We spoke with eight patients. All patients told us they felt safe and they knew who to speak to if they had any concerns. No patients had seen any incidents that had caused them concern.

All patients told us they had no concerns about the environment. One patient said it was, “Brilliant – clean, calm, tranquil.” Another patient said, “The showers are lovely.” Another patient said, “The new bathroom is fantastic, it is well designed.”

All patients told us they had no concerns regarding the confidentiality of their records. One patient said, “Confidentiality is respected – only doctors and nurses see them.” Another patient said, “My main file is kept at the nurse station which I believe is secure as a member of staff is always there.”

We found that patients were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that patients, staff and visitors were protected against the risks of unsafe and unsuitable premises and that patients' personal records, including medical records, were kept securely.

People told us what it was like to be a patient in Nottingham City Hospital. They

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 older patients in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by three Care Quality Commission (CQC) inspectors joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

To carry out the inspection, we identified two wards, where there were a percentage of older patients, in order to focus the dignity and nutrition inspection (DANI). As part of the inspection process we spoke with a number of patients and visitors on both wards. We also spoke with a senior member of staff for Nottingham University Hospitals Trust. A range of staff members were spoken with on both wards throughout the site inspection. We did this to gain the views of patients who received care and treatment and people who visited the hospital or worked there. We also observed care, spoke with patients and staff on two other wards.

Patients were very happy with the care being provided by staff. One patient said, “Staff always pull the curtains round when providing me with personal care and respect me.” Another patient said, “My decisions are respected by staff.” Another patient told us their privacy and dignity were respected by staff.

Patients told us that they were happy with the information provided to them and they had opportunity to give their views on whether they were happy with the care provided. Two patients told us they had expressed a preference regarding the gender of the carer providing them with personal care. They told us that their wishes had been respected by staff.

Patients we spoke with had mixed views about the quality of food. One patient said, “lovely food, can’t complain.” Another patient said, “fish pie was beautiful but carrots and cauli – no juice – too dry.”

Patients we spoke with told us that they had enough to drink. A patient said, “There’s plenty of drinks, always a decent drink.” Patients told us that a range of drinks were available including tea, coffee, malted milk and hot chocolate and they described having drinks at times other than the prescribed times.

Patients we spoke with told us there was plenty of food available at mealtimes and other food was available between mealtimes. They also told us that if they were away from the ward at mealtimes then food would be made available for them when they returned.

Most patients we spoke with told us they did not have any specific cultural or religious requirements in relation to their food or drink, however, patients told us they felt staff would accommodate their wishes if they did have those requirements. They also told us they had been asked whether they had any cultural or dietary requirements when they were admitted to the ward. Patients who required gluten-free or diabetic food told us that this food was available for them. A patient said, “It’s alright, I eat it, there’s quite a large choice, I order it in the morning and get it delivered, there’s plenty to eat.”

Patients told us they received support at mealtimes if they needed it. They also told us that staff monitored their eating and drinking in their records and also weighed them regularly.

Patients we spoke with told us that they felt safe. They also told us they had not seen any practice that they were not happy with. Patients also told us they knew who to speak to if they had any concerns.

Patients were very happy with the care they received from staff. A patient said, “They are all kind, the level of care is to be commended.” Another patient said, “[The staff are] absolutely fantastic, outstanding, nothing’s been too much trouble.” Another patient said, “[I have] nothing but praise [for the staff].”

Patients felt there were generally enough staff to provide care. Staff were busy at times but one patient said, “Staff apologise if they’ve kept you waiting.” Patients told us that call bells were always answered and staff generally answered them quickly.

Some patients we spoke with had seen their care records, some patients had not. One patient told us they knew where their records were and would ask staff if they wanted any information. Another patient told us they had looked at their records and a nurse had explained some of the information to them. Another patient said, “never thought to look at notes, I don’t know if you can or not. I rely on doctors coming round to explain things.” Another patient said, “not seen medical records, not been offered to see medical records.”

Patients did not raise any concerns about the security of their records.

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.

Patients told us that they understood the care and treatment choices available to them. One patient said, "I was given options, choices, the risks and the prognosis, they were my decisions to make." They also told us they could express their views and were involved in making decisions about their care and treatment. One patient said, "I’ve always felt in control." Patients told us their privacy and dignity was respected and that their views were taken into account.

Patients told us that they were able to give consent to the care and treatment that they received. They also told us that they understood and knew how to change any decisions about care and treatment that had been previously agreed. One patient said, "I have changed my mind about this [treatment options available] and I refused to continue a certain treatment."

Patients told us that they experienced appropriate care and treatment that met their needs. Most patients told us that they received safe and coordinated care where more than one provider was involved or when they were moved between services. However, we were also told that patients were left waiting long periods (3+ hours) for transport home after receiving radiotherapy treatment.

Patients told us that they felt safe and they knew who to speak to if they had any concerns. Most patients told us that they were happy with the premises. However on one ward, there were no lockers for patients to store their belongings in. On this ward, one patient said, "I don’t know if my belongings are safe, there’s no lockers, my things are on the floor."

Patients told us that their needs were met by competent staff. One patient said, "My buzzer’s always answered in good time, they’re confident and I’ve got confidence in them." Another patient said, "They all know what they’re supposed to be doing and they get on and do it." Patients also told us while they were not aware of the content of their records they were confident that their records were accurate and held securely.

• Staff understood how to protect patients from abuse and the services worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
• The service mostly had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment, however actual staffing levels did not always meet planned levels.
• The services provided care and treatment based on national guidance and monitored patient outcome to monitor for the effectiveness.
• Staff worked together as a team to benefit patients.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The trust planned and provided services in a way that met the needs of local people.
• The services took account of patients’ individual needs.
• Managers at all levels in the core services had the right skills and abilities to run a service providing high-quality sustainable care.
• The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.