The CQC carried out follow-up inspections at the hospital in October and November and found a number of improvements had been made since its last inspection in January, but said further work was needed. The Trust received an overall rating of Requires Improvement and the recommendation from the chief inspector of hospitals, Professor Sir Mike Richards, was for the Trust to remain in special measures so it could continue to receive support to make sustainable changes. I have made a recommendation to the Trust Development Authority (TDA) that the trust remains in special measures. We have informed the TDA of our findings for it to ensure these are appropriately addressed and that progress continues to be monitored through the special measures action plan. Professor Richards highlighted a number of concerns regarding how the trust manages and monitors risk in a number of areas. There were also concerns regarding the A&E department, including infection control practices. Urgent and emergency services are rated as Inadequate overall. We also saw a number of areas of good and outstanding practice, which included the chaplaincy service, which remains excellent and supportive to patients, their families and carers, and work on Apple Tree Ward to help patients with dementia. The trust was given feedback on all the areas where improvement is needed following the inspection and knows what it must do now to ensure positive changes are made. We will continue to monitor the trust and this will include further inspections. The hospitals overall rating is Requires Improvement for whether services are safe, effective, responsive and well-led and it has a Good rating for whether its services are caring. Overall, inspectors found the service was in a transition period following structural management changes. New systems and process were in place but these were yet to be embedded. The report said staff were caring and compassionate towards patients, but the emergency and medical services required improvement to ensure people were protected from avoidable harm. Services for patients at the end of their lives required improvement to ensure they received a safe, effective and responsive service that was well led. The inspection highlighted where the trust it must improve and this includes: Being able to provide assurance that all members of staff are aware of the procedure for and necessity to, report all clinical incidents and near misses in a timely and accurate manner, ensuring these are thoroughly investigated and reported externally where necessary. Ensuring all staff responsible for supporting the feeding of patients have adequate training in relation to the risks associated with various medical conditions. The end of life risk register must record all relevant risks involved in delivering end of life care to patients. Patient outcomes must be monitored and audited and the information used when reviewing the service. A robust incident and accident reporting system needs to be in place and lessons learned from investigations of reports shared with staff. Ensuring the service has effective governance and risk management systems to reflect current risk and that this is understood by all staff. Environmental risk assessments must be undertaken to ensure mental health patients are safe from ligatures and self-harm within the department. An effective process for monitoring ECGs and observations needs to be in place. An immediate review of the environment and provision of childrens services must take place. In the emergency department the time from treatment from a clinician must be reviewed and improved, infection control practices and processes for checking equipment also need to be improved. Inspectors found examples of outstanding practice at the trust, including: A member of staff on Apple Tree ward had introduced sensory bands for the wards dementia patients. These were knitted pockets, embellished with buttons and beads, for patients to wear or hold to give them an immediate focus to explore. There was a good infection prevention and control initiative which included different coloured aprons, for different ward bays, which acted as a reminder to staff to change or remove when staff moved out of areas. The chaplaincy service continued to provide an excellent service, supportive of patients, families, carers and staff. There was robust implementation of Duty of Candour. The inspection included an inspection on October 20 and 21 as well as unannounced inspections on October 26 and 27 and November 5.