Nuffield Health Bristol Hospital - The Chesterfield

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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. Learning Culture: The service provided safe care and treatment. Learning from incidents was evident with outcomes of incident investigations shared with staff throughout the service and organisation. However, some complaint responses did not always cover all the elements raised in the complaint . Leaders told us they met with each complainant and ensured they addressed all the complainant’s concerns. However, they accepted this was not clear in their response letters. Safeguarding: The service had safeguarding processes and staff were aware of how to follow the correct referral process. Staff could discuss situations where they had escalated concerns. Safe Environments: The design of the environment followed national guidance for safety. The service had 3 operating theatres on the first floor of the hospital. All patient rooms were single occupancy to prevent any risks of cross infection. Staff carried out daily safety checks of specialist equipment to ensure they were in good working order. The service had suitable facilities and equipment to safely meet the needs of patients and their families.

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 to report incidents and received feedback from incidents they reported. Any incidents reported over a 24- hour period were discussed the following day at the safety huddle and then shared with staff. Staff were encouraged to drive improvement for the service. For example, the ward’s dementia lead had shared ideas about how to improve the service for patients and families. Staff had a good understanding of the duty of candour and understood their responsibilities. The duty of candour requires registered providers and registered managers (known as ‘registered persons’) to act in an open and transparent way with people receiving care or treatment from them. Staff gave patients and families a full explanation and apology when things went wrong in line with the duty of candour corporate policy. However, we reviewed 5 complaints and found the response letters to complaints did not always cover all the elements raised in the complaint. This meant there could be missed opportunities to learn from complaints and prevent recurrence. Leaders told us they met with each complainant and ensured they addressed all the complainant’s concerns. However, they accepted this was not clear in their response letters.

The service had appropriate corporate policies and local procedures to guide staff. Managers shared learning with their staff about never events that happened elsewhere at the hospital and across the organisation, through team meetings and newsletters. The hospital senior leadership team attended Nuffield’s national group meetings where learning from incidents were discussed. We reviewed learning from blood clot incidents that had occurred within the surgical service. Staff reviewed the incidents and ensured that national guidance had been followed. Staff identified and shared learning outcomes from incidents. They ensured any required actions were implemented to promote effective learning and prevent similar incidents happening again. 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.

Staff had completed safeguarding training in line with national guidance. Staff were trained in safeguarding level 2 for both adults and children and young people safeguarding as a minimum. Training schedules showed senior staff within the hospital were trained in level 3 safeguarding adults and children and young people. Staff had completed the Oliver McGowan mandatory training on learning disability and autism and whistleblowing training. The service provided evidence showing compliance rates which met the corporate target levels. We reviewed evidence that showed how the process had worked following concerns raised. The documentation followed the corporate safeguarding policy. It was clear and concise, and concerns were escalated appropriately as detailed within the Nuffield safeguarding processes.

Staff received training specific for their role on how to recognise and report abuse. Staff in all areas had access to safeguarding information about how to refer and escalate concerns. Staff escalated safeguarding concerns to the ward manager. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Safeguarding adults level 3 training had been introduced for staff in all clinical areas in line with national guidance. Staff we spoke with had completed the training or were booked to do the training in the next month.

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.

The design of the environment followed national guidance for safety. The service had 3 operating theatres on the first floor of the hospital, all with laminar flow to minimize infections. On wards and in departments we visited, patients could reach call bells and staff responded quickly when called. Staff carried out daily safety checks of specialist equipment to ensure they were in good working order. All patient rooms were single occupancy to prevent any risks of cross infection. The hospital had its own team of engineers for all daily maintenance tasks. The onsite engineer oversaw all the equipment compliance checks. Equipment in theatres and the ward areas had stickers to indicate recent electrical testing and servicing .

Staff told us the environment was safe and that they had access to suitable equipment to carry out their role. They told us they carried out daily safety checks and we saw these were completed consistently. The service had suitable facilities and equipment to safely meet the needs of patients and their families. Staff disposed of clinical waste safely.

Digital systems had been implemented within the surgical service. We reviewed standard operating procedures and implementation processes for the electronic patient records system that recorded and tracked patient data. Service leads completed risk registers with evidence of actions and timescales where necessary. Quarterly environmental audits were performed within surgical areas. Medical gases and theatre ventilation systems were maintained in line with the corporate policy. Any advisory actions were addressed. This was compliant with Health Technical Memorandum 03-01 Specialist ventilation for healthcare premises. This meant there was an adequate number of air changes in theatres per hour, which reduced the risk to patients of infection.

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.