home.”

Although people visiting the outpatient clinics were generally satisfied with their care, some people commented that they had to wait along time for follow up appointments.

During this review we spoke with more that 50 people who were ‘in patients’ or attending out patient appointments.

People that we spoke with in all areas of the hospital praised the staff that were caring for them. They said that staff were friendly and helpful and never kept them waiting long when they pressed the call bell despite the fact that they were always very busy.

They said that the staff were generally competent and always explained what they were doing during procedures, and that the approach and attitude of staff was pleasant, supportive and respectful.

People confirmed that they were given choices in order to make informed choices about the care they needed, both in hospital and after discharge, and that there was plenty of information available to help them make decisions about their treatment.

The only negative comments we received during this review were related to waiting times in some of the Out Patient Clinics and in the Accident and Emergency (A&E) department, which had then impacted on the charges that people had to pay for parking.

During this review of compliance we visited the Luton and Dunstable hospital and spoke with patients and their relatives on wards 15 and 16. These are both Elderly Care Medical wards.

Generally, people spoke highly about the staff, with one person saying, “That young man is very kind and will do anything for you." Another said, "The staff are very nice but they are always so busy."

This latter comment was also reflected by a relative, who said that nurses did not always respond to patient’s call bells very quickly and that this sometimes meant that the person could remain soiled for long periods of time. This person also said that communication between the doctors and the nurses "is lacking at times" and gave an example of medication changes not being conveyed to staff in a timely way. However, they also said that, when they raised these concerns with the relevant ward sister, they were satisfied that matters were being addressed.

When we spoke with people about their discharge plans, we found that the level of information shared with people and their degree of involvement in agreeing these plans was inconsistent.

One person confirmed that they were fully aware of the plans for their discharge and that their relative had been involved in the planning process. They were due to be discharged that afternoon. However, despite this detailed planning, transport arrived just as the midday meal was being served on the ward. This meant that this person was discharged to a care home, without having their midday meal.

Another person confirmed that they were aware of what was in their care plan and their original discharge plan. However, they described themselves as ‘cross’ because plans to be discharged into a rehabilitation bed had been changed at short notice and they were now being discharged straight home.

A relative told us that they were unaware of any discharge plan, despite the fact that they visited their loved one every day. They felt that this was because the individual receiving care did not speak English and that no effort had been made to discuss this with them in a way that they could understand.

Another person was unhappy because they were being sent home with the support of a domiciliary care agency, instead of going to a rehabilitation unit as previously planned and agreed. They and their family were worried that the alternative support package may not be sufficient for them to cope at home.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

At this inspection, we inspected medical care, surgery, critical care, and children and young people services. We did not inspect urgent and emergency care, maternity, end of life care or outpatients at this inspection, but we combine the last inspection ratings to give the overall rating for the hospital.

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

• Our rating for safe remained requires improvement overall. Not all services had enough staff with the right qualifications, skills and training. Not all staff had attended mandatory training and not all staff complied with infection control practices and medicines management was not always managed safely.
• Our rating for effective remained good overall. Not all guidance was up to date. The services provided care and treatment based on national guidance and had evidence of its effectiveness. Patients at the trust had a higher than expected risk of readmission for elective admissions compared to the England average. We saw action plans were in place to address this.
• Our rating for caring remained good overall. All services were rated good for caring. Staff cared for patients with compassion. Feedback from patients confirmed staff treated them well and with kindness.
• Our rating for responsive remained outstanding overall. The trust planned and provided services in a way that met the needs of local people. Services were planned to consider the individual needs of patients. Adjustments were made for patients living with a physical disability. The hospital had disabled access across all areas of the medical services. Waiting times from referral to treatment were longer than the England average in four specialities from May 2017 to April 2018. As of April 2018, RTT data was improving, the trust was 4% below the national average overall.
• Our rating for well led remained outstanding overall. Leaders at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Senior leaders were visible and demonstrated commitment.