Newham University Hospital

Updated 17 July 2026

Newham University Hospital provides a range of NHS hospital services and has 274 general and acute beds. Newham University Hospital emergency department is 1 of 3 emergency departments run by Barts Health NHS Trust. The hospital offers urgent and emergency care services, including an emergency department, urgent treatment centre, same day emergency care and paediatric emergency department.

This assessment focused on urgent and emergency care services due to identified risks and the age of the previous rating, which was requires improvement. The rating for this service has been combined with ratings from other services assessed at the last inspection. For a full overview of services at Newham University Hospital, please refer to our previous reports. The overall rating for Newham University Hospital remains requires improvement.

Updated 29 October 2025

We carried out a responsive assessment of urgent and emergency care services at Newham University Hospital on 5 and 6 May 2026 due to identified risks and the length of time since the previous inspection. We rated the service as requires improvement.

Overall, we rated urgent and emergency care as requires improvement because people were not always kept safe and did not always receive care in a timely way. We found breaches of regulations relating to safe care and treatment and staffing. At the time of our inspection, the hospital was operating under significant operational pressure, including sustained crowding and limited inpatient bed capacity, which affected the delivery of timely care.

Risks to patient’s safety were increased by delays in triage and assessment and inconsistent completion of risk assessments and clinical documentation. People experienced prolonged waits, including long stays in the emergency department and clinical decision unit, and we saw corridor care during busy periods. These issues increased risks to dignity, privacy, and timely escalation of care, particularly for people with frailty, mental health needs or complex conditions.

Staff were caring, compassionate and committed to providing good care, and people generally spoke positively about how staff treated them. Safeguarding systems were in place and staff understood how to identify and respond to safeguarding concerns.

Staffing levels did not always meet demand, with high vacancy rates within the medical workforce and reliance on temporary staff. Medical staffing gaps and inconsistent senior decision-maker presence contributed to delays in assessment and flow. Although leaders had plans in place to improve workforce capacity and had begun reviews of staffing models, these were not yet fully embedded.

Leaders had a clear vision for improving urgent and emergency care and were working with system partners to improve flow. This included through mental health pathways, GP redirect schemes and same day emergency care. However, governance arrangements were not always effective in addressing long‑standing risks, including poor documentation, deteriorating patient processes and delays in care.

Following our inspection, leaders told us they had taken immediate action to strengthen oversight of clinical documentation, risk assessments and waiting area monitoring, and had plans to improve staffing oversight and patient flow. These actions were at an early stage and had not yet led to sustained improvement.

We have requested an action plan, this will be requested upon publication of the final report.

Updated 12 February 2019

Our rating of this service went down. We rated it as requires improvement because:

• A significant number of medical staff were not meeting the trust target of 85% in their mandatory training modules, including key modules such as Basic Life Support (60%), and Infection Prevention and Control (74%). The trust did not have an action plan to address this issue.
• In the 30 patient records we looked at, risk assessments were not consistently completed. Risk assessments for falls, pressure ulcers, and National Early Warning Scores (NEWS) were not consistently recorded. This meant that oversight of patient risk was not consistent, and patients may have been at unnecessary risk without sufficient safety or monitoring measures in places. It also meant patients at risk of deteriorating may not be picked up as quickly as possible.
• On several occasions we found patient records trolleys unsecured and patient record booklets unattended in corridors, as well as computer terminals unlocked. This lack of security presented a risk to patient confidentiality, as well as clinical records being lost.
• We found that recording of capacity assessments and decisions on deprivation of liberty safeguards (DoLS) were not consistently documented appropriately in patient records. The nursing records contained a proforma pathway for assessing if a patient needed a DoLS application, however this was not being used consistently. We also found staff understanding of when patients needed an assessment under the Mental Capacity Act (MCA) and DoLS application was variable. Some staff were not able to demonstrate awareness of when MCA and DoLS assessments would be necessary. Safeguarding leads for the trust stated they recognised that there were gaps in training and understanding for MCA and DoLS which was due to a lack of staff in the safeguarding team.
• Some family members of patients we spoke with were concerned that patients who needed assistance eating were not supported to do so by staff, and so were not finishing meals. We observed nursing staff taking meals to patients and discussing supporting patients to eat, but also observed patients with meals that were not able to eat without support.
• The nursing records contained a section for completion on pain and comfort. In the records we viewed we found this to be inconsistently completed or not completed. This meant that pain management for some patients may not be as effective as it could be.
• Data provided by the trust showed that as of December 2018, appraisal rates of nursing staff on some wards in the Emergency and Acute Medicine division did not meet the trust target of 90%, with the lowest ward being 70%.
• The ECIP report stated that the ambulatory care model was in its infancy, staffing was variable and that the service ran extremely limited hours with strict exclusion criteria. We observed that the consultant presence on the ACU was extremely stretched between seeing patients and triaging referrals from GPs.
• Although the trust had an overall strategy for Newham hospital, some of which related to medical wards, there was no overall clinical strategy for the Medicines Divisions. Staff we spoke with across medical wards were unsure of the future development plans for medical wards at Newham Hospital.

However, we also found:

• The environment on the medical wards and areas we visited was visibly clean and tidy. Staff also followed the trust’s infection control policy, using personal protective equipment such as gloves and aprons, and adhered to the trust’s ‘bare below the elbow’ policy.
• Staff were aware of policies and protocols in relation to the administration of medication, and we observed adherence to these protocols. Staff recorded administration on medication charts, and performance was maintained through regular audits by the pharmacy team. Controlled drugs (CDs) were also managed safely and securely.
• Medical wards investigated all incidents and used learning from investigations to improve the delivery of care. Incidents were reported on and discussed through the divisional governance structure, and from this, actions were identified to minimise the risk of repeat occurrences. Staff also told us they were encouraged to report incidents by managers, and we found there was a positive attitude towards raising concerns.
• We observed care on medical wards during our visit and found it was delivered in line with evidence-based guidance such as those published by National Institute for Health and Care Excellence (NICE), the Royal Colleges and other relevant bodies, and was supported by local guidelines and standard operating procedures.
• Patients received screening and assessment for sepsis on medical wards and were managed in line with national guidance. A sepsis screening and management tool was in use across wards and each ward had a sepsis trolley, which allowed staff to start the sepsis 6 care bundle quickly for any patient identified as being a risk. The hospital had established a local multidisciplinary sepsis team responsible for coordinating sepsis promotion and education at the hospital, monitoring sepsis outcomes, and delivering sepsis specific improvement projects.
• Throughout our inspection we saw consistent evidence of multidisciplinary team (MDT) working across all disciplines and wards. The delivery of patient care included healthcare professionals from all backgrounds necessary, and MDT input was well reflected in patient records. During our inspection, we saw regular consultant-led multidisciplinary meetings and ward rounds attended by various disciplines. Daily MDT meetings were in use seven days a week to review patients, and we observed that they were attended by a consultant, nurse in charge, discharge co-ordinator, bed managers, junior doctors, social workers, and therapies co-ordinator.
• Staff and senior leads informed us that monthly clinical boards, which included several medical specialties, included representation from patients or family members who have used those service. Clinical staff we spoke with were very positive about the input of the patient experience contributors, and felt that they helped to ensure the patient voice was appropriately considered when discussing changes to service delivery or performance.
• There were several specialist staff available to medical wards to support patients with complex needs. This included a dementia and delirium team who supported the dementia and delirium pathway, and a specialist learning disability nurse (shared across sites) that supported patients diagnosed with a learning disability and/or autism spectrum disorders.
• In November 2017, an Emergency Care Improvement Programme (ECIP) team, which included involvement from NHS Improvement and NHS England, were invited to review current practice in acute medicine and offer suggestions for improvement. The team visited the observations unit, clinical decisions unit, ambulatory care unit, and took time to meet with staff. The report stated that the model for the observations unit is complex but it works for the site, however capacity within the Observation Ward was a challenge for the size of the medical take. The report was also positive about the ward rounds system and medical staffing.
• Staff were generally positive about working for the trust and felt valued. Staff stated there was a strong multi-disciplinary team working culture within the organisation, and that managers were supportive and accessible. Morale amongst staff we spoke to was generally positive. Medical staff we spoke with felt there was a positive relationship between consultants and junior doctors, and that there were good opportunities for learning for junior doctors.
• There was a clear governance structure within the division and staff at all levels were clear about their roles and what they were accountable for. Medical wards had systems in place for monitoring and reporting on risk and performance at ward and divisional level.

Updated 12 February 2019

Our rating of this service improved. We rated it as good because:

• The service had taken steps to address the requirement notice set at the previous inspection and there were improvements to all the previous concerns we reported.
• The trust had invested heavily in the new Rainbow Centre and the new environment was clean, tidy and very well-maintained. New equipment on the unit was well-maintained. Infection prevention and control (IPC) was managed safely and effectively, all clinical areas were visibly clean and staff complied with current IPC guidelines.
• There was a good overall safety performance across paediatric and neonatal services and there was culture of learning to ensure safety improvements. Learning was shared from incidents.
• There were appropriate systems for staff to monitor and escalate deteriorating patients. Staff had a good understanding of safeguarding and there were robust security measures in place to prevent unauthorised access to both the Rainbow Centre and neonatal unit. Medicines and Controlled Drugs were stored appropriately and patient records were completed to a good standard.
• Staffing was generally well managed and nurse staffing levels had improved since our previous inspection. Medical staffing was stable, but there was a need for more consultant doctor capacity.
• Care pathways for CYP services were delivered in line with referenced national clinical guidelines. The service conducted routine quantitative and qualitative audits to review and benchmark practice. The hospital participated in local and national clinical audits for which the service performed well against other similar hospitals.
• There were appropriate processes in place to ensure that patients’ nutritional and pain relief needs were met.
• Staff reported a supportive and developmental environment with good learning opportunities to maintain and develop their skills and knowledge. Student nurses and doctors in training reported a supportive educational environment with good supervision. There was an effective multidisciplinary team (MDT) working environment which supported patients’ health and wellbeing.
• Clinicians were involved in some national research projects as well as local public health promotion initiatives.
• Staff were caring and child-centred and they interacted with patients, their family members and carers in a polite and friendly manner. Children and young people were spoken with in an age appropriate way. The people we spoke with during the inspection were very happy with their care and treatment. Staff spent time with children to help make their experience more comfortable, relaxed and home-like. There were appropriate and sensitive processes for end of life care. The service signposted patients and their families to local services and support groups.
• There were improvements to the post-operative recovery area which was decorated with child friendly transfer images on the walls in a consistent theme with other areas of the CYP service. There were new dedicated family rooms in the Rainbow Centre.
• Flow within children and young people services from admission, through theatres, wards and discharge was mostly managed effectively.
• There was comprehensive provision to meet the individual needs of children and young people, including vulnerable patients and those with specific needs. The hospital had introduced a learning disability ‘passport’ system to record individual patients’ specific needs. There was specific equipment for staff to use to help engage and care for children and young people with learning disabilities. Staff had sufficient access to appropriate translation and advocacy services.
• Parents and families could seek support and advice from a community lead practitioner and could access a family support worker. The hospital play therapist provided a comprehensive programme of play support to children across all paediatric areas. There was sufficient provision of clear and accessible patient literature.
• Most CYP specialities were meeting referral to treatment targets (RTT) and CYP services received very few formal complaints.
• The hospital provided a wide variety of child friendly food and snacks with specific menus for children and young people. The children’s outpatients’ department was flexible with appointment times and parents told us this better suited their needs.
• There was trust-wide strategy for CYP services which incorporated the Rainbow Centre and neonatal unit. There was an established and stable service leadership team and staff told us they were visible, approachable and supportive. There was improved leadership capacity in the Rainbow Centre with dedicated matrons for the Rainbow Centre and NNU. There was an inclusive and constructive working culture within the services.
• Governance and risk management processes were effective, documentation was completed appropriately and concerns were escalated. There was clear representation of children and young people services at hospital board level.
• There were some examples of innovative practice, including dedicated blood gas analyser machines in the Rainbow Centre and NNU for instantaneous blood test results. The CYP service had also co-designed tailored training for clinicians to equip them with skills to support young people in mental health crisis.

However, we also found:

• Completion of some mandatory training modules, particularly for medical staff was slightly below trust targets. Managers were aware of this and plans were in place to address it.
• Medicines management was generally good; however, at the time of the inspection there was no system for recording the balance of FP10 forms against what was available. We notified the trust pharmacy team and a check process was subsequently put in place.
• Some staff in the NNU told us there was a need for further investment in new equipment on the unit.
• Some doctors in training found the work intensity and acuity challenging and some felt they were working to the limits of their competency and capacity.
• There was limited access to dedicated on-site paediatric allied health professions. Senior staff were aware of this and there were plans to increase staffing in this area.
• Consent processes in CYP services did not always follow best practice as direct consent of the child was not always sought.
• The route from paediatric theatre back to the Rainbow Centre was not optimal, from a patient perspective, as patients had to be transported through the Rainbow Centre reception, which could potentially be distressing for some children.
• Most CYP outpatients’ clinics were delivered in the Rainbow Centre, however some services were provided in the main hospital outpatients area which was not a child friendly environment. Senior leaders of the service were aware of this and were working to further consolidate CYP outpatients provision in the Rainbow Centre.
• The hospital had some transition pathways for young people moving from CYP to adult services, however for some services this was more structured than others. Some teenagers we spoke with did not have transition plans in place.
• There were isolated examples of potential risks which were not recorded on the service risk register.
• There were some isolated comments from nurses in the Rainbow Centre and NNU about perceived bullying and harassment and not feeling supported or listened to when they raised concerns, but this was not representative of most of the feedback we received from staff.

Updated 12 February 2019

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

• Staff did not always clean their hands when entering the unit or before patient contact.
• Cleaning records were not kept to show whether the environment or equipment had been cleaned and when. The “I am clean” green stickers were also not used consistently to show what equipment was clean and ready to use.
• The service did not comply with building guidelines for critical care services due to a lack of bed and storage space, and insufficient hand-wash basins. We raised this as a concern in 2015 and at this inspection in 2018 found no action had been taken. Furthermore, senior managers could not provide us with assurance that these issues were going to be resolved in a timely way. We saw that these environmental concerns put patients, staff and visitors at risk.
• Equipment used for the transfer of patients to and from the critical care unit was not regularly checked.
• Oxygen cylinders were stored without safety notices in place.
• Records to show equipment servicing were not kept up-to-date.
• Whilst nursing staffing numbers had improved significantly since our last inspection, we found that the coordinator for the critical care unit was counted as part of the staffing numbers at times, opposed to being supernumerary as required and that six of the seven middle-grade doctors employed were locums. However, we were told that three middle-grade doctors had been appointed to post and due to start at the end of October 2018.
• Seven of the 15 policies and procedures staff had access to were either not up-to-date or not the most recent version available.
• There was no policy in place for the management of sedation.
• The trust reported a sickness rate of 5.8% for nursing staff in critical care; this was higher than the trusts target of 3%.
• The critical care unit did not use patient diaries.
• The relative’s room did not meet the needs of the people who used it. It was small, dull, with a sofa bed which was marked and appeared unclean, and there were no beverage making facilities available. We raised this concern in 2015 and found minimal action had been taken to improve this area. However, following this inspection in 2018 the trust told us they had taken immediate steps to paint the room, add a lamp and table and had ordered a water cooling machine for the room.
• Out of hours discharge rates remained high. Between January to September 2018, 43% of all critical care unit discharges took place between 10:00pm and 6:59am. We also raised this as a concern in 2015.
• Delayed discharge rates for patients ready to step down from the critical care unit remained high. Data from January to September 2018 showed that there had been 78 delayed discharge incidents of more than eight hours during this time period, with 21 of these discharges exceeding 72 hours. We raised this same concern at our inspection in 2015.
• There was a lack of information available to patients and those close to them in alternative languages other than English.
• The service did not collect data to show the amount of level three admissions to the critical care unit which occurred within four hours of making the decision to admit.
• There had been no needs assessment of the local population served to support the planning of the critical care service provision.
• There was no formalised vision and strategy for the critical care service.
• There was a lack of formalised action plans in place for identified risk. This included for delayed and out of hours discharges.
• The Critical Care Outreach Team (CCOT) and the critical care follow up clinic lacked supporting operational policies and procedures.

However, we also found:

• Numerous improvements had been made following the concerns we raised in 2015. This included improvements to medical and nursing staffing numbers, a practice development nurse had been in post for the past year, the number of cancelled elective operation rates had reduced, staff understanding about the Mental Capacity Act and consent was satisfactory and better governance systems were in place.
• More than 85% of nursing and medical staff had completed their mandatory training which was above the trust target. This included annual training on sepsis management which incorporated the use of sepsis screening tools and sepsis care bundles.
• There were plans being actioned to increase the CCOT service to a 24-hour, seven day a week service. Staff had access to the hospital’s mental health liaison service 24 hours, seven days a week.
• Staffing requirements were reviewed regularly. Medical and nursing staffing levels and skill mix was good.
• Patient’s healthcare records contained holistic needs assessments and were complete, containing all the information staff needed to deliver safe care and treatment to patients.
• Medicines were stored and disposed of safely. Medicines were prescribed and administered in line with relevant standards for medicines management.
• Incidents were reported and investigated appropriately, with lessons learnt, identified and changes to practice made where required.
• Data showed that safety performance over time was good. For example, data from the NHS Safety Thermometer for August 2018 showed 100% harm free care.
• People’s care was assessed and planned based on evidence-based practice, with service participation in national benchmarking clinical audits.
• There was a designated dietician for the unit who was available Monday to Friday, with robust protocols in place for staff to follow out of hours. People’s nutrition and hydration needs were identified, monitored and met.
• People’s pain was assessed regularly and managed effectively, including for those with difficulties communicating.
• Outcomes for people’s care and treatment were routinely monitored and collected, generally showing intended outcomes of people being achieved or, if not met, information was used to improve outcomes.
• Staff had the skills, knowledge and experience to deliver effective care, support and treatment. There were competencies in place for all nursing levels and 67% of nurses had completed the post registration award in critical care nursing.
• Staff, teams and services throughout the hospital were involved in assessing, planning and delivering care and treatment for people using the critical care service. We saw that the multidisciplinary team (MDT) consistently worked well together.
• There was consultant presence seven days a week, with an on-call rota out of hours where a consultant was present within 30 minutes as needed. There was physiotherapy support seven days a week and pharmacist support available 24 hours a day, seven days a week.
• Staff consistently treated people using the service and those close to them with kindness and compassion. There were also additional support services available for people living with dementia, a mental health concern or learning disability who required this.
• As much as possible people who used the service or those close to them were actively involved in making decisions about their care, support and treatment. Advocacy services were available.
• People’s privacy and dignity needs were always respected including during physical or intimate care and examinations.

Updated 17 December 2019

This was a follow up inspection to assess whether the trust had made enough progress in response to the requirement notice issued in September 2019. We did not inspect all domains, but focused on

Safe and Well led.

The trust had drawn up an action plan and had put in place new systems to deal with the main concerns in safety and governance. Many senior staff were doing everything in their power to take the service forward. However, sustainable improvements were not seen in every area.

We did not identify any breaches of regulation and rated safe as requires improvement to reflect that although improvement was seen we were not assured of long-term sustainability. We rated well led as Good to reflect the improvement seen since the last inspection.

Updated 12 February 2019

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

• Whilst the service had an education strategy for end of life care, the trust did not follow the national standard for end of life care training for all staff, as end of life care training was not mandatory. End of life training was mandated by the National Care of the Dying Audit of Hospitals (NCDAH) 2014-2015 across all staff groups.
• There was no robust system to identify review and learn from information that related to end of life care or performance measures for the specialist palliative care team to report on.
• Alarm checks of the DHU temperatures out of hours and at weekends were not being monitored by security staff on a two-hourly basis as detailed in the ‘Newham Mortuary Temporary Body Fridges Alarm Escalation Procedure Out of Hours’. However, the trust provided evidence to show that the checks undertaken exceeded best practice guidance according to the Human Tissue Authority.
• Most of the ward staff we spoke with had not received formal training in syringe drivers.
• Incidents related to deceased patients were reported but not discussed at the end of life steering group. It was not clear how learning from these incidents were shared with the wider service.
• Pain assessments and pain scores were not completed consistently.
• The end of life service was not meeting the National Institute for Health and Care Excellence (NICE) guidelines for adults to provide palliative care services face-to-face seven days a week. This had not changed since the last inspection in November 2016.
• Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms were not always completed correctly. This meant that the trust could not be assured that DNACPR decision were made appropriately and were in line with national guidance.
• Although we saw evidence that palliative and end of life care patients had plans of care which included the patients preferred place of death, the service had not consistently collected data to evaluate this.
• Although the Compassionate Care Plan was in place, there was variation in how consistently this was completed.
• Medical staffing in the SPCT was 0.9 whole time consultants (WTE). This was an increase of 0.4WTE since the last inspection. The trust recognised that consultant levels were still below the ‘Helping to deliver commissioning objectives’ (Dec 2012) based upon the total number of hospital beds.

However, we also found:

• The trust had further developed the end of life care strategy and an action plan for delivery was in place.
• Staff we spoke with told us the specialist palliative care team were very visible and accessible and worked collaboratively with staff on the wards in providing end of life care. Staff were positive about the support provided by the specialist palliative care team.
• The specialist palliative care team were knowledgeable about their role and responsibilities regarding the safeguarding of vulnerable adults and children.
• During our last inspection we found poor standards of cleanliness and upkeep in the mortuary. At this inspection we found end of life care facilities provided for the use of patients and their families were visibly clean, tidy and well maintained. this included the multi-faith rooms and the viewing room. Cleaning schedules in the DHU were now in place.
• Medicines were readily available to patients requiring treatment for palliative and EoLC. The specialist palliative care team worked closely with medical staff on the wards to support the prescription of anticipatory medicines. Since the last inspection a clinical nurse specialist in palliative medicine had been trained as a non-medical prescriber.
• The specialist palliative care team had access to the liaison psychiatry service provided by a neighbouring mental health trust
• End of life care policies and procedures were based on national guidance and the trusts strategy was based on the ‘Ambitions for palliative and end of life care: a national framework for local action 2015 – 2020’.
• The service had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff treated people with dignity, respect and kindness. Staff were seen to be considerate and empathetic towards patients. Feedback from relatives was very positive about the staff and felt they could ask staff questions about their loved one’s care and treatment.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment. Feedback from relatives confirmed the staff communicated with them and their relative in a way that helped them understand their care, treatment and condition.
• The trusts bereavement policy took account of different faiths and cultures in how to deal with death.

Updated 17 September 2021

Updated 12 February 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated the service as requires improvement because:

• The hospital was not undertaking medical records audits but we were told by the general manager that they planned to do this soon. This had been raised in our last inspection. Further to our inspection, we were however provided with data to show that the service was monitoring notes availability, showing results of 95% and 94% in March and June respectively, against a target threshold of 95% - 98%.
• Medical records did not always arrive with a patient’s referral letter.
• The service was not participating in any national audits.
• The only local audits that the service was participating in were hand hygiene and medicines management audits.
• Data showed that the service still had a high ratio of follow-up patients to new patients.
• Though the service had introduced some targeted work to address the high DNA (did not attend) rate, the rate was still higher than the England average and was the highest out of all hospitals within the trust.
• The West Wing waiting area, which was run by a different division, did not provide adequate space or privacy for patients, despite this being raised as an issue in the last inspection.
• Though the trust had only started reporting RTT again since April 2018, the performance of RTT from this date to August 2018, showed results of 85% against a trust target of 92%.
• Though risks were being effectively managed, the service only had one risk on their risk register, despite high DNA rates and follow-up rates.
• The service had just entered into a new site based structure, which meant that it was difficult for us to appraise the leadership.
• Though the service had plans to monitor patient outcomes in the near future, they were not currently being monitored at the time of our inspection.

However, we also found:

• Improvements had been made in compliance with Infection Prevention and Control training, though compliance will still slightly under target threshold. Hand gel sanitisers were visible, full and in use across the outpatient areas that we had visited. The Health Central Outpatients Department, had week-on-week 100% hand hygiene compliance between May 2018 and August 2018.
• Staff were 100% compliant in Safeguarding Adults Training Level 1 and 2. Staff were also 100% compliant in Level 1, 2 and 3 Safeguarding Children Training.
• Improvements had been made with staff being able to access the electronic system to report incidents, as well as receiving feedback following incidents that had been submitted.
• All staff members bar one had received an appraisal, with clear objectives being set out, which hadn’t been the case previously. The remaining appraisal date had been organised.
• We saw episodes of good care with patients and carers being in full understanding of what was being explained to them.
• Patient satisfaction forms showed that patients were extremely likely to recommend the service to friends and family if they needed similar care or treatment.
• Patient waiting times were clearly articulated to patients, both on a notice board and through nurse announcements.
• The trust was performing better than the England average for cancer waiting times.
• Between September 2017 and August 2018 there were 3 complaints which went through the formal complaints process. In addition there were 20 complaints received through PALS. For the formal complaints, all were responded to within 25 days.
• The culture within the outpatient’s service was described by staff and managers as good, with senior staff being described as very supportive.
• Under the new structure for outpatient services, several new meetings had been devised such as an Outpatients Transformation Board, where any decisions or changes to the new site-based structure would be discussed.

Updated 28 April 2017

We found that there was much improvement made in the hospital’s surgical services from the time of our last inspection in January 2015, when four domains were rated as requires improvement and one as inadequate. During this inspection, we found that four domains were good and one required improvement.

There was a new site based management team and a more robust clinical governance structure which meant there was better oversight of risk. Staff expressed a greater level of confidence in management and general morale was high. We found that there were reduced numbers of staff vacancies and better planning of skill mix. Staff reported on a supportive learning environment with good continuous professional development opportunities.

Patient flow was well-managed and there were no surgical site infections for knee and hip replacements and length of stay for elective and non-elective surgical patients was better than the England average.

The majority of patients we spoke with were happy with the care and treatment they received and we observed kind and compassionate care being given.

However, we also found:

There were low levels of training amongst certain groups of staff in Level 2 safeguarding adults and safeguarding children.