Nuffield Health Brentwood 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

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The service investigated and recorded complaints in line with the complaints policy. Complainants were invited to meetings to discuss their concerns in greater detail and to support mutual understanding. Complaints were resolved appropriately, and lessons learned were identified. Evidence of this learning was demonstrated in department-specific meeting minutes provided to us following the inspection.

Staff demonstrated awareness of what incidents to report and how to escalate them, in line with hospital policy. They told us they raised concerns appropriately and reported incidents and near misses as required. Staff reported that they received feedback on incidents they had raised, and that learning was shared through monthly governance meetings, daily safety huddles, and email communication. They also said incident summaries were made available online, although they were unable to identify where this information could be accessed.

Between January and June 2025, staff reported 35 incidents in the outpatient department. Most were categorised as causing no harm to patients. One incident resulted in moderate harm, and the patient was promptly transferred to the nearest accident and emergency department in line with policy. However, it was not clear what specific learning had been identified as a result of this incident. This meant that assurance could not be given that learning had been embedded to reduce future risk.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The service did not operate safe systems for managing patient records, which impacted the continuity and safety of care.

In outpatients, the service relied on handwritten patient notes. We were informed that consultants sometimes took original records off site. Staff told us this created challenges, for example when patients returned for wound care and no documented information on wound management was available. Staff explained that if notes could not be located, they would contact the consultant’s secretary or the consultant directly to clarify care instructions. There was a risk that staff would not have an awareness of the risks to people across their care journey if they did not have access to all the relevant information.

Senior leaders acknowledged the concern and confirmed that consultants should not remove original records from the premises, clarifying that only carbon copies or personal notes should be taken off site. However, when asked for an action plan to address this, the provider did not supply sufficient evidence of measures to mitigate the risks.

All physiotherapy notes were recorded electronically using a Nuffield-wide system. This ensured records could be accessed at any Nuffield site, supporting continuity of care if a patient chose to attend physiotherapy at a different location. Staff told us this system enabled timely access to patient information and reduced the risks associated with missing or unavailable notes.

The department worked effectively with other hospital services, including physiotherapy and the pre-assessment clinic. Staff described positive working relationships with consultants and reported that care was well coordinated. For example, physiotherapists said they were able to raise concerns directly with consultants if patients presented with increased pain, and consultants responded promptly. Consultants also coordinated treatment plans with the physiotherapy team when referrals were required.

Patients gave positive feedback about the service. One patient told us, “It was quick to be referred to their physiotherapy team, they even let me pick my physiotherapist.” Another commented, “Everything is seamless, as we did it all online. It showed me all the consultants I could choose.”

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Patients we spoke with during the inspection told us they knew how to raise concerns if they did not feel safe, or if they were concerned about the safety of others. They reported feeling safe and supported in the environment.

This feedback was consistent with the June 2025 patient survey, which showed that 67% of patients said they had found a member of hospital staff they could talk to about their worries and fears. A further 32% of patients reported they had no worries or fears.

Staff demonstrated a clear understanding of safeguarding and knew how to raise a referral and who to inform if they had concerns. Nursing staff received role-specific training on recognising and reporting abuse. Following our inspection, the service provided an updated training matrix confirming that, as of July 2025, all staff had completed the required online safeguarding training for adults and young people as part of their mandatory training. In addition, 100% of outpatient staff had completed the Oliver McGowan Mandatory Training on Learning Disability and Autism.

We reviewed the safeguarding policy, which was in date and ratified. It clearly outlined referral pathways and set out the key indicators staff should look for when identifying potential safeguarding concerns.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff demonstrated an understanding of how to respond to a deteriorating patient and were aware of where to locate the deteriorating patient policy. At the time of inspection, 81% of staff had up-to-date training in either Adult Basic Life Support (BLS) or Immediate Life Support (ILS). In addition, 75% of staff had completed and maintained up-to-date training in either Paediatric Basic Life Support (PBLS) or Paediatric Immediate Life Support (PILS). Outpatient nurses and healthcare assistants met twice daily, before the start of clinics, to review scheduled treatments, discuss capacity and staffing issues, and identify any pressures on the service.

Patients we spoke with told us they were involved in decisions about their treatment and felt well informed about the care they were due to receive or had already received. This was supported by our observations of outpatient appointments, where consultants gave patients time to ask questions, did not rush consultations, and explained treatment options clearly to support informed decision-making. Consultants also gathered information from patients to assess risk and provided clear information about any associated risks.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some clinical areas did not meet national standards for flooring, specifically Health Building Note (HBN) 00-10. For example, the lino flooring did not extend partway up the walls as required.

Overall, the environment was visibly clean and largely clutter free, with furnishings in good condition. However, in the physiotherapy outpatient’s area, the gym room was cluttered and, at the time of our inspection, was also being used to store delivery boxes.

The service had sufficient and suitable equipment to support safe patient care. Staff were trained in its use, and equipment was maintained appropriately, and consumables were in date. Most portable electrical equipment had been safety tested, and servicing schedules were clearly displayed. However, we noted a small number of items where testing was overdue, including one device last tested in March 2024.

Clinical waste was disposed of safely. Domestic and clinical waste bins were clearly labelled and emptied regularly, and sharps and hazardous waste bins were stored appropriately.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff and consultants worked well together to provide safe care that met people’s individual needs.

Staffing levels were planned in line with the number of clinics running each day. Twice-daily huddles took place, during which staffing and clinic activity were reviewed.

The service did not use agency staff, instead relying on bank staff. Staff reported that they mainly worked with regular bank staff and that an induction process was in place for any new staff members.

At the time of our inspection, the service was undergoing a transformation programme that was changing how outpatient services were delivered. Staff told us this was challenging, as they felt they had not received sufficient training to use the new systems being introduced. For example, some staff Some staff reported that the phlebotomy training was not sufficiently robust, as they continued to require support—particularly in selecting the correct blood collection tubes for specific blood tests. Staff had raised these concerns, and senior leaders were aware of them. Plans were already in place to provide additional training to support staff in upskilling.

At the time of our assessment, compliance with mandatory training averaged at 93.9%. The service did not audit compliance with annual appraisals at departmental level but instead monitored performance across all staff groups, which showed 95% compliance. Staff told us they had regular appraisals, during which they were able to discuss their learning and development needs, and that they were supported in taking study days.

We scored the service as 2. The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

During the inspection, we noted that some cleaning checklists in clinical rooms had not been fully completed. We reviewed the month of June and saw that on several checklists there were days that were not completed. Where days were missed, reasons were sometimes recorded — for example, one entry stated the service was too short-staffed to complete cleaning that day. We also found that not all equipment displayed the green 'I am clean' sticker; for instance, a metal trolley in the treatment room had no sticker, meaning we could not be assured it had been cleaned and was ready for use. Following the inspection, we requested the most recent cleaning audits for the outpatient department, which reported 100% compliance. This indicates that the service’s audit processes may not always be sufficient to identify gaps such as those we observed.

We observed effective infection prevention and control (IPC) practices, as well as safe hazardous waste and sharps management. A dedicated housekeeping team maintained cleanliness and hygiene across the environment. Good hand hygiene practice was embedded in daily routines, supported by regular training and auditing. Over the previous 12 months, staff achieved an average of 94.5% compliance with hand hygiene standards.

Staff worked in line with a range of policies and standard operating procedures (SOPs), which provided assurance of consistent practice. Policies were also in place to support the management of outbreaks and emergencies.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

There were systems and processes in place to ensure medicines were prescribed safely for people attending outpatients. Patients were given clear information about their medicines. Pharmacy supported outpatient dispensing and provided advice on prescribing and administration. All controlled drugs for the outpatients were dispensed by the onsite pharmacy to ensure there was appropriate oversight. Staff could escalate concerns and receive feedback through daily huddles.