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Inspection carried out on 16 April 2018

During a routine inspection

Our rating of services improved. We rated them as good.

A summary of this hospital appears in the overall summary above.

Inspection carried out on 18, 19, 20 July 2016

During an inspection to make sure that the improvements required had been made

Inspection carried out on 7, 9, 16 to 19, and 30 June 2015

During a routine inspection

Sherwood Forest Hospitals NHS Foundation Trust was formed in 2001, and achieved foundation status in 2007. Sherwood Forest Hospitals is the main acute hospital trust for the local population, providing care for people across north and mid-Nottinghamshire, as well as parts of Derbyshire and Lincolnshire. The trust employs 4,300 members of staff working across the hospital sites.

King’s Mill Hospital in Sutton-in-Ashfield is the main acute hospital site. It provides over 550 inpatient beds (more than half in single-occupancy en-suite rooms), 13 operating theatres, and a 24 hour emergency department. Each year there are more than 45,000 inpatient admissions and 36,000 day case patients; 100,000 patients attend the emergency department, around 3,500 babies are delivered, and more than 390,000 people attend outpatient and therapy appointments in the King’s Treatment Centre.

In February 2013, the trust was identified as being one of the 14 healthcare providers in England which had higher than expected mortality rates. This led to the trust being reviewed by Professor Sir Bruce Keogh, NHS Medical Director for England. This review in July 2013 led to the trust being placed in special measures by Monitor, the independent regulator of NHS foundation trusts.

We inspected the trust in April 2014 and gave an overall rating of ‘Requires Improvement.’ We judged the provider was not meeting seven out of 16 essential standards of quality and safety.

We carried out an announced inspection visit from 16 to 19 June 2015 and three unannounced visits on 7, 9 and 30 June 2015. We held focus groups with a range of staff in the hospital, including nurses, junior doctors, consultants, midwives, student nurses, administrative and clerical staff, physiotherapists, occupational therapists, pharmacists, domestic staff and porters. We also spoke with staff individually.

Overall, this trust was rated as inadequate. We identified significant concerns in safety and leadership of the trust. We found that effectiveness and responsiveness required improvement but the caring was good.

Our key findings were as follows:

  • Staff were kind and caring and treated people with dignity and respect, but there were some instances where improvements were required. A greater emphasis was needed on providing care that was based on people’s individual needs rather than as tasks.
  • Overall the hospital was clean, hygienic and well maintained. There had been 54 cases of clostridium difficile (c. diff) infections in 2014/2015. C diff is an infective bacteria that causes diarrhoea, and can make patients very ill. This was worse than the national average and above the trust’s target, which was a total of 48 cases per year. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections MRSA rates for the hospital were low with one case recorded between 2014 and 2015. Routine screening of patients for MRSA was completed with further screening repeated after 21 days.
  • Nursing and midwifery staffing had increased since 2013 and it had been a focus of the Executive Director of Nursing. Midwifery staffing levels were almost meeting the national recommended levels of 1:28. Planned nurse staffing levels were in accordance with national guidance of one registered nurse for every eight patients.
  • There was an escalation process in place if staffing levels did not meet the planned levels, but staff didn’t always feel this resulted in a change. We saw some occasions where patients were not able to receive their assessed level of care due to shortages of healthcare assistant staff.
  • In May 2015 there were 94.89 whole time equivalent (ETE) registered nurse vacancies. This was a high risk on the trusts risk register. A recruitment programme was ongoing and changes had been made to speed up the recruitment process. Oversees recruitment had taken place.
  • There were medical staffing vacancies and there was a high use of locum medical staff.
  • Patients pain was well managed and women in labour received a choice of pain relief. Patients at the end of life were given adequate pain relief and anticipatory prescribing was used to manage symptoms.
  • Monitoring by the Care Quality Commission had identified areas where medical care was considered a statistical outlier when compared with other hospitals. The trust reported on their mortality indicators using the Summary Hospital- level Mortality Indicator (SHMI) and the Hospital Standardised Mortality Ratio (HSMR). These indicate if more patients are dying than would be expected. The data for the trust was higher than would be expected and its overall level of HSMR was 120.67. This had been reported to the trust board and it was one of the trusts top three objectives for improvement.
  • We were concerned about the hospitals performance in relation to the management of people with sepsis. There have been longstanding concerns about the management of patients with sepsis. This is a severe infection which spreads in the bloodstream. In 2010 and 2012 we raised mortality outlier alerts with the trust, when information showed there were a higher number of deaths than expected for patients with sepsis. The trust had identified a third mortality outlier for patients with sepsis in the period April 2014 to January 2015. Our analysis of the data from April 2014 to February 2015 found 88 deaths of patients with a diagnosis of “unspecified septicaemia” compared with an expected number of 58. The death rate for patients with this diagnosis was 32%, almost twice as much as the England rate of 17%.
  • The trust participated in a range of national audits and outcomes varied. Outcomes for women in labour were good, although the trust was significantly higher for induced births. They did not understand the reason for this high rate.
  • Like many trusts in England, their hospitals were busy. Bed occupancy rates were high and were consistently above 90% which was above the England average of 88%. It is generally accepted that when occupancy rates rise above 85%, this can affect the quality of care and the orderly running of the hospital. There were initiatives in place to reduce bed occupancy and improve the flow of patients through the hospital. Delayed discharges were a problem across the trust.
  • The trust were not meeting the national targets set regarding patients access to treatment and they had failed to meet the 18 week target for access to treatment. The trust were however meeting the standard for patients being admitted, referred or discharged from the A&E department within four hours.
  • There was a vision and strategy for the trust but staff were not able to articulate this to us. The priority for the organisation was to come out of special measures.
  • Staff generally felt they were well supported at their ward or department level.

We saw several areas of outstanding practice including:

  • There was some innovative work taking place at King’s Mill Hospital where the trust had developed a new changing facility for patients with complex disabilities. The facility offered a large changing area that would meet the needs of patients with profound disabilities.

  • Staff went out of their way to meet the needs of their patients on the critical care unit. Some patients could be moved on their beds out of the critical care unit to an outdoor area. Staff told us they tried to do this when possible as patients appreciated being outside and away from the unit. Staff had been able to allow visiting by patients’ pet dogs in this way.

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

Importantly, the trust must:

  • Ensure all staff receive training in safeguarding children and vulnerable adults. The training must be at an appropriate level for the role and responsibilities of individual staff.
  • Ensure staff are appropriately trained to provide the care and support needed by patients at risk of self-harm.
  • Ensure staff receive effective and appropriate guidance and training about the assessment and treatment of sepsis.
  • Ensure staff understand the requirements of the Mental Capacity Act 2005 in relation to their role and responsibilities.
  • Ensure all patients in the emergency department are able to summon help if they need it.
  • Ensure all patients over the age of 75 have a cognitive assessment when arriving in the emergency department.
  • Ensure learning from complaints is shared with staff in the emergency department which leads to improvement in care.
  • Ensure the governance framework in the emergency department clearly identifies risks, responsibilities and actions required to manage those risks within a stated timeframe.
  • Ensure systems and processes are effective in identifying where quality and safety are being compromised and in responding appropriately and without delay. Specifically, systems and processes to identify and respond to outpatient appointment issues.
  • Ensure any remedial actions taken to address outpatient appointment issues are regularly audited to give assurances improvement has taken place.
  • Ensure patients in the critical care unit are routinely and properly assessed for delirium.
  • Ensure the provision of level two critical care on Ward 43 includes nursing staffing levels in line with the ‘Core Standards for Intensive Care Units’ published by the Intensive Care Society and the commissioners expectations.
  • Ensure patients requiring critical care at level two on Ward 43 are cared for by appropriately trained staff in line with the ‘Core Standards for Intensive Care Units’ published by the Intensive Care Society.
  • Ensure staff delivering end of life care receive suitable training and development.
  • Ensure all patients at the end of life receive care and treatment in line with current local and national guidance and evidence based best practice.
  • Ensure the quality of the service provided by the specialist palliative care team is monitored to ensure the service is meeting the needs of patients throughout the trust.
  • Ensure risks for end of life care services are specifically identified, and effectively monitored and reviewed with appropriate action taken.
  • Ensure that the resuscitation trolleys and their equipment are checked, properly maintained and fit for purpose in all clinical areas in the children’s and young people’s service.
  • Ensure that medication is monitored, in date and fit for purpose in all clinical areas of the children’s and young people’s service.
  • Ensure emergency lifesaving equipment in the maternity service is checked regularly and consistently to ensure it is safe to use and properly maintained.
  • Ensure staff have the appropriate competence and skills to provide the required care and treatment to women using the maternity and gynaecology service. Specifically, women who are acutely ill or who are recovering from a general or local anaesthetic.
  • Ensure patients in the medical care wards receive person-centred care and treatment to meet their needs and reflect their personal preferences, including patients living with dementia and those with a learning disability.
  • Ensure all staff working in the medical care service receive appropriate supervision, appraisal and training to enable them to fulfil the requirements of their role.
  • Ensure patients in the medical wards are treated with dignity and respect at all times.
  • Ensure sufficient provision of hand gel dispensers within the emergency department.
  • Ensure adequate provision of defibrillators and cardiac monitoring equipment within the emergency department.

In addition the trust should:

  • Ensure there are effective and consistent systems for learning from incidents to be shared across the trust at all locations.
  • Ensure there are sufficient computers available for staff use in the ambulatory care area of the emergency department.
  • Ensure there is appropriate signage and information in the emergency department and that this is available and accessible to all people using the service.
  • Ensure the process for diagnosis of fractures and how learning is analysed and shared within the emergency department reduces the impact of missed diagnosis on patients.
  • Improve the time taken for the transfer of patient care from ambulance staff to emergency department staff.
  • Ensure clinical leadership in the emergency department is delivered at a consistently high standard 24 hours a day, seven days a week.
  • Ensure patient records are available when patients attend outpatient and diagnostic imaging clinic appointments.
  • Ensure patient records are available when patients attend outpatient and diagnostic imaging clinic appointments..
  • Ensure systems and processes are operated effectively to minimise delays for patients in outpatient clinics.
  • Ensure there is a review the hours of service provided by the specialist palliative care team to consider a face to face service available seven days a week.
  • Ensure patient outcomes are regularly monitored and reviewed to ensure the end of life care service is meeting the needs of patients.
  • Ensure that medical consultant staffing for the children’s and young people’s service is in line with Royal College of Paediatrics and Child Health (RCPCH) standards.
  • Ensure acute paediatric clinical guidelines are reviewed and follow best practice guidance.
  • Ensure that the paediatric allergy clinic meets the 18 week referral to treatment target.
  • Ensure that all nursing and medical staff in the children’s and young people’s service receive a minimum of yearly appraisals.
  • Ensure controlled drugs are checked twice a day on the maternity ward, in line with the trust’s policy.
  • Ensure that staff in the maternity service follow the trust hand hygiene policy.
  • Ensure that workforce requirements are analysed in terms of what women using the service need, rather than what midwives do.
  • Ensure accurate data is collected regarding the use of steroid medication for pregnant women at risk of early labour.
  • Ensure information and guidance about how to complain is available and accessible to patients and visitors in the maternity service.
  • Ensure appropriate care and treatment pathways are developed for women using the pregnancy day care unit.
  • Ensure that midwife visits to mothers with new-born babies are in line with current National Institute for Health and Care Excellence (NICE) guidance.
  • Actively seek and record women’s views and preferences regarding one to one care and postnatal visits by midwives
  • Ensure cardiotocograph documentation follows current local and national guidance.
  • Consider appointing a designated bereavement midwife and a diabetic specialist midwife.
  • Ensure all staff in the maternity and gynaecology service understand their role and responsibilities regarding the Deprivation of Liberty Safeguards.
  • Provide a home from home environment for giving birth for women at low risk of complications.
  • Ensure women attending the termination of pregnancy clinic are seen by a diploma level qualified counsellor.
  • Ensure there is a designated consultant to take the lead for fetal medicine and the pregnancy day care unit.
  • Ensure there are sufficient operating theatre facilities and time dedicated for planned caesarean section operations.
  • Review the protocols for how long women remain in hospital after giving birth and consider changes to improve access to the maternity service.
  • Ensure staff in the maternity and gynaecology service understand and comply with the trust’s policy regarding interpreter and translation services.
  • Ensure that all identified risks in the maternity service are regularly reviewed and added to the trust risk register where appropriate.
  • Ensure maternity information leaflets are easily available in languages other than English.
  • Consider the development of a maternity services liaison committee.
  • Ensure systems are operated effectively to reduce delays in transfer from theatre recovery to the surgical wards.
  • Review the use of theatres to improve flow and reduce delays between surgical cases.
  • Ensure the delays in orthopaedic surgery caused by limited access to a skilled periprosthetic consultant are monitored and reviewed and appropriate measures put in place to mitigate risk.
  • Ensure that staff practices on the medical care wards are in line with trust policy and current legislation regarding the prevention and control of infection.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 16 June 2015

During Reference: R6 not found

Inspection carried out on 01/04/2014

During a routine inspection

In 2013, the trust was identified nationally as having high mortality rates and it was one of 14 hospital trusts to be investigated by Sir Bruce Keogh (the Medical Director for NHS England) as part of the Keogh Mortality Review in July that year. After that review, the trust entered special measures.

We chose this hospital because they represented the variation in hospital care according to our new intelligent monitoring model. This 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. Using this model, Sherwood Forest Hospitals Foundation Trust was considered to be a high risk trust.

We carried out an announced visit on 24 and 25 April 2014 and unannounced, out-of-hours visits on 29 April and 9 May 2014.

Our key findings were as follows:

  • We saw poor record keeping in some areas, particularly relating to patients care.
  • We found that staffing in some areas was below the levels that would be expected.
  • Care plans should be improved to reflect patients needs.,
  • Discharge planning should be improved.
  • The WHO surgical checklist should be embedded in all practice.

We saw several areas of outstanding practice including:

  • The Rotherham model for reducing smoking in teenage pregnancy has reduced  smoking rates.
  • Pillow cards were left in Gynaecology during comfort rounds when a patient was asleep or not in their bed so they knew when the next round would be.
  • There was good multidisciplinary working across the trust.

Importantly, the trust must:

  • ensure that accurate record keeping is maintained with regard to people’s observations and hydration.
  • ensure that accurate record keeping is maintained on drug administration charts so people receive the appropriate care and treatment for their needs.
  • ensure that all staff have the competence to recognise when a person is deteriorating so appropriate care is provided.
  • ensure that there are secure systems for storing medicines and that people are given medicines according to their prescription.
  • ensure that all people have an effective and current care plan that meets their individual needs and provides appropriate guidance for staff to be able to meet their needs.
  • ensure there is full medical support for all surgical specialties, in particular vascular services.
  • ensure mandatory training and appraisals take place to ensure all staff are appropriately trained and have up-to-date knowledge.
  • ensure actions taken and lessons learned are shared with staff at all levels
  • ensure that staff mandatory training and appraisals are completed to meet trust targets

In addition the trust should:

  • Equipment should all be portable appliance tested and serviced to ensure they are fit-for-purpose
  • Midwifery staffing could be improved by completion of the directorate's on-going recruitment programme
  • The trust should ensure that team briefings are completed before and after surgery, including fully embedding WHO surgical safety checklists
  • Introduction and implementation of children and young people services specific pain management guidance and protocols.
  • Nurse presence and inclusion at all 'Team Around the Child' ward rounds on paediatric ward, ward 25.
  • Confirm and establish longer term nurse management structures on paediatric ward, ward 25, to provide staff with increased, visible managerial support.
  • Increased receptionist staffing on paediatric ward, ward 25, including weekends.
  • The trust should ensure that people with a dementia have an accurate and current care plan to provide staff with clear guidance to meet their needs.
  • The trust should ensure there is an appropriate skill mix of nursing staff on duty so that people’s needs are recognised and met.
  • The trust should plan to provide seven day a week and effective out of hours cover by doctors and consultants for all specialties.
  • The trust should ensure that effective discharge planning occurs across all specialties for all people who are fit for discharge.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 4 December 2013

During an inspection to make sure that the improvements required had been made

We inspected Kings Mill Hospital between June and July 2013 and found serious concerns over the way the trust assessed and monitored the quality of services.

At this visit we inspected Kings Mill Hospital in order to follow up on compliance with the Warning Notice served in June 2013.

We visited a range of wards and departments, spoke with patients, their relatives and visitors. We spoke with a range of staff including the Chief Executive and Chair, members of the executive team, doctors, nurses and support staff. We were assisted by a specialist advisor in trust governance and assurance. We worked with NHS England who had a team visiting the hospital undertaking an assurance review of actions taken to address issues from the Bruce Keogh Rapid Responsive Review, which took place in June 2013. We attended interviews and staff focus groups with the NHS England team and shared information before and during the inspection. We examined documents such as Board minutes, information about complaint monitoring and the Board Assurance Framework.

We found in the leadership team a commitment to improving the quality of care experienced by patients and a determination to address shortfalls identified in the past. New appointments to the Board and governors had taken place. Work was progressing on the development of the leadership team and governance members with their role in supporting good governance in the trust.

We found the trust had introduced a broad range of initiatives to improve the governance arrangements and to align these with the Board Assurance Framework.

We found a number of examples where new initiatives demonstrated better communication and reporting between the Board and the ward and back to the Board. Some initiatives had only been introduced a week or two before the inspection or were still in the planning stage. Therefore the trust was not in a position to assess whether these were effective, although early indications were positive.

We found improvements in the way the trust maintained its risk registers. The system was more robust and ensured accountability for actions. We were informed by the trust that they had dealt with the backlog in radiology reporting. A system had been introduced so that when necessary reports were dealt with through evening lists or assistance from external providers. The issues within the radiology department remain a significant risk due to the high number of vacancies unfilled and the trust is working with the Royal College of Radiology to find a solution.

We found a Nursing and Midwifery Strategy had been introduced and there was an increase in nursing staff on nights. Staffing levels were reviewed daily, with numbers on duty being displayed on ward notice boards. In October 2013 a paper had gone before the Trust Board proposing a £4million investment in nursing posts. We were informed following the inspection that this investment had been agreed at the December 2013 Trust Board meeting.A recruitment strategy had been developed including international recruitment and a return to nursing practice programme. Recruitment for medical staff remained a challenge. There had been an effort to increase middle grade and consultant support, but some doctors reported this had not kept pace with increasing patient numbers.

We found a commitment to improve the patient experience and embed the patient’s voice into the activities of the trust. Listening events with the general public and staff had taken place to improve patient, public and staff engagement. Plans were being developed on how to improve services by incorporating feedback from these events.

Staff were committed to improving the processes for feedback on patients’ experience and learning from incidents and complaints. The backlog of complaints had been cleared and improvements on information about complaints, including themes was being provided to the Board.

The director of nursing was developing a Patients’ Experience Strategy and better working was reported between the wards and the Patient Advice and Liaison Service (PALS) to ensure improvements followed from patient feedback.

We found information available throughout the hospital about how to complain and the PALS but most patients spoken with were not aware of the process or the services available. However, all patients spoken with stated staff had been supportive and they could raise any concerns with them. One patient said, “Staff asked me whether I would like to complete a ‘Friends and Family Test Form’. I was happy to do so as I have felt safe here.” Another patient said, “I would recommend this place to my family and friends, which several years ago I wouldn’t have been able to do.”

Many of the staff described the trust as, “Being on a journey’. The challenge for the trust is to complete work on planned initiatives, embed new arrangements across the trust and ensure improvements are sustained in the long term. This will require a commitment from the Trust Board, particularly in ensuring the pace of change is timely with a continuous review of effectiveness going forward.

Inspection carried out on 26 June and 8, 9, 10, 17, 18 July 2013

During an inspection in response to concerns

We visited the Emergency Department and sixteen wards during the inspection. We spoke with 75 patients, four relatives and approximately 100 staff. We looked at approximately 20 patient records.

Almost all patients were happy with their overall experience within the hospital. Patients were generally positive about the quality of food provided and felt sufficient drinks were available. They were positive about discharge processes and were generally positive about the cleanliness of the hospital.

Patients gave us mixed feedback regarding whether staffing levels were sufficient. Patients felt safe and trusted the staff to carry out their care. Patients did not know how to provide feedback to the trust and most of those patients that we asked about the complaints system were not aware of it.

We found that care and treatment was not always delivered in a way that ensured patients’ safety and welfare. Patients were not fully protected from the risks of inadequate nutrition and dehydration. However, patients’ health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We found that patients were protected from the risk of infection because appropriate guidance had been followed. We also found that patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. However, there were not enough qualified, skilled and experienced staff to meet people’s needs.

We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive. The provider also did not have an effective complaints system.

Inspection carried out on 10 October 2012

During an inspection in response to concerns

We had been informed that some patients had received inaccurate information following an examination of breast tissue taken and tested at the Kings Mill hospital between 2004 and 2011. Although the results of testing had an effect on individual treatment plans, the patients concerned were not recalled by the hospital until October 2012.

Current breast care patients we spoke with reported that they were very satisfied with the care and support they had received from the breast care unit at the hospital. One patient explained that that they were, "more comfortable, because I know why I am here and what’s happening." Another patient told us,"The care here is spot on."

Patients on the wards we visited gave us positive comments about their care and treatment. One patient told us, "I have been happy with the treatment provided. I think the care is good and I trust the nurses with what they do."

We spoke with the relatives of patients and one said that the hospital was, "Very good, any problems we had were sorted straight away and I feel I can speak with the doctors and nurses openly."

We found that nursing care planning followed a standard format in the hospital, and core care plans were being used. Daily records were up to date and showed that patients were offered individual sessions with staff to discuss their progress. Each nursing entry commenced with "Consent gained prior to nursing ."

We could not assure people that the care, treatment and support they received when they used the diagnostic services met their needs and protected their rights. We asked the Royal College of Pathologists to investigate services in the histopathology department. This confirmed that people's care and welfare needs were being met with regard to diagnostic and screening procedures at the hospital. A summary of the findings is included in our report and their full report from the Royal College of Pathologists has been published separately.

We had been informed by Monitor (the independent body who authorise and regulate NHS foundation trusts) that they were concerned about the trust’s governance duties and its general duty to exercise its functions effectively, efficiently and economically.

We asked a ward manager if they were confident in the running of the trust. They answered, "More than I was. It’s all more organised now." They also told us of helpful weekly meetings with the head of nursing.

We spoke with non executive directors who were well informed and aware of their roles and responsibilities within the organisation. They were very supportive of the executive team and they assured us that quality of care would not be compromised by any financial decisions. They also told us, "All concerns need to get to the board quicker. At present some of the emphasis is lost."

Inspection carried out on 20, 21 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.

Inspection carried out on 27 April 2012

During an inspection to make sure that the improvements required had been made

We spoke with three patients who told us that before they received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We spoke with four patients who told us they had no concerns about the security of their records and had not seen any incidents where personal information had not been kept confidential.

Inspection carried out on 31 October 2011

During an inspection to make sure that the improvements required had been made

Patients told us that they understood the care and treatment choices available to them. They told us that their privacy and dignity was respected. They also told us that they felt listened to and their views were taken into account.

Patients told us that they had not been asked to sign any consent forms (for nursing care). This is in line with the Trust's policy which is based upon Department of Health guidance. They also told us that staff did ask permission before providing basic care and treatment such as toileting and bathing.

Patients told us that they were satisfied that the ward and their bed areas were kept very clean and tidy. All patients told us that they observed all staff use hand gels after they had provided them with treatment.

All patients told us that staff gave them their medicines in a timely manner. Patients also told us that their medicines were appropriately locked up and that staff always waited and supervised them to take their medication. A patient said, “I forgot to bring my anti depressants, when I told staff about this they quickly arranged for some more from the pharmacy, I was very impressed.”

All patients told us that staff across all different levels and job roles were competent and suitably skilled to do their job. A patient said, “I feel safe here and the staff are competent in what they do.”

All of the patients that we spoke with told us that staff had not told them how to make a complaint, nor had they been provided with any written information telling them how to make a complaint. A patient said, “I have not been told how to make a complaint, but if I had one I would speak to the nurses as they are very approachable.” Another patient said, “Staff have not told me how to make a complaint, but I have seen a complaints’ notice behind the nurses station, I have not had to make a complaint.”

Patients told us that their records were kept safe and that staff ensured their confidentiality was protected. A patient said, “I do feel that the records are kept safe and confidential, I have not seen any lying around."

Inspection carried out on 25 May 2011 and 7 March 2012

During a routine inspection

Most of the people we spoke with were very pleased with their care and treatment. A patient told us, “Staff are very nice and… very helpful, I couldn’t fault any of them”. Another said, “They haven’t just looked after us physically, they’ve looked after our mental health as well.” Although people we spoke with told us they felt confident to make a complaint if they needed, no one knew how they would go about it and we did not see any information or leaflets about making a complaint on display.

People found that different departments communicated with each other and referrals between services took place promptly. Mothers attending the maternity unit told us about good communication between the hospital and the community, including their GP. Some patients were not clear about what was happening or had been given conflicting information from different healthcare professionals. They also found the uniforms confusing and which staff had which roles. A patient told us, “I’m not sure who’s who on the ward; I know they don’t call them sister anymore”.

Patients and visitors told us the hospital environment was clean, pleasant and well maintained. We saw that information on infection prevention and control was displayed throughout inpatient areas, the main corridors, visitors’ toilets and outpatient clinics. Several patients told us how busy the staff were but they felt they received the care they needed: “They can’t do enough”; “I can’t fault anyone, they’re exceptional”; “The care and nursing are outstanding.”

Inspection carried out on 1 September 2010

During an inspection to make sure that the improvements required had been made

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

Inspection carried out on 3, 4 August 2010

During an inspection to make sure that the improvements required had been made

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.