We had not previously rated this location for this provider. We rated it them as requires improvement because:

• We rated urgent and emergency care, surgery and outpatients as requires improvement.
• People could not always access the service when they needed it. The urgent and emergency care service had consistently struggled to meet the four hour standard to admit, treat or discharge patients. Within surgical services, the cancelled operation rate was higher than the England average, the service was not meeting the 62 day cancer target, and there were a number of breaches of the 52 week target. We observed patients that had waited in the main outpatient department, from time of booking to consultation for up to two hours.
• The surgical service was not consistently complying with the surgical safety checklist which meant that opportunities to minimise or prevent harm could be missed. The surgical services risk assurance systems were not sufficiently robust to identify areas of concerns surrounding the surgical safety checklist.
• Within the emergency department, there were a high number of occasions when the planned number of nursing staff had not been achieved to provide the right care and treatment.
• We found that records were not always available within surgical services and the outpatients department. Records were not always completed in the urgent and emergency care service or outpatients.
• The urgent and emergency care service and surgical services did not always ensure its premises were suitable or that equipment was looked after.
• The urgent and emergency care service and surgical services. We found several areas of the emergency department, including some equipment to be visibly dirty and inconsistent infection control practices in theatres.
• There was not a consistently positive culture within surgical services.

However:

• We rated critical care as outstanding. Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care and there was a strong leadership structure. Patients and relatives felt that staff went the extra mile and their care and support exceeded their expectations.
• We rated medical care and end of life care as good. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe and staff understood risks and gave a clear, and current picture of safety. Effective processes were in place so lessons were learned when things went wrong.
• Across all services we found that staff cared for patients with dignity and compassion.