Patients told us what it was like to stay at this hospital and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether patients staying in hospitals are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and joined by an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We visited four wards as part of our inspection. We went to two acute general medicine wards, a surgical ward, and a trauma and orthopaedics ward. We talked to 39 patients during our visit.

Patients were positive in their views of how they were supported by the staff team. Examples of comments they made included, “the nurses are excellent and so are the doctors”.” This is a very good hospital”. “The nurses are fine, I’ve got no problems with any of them”. “They are very good staff and they take their time helping patients with their meals”. ” Meals have been fine in quantity and quality”. “At first I didn’t feel like eating, but the staff have encouraged me”.

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.

During our visit on 12 July 2011, patients at the Horton General Hospital were very positive about their experiences of care and treatment.

Patients felt involved in making decisions about their care and treatment and stated that staff kept them informed about the care they could expect to receive. They also told us that staff responded promptly when called and that staff took time to help and support them.

Our rating of services stayed the same. We rated it as good because:

• People were protected from harm. Lessons were learned and communicated widely to support improvement in other areas where relevant, as well as services that are directly affected.
• When people received care from a range of different staff, teams or services, it was co-ordinated. Staff worked collaboratively to understand and meet the range and complexity of people’s needs.
• People were supported, treated with dignity and respect and were involved as partners in their care
• Reasonable adjustments were made and action taken to remove barriers when people found it hard to access or use services.
• Consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity act 2005. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded.
• Leaders were visible and approachable. Leaders modelled and encouraged compassionate, inclusive and supportive relationships among staff so that they felt respected, valued and supported.
• There was an effective and comprehensive process to identify, understand, monitor and address future and current risk.

However,

• The services provided mandatory training in key skills to all staff but not everyone had completed it. Nursing staff compliance was significantly higher than medical staff.
• Management and support arrangements for staff were not always effective. Appraisals were significantly below the trust target of 90% for all staff groups with the exception of medical staff.
• The services did not always have enough nursing staff, with the right mix of qualification and skills, although they were working hard to remedy this.
• While the trust took complaints seriously and ensured they were investigated the trust’s responses to complaints were not always completed in a timely manner.
• A proportion of patients did experience a delay when medically fit for discharge or transfer.
• There was no vision for what the ED at the Horton General Hospital wanted to achieve and no workable plans developed with involvement from staff, patients, and key groups representing the local community.