The patients we spoke with at Hemel Hempstead Hospital told us that generally they were happy with the care they were given. They said that their care and treatment had been explained to them and that staff made every effort to include them in how thier care was administered. The said that the staff were busy but were always nice and cheerful. One person was not happy that the gym was out of commission as part of it had been used to accommodate patients who were transferred from Watford General Hospital due to surge in demand.

We had mixed comments on the food but overall people were happy with the quality and the quantity of the food. One person told us that the staff made sure they got a hot meal on the day they were admitted. Another person said that the staff would make them soup and toast if they didn't like the menu on a particular day.

We found that the patients were well cared for by staff who showed the patients that they cared about them. All the patients had the appropriate health assessment and risk assessments.

We were told that there was not always the right number of permanent staff available to cover the wards this was supplemented by agency and bank staff. Senior staff were not happy with the quality of the staff provided by NHS Professionals the agency the hospital had to use.

Overall people felt safe and reasonably confident in the service they received. People we spoke to said that staff were generally friendly but did not feel informed about what to expect or how long they would have to wait. People using the service were not aware of their treatment plans or if they could eat or drink before being seen by a nurse or doctor.

At this inspection, we inspected urgent and emergency care. We did not inspect end of life care (mortuary only) or outpatients at this inspection, but we combine the last inspection ratings to give the overall rating for the hospital.

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

• Our rating for safe remained requires improvement overall. Mandatory training rates remained low and below the trust target.
• Our rating for effective remained requires improvement overall. There remained a lack of monitoring of patient outcomes and compliance with evidence-based protocols. This had previously been identified by the Care Quality Commission as an area which required improvement.
• Our rating for caring remained good overall. Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Our rating for responsive remained good overall. In most cases, patients could access the service when they needed it.

Our rating for well led went down to inadequate overall.

• Whilst there had been changes to the leadership team with the addition of a senior emergency nurse practitioner to oversee and manage the urgent care centre, there remained little oversight of the service at divisional level.