Nuffield Health Taunton Hospital

We carried out this inspection as part of our programme of independent healthcare inspections under our new methodology. The comprehensive inspection was carried out through an announced visit on 12 and 13 July 2016. We did not carry out an unannounced inspection.

We rated this hospital as good overall. Our key findings were as follows:

Are services safe at this hospital?

• The hospital had a good track record on safety. In the year April 2015 to March 2016 there were no never events, serious injuries or deaths reported and no cases of hospital-acquired infection.

• There was a culture in which staff were encouraged to report concerns or incidents. Staff told us they were confident to raise concerns and that these would be dealt with. There was evidence of learning and improvement following incidents.

• The hospital was clean and staff observed appropriate precautions to prevent and control infection.

• Premises and equipment were mostly well maintained, fit for purpose and used correctly and safely.

• Pre-operative assessment of patients took place to ensure early recognition of co-morbidities which may present risks in relation to surgery.

• Surgical safety checklists were used in theatres and staff used early warning scores to ensure they recognised and supported deteriorating patients.

• Staff followed safe systems in respect of the management of medicines.

• Staff were appropriately trained and familiar with their responsibilities to safeguard vulnerable people.

Are services effective at this hospital?

• Patient care was delivered following recognised national guidelines, standards and best practice recommendations.

• The rate of unplanned readmissions was low compared with other providers.

• Patients’ pain was assessed and managed appropriately.

• There were robust arrangements in place for granting and reviewing practising privileges.

• Staff told us they were encouraged and supported to acquire more skills and develop professionally.

• Staff, teams and services worked together to deliver coordinated care and treatment.

Are services caring at this hospital?

• Staff engaged with patients in a friendly and caring manner.

• Staff treated patients with dignity and respect.

• Privacy was maintained at all times.

• Patients were extremely positive about the care and treatment they received.

• Patient feedback was consistently positive. Friends and family scores for the period April 2015 to March 2016 were on average 95.6%.

Are services responsive at this hospital?

• Services were organised so that they met people’s needs.

• The hospital exceeded the national standard which requires that NHS patients should wait no longer than 18 weeks from GP referral to consultant-led treatment.

• Patients were offered a degree of choice with regard to the consultant they saw, their appointment time and payments methods (where appropriate).

• Patients attending outpatients and diagnostic imaging departments told us they were seen promptly at their appointments.

• Diagnostic imaging results were reported promptly to ensure treatment could progress without delay.

• Services took account of the individual needs of people, including those in vulnerable circumstances.

• The service had taken steps to support patients living with dementia. There were dementia link nurses who acted as a source of advice to colleagues and who had raised awareness of the needs of this patient group.

• People’s concerns and complaints were listened and responded to sensitively, and learning was used to drive service improvement.

Are services well led at this hospital?

• Local managers were highly respected, visible, approachable and supportive. They worked well as a team to drive service improvement, while maintaining a culture which supported happy and motivated staff. Managers provided good role models and encouraged cooperative, supportive relationships among staff. Staff felt respected, valued and supported.

• There was a well-publicised and well understood corporate mission, supported by a set of values and behaviours. Staff were signed up to these and had been engaged in applying them to their place of work. All staff we spoke with passionately articulated shared values, focused on patient-centred care and compassion, which underpinned their work.

• There were high levels of staff satisfaction throughout the hospital Staff were proud of the organisation as a place to work. There was effective communication and engagement with staff and they were encouraged to raise concerns or make suggestions for improvement.

• There was an effective governance framework. Information was regularly reviewed to provide a holistic view of performance, which included patient safety, patient satisfaction and clinical outcomes. Risks were well understood, regularly discussed and actions were taken to mitigate them. External peer review of the hospital included a review of governance arrangements to ensure their continued effectiveness.

• The hospital encouraged, welcomed and acted on feedback from patients. There was openness and transparency when things went wrong and a constructive approach to learning from mistakes and supporting staff to improve their practice.

We saw several areas of outstanding practice, including:

• Staff had produced a video to promote hand-washing practice in a fun and innovative way.

• The hospital worked closely with a local sixth form college and had developed apprenticeships. Two healthcare assistant apprentices were employed in 2015, as well as a business office apprentice in the finance team.

• Staff told us they felt well supported in terms of their ongoing education and development. Staff with a particular interest in a field were supported to develop in the area, irrespective of grade or designation within the organisation. This recognised the value of all levels of clinical and non-clinical staff. A number of ‘lunch and learn’ sessions had been held to share knowledge amongst all staff groups.

• There was a dementia working party established in the hospital. Staff members of this group were very proactive in improving their understanding of dementia care and had attended further self-study courses in their own time. Learning from these courses was then shared with other hospital staff.

• Staff had taken steps to support patients living with dementia. One bedroom had been adapted with appropriate signage and large face clocks to enable patients living with dementia to identify areas within their room. Patients living with dementia were identified by the use of a blue pillow case and a ‘forget me not’ symbol on the patient’s record. This ensured that all staff involved in their care were alerted the fact that these patients may require extra support.

• There was a group of ‘dementia friendly’ staff who had made ‘twiddle muffs’. These are knitted hand muffs with items such as ribbons and buttons attached. They are used to provide a source of visual, tactile and sensory stimulation for people living with dementia who have restless hands.

• The patients’ forum had recently been re-launched and provided opportunities to capture recent patient experiences first hand. There was evidence that patient feedback and suggestions had been acted on swiftly to improve patient experience.

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

The provider should:

• Ensure that clinical procedures, where there is a risk of bodily fluids being spilt, should not take place in consulting rooms with carpet under foot. If unavoidable then appropriate risk assessment and IPC advice to be sought and adhered to.

• Ensure that resuscitation equipment checks are thorough and equipment is replaced when out of date or damaged.

• Ensure that mandatory training records are up-to-date and accessible for governance purposes. 

• Undertake temporary remedial work in theatres, pending the theatre replacement scheduled for 2017, to make good cracked doors, which had the potential to harbour bacteria.

• Continue to take steps to improve record keeping, including the completion of risk assessments, recording of patient observations, early warning scores and clinicians’ signatures and counter-signatures.

• Ensure that falls risk assessments are completed in pre-assessment clinics.

• Consider that where audit reflects a risk, such as lack of falls assessments being completed, that appropriate action is taken and monitored via the relevant governance forum.

• Review documentation used to record risk assessments of VTE and ensure that patients’ records clearly show all risk factors present and the reasons for the choice of preventative treatment.

• Ensure that theatre staff sign separately for the supply, administration and disposal (if appropriate) of medicines in the controlled drugs register.

• Review the use of printed stickers on medicines administration charts so that there is sufficient space to document all medicines prescribed and administered.

Professor Sir Mike Richards

Chief Inspector of Hospitals