A team of four inspectors carried out an unannounced visit to Hereford hospital. We spent time on four wards at the hospital, where we observed the care and support that people received from staff. We spoke with seventeen people using the service and with two relatives who were visiting. We also spoke with staff and we reviewed records.

People were very positive about the staff at the hospital, describing them as, “very cheerful and friendly” and, “very good at asking if I need anything”. We saw that staff were attentive to people's needs and spent time making sure that people had what they needed and were comfortable.

People told us that they felt safe and well cared for at the hospital. One person said, “I feel privileged to have received the treatment I’ve had”. We saw staff providing care and support to people in accordance with their care plans.

Staff had a good understanding and knowledge of people's individual needs. They showed empathy and sensitivity when talking with people. Staff received the training they needed to carry out their roles.

At our previous inspection in March 2012, we had concerns about some aspects of record keeping at the hospital. The trust had sent us a detailed action plan to tell us how they would make the necessary improvements. At this inspection, we found that there were effective systems in place to ensure that records were accurate and fit for purpose.

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.

At this inspection, we inspected urgent and emergency care, surgery, outpatient, maternity, medicine and children and young people services. We did not inspect critical care or acute end of life care services 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 as requires improvement because:

• Our rating for safe remained requires improvement overall. Not all services had staff with the right skills, experience and qualifications. Risks to patients were not always assessed.
• Our rating for effective remained requires improvement overall. Not all guidance was up to date. Staff were competent for their roles and in most areas
• Our rating for caring remained the same as good overall. Staff were cared for patients with respect and compassion and feedback from patients was positive. We rated children and young people services outstanding for caring.
• Our rating for responsive improved. We rated it as requires improvement overall. We rated surgery as inadequate. Patients could not always access services when they needed and they were not meeting referral to treatment targets.
• Our rating for well led improved. We rated it as good overall. Managers promoted a positive culture that supported and valued staff, to provide patient care and treatment.