Patients we spoke with in both inpatient and outpatient areas said their care and treatment options had been discussed with them. They were asked for their consent before treatment was provided. They said they usually gave ‘verbal’ consent, although sometimes it was written consent. Patients knew they were able to change their mind or decline treatment if they wished to.

Parents we spoke with had given consent for their children to be treated. They told us this was handled very well by staff and that care and treatment options were always discussed with them. One parent told us “All of my questions were fully answered”. All of the treatment for their child had been “agreed between me and the staff who have been supportive and helpful”. The provider may wish to note that the care records we looked at did not consistently records patient’s decisions about their consent to their care and treatment.

Every patient spoke very highly of the care and treatment provided in the hospital. Comments from patients included: “I’m very happy with my treatment” and “The care was absolutely excellent when I was in A&E and has been brilliant since I came onto this ward”. Some had used this hospital for a number of years. One patient told us “the staff have cared very well for me. We are very lucky here. The staff really get to know you”. Another said they had always been “consulted on care plans. As an inpatient they “had never felt embarrassed or uncomfortable through the actions of staff. They respected my dignity and privacy” and provided “wonderful care”. The provider may wish to not that we found some patient’s care and treatment records were not well kept.

We asked patients about the food served in the hospital. They told us they had a choice of meals and that the food was generally very good. They knew they could request an additional snack if they wanted one. They could also purchase snacks and drinks from a trolley which was taken around each ward. One patient said “Yes, the food is very good. We had a lovely meal yesterday. I have my menu here so I will choose what I want for tomorrow. You can choose an extra snack if you want when you order”.

We asked patients about their views of being discharged from the hospital. They told us their discharges had been handled well. Some patients had been discharged from the wards; others had used the discharge lounge. One said “I’m going home tomorrow. They have already discussed this with me. I’ve asked to use the discharge lounge this time as I have so much to take with me. They have sorted this out for me”.

Patients told us they felt safe in the hospital. No concerns were raised with us during our two days of inspections. Patients we spoke with said they were happy with their care and treatment and were very complimentary towards staff. Comments included “I haven’t had any concerns at all. It’s all been fine since I have been here” and “I’ve not had any concerns and I have never been upset about anything here”.

Patients spoke very highly of the staff. Comments included “They are very good nursing staff” and “The doctors, consultants and nursing staff are all very good”. Patients told us that there were enough staff working to meet their needs. One said “It does feel like there are enough staff around. All of the staff are very friendly and helpful. I last came into the hospital in January. That stay was fine as well”.

Patients told us they were asked to share their views. They felt their views were very important to the trust, that they were listened to and acted upon wherever possible. The trust had a Patient Experience Committee which met regularly. Patient stories were often presented as part of this meeting. Some patients had been asked to help the hospital develop and improve their care for certain patients, such as those with dementia.

Patients spoke about the different ways that their views were captured. These included the use of questionnaires and surveys. One patient told us “I have filled in a card that asks about the care, how clean the hospital was and how the staff were towards me. I was very happy with all of it”. Another said they had not yet completed a questionnaire as “they normally do this when you are leaving. I haven’t filled one in yet but I did when I was discharged last time. I was very happy with my care and I said so”.

Patients told us they knew how to complain should they need to. None of the patients we spoke with said they had ever complained about their care or the hospital more generally.

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 treatment for the termination of pregnancy was not commenced unless two certificated opinions from doctors had been obtained.

People told us they were involved in decisions about their care and treatment and were kept informed of their progress. Some people we spoke with had been given leaflets about their treatments. Others told us they understood why they were in hospital and what treatment they needed.

Information about the hospital was not consistently available. Some people said that they had been given information about their treatment and the hospital although others were unaware of this. Some people had been in this hospital before so they knew what facilities were available and shared this with fellow patients. One person said “no information was given to me, but I have been in here before so I know what facilities there are”. Another person said “it does not seem to be automatic, but when I asked I was told about the facilities here, but no booklet was given to me”.

There were mixed responses when we asked people if they had been asked for feedback on their experience of using the hospital; most people said they had not been asked but a few had completed a questionnaire. We discussed this with senior members of the management team who said they wanted to increase the number of surveys people complete; this is noted as a priority in this year’s annual plan.

People's needs were assessed and reviewed to make sure that they received the right treatment. We saw staff treat people with dignity and respect. Staff were able to adapt their care to meet the differing needs of people. One person said “the staff are always respectful as I’m very independent and they do care for more dependent people. I’m always listened to and I can do my own thing”.

We observed the care people received. We saw that staff were well organised, cheerful and friendly and that they had time for people. There appeared to be enough staff to meet people’s needs and we saw call bells were answered reasonably quickly. One person said “staff come quickly when I need them, you don’t have to wait. All the staff are excellent. There is plenty of staff day and night”.

People were protected from abuse and the risk of harm. People told us they felt safe in the hospital. There were very few concerns raised with us during our two day inspection. The majority of people we spoke with said they were happy with their care and treatment and were very complimentary towards staff.

People spoke very highly of the care that they received from individual staff. Their comments included “I am very happy with how staff treat me, they are very respectful and kind”, “they are extremely kind, caring and respectful. All the staff are very cheerful and positive” and “all of the staff have been wonderful, kind and patient. They always have time for you”.

People we spoke with told us they felt they were cared for by competent staff. Comments included “yes, I feel the staff are very competent, they know what care I need”, “they always make me feel they know what they are doing” and “I have found all the staff here, including the doctors, very good and they certainly know what they are doing”.

We spoke with people who had used the hospital on separate occasions over recent years and one person said “I have been in this hospital before and I thought they have always been very good, but things seemed to have improved and it’s a lot better now”. Another person said “over the years I have been a patient in the hospital and used outpatients as I am today. The hospital is very good and they always seem to be trying to make things better. When you hear stories about other hospitals we are very lucky to have one like Yeovil”.

Our rating of services improved. We rated it them as good because:

• There were systems and processes to keep patients safe and safeguarded from abuse. There was a proactive approach to safeguarding and prevention of harm. Staff had received up-to-date training. Staffing levels were planned and with staff with the right skills to keep patients safe. There were effective handovers so staff knew about the patients they were caring for. Medicines were used and provided safely. They were well managed. Lessons were learned when things went wrong, and staff were confident about reporting incidents.
• Patients had good outcomes, and there was a strong culture of doing what was right for patients. Care was delivered in line with national guidance and legislation. There were good assessments of patients’ needs, including pain relief, hydration and nutrition. Staff were trained and their performance regularly reviewed. They were supported to gain new and improved skills to develop their practice and experience. Staff worked together to ensure care and treatment was effective.
• Patients and relatives spoke highly of staff and the standards and quality of care. Feedback was positive, and patients we met said they had been treated with dignity and respect. Patients could make their own decisions, and the right people were involved if a patient was not able to do so. Patients’ emotional needs were recognised and supported.
• Services were planned and arranged to meet the general and specific needs of local people. The needs and preferences of different people were accounted for to give patients the best outcomes. The hospital was treating most patients on time and within national targets and standards.
• The staff leadership had the skills, knowledge, experience to oversee services. High-quality and patient-centred care was promoted. There was a clear set of values for staff which were based on the experience for the patient. Staff were well supported and there was good morale and a strong culture. Staff were willing to challenge poor practice and support each other. There was a strong culture around innovation, research, development and improvement. Staff had good systems to assure themselves they were providing a good, safe and quality service.

However:

• Some staff had yet to update their mandatory training in line with trust targets. Not all resuscitation equipment was checked as required. There were some areas where infection prevention and control were not as strong as they should be.
• Not all patients’ medical records were completed as well as they should have been. There were gaps around assessing patients’ mental health, risk assessments and responding to the needs of deteriorating patients. The paperwork documenting resuscitation discussions was not always completed in line with trust policy.
• There were issues with the environment in the children’s ward which impacted on patients. A business plan to resolve much of this had yet to be approved. Some specialist training around eating disorders for staff looking after children had yet to be provided. There was limited access to therapy for children over the weekend. The processes for safe administration of medicines through a syringe driver were not sufficient to guide staff.