We had received information that people were not always treated with respect and dignity. People had told us that they were not always kept informed about what was happening and that staff were not always helpful.

We visited wards Priory 4 and Lyndon 4. No one knew we would be visiting that day. We spoke with six members of staff and five people who were receiving care and treatment. A number of people on these wards had dementia care needs and were not able to tell us about their experiences. We spent some time observing their care and interactions from the staff. We were unable to speak to relatives as visiting hours had not commenced at the time of our visit.

We saw that staff treated people with respect and dignity. One person said “They pull the curtains around, they only have to see a sight crack in them and they are there to pull them together, there is no indecency here, nothing like that”.

People told us that they knew who was looking after them. They told us that they knew what was happening with their care and that staff answered their questions. People told us that they made their own decisions and we saw staff offering people choices.

All of the people we spoke with told us that they were satisfied with the care and treatment they had received. One person said "The care has been excellent, I could not fault it, it’s not their specialty on here but they found out and answered all my questions”.

Staff received a range of training so that they had up to date knowledge and skills in order to support people’s individual needs.

Staff were motivated and wanted to tell us what they did well and how they had improved since our last visit. They also told us about things they wanted to improve further.

Sandwell General Hospital is part of Sandwell and West Birmingham Hospitals NHS Trust (the trust). In March 2011 and August 2011 we carried out reviews of Sandwell General Hospital. These reviews were part of a targeted inspection programme in acute National Health Service (NHS) hospitals to assess how well older people are treated during their hospital stay. In particular we focused on whether people were treated with dignity and respect and whether people’s nutritional needs were being met. Both our March 2011 and August 2011 reviews showed that Sandwell General Hospital was not compliant with the outcome areas we assessed which were:

Outcome 01- Respecting and involving people who use services (we assessed that there were moderate concerns in this area both in March and August 2011).

Outcome 05- Meeting nutritional needs (we assessed that there were major concerns in this area in March 2011 and minor concerns in August 2011).

Following our August 2011 review the trust closed a ward called Newton 4 as this is the ward where we identified shortfalls and concerns.The trust have kept us updated with their plans to make improvements.

We carried out this December 2011 review to check whether Sandwell General Hospital had made improvements. The wide range of evidence that we gathered during this review confirmed compliance with both outcome areas.

A reconfiguration of wards and stroke provision has taken place. There are two dedicated wards to care for people who have suffered a stroke. Newton 1 is the acute assessment ward and Newton 4 is dedicated to stroke rehabilitation.

We assessed both of these wards as part of our review. Staff told us how the reconfiguration of wards had benefitted people in terms of there being clear stroke care pathways from the time they arrive at accident and emergency through to assessment, rehabilitation and discharge.

Staff wanted to speak with us. They wanted to tell us about the improvements that had been made. They told us how these improvements and changes were having a positive impact on the people that were being cared for on their wards.

All of the staff we spoke with highlighted the importance of "team working" and how everyone had an important role in making sure that people received a good standard of care. Staff were enthusiastic about the changes and improvements that they had made. Staff at all levels were aware of the need to continue with the work they had undertaken to make sure that improvements are furthered and sustained. Below are a few comments staff made;

"Things are where they should be now it was terrible before. It has taken a lot of hard work to get where we are now but things are a lot better".

"Staffing levels are better and leadership is better. There have been great improvements since March".

"There have been a lot of changes since August. Newton 4 was very busy and people were heavily dependant. Staff did not understand expectations. We have put a lot of processes into place to improve and improvements have been made".

"We have more time to spend with people to give them reassurance".

On both wards we spent time observing. We observed staff engaging with people. We listened to find out if staff gave people choices and spoke with them politely. We watched staff to see how they supported people to eat their meals. We looked at records to make sure that the care delivered was personalised and effective. Our findings from these observations demonstrated improvement and compliance.

We spoke with people to find out their views on the care provided. In total we spoke with twelve people across both wards.

People were complimentary about the care and service they had received. People made positive comments about their treatment and the staff. Below are a few comments people made;

"Everyone has been extremely kind to me".

"Have been treated well here, can't better it".

"Nothing could be improved".

"The staff are absolutely wonderful, I can't fault them at all. They do everything they can for me".

"Honestly, I can not complain about anything".

"The food is nice. We have choices every meal time".

"The food is not a problem".

Sandwell General Hospital is part of Sandwell and West Birmingham Hospitals NHS Trust (the trust). In March 2011 we carried out a review of Sandwell General Hospital. This review was part of a targeted inspection programme in acute National Health Service (NHS) hospitals to assess how well older people are treated during their hospital stay. In particular we focused on whether they were treated with dignity and respect and whether their nutritional needs were met. Our March 2011 review showed that Sandwell General Hospital was not compliant with the outcome areas we assessed which were:

Outcome 01- Respecting and involving people who use services (we assessed that there were moderate concerns in this area).

Outcome 05- Meeting nutritional needs (we assessed that there were major concerns in this area).

We carried out this review to check whether Sandwell General Hospital had made improvements in respect of these two outcome areas.

We assessed two wards during our inspection; the Emergency Assessment Unit (EAU) and Newton 4 (which provides care to people primarily who have had a stroke). In total we spoke with eleven people. However, out of these eleven, due to individual conditions and communication levels only nine people could answer our questions in detail.

Overall people who were able to talk with us were happy with their care and treatment. People also made positive comments about the food and drink provided. Below are some of the comments they made:

“I am very pleased with everything on EAU. All staff including the doctors keep me informed and they always ask how I am feeling or if there is anything I need”. This person further stated “Nothing could be improved on EAU”.

“They are very good”.

“I am informed of my situation. The staff are very good and they are polite. Overall everything is OK, better than when I was in another hospital ten years ago”.

“The food is very good. I am more than happy with it. In fact I was going to fill a comments form in”.

On both wards we spent time observing the care provided to people and looking at records, an example being, records of diet and fluid intake. Our observations showed that although improvements have been made since our March 2011 inspection there was still non-compliance particularly regarding how staff protect and/or promote people’s dignity. We observed situations that could have been avoided. The outcome for the people involved was that their dignity was not maintained. We also found that further improvements are needed so that people can be assured that their nutritional and hydration needs are met.

Following our inspection the trust informed us that they had taken the decision to close Newton 4 and replace it with two separate units for acute stroke and stroke rehabilitation. The trust told us that the ward would be closed in September 2011 and general medical admissions to the ward would cease immediately.

Patients we spoke with gave mixed views about their experiences of care and treatment. A number stated that they were kept informed and were involved in making decisions about treatment. Some patients told us that they had their care needs met and had been treated respectfully. One patient told us that their experience could not have been better. They described one ward as being ‘marvellous’. They said; “Staff come and talk to you, have time and give you a hug if you are feeling down”. Other comments made by patients were; “Not really listened to. Some staff just seem to do their own thing regardless of what I say”. Staff can be gruff and miserable. Doctors talk down to you. Nursing staff are rushed when caring because there are not enough”. One patient told us; “not very nice” being placed in a bay, on a ward with patients of opposite gender.

‘NHS choices’ is a NHS national and local information giving website which also enables people to make comments about NHS services they have received. There were six positive comments submitted to NHS choices between March 2010 and January 2011 for Sandwell and West Birmingham Hospitals NHS Trust (the trust) overall. These detailed encounters with attentive, caring staff who treated patients with respect. There were also six negative comments three of which made reference to rude or disrespectful behaviour by some staff.

Some patients we spoke with were happy about their experiences of mealtimes. They commented that there was a good choice of food. However, some were not happy with the quality of food provided and felt that it could be improved. A patient commented “give you menu food, horrible. Good food wasted. I feel sorry for those who have to be fed”.

Our rating of services stayed the same. We rated it them as requires improvement because:

• Our rating of safe was requires improvement overall. Nursing and medical staff were not always available in sufficient numbers to provide safe care and treatment. Mandatory for some nursing and medical staff did not meet trust targets. Systems for protecting patients from the risk of the spread of infection were not robust. Patients records were not always updated or kept securely.
• Our rating of effective went down to requires improvement overall. Staff did not always understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Not all staff were appraised, staff work performance and supervision meetings were not always held
• Our rating of caring remained as good overall. Staff treated patients with compassion and kindness.
• Our rating of responsive improved to good overall. The trust did not always plan and provide services in a way that met the needs of local people. Not all services always took into account the individual needs of patients. People could not always access services when they needed to.
• Our rating of well-led remained as requires improvement overall. Managers did not always have the dedicated time and skills to lead services. There was not effective systems for identifying risks managing and planning to mitigate or reduce them. Processes were not always in place to promote learning and continuous improvement. The IT systems in place were fragile and did not support staff to deliver patient care.