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.