This unannounced inspection was carried out by a team of four including a specialist advisor and an Expert by Experience. We visited three wards. We spoke with patients or their relatives and staff on all of the wards we visited and spent time observing how care and support was delivered. We also looked at patients’ notes and care plans.

Patients and their relatives on the Children’s ward were particularly complimentary about the service they received in the hospital. One patient told us, “It’s happy and fun here”. A relative of another patient told us, “It’s absolutely brilliant”. On other wards, patients were overwhelmingly positive about their experiences although one patient was unhappy about the care they had received after an operation.

We found that measures in place to keep people safe were in place across the hospital but were particularly good on the children’s ward. Information was available in language that children could understand and patients told us that they felt very safe on the ward.

All the patients we spoke with told us that doctors had explained the benefits and risks of their operations in great detail. We saw that consent forms had been fully completed and signed. Patients also told us that staff asked for their verbal agreement before carrying out treatment or care on the wards.

We found that there were generally enough qualified staff on duty to provide good care for the number of patients accommodated. However, two nurses mentioned that it could be difficult to find a doctor on a Sunday to sign discharge notes so that patients could go home.

We inspected three wards; spoke with 20 patients, 10 staff and four visitors.

People told us what it was like to be a patient in the hospital. They described how they were treated by staff and their involvement in making choices about their care.

People mainly shared positive experiences about the care, treatment and support they received. They said they were treated with dignity and respect and that staff responded to their needs. People’s records we sampled were kept securely and reflected the knowledge that staff had about the needs of individuals within their care.

People told us they felt safe at the hospital. We saw good interactions that enabled people to feel secure and reassured. Staff demonstrated an understanding of the different forms of abuse and knew the procedure to follow if they suspected abuse.

There were sufficient levels of staffing available on the three wards on the day that we inspected. However, people aired some dissatisfaction in this area, which the trust had identified as an area requiring improvement. One person told us, “I ask to go to bed early just so I’m in bed and not hanging around waiting for staff.”

The trust informed us that action was being taken to address the staffing structure in the wards we visited.

The trust monitored formal complaints, investigated any poor practice and improved the service by learning from outcomes so that people received appropriate care.

People told us that their choices, independence, human rights, dignity and privacy were considered and respected. They felt they were supported to make decisions about their care and influence how the service is run.

Processes were in place to ensure that people were able to give consent to their care and people said that staff asked permission before carrying out any care with them.

People considered that they were involved in pre-operative assessments of care and were aware that they had a care pathway record. They told us that the attitude of staff was good and they felt safe and well cared for in the hospital. Comments about food and drink were favourable and all felt they had enough to eat.

Cleanliness and tidiness was reported to be very good. All people spoken with liked the hospital and said the environment was very nice to be in.

They said that staff made them feel very at ease and were skilled at making them feel less anxious about treatment. People said that staff were very kind and certainly seemed to know what they were doing. People had confidence that staff would do the right thing for them.

Visitors said that staff tried their hardest to sort things out and kept at it until a suitable outcome was achieved. They said they were able to make comments about the service and understood that they could complain formally.

Our rating of services improved. We rated it them as good because:

• Our rating of safe was overall. Services managed patient safety incidents well. Services had sufficient numbers of permanent staff with the right qualifications, training and experience to keep people safe from avoidable harm and abuse. Services controlled infection risk well.

• Our rating of effective was good overall. Services monitored the effectiveness of care and treatment and used the findings to improve them. Staff were competent to carry out their role. Patients were supported to live healthier lives and manage their own care and wellbeing needs where appropriate.

• Our rating of caring was outstanding overall. Staff exceeded the expectations of patients and family members in their passion for patient care. Staff worked in a creative and innovative manner to provide exceptional, strong and caring emotional support that exceeded patients’ expectations to minimise their distress. Staff consistently involved and empowered patients and those close to them as active partners in their care and treatment.

• Our rating of responsive was good overall. Services took account of patients’ individual needs and planned and provided services in a way that met the needs of local people and the specialist needs of people within the region who were living with spinal injuries.

• Our rating of well-led was good overall. Managers at all levels in the trust had the right skills and abilities to run a service providing high quality sustainable care. There was a vision in place for what the trust wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.