We spoke with six people who used the service and one person’s relative. People were positive about the care they received. They told us they felt safe, protected and their needs were met. One person said, “They (staff) are very thorough."

We looked at four people’s care and treatment records. People’s needs were assessed and care and treatment was planned and delivered in line with their individual needs.

We saw the provider’s policies and procedures, which included safeguarding vulnerable adults from abuse, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw that the safeguarding policy included information of the local procedures for reporting abuse.

We saw that the provider had effective recruitment and selection procedures in place and carried out the relevant checks when they employed people.

The provider had robust systems and procedures in place to regularly monitor and assess the quality of the service provided.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. The hospital had a well developed documented care record system that included pre admission assessments, risk assessments, consent practices, care programmes, care records and discharge records.

We spoke with nine people during our visit and they told us that the care that they received whilst in the hospital was excellent. One person told us, “The staff are professional and very kind.” Another person told us that the staff are, “Charming, nice and friendly.”

People were provided with a choice of suitable and nutritious food and drink. The hospital had detailed menus that provided suitable food and drink for all people who used the service. People that we spoke with told us that the food was very good and staff were very helpful when they needed help with their choices.

There was a detailed concerns and complaint process that was accessible to staff and people who used the service.

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.

The people spoken with during a visit to the hospital confirmed that they were well informed about their treatment and care plans. They all felt that they were treated with a great deal of respect and dignity and their wishes were clearly listened to and acted upon.

The people that were spoken with during a visit to the hospital confirmed that they had experienced safe, individualised care to a high standard

We carried out an announced inspection visit on 16 August 2016 and an unannounced inspection on 25 August 2016.

Our key findings were as follows:

Overall, the hospital was rated as good, with surgery and outpatients rated as good overall and children’s and young people’s services rated as outstanding overall.

We have rated surgery as good overall with effective and caring as outstanding but due to being requires improvement in the key question of safe we have rated the service as good overall.

The key questions of effective and caring for the hospital overall have been rated as outstanding, with well led and responsive rated as good. Overall safe has been rated as requires improvement, and the responsiveness of the service has been rated as good. Whilst we note that the children’s and young people’s service has been rated as outstanding in responsive we acknowledge that the numbers of children seen by the service is very small in comparison to the overall numbers treated by the service. Therefore, we have rated responsive as good overall.

We saw several areas of outstanding practice including:

• Staff, teams and other services worked exceptionally well together as a multidisciplinary team.
• Care provided to patients was outstanding.
• The range and selection of home cooked food available to patients, and the ability to provide a patient’s dedicated food request was outstanding.
• The hospital provided regular training events for local GPs, which demonstrated outstanding practice.
• Outcomes for people who used the service were outstanding. The hospital participated in certain national audits, including the National Joint Registry (NJR), which showed 100% consent rate.
• Outcomes from the Oxford Hip and Knee score, as well as PROMS outcomes were outstanding.

However, there were also areas of where the provider needs to make improvements.

The provider should:

• Ensure medical notes are always available for staff who are treating patients in the outpatients department.
• Ensure that assessment of Gillick competence is recorded in the patient record.
• Consider further development of the vision and strategy for the future of children’s services.
• Improve the process for treating patients with learning difficulties.
• Review the plans for the endoscopy suite to ensure it meets the Medicines and Healthcare products Regulatory Agency (MHRA) requirements as soon as reasonably practicable.
• Undertake further audits on the World Health Organisation (WHO) ‘Safer Surgery’ checklist.
• Consider the need for an admission policy setting out safe and agreed criteria for selection and admission of people using the service.

Professor Sir Mike Richards

Chief Inspector of Hospitals