There are ongoing concerns about racism, discrimination and excessive working hours at Weston General Hospital, according to inspectors.
But a new review has found medical care at the North Somerset hospital has improved since a previous inspection which saw it rated as inadequate.
Healthcare watchdog the Care and Quality Commission (CQC) has now given the Weston-super-Mare hospital an overall rating of requires improvement following a visit in August.
In a report published today (12 October), the CQC says there are "ongoing concerns around racist behaviours and discrimination against staff who were from ethnic minority backgrounds".
The report also says staff recruited from overseas faced additional problems - including the timeframe for them taking up their posts fully being extended. It says this has caused "friction in some areas and risked them being segregated as a group from the rest of the workforce".
The CQC also said some staff at Weston General told inspectors that they regularly worked "excessive hours" to keep patients safe.
Inspectors found this was particularly the case for ward managers and matrons, who worked long days to ensure there were enough staff to care for them.
While it found staffing levels kept patients safe, the CQC found staff were being moved to different roles at the beginning of their shifts to ensure there was adequate cover. This also meant ward managers were having to act down.
Workers also told inspectors medical staffing was "stretched" out of hours - especially at the weekends.
Inspectors were told the issue of racial discrimination against staff would be tackled as a priority after they raised it with the leadership of the University Hospitals Bristol and Weston (UHBW) NHS Foundation Trust, which runs the site.
'Standards of care for people as well as their experiences have improved'
Despite some ongoing issues, the report says the site has progressed in a number of areas.
The rating around safety has improved from inadequate to requires improvement and its effectiveness has gone from requires improvement to good. How well-led the service is previously needed improvement but is also now deemed to be good.
However, the hospital's responsiveness still requires improvement, according to the report.
The NHS trust responsible for the hospital is unaffected by the latest review and continues to be rated as good.
The CQC's head of hospital inspection Catherine Campbell said she was "pleased to see improvements had been made" and that the standards of care for people and their experiences had improved.
She said: “During the inspection, we saw a patient due to be discharged the following day had developed good relationships with those caring for them. The person was clearly very grateful, and a number of nursing and medical staff came to wish the individual well. This was a caring, thoughtful and positive act by staff."
She also said another patient who had a condition that made drinking more difficult was provided with beakers while cutlery was adapted with foam handles to make gripping it easier.
"This is a great example of person-centred care," Ms Campbell said.
Inspectors found a "clear, proactive approach" to explaining the hospital's strategy and vision to staff, while workers were felt to be "dedicated to the future direction of the hospital and understood their role" in this.
Catherine added: “These improvements are testament to the hard work and commitment made by staff and leaders, who have made great strides since our last inspection in June 2021.
“While the trust recognises there is still work to do, the progress that has been made is extremely encouraging and I look forward to seeing it build on these strong foundations in all other core services provided by the trust.”
The CQC report concluded that there are a number of other areas the hospital needs to improve on, aside from discrimination and long hours.
It said this included ensuring the "environment in the surgical day case unit is fit for purpose for those staying overnight" by ensuring patients have access to lighting by their beds, as well as lockers and showers on their ward.
It also added the hospital should review and improve staffing models to ensure it meets the needs of patients and "should consider ways in which patient experience is a focus of, and can be factored into, conversations about operational pressures."
'A significant step in the right direction but there is more to do' - UHBW NHS Trust
Chief executive at UHBW Trust Eugine Yafele said it welcomes the report and is "pleased inspectors found many positives".
He added: “Whilst all this is a significant step in the right direction, we know there is more to do.
"We are committed to making the necessary improvements, building on the many successful initiatives already underway and ensuring our talented and dedicated staff have the time and resources they need to deliver excellent care to our patients.”