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  • NHS hospital

St Peter's Hospital

Overall: Requires improvement read more about inspection ratings

Guildford Road, Chertsey, Surrey, KT16 0PZ (01932) 872000

Provided and run by:
Ashford and St. Peter's Hospitals NHS Foundation Trust

Important: We are carrying out a review of quality at St Peter's Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

4 January 2023

During an inspection looking at part of the service

Pages 1 and 2 of this report relate to the overall hospital ratings of this location, from page 3 the ratings and information relate to maternity services based at St Peters Hospital.

We inspected the maternity service at St Peters Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice unannounced focused inspection of the maternity service, looking only at the safe and well-led key questions.

St Peters Hospital is in Chertsey Surrey and part of the Ashford and St Peters NHS Foundation Trust. The trust serves a population of 410,000 people. Maternity forms part of the Women Health and Paediatric division with an annual birth rate of 3,280 births with 6% of women choosing to give birth in the co-located Abbey Birth Centre or at home.

Maternity services offered low and acute care during the antenatal, intrapartum, postnatal and community care. Services included antenatal clinics, antenatal education programme a maternity day assessment unit, maternity triage, an obstetric led labour ward, and antenatal and postnatal wards. Women and pregnant people could access their personal care records digitally.

Our rating of this hospital stayed the same. We rated it as requires improvement because:

  • Our ratings of the Maternity service went down but the ratings for the hospital remained the same. We rated safe as inadequate and well-led as requires improvement and the hospital as requires improvement.

How we carried out the inspection

This maternity thematic review was a focused inspection; we inspected the domains of safe and well-led using the CQC’s specific key lines of enquiry designed to support the National Maternity Services Inspection Programme.

Inspectors visited maternity services on 4 January 2023. We spoke with 20 staff and reviewed 6 sets of patient care records. We looked at a wide range of documents including audits, standard operating procedures, meeting minutes, risk assessments and recently reported incidents.

After the inspection we requested further documentary evidence to support our judgements including training records, staffing roster, reports, and quality improvement initiatives.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

17th and 18th November 2021

During an inspection looking at part of the service

We carried out an unannounced focused inspection because we had concerns about the safety and quality of services.

Prior to our inspection we received information of concern from several sources. The information related to the culture in surgery and anaesthetics division and suggested patients were not being safely discharged from care in the medical care division.

This was a focused inspection and we rated the domains of safe and well led for medical care and surgery at St Peters Hospital. We also looked at some aspects of the effective and responsive domains for medical care.

Because this was a focused inspection the overall rating for the trust stayed the same. We rated the domains of safe and well-led. Our rating for surgery went down because we rated safe and well led as requires improvement. Our rating of medical care remained the same we rated safe and well led as good.

Our rating for the hospital went down because:

  • Nursing staff numbers were consistently below planned levels.
  • Staff were not up to date with mandatory safeguarding training.
  • The environment on the wards and in theatres did not always meet national guidance.
  • There was a significant number of senior surgical staff who felt disengaged and disenfranchised and the strategies to address this appeared to be lacking impact.

However:

  • Staff understood how to protect patients from abuse and harm most of the time, and managed safety well. They controlled infection risks and managed medicines well.
  • Staff assessed risks to patients, acted on them and kept good care records.
  • Staff managed safety incidents well and learned lessons from them. They collected safety information and used it to make improvements and were committed to continuous improvement.
  • Staff understood the services vision and values, and how to apply them in their work. They were clear about their roles and accountabilities.
  • Staff were focused on the needs of patients receiving care. They treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs. Services engaged well with patients and the community to plan and manage services.

How we carried out the inspection

During the inspection we visited medical and surgical services. We looked at the environment, observed staff huddles, patient handovers and patient care. We spoke with 76 members of staff including doctors all grades of nurses, allied health professionals, consultants, anaesthetists and senior leaders. We spoke with two patients who attended the hospital for surgery and two patients on the medical wards. We reviewed 22 patient’s records including medicine charts. We looked at a range of policies, procedures and other documents relating to the running of the service.

We reviewed data for this inspection from November 2020 – October 2021.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

13 June to 11 July 2018

During a routine inspection

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

We rated effective, caring responsive and well-led as good. We rated safe requires improvement overall.

In urgent and emergency care we rated safe, responsive and well-led as requires improvement and caring and effective as good. We rated the service as requires improvement overall.

In critical care we rated safety, responsive and effective as good and caring and well-led as outstanding. We rated the service as good overall.

In medicine we rated safe as requires improvement and effective, caring, responsive and well led as good. We rated the service as good overall.

In children and young people’s services we rated safe, effective, caring, responsive and well-led as good, and the service as good overall.

We did not inspect all core services. The previous rating for those services we did not inspect were taken into account when working out the overall trust ratings for this inspection

The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately and could discuss the processes involved.

The service used safety monitoring results well and participated in the national safety thermometer scheme. Staff collected safety information and shared it with staff, patients and visitors. The trust used information to improve the service.

The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Standards of hygiene and infection rates were monitored to identify any risks and infection rates were low.

Staff kept appropriate records of patients’ care and treatment. Multi-disciplinary, electronic records were clear, up-to-date and available to all staff providing care.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Specialist teams support ward staff and patients in vulnerable circumstances.

The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Recruitment, especially of nursing staff was a major challenge to the trust. However, there were systems, including the use of a flexible workforce that ensured there was a match between staff on duty and patients’ needs.

The services provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance through programmes of audit.

The trust made sure staff were competent for their roles. There was a programme of mandatory training and staff had opportunities to develop their skills and gain experience and qualifications to help them do their jobs effectively.

Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Electronic records were used effectively and there were electronic systems to ensure patients’ conditions were monitored

Staff cared for patients with compassion. Feedback from patients and our observations confirmed that staff treated them well and with kindness and respected their privacy. In critical care there were examples of staff making exceptional efforts to deliver a caring service.

Staff involved patients and those close to them in decisions about their care and treatment. Patients said they were given sufficient information and support to make decisions about their care and treatment

Staff provided emotional support to patients to minimise their distress, and patients could access a member of a multi-faith chaplaincy team to discuss spiritual matters.

The trust planned and provided services in a way that met the needs of local people. They worked collaboratively with other healthcare organisations and patient groups to identify and meet local needs.

Generally, people could access the service when they needed it. Waiting times from referral to treatment met government standards and arrangements to admit, treat and discharge patients were in line with good practice. However, waiting times for assessment and treatment or admission in emergency care did not meet government and professional standards.

The service took account of patients’ individual needs. There were specialist teams to support those with additional needs, for example those living with dementia or those in vulnerable circumstances.

The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. However, the trust acknowledged there were issues with the timeliness of complaints responses and sometimes in the quality of the response. An action plan was in progress at the time of inspection to address these issues.

Generally, the trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care and promoted a positive culture focussed on the needs of patients. The organisational values were embedded and staff could give examples of how they guided them in their work.

The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. The trust had recently reset its overall strategy, mission and strategic objectives; these were well understood by staff.

Staff had been engaged in setting the trust’s recently revised vison, mission statement and strategic objectives. These and the existing trust values, were well understood and embedded in staff’s work.

The trust used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. Staff were involved in quality improvement projects and research activity.

The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively. Patients were involved in the production of pathways of care and other initiatives. There were arrangements for staff to register concerns or to highlight areas of exceptional practice or achievement.

However:

Medicines were not always stored in a way that ensured their effectiveness although patients were prescribed and given medicines well. Patients received the right medication at the right dose at the right time.

The service had suitable premises and equipment but did not always look after them well. We found issues relating to fire safety, waste management, storage of substances hazardous to health and emergency equipment being checked to ensure it was ready for immediate use.

Departmental managers did not always identify safety hazards and manage them.

The service provided mandatory training in key skills to all staff but completion rates were variable and often did not meet the trust own targets.

19th September 2017

During an inspection looking at part of the service

Ashford and St Peter’s NHS Foundation Trust provides healthcare services across north-west Surrey to a population of 302,600. The trust provides district general hospital services and some specialist services such as neonatal intensive care and limb reconstruction surgery from sites at Ashford and St Peter’s Hospitals.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so, we rate the performance of services against each key question as outstanding, good, requires improvement or inadequate.

We also apply ratings to the trust’s overall performance. When we inspected the trust in December 2014 and published in 2015 we rated it as ‘good’ overall. We rated safety as ‘requires improvement’ ‘good’ for effective, caring, responsive and well led. We found that the trust was in breach of some regulations and we told the trust it must address this. We returned to the trust in February 2017 to review progress and found the trust had improved and was compliant with all regulations.

This unannounced responsive inspection was undertaken as we had received information of concern regarding standards of nursing care on medical wards at St Peter’s Hospital. We followed this up with the trust who provided us with further information. However, we needed to go and test this information to ensure patients were receiving safe care. We focussed the inspection on this issue and did not inspect other services or cover all of our key lines of enquiry. The results of this responsive inspection have not changed the ratings from the previous inspection report published in 2015.

We saw several areas of good practice including:

  • The strategy and initiatives to prevent and monitor pressure ulcers

  • The planning and delivery of nursing care

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure fire safety is regularly reviewed and enforced.

  • Ensure the safe storage and security of medicines.

  • Ensure safety checks and services on patient equipment are consistently completed.

In addition the trust should:

  • Support and enable all staff to complete mandatory training.

  • Continue its strategy to make safety thermometer information more accessible to staff and patients.

Professor Edward Baker

Chief Inspector of Hospitals

3-5 & 14 December 2014

During a routine inspection

Ashford and St Peter’s Hospitals became a foundation trust on 1 December 2010. As an NHS Foundation Trust there is greater freedom and scope to provide services for patients and the communities and more financial control of investments and expenditure.

The trust provides district general hospital services to a population of around 410,000 people living in the boroughs of Runnymede, Spelthorne, Woking and parts of Elmbridge, Hounslow and Surrey Heath. There are variations within those areas in terms of the ethnic diversity of the local populations and levels of deprivation. In Spelthorne and Runnymede the average proportion of Black and minority ethnic residents was 12.7% and 11% respectively, both lower than that of England of 14.6%. The average proportion of Black and minority ethnic residents in Hounslow was 48.6%, significantly higher than that of England (14.6%). Deprivation in all three areas was the same as the England average, but with higher-than-the-England-average rates of children in poverty and statutory homelessness in Hounslow. The trust also provided some specialist services including neonatal intensive care, bariatric (weight loss) and limb reconstruction surgery.

At the time of this inspection, there had been some recent changes within the executive team. The chief executive had been in post since September 2014, having previously been the chief nurse since 2010.The chief nurse had been in post since October 2014, having previously been the deputy chief nurse and associate director of quality. The chair had been in post since 2008.

We carried out this comprehensive inspection as part of our in-depth inspection programme. The trust had been assessed as band 6 and 5 in our ‘intelligent monitoring’ system between March 2014 and July 2014. (The intelligent monitoring looks at a wide range of data, including patient and staff surveys, hospital performance information, and the views of the public and local partner organisations.) Our inspection was carried out in two parts: the announced visit, which took place on 3–5 December 2014; and the unannounced visit, which took place on 14 December 2014.

Our key findings were as follows:

Safety

  • Safety required improvement in urgent and emergency care, medical care, surgery, critical care and children and young people.
  • Staff were aware of the requirements for reporting of incidents which were investigated with findings and learning being fed back locally.
  • There were concerns with the safe storage of medicines in some medical and surgical wards and that staff in the children wards were not all up to date with medicines management training.
  • The trust was taking action and implementing changes to respond to an increased demand in some outpatient clinic services. Some additional clinics were being run and action was being taken to improve the patient experience with regards to appointment booking.
  • All areas visited were seen to be visibly clean.
  • We looked at a selection of resuscitation equipment across clinical areas and found that this was correctly serviced, cleaned and checked at regular intervals.
  • Records were not consistently stored to maintain patient confidentiality. Some records were not accurate in reflecting the needs of the patient.
  • There were challenges in clinical areas being able to recruit and retain staff which led to a lack of sufficient permanent staff and caused a number to work additional hours in theatres, critical care and the children’s ward. Staff in other areas found it difficult at times to attend training.
  • The trust was working to achieve a target of 100% for completion of the World Health Organization (WHO) checklist. There had been a recent re-launch and communication to staff as part of the drive for improvement.

Effective

  • All services were found to be effective.
  • There was evidence of good multidisciplinary working. Of note was the competent specialist palliative care team who worked successfully throughout the hospital. They were accessible, visible and utilised.
  • The clinical effectiveness of the services was good. Care and treatment was delivered by trained and experienced medical staff and committed nurses. The service followed national guidelines, practice and directives.
  • Patients’ pain was assessed in services using appropriate pain assessment tools and there was a dedicated acute pain team who were easily accessible to ward staff. For patients who had a cognitive impairment, such as dementia, staff used the Bolton Pain Assessment Scale to aid their assessment.
  • Staff had access to policies and protocols which took account of requirements for National Institute for Health and Care Excellence (NICE) guidance relevant to their area of practice. For example, we specifically looked at the requirements of the guidance Acutely Ill Patients in Hospital (QS6), Preventing Falls in Older People (CG161) and IV Therapy in Adults in Hospital (CG174) and found that policies and practice met the guidance.
  • Although no data was provided at this early stage, the Abbey Birth Centre was reporting improved outcomes for reduced uptake of pain relief, mobility in labour, less use of Syntocinon for augmentation of labour and fewer operative deliveries.

Caring

  • All services were found to be caring.
  • Caring staff throughout the hospital were seen to treat patients at the end of their lives and patients’ relatives with dignity and respect.
  • The chaplaincy department of the hospital was proactive in its support of end of life care. The chaplain and volunteers visited the wards daily providing support to those patients who needed spiritual support. The chaplain was also present on the end of life steering group to ensure that the spiritual needs of patients continued to be in focus. The chaplain had also reintroduced the end of life care group for relatives to provide further support.
  • Children and young people were encouraged by staff to be involved in their own care. Two young people told us that they were able to do a lot of things for themselves but that the staff were available if they needed any extra help or support. They were also able to speak to clinicians on their own.

Responsive

  • Aside from urgent and emergency services all were found to be responsive.
  • The emergency and urgent care services at St Peter’s Hospital were not always able to achieve and sustain delivery on the expected targets, despite their best intentions. This impacted on patient flow and there were frequent occurrences of patients staying in the department for excessive hours, awaiting ward beds.
  • The trust had introduced a telephone reminding service for appointments. This had helped to reduce the rate for patients not attending appointments from 13% to an average in the last 12 months of 8%.
  • To reduce the number of times a patient may have to attend for several outpatient appointments, staff aimed to arrange to have more than one appointment on the same day. Patients’ experience was that this worked well and, though they had a long wait at times, they were please they only had to visit the hospital once.

Well-led

  • We judged improvements were required in the well led domain for critical care, services for children and young people and maternity and gynaecology services. All other services were found to be well-led.
  • In critical care we found there was no robust programme of governance, risk assessment, assurance and audit. The governance arrangements of the service were not providing feedback on incidents, audits, or results from those quality measures it had. There was a lack of accountability for driving through actions and improvements.
  • In maternity and gynaecology We found a considerable number of staff had been impacted by what had been acknowledged as some inappropriate leadership behaviours. The new Associate Director of Midwifery had been in post for 14 months and a new engaging leadership style was evident. The current leadership team had developed a vision and were working on an action plan following the external review which focused on quality and team work.
  • In services for children and young people staff on Ash Ward told us they had not had any formal leadership for the last six months and it had been a very difficult period. We were told of a number of new appointments to senior posts that were just about to start, meaning that all of the wards and departments would have their current designated senior posts filled. A Recent senior nursing staff appointment had been welcomed as there had been a period of time without leadership within the paediatric services.
  • All staff we spoke to across the hospital were aware of the trust’s vision. We observed that staff were putting the principles into action and could give examples of how they did so.
  • All staff we spoke with told us that trust and divisional leaders were highly visible.

We saw several areas of outstanding practice including:

  • Good joint working between the wards and departments, the bereavement services, chaplaincy services and the mortuary services to ensure as little distress as possible to bereaved relatives.
  • Caring staff throughout the hospital, who were seen to treat patients at the end of their lives and patients’ relatives with dignity and respect.
  • The trust had a proactive escalation procedure for dealing with surges in activity and managing capacity.
  • The major incident procedures had been regularly tested internally and with external partners with reviews of learning being implemented.
  • The trust had developed an Older People’s Assessment and Liaison (OPAL) team which enhanced the care of the frail elderly by ensuring these patients were effectively managed by a specialist team early in their admission. Their interventions decreased the number of admissions of this group to speciality wards, and also contributed to fewer patients being readmitted. Patients and their supporters said they felt involved in care planning and discharge arrangements.
  • The electronic patient record system in the intensive care unit (soon to be brought into the high dependency unit) was outstanding. Patients benefitted from comprehensive, detailed records in one place, where all appropriate staff could access and update them at all times.
  • In critical care there was an outstanding handover session between the consultants going off duty and those coming onto shift. This included trainee doctors and made excellent use of the electronic patient record system.
  • The dinosaur trail designed to distract children on their walk to the operating theatre had proven to be very successful. It meant children were not scared when they arrived at the operating theatre.
  • The play therapy team who worked within the paediatric services were very enthusiastic about their work, were well-respected by children and their parents and staff. The team had won a £3,000 prize for innovative ways to brighten up the playroom.
  • The children’s ward staff worked hard, with the clinical nurse specialist to ensure patients with diabetes had a high standard of care and there was a well-established transition to adult services.
  • The trust had a very detailed policy for use at times when patient safety needed to be maintained to enable treatment through applying ‘mittens’. The policy provided staff with guidance on their use in line with the Mental Capacity Act 2005, from the assessment of the patient, recording the decisions and the continual review of decision and when to stop using them.
  • The trauma and orthopaedic unit had set up an early discharge team to reduce the length of stay for patients with hip fractures. Patients had continuity of care from hospital into their own home as they had the same staff. This had reduced their length of stay in hospital.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Take action to ensure medicines in medical care services are stored at temperatures that ensure they remain in optimum condition and provide effective treatment.
  • Ensure that all trained paediatric nurses are up to date with medicines management training.
  • Take action to ensure patient records are kept securely and can be located promptly when required.
  • Take action to ensure the critical care department has sufficient numbers of suitably qualified, skilled and experienced nursing staff on the units and the outreach team to safeguard the health, safety and welfare of patients at all times.
  • Take action to ensure staffing levels on Ash Ward are such that they are able to meet the needs of their patients at all times.
  • Take action to ensure theatres, anaesthetics and surgical wards have sufficient numbers of suitably qualified, skilled and experienced nursing staff to safeguard the health, safety and welfare of patients at all times.
  • Ensure in the critical care department that there is a full range of robust safety, quality and performance data collected, audited, examined, evaluated and reported. The trust must ensure it has sight of this data, which follows the standards of a national programme, at board level.

In addition the trust should:

  • Ensure the security arrangements for accessing the paediatric area in the A&E department are adhered to in order to prevent unauthorised access.
  • Ensure the layout of the A&E department waiting area enables sufficient visibility for staff to identify if a patient’s condition deteriorated.
  • Ensure the access/exit routes of the room used for psychiatric assessment in the A&E department are not obstructed to protect the safety of staff and patients.
  • Follow up the recommendations from the maternity external review to provide an improved experience and outcomes for women and their babies from ethnic minorities and for families with greater social factors and stress.
  • Ensure adherence to the trust policy on inappropriate movement of patients at night, in particular those receiving palliative care.
  • Ensure those patients who receive palliative care and have complex needs do not have a protracted journey via several clinical areas on their admission to hospital.
  • Report on and display in the critical care department incidents of all categories of patient harms. These should be reported in staff and clinical governance meetings and actions taken around any trends or performance improvement identified.
  • Ensure in the critical care department that all investigations it carries out into serious incidents have action plans attributable to members of the team, and mechanisms for actions to be followed up and reported.
  • Ensure in the critical care department that all clinical areas are able to be easily cleaned and free from dust and sticky tape on the walls in clinical areas. The critical care operational policy should set out what area is considered as the ‘clinical area’ and how staff should behave in relation to infection prevention and control in this area. This should follow the trust policy on infection control.
  • Audit critical care recommendations for the Faculty of Intensive Care Medicine Core Standards and escalate areas where it does not meet the standards to the trust risk register. This should extend to: cover provided from allied health professionals, including the pharmacist, confidentiality of patient records in the high dependency unit (HDU), and the environment of the HDU.
  • Ensure any secure areas, such as the clinical room in the HDU, are attended to immediately when security fails due to broken door locks.
  • Ensure critical care has access to a practitioner skilled in advance airway techniques at all times.
  • Monitor all critical care patients for delirium using a recognised tool.
  • Look to provide patients in the critical care department with innovative services to contribute to their emotional support and wellbeing. Patients’ and relatives’ views should be sought to determine what patients want from critical care. Their views and opinions should be acted on and used to improve the service.
  • Ensure that any policy used in the critical care department be approved by the relevant party within the hospital trust. Operational policies should be written in accordance with trust policies. The critical care operational policy should ensure statements around patient consent are made in line with current legislation and the Mental Capacity Act 2005.
  • Consider how to improve the dementia-friendly design of its facilities.
  • Ensure that medical care services consider how it formulates and records its strategy.
  • Ensure negotiations remain ongoing with the local clinical commissioning group around designation of high dependency beds on Ash Ward.
  • Ensure the staff skill mix on Ash Ward is such that the needs of children and young people with mental health needs can be effectively cared for and managed at all times.
  • Ensure that all parents and staff are aware of the hot drinks policy when on the paediatric wards.
  • Ensure the inpatient observation charts include a section for ongoing pain assessment, including how a child is responding to pain relief given.
  • Review the dispensing of medication on Wren Ward from their medication room directly to patients without the use of safe and secure storage facilities.
  • Review the storage arrangements of the oxygen cylinders in the sluice area in recovery.
  • Ensure that staff receive safeguarding training to meet their target.
  • Review the use of the mobile privacy screen on Wren Ward to ensure privacy for patients.
  • Ensure assistance is provided to visually impaired patients with their meals.
  • Consider how they ensure that staff in A&E understand their responsibilities regarding the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards.

Professor Sir Mike Richards

Chief Inspector of Hospitals

13, 14 January 2014

During a routine inspection

When we visited the services at St Peter's Hospital we were supported by a paediatric specialist, a maternity specialist and an emergency services specialist.

We spoke with staff at all levels of the trust as well as members of the Council of Governors to gain their views about the delivery and safety of the services we reviewed. We looked at systems, and reviewed documentation. We spoke with patients, parents, mothers and relatives of people using these services about their experience. We spoke with external health care and other professionals who worked with trust staff and patients.

From the feedback we received and records viewed we were satisfied that the trust was providing a safe, effective, responsive, caring and well led maternity, paediatric and accident and emergency service.

11 September 2012

During an inspection looking at part of the service

As this inspection was specifically focused on assessing required improvements of St Peter's Hospital, it was not necessary to speak with people who had used the service on this occasion.

However, one person who was to be discharged on the day of our visit was keen to tell us their experience. We were told the nurses and doctors had been brilliant which had enabled this patient to make a speedy recovery. We were told that the hospital was 'wonderful' and that they couldn't be more complementary about the kindness that had been shown to them.

23 May 2012

During an inspection looking at part of the service

We spoke to people using the service or their representatives on Aspen ward, Falcon ward, Rowley Bristow ward, Swift ward and the Day Surgery Unit.

The majority of people using the service were happy and satisfied with their care and treatment and said it had been explained to them. One person said 'they always tell you what they're going to do before they do it' and people made positive comments including 'they've treated me very well', 'staff are wonderful' and 'the staff have all been excellent'. One person said they felt there was room for improvement although many individual staff were very caring.

People using the service gave mixed views about the food served with the majority of people speaking appreciatively of the food and a small number of others making less positive comments.

We received very positive comments about the standards of cleanliness and hygiene in the hospital. People using the service told us 'I've got no complaints about the cleanliness - they clean in here every day'. Another person using the service told us they were 'very impressed' - cleaning is first class'.

20 March 2012

During a themed inspection looking at Termination of Pregnancy Services

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.

1 December 2011

During a routine inspection

We spoke to many patients during our visit and received information from patients giving differing views about their experience of using the hospital services. Most of these were positive, although some negative comments were also received.

A number of patients told us that the majority of staff were helpful, patient and explained the care and treatment being provided.

Examples of comments we received from patients included that the staff always draw the curtains round the bed when necessary to ensure their privacy and dignity and that staff respected their dignity and were very discreet in their care.

We were also told that people thought their care was "absolutely excellent", that "staff

were very good" and "the staff on the ward were very nice" and that they (the patient) had been treated very well.

Other, less positive feedback included a patient who told us that they did not feel involved in their care or treatment and expressed concerns about some aspects of their care. One patient told us that one of their doctors had used medical language to explain their operation which they did not understand.

Another patient was due to be discharged the next day but did not know what

arrangements were in place regarding their discharge.