Nuffield Health Taunton Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed the learning culture, safeguarding and safe environments quality statements for the safe key question. There was a culture of safety and learning. This was based on openness, transparency and learning from events that have either put people and staff at risk of harm, or that have caused them harm. Lessons were learned from safety incidents or complaints, resulting in changes that improved care for others. There was a strong understanding of safeguarding and how to take appropriate action. There were effective systems, processes and practices to make sure people were protected from abuse and neglect. People were cared for in safe environments that were designed to meet their needs. Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were encouraged and supported to raise concerns. Staff we spoke with felt confident to raise concerns and were clear about who to report concerns to. Staff told us they reported incidents and near misses promptly in line with the organisation’s policy and received feedback. Learning from incidents was shared with staff. The was a duty of candour policy and staff understood the importance of duty of candour.

There was a clear patient safety incident policy and pathways to guide staff to identify and report incidents and investigate them appropriately. Incidents and complaints were appropriately investigated and reported. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. We saw reports from 9 investigations of incidents which showed managers investigated incidents thoroughly. There was evidence that changes had been made as a result of identified learning. Staff received feedback from investigation of incidents, both internal and external to the service. Senior staff shared safety alerts throughout the surgical service and ensured actions were implemented in line with national guidance.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

There was a strong understanding of safeguarding and how to take appropriate action. Staff we spoke with understood how to protect patients at risk of, or suffering, significant harm and the service worked well with other agencies to do so. Staff had updated training on how to recognise and report abuse and they knew how to apply it. Staff gave examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff told us about a recent example where they followed the safeguarding procedure and learning from the safeguarding incident was shared. All staff we spoke with knew the safeguarding lead and were confident to challenge to ensure the safety of patients. Staff followed safe procedures for children visiting the department. Information for staff was contained within safeguarding policies and procedures. This included the action to take when staff had concerns regarding child protection and domestic abuse.

There were effective systems, processes and practices to make sure people are protected from abuse and neglect. Staff received training specific for their role on how to recognise and report abuse. Most staff maintained up-to-date mandatory training, which included Safeguarding Adults level 3 and Safeguarding Children level 2. All staff are up to date with Safeguarding Children Level 2. Staff also received mandatory training on learning disability and autism, and whistleblowing training.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff told us they had access to the equipment they needed for the care and treatment of patients. Staff disposed of clinical waste safely. There was access to emergency equipment, including a trolley for the treatment of sepsis. The emergency trollies were located on the wards and in theatre. They were clean, tamper evident and ready to use. Staff conducted daily, weekly and quarterly checks of the equipment and medicines to ensure they were ready to use and in date. From the records we reviewed during a three-month period there were no gaps in the log. Equipment was serviced and staff told us the ward had recently received 6 new beds and 6 new chairs. Staff knew the Infection Prevention Control lead.

The service had suitable facilities and equipment to safely meet the needs of patients. Disposable items of equipment were discarded appropriately, either in clinical waste bins or sharp instrument containers. None of the bins or containers we saw were unacceptably full. We observed clean clinical environments and equipment. They had enough space to move freely through the department. We observed rooms on Luttrell ward were clean, spacious and equipped call bells.

There were effective arrangements to monitor the safety and upkeep of the premises. There were a number of policies including an infection control policy, environmental policy and a medical gas pipeline systems policy and cylinder management policy. We saw the risk register list report which outlined the risk of procedures being cancelled due to a lack of equipment/medication and the actions taken to mitigate the risks. These included hospital and theatre daily safety huddles to ensure the correct supplies were in place.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.