During our inspection of Stepping Hill Hospital on 17 and 19 September 2012 we visited four wards: the MAU (Medical Assessment Unit), ward D2 (elective orthopaedics), ward E2 (medicine for older people ) and A11 (diabetes and endocrinology). During our visits we spoke with several patients on each of these wards and one visiting relative. As part of the inspection we also followed up action taken by the trust following our previous inspection in March 2012.

The patients we spoke with told us they were treated with dignity and respect. For example, one said; “They close the curtain when they are talking to you in private or helping you. They don’t patronise you or belittle you and they explain things well.” Another said; “Everyone has acted properly and is respectful.” All said they were satisfied with the information they were given and that updates from nurses and doctors met their needs.

Patients we spoke with were also very positive about how their care and welfare needs were met. They told us that staff were kind and caring, looked after them well and helped them when they needed. None had any concerns about their care. For example one said; “I am very satisfied and happy. I have all the help I need. I only have to ring and they come.” Another said; “I am very happy with my care and can’t speak highly enough of them all.” Another said; “It’s very good on this ward. I have no complaints whatsoever. Nothing is too much trouble for the staff.” And another; “I have no issues with the staff at all. I want for nothing. They know what they are doing and they know the patients here.”

We spoke with patients on ward A11 and the MAU about their medicines. Overall patients we spoke with were very positive about how their medicines were handled. Comments they made included: ‘’kept well informed’’, ‘’they have explained everything to me’’, ‘’medicines all ok’’ and ‘’they have told me about my medicines.”

We carried out this review because concerns had been raised with us by a number of people about the standard of care on the Medical Assessment Unit at the hospital. For this reason we focussed our inspection on this unit. We also visited two wards Medical short stay unit - male and Medical short stay unit- female.

We spoke to patients about their care when we visited Stepping Hill Hospital. Most people we spoke with were happy with their care. They told us they had not had to wait long to be seen by a doctor and they said they felt well cared for. Comments included: "It's been very good." " They've been great here. Everyone is very good."

We asked patients and their families how their medicines were managed at the hospital. Most of the people we spoke with said there had been no problems. They had got their medicines when they needed them.

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 told us that staff were respectful and treated them with kindness and patience, maintaining their privacy and dignity.

Comments included “Staff are brilliant, very kind and caring”, “they are very caring and tell you everything they are doing”, “if I need help I press the buzzer and they come as quickly as they can” and “they always close the curtains when they use the hoist”.

Patients told us they enjoyed the food provided for them and staff helped people when needed.

Comments included “The food is very good indeed for such a large hospital, always nice and hot. I get plenty of drinks between meals”, “They always tell you what is for lunch and they sit and help me cut up my food”, “the food is very tasty” and “I have not felt like eating but they always try and tempt you with something”. One patient told us that although she did not need help herself she had noticed that staff helped others willingly and were very professional.

Overall throughout the inspection staff told us that following the original Dignity and Nutrition inspection, where shortfalls in practice were found, awareness of these essential standards had been raised across the trust. Staff told us they had reflected on practice and did feel that the increased focus had highlighted to them where improvements could be made. From our observations and from feedback from patients we were satisfied that the measures put in place for addressing the issues raised from our first inspection had resulted in improved outcomes for patients.

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

• We rated safe, effective and responsive as requires improvement. We rated caring and well-led as good.
• We noted improvements within the safe and well-led domains in medicine and urgent and emergency care. However, there were still patient safety concerns.
• In maternity there was improvement in the effective and well-led domains. However, we had concerns regarding patient safety for different reasons than those outlined in our last inspection.
• Staffing remained a challenge. Across maternity and medical services the hospital did not have sufficient numbers of trained staff, including support staff. Whilst this position had improved since our last inspection, the trust was still heavily reliant on the use of bank and agency staff.
• Across the medicine business group, whilst care assessments generally considered the full range of people’s diverse needs, care provided did not consistently reflect the adjustments made particularly in relation to patients with learning disabilities.
• Whilst most staff had the skills and competencies required to deliver their roles, the hospital did not have an effective system to record this. Due to staff moves, staff were not always placed in areas where their competencies could be best utilised.
• In relation to Deprivation of Liberty Safeguards, records we reviewed did not consistently evidence that care was provided in line with patients’ ‘best interests’. The trust did not have an effective system in place to evidence that these patients were monitored to ensure care delivery was in their ‘best interests’. We continued to be concerned regarding capacity assessments and staff’s understanding around them.
• In medicine, patients were moved to other beds and wards during the night to meet bed capacity demands.
• The average length of stay for non-elective patients in geriatric medicine and cardiology was longer than the England average from April 2017 to March 2018. Work was on-going to improve patient length of stay through improvements in patient discharge processes.

However,

• Most care was provided in line with best practice and current national guidance.
• Patients were supported, treated with dignity and respect, and were involved as partners in their care.
• There were changes in the leadership within the business groups, which were having a positive impact on service delivery and improvement.
• The most recent Sentinel Stroke National Audit Programme (SSNAP) audit identified the stroke services at the hospital as the top performing unit nationally.