Nuffield Health Hereford Hospital

On this page

• 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 looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration.

At our last assessment we rated this key question good. At this assessment the rating has remained good. Patients 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.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared with staff.

The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. 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. Managers ensured actions from patient safety alerts were addressed and progress was monitored.

The service had a current incident reporting and reviewing policy, which reflected the provider and national guidance.

We saw evidence of incidents having been investigated, and sufficient action taken to reduce the risk of recurrence. We looked at the system for managing incidents which was electronic. The service had clear policies for incident management. They explained how to report, categorise, and investigate incidents. Incidents were discussed within governance and team meetings.

We reviewed theatre and ward team meeting minutes, which showed incidents had been recorded and discussed. The minutes documented how lessons learnt had resulted in improvements being made.

All staff received feedback from incidents, or complaints, via daily communication meetings, safety huddles and videos. Information was shared in weekly clinical bulletins and monthly newsletters. Incidents were analysed to identify trends or themes and potential links to individual practitioners.

There had been no reported never events in the preceding year. Never Events are serious, preventable safety incidents which should not occur if the available preventative measures are followed. They include things like wrong site surgery or foreign objects left in a person’s body after an operation

Staff were able to identify and report risks, secure in the knowledge these would be addressed. For example, a registered nurse told us of an incident they had reported, and this was communicated through email and discussed in meetings. Where there was an immediate risk of harm to patients or others, staff felt confident to intervene to prevent harms occurring.

Staff understood duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. Staff received feedback from investigation of incidents, both internal and external to the service.

There was evidence that changes had been made because of feedback. Managers debriefed and supported staff after any serious incident. For example, there was a data base built, that came from looking into serious events.

The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when responsibility for patient care moved between different areas of a service and between providers.

Safety and continuity of care was a priority throughout people’s care pathway. Patients were assessed prior to surgery and findings considered when planning care and treatment. This may include cancelling or delaying the surgery in cases where an underlying condition was identified.

There was an admission criterion for both private and NHS patients. These criteria set out where they had limitations in services and therefore were minimised risks by excluding some patients. For example, people with high risk of needing additional support such as, patients with multiple medical concerns and a high body mass index would not be able to have surgery as they are regarded as high risk. Patients requiring tests and investigations were given enough information to enable them to understand the procedure.

There were systems and processes to ensure the correct patients were treated throughout the patient journey. We walked the patient journey and tracked patient care from admission the wards to the operating theatre. We observed handover of patient information including all related identification checking processes.

Patient records were a mixture of electronic, and paper based and were kept securely. The information technology (IT) connectivity was consistently available across the service to meet the needs of staff completing the records.

Consideration was given to whether a patient was likely to require high dependency support and when necessary, this was planned in advance.

When overall responsibility for the care and treatment of a patient moved to a different service provider, such as transfer to the NHS, there was effective communication, which allowed for seamless transfer. A service level agreement was in place for the transfer of patients that deteriorated, to the local NHS Trust.

Care and support was planned and organised with people, together with partners and communities in ways which ensured continuity.

The service worked with patients and healthcare partners where required, to understand how best to keep people safe, what it meant for individuals and the best way to achieve that. Staff concentrated on protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff received adult and children's safeguarding training.

Data showed compliance for theatre staff was 100% for adults safeguarding level 3 and 100% for adult safeguarding level 2. For children’s safeguarding, compliance was 94% for level 2. One member of staff was out of date and due to complete once back from annual leave.

Safeguarding compliance for ward staff was 91% for adult safeguarding level 3 and 100% for adult safeguarding level 2. For children’s safeguarding level 2, compliance was 95%. The deficit in compliance for level 2 was due to 2 bank members of staff, that were booked on courses in April 2026.

Although the service did not treat children, staff still completed safeguarding training children level 2.

Staff knew how to make a referral or who to contact for support. In the 12 months prior to inspection there had been two safeguarding referrals for surgical patients. We were given evidence of recent patient concerns that showed that they followed the correct procedures according to the providers policy.

There were current safeguarding policies, and these reflected the national guidance for adults and children, including visitors.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Expert safeguarding advice was available to support staff from Monday to Friday. Staff knew how to contact them. There was a named nurse and named doctor for adult/child safeguarding.

Staff knew how to identify adults suffering, significant harm and worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

The registered manager had oversight of safeguarding within the service. Where relevant, staff checked that people claiming Lasting Power of Attorney had the appropriate documents to support this. Discharge and follow up arrangements were organised safely. Patients knew what to expect and when they would be next seen by a nurse or doctor.

Staff followed safe procedures for visitors visiting the wards and patients we spoke to told us they felt safe.

The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patient’s needs which was safe, supportive and enabled patient to do the things that mattered to them.

Staff understood how to manage people’s risks during an emergency. All used the National Early Warning Score (NEWS) following surgery. We observed staff carrying out routine observations during and following treatment.

The hospital had an advanced life support-trained resident doctor (RD) onsite 24 hours a day. They were well supported within the hospital by the senior management team.

The service had several members of staff trained in advanced life support (ALS). These were the resident doctor (RD) and consultant anaesthetists. All nursing staff were trained in immediate life support (ILS). There were 2 members of theatre staff whose training had expired; however, they were booked onto future courses.

Each morning the resuscitation team was discussed, which included who would be the lead. We saw from previous documentation that on each shift there was an ALS provider, ILS and then basic life support for staff supporting.

The service worked with patients to understand and manage risks. Treatment and care met patients' needs in a way which was safe and supportive and enabled them to do the things that mattered to them. Staff knew how to identify adults and children at risk of or suffering significant harm. This included working in partnership with other agencies. Staff followed safe procedures for children as visitors, due to children not being treated at this hospital as patients.

The World Health Organisation (WHO) surgical safety check list was used in the operating theatre to avoid harm and maintain patient and staff safety. We observed completion of the process during our inspection. Staff confirmed the surgical safety standards such as a stop the line policy was understood by staff in the event of any concerns raised.

Stop the line is a process where any staff member can raise their hand and raise a potential safety issue during the checking process in theatres.

The transfer of patients from the operating theatre to the recovery was managed safely, with the anaesthetist retaining responsibility for determining the readiness for transfer. Suitably skilled and qualified staff accompanied patients in all areas.

We spoke to several patients during our assessment who told us they felt listened to, risks had been explained, and they were involved in decisions about their care and treatment. For example, we observed several care records that showed that risk assessments had been completed.

There was suitable equipment provided and used correctly, such as for patients who were at increased risk of pressure damage or a blood clot developing. Staff carried out daily safety checks of specialist equipment. There was ready access to resuscitation equipment on the ward and in theatres.

The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care. Where they were unable to do so, they mitigated the risks.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use equipment and to manage different types of waste safely.

The design of the environment followed national guidance around the built environment. Where required, areas were secure and protected patients. Access was restricted by a key pad system to all clinical areas.

The environment of the wards and other areas used for patient care reduced the risk of patient harm, and included, for example, safe flooring, handrails and window restrictions.

There were emergency call bells sited close to each bed and in recovery and theatre to ensure staff could call for additional and expert help. People who used mobility aids such as walking frames or crutches had them close by and were assisted to use them until they regained their usual level of mobility.

Fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. There were effective means of ensuring repair or replacement of broken or missing equipment.

Specialist equipment used in the operating theatres was used in accordance with national guidance and regulatory requirements.

Patients could reach call bells. Call bells were positioned by patient beds, and staff showed patients how to use them to summon help. We saw call bells were responded to swiftly and the noise level from unanswered call bells was minimal. Patients reported that lighting was reduced at night, and the noise levels were minimised.

The service had suitable facilities to meet the needs of patients’ families when necessary.

Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled in accordance with the trust policy. The risk of sharps injuries was minimised because of the safe management of sharp implements.

Hazardous substances were stored safely and information about products was available to staff.

The service made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patient’s individual needs.

The service had enough clinical staff including nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff were made aware of their shifts in advance and could make requests.

New staff had a full induction tailored to their role before they started work. Managers supported staff to develop through constructive recorded, annual appraisals and constructive clinical supervision of their work. Temporary bank and agency workers had a local induction to the area in which they were working.

The service provided mandatory training in key skills to all staff. Managers monitored mandatory training and alerted staff when they needed to complete updates.

Nursing staff received and kept up to date with their mandatory training. The data showed a completion rate of 97% for theatres and 94% for the ward staff.

Clinical staff completed training on recognising and responding to patients with for example, patients with mental health needs, learning disabilities and dementia.

Managers reviewed the number and grade of clinical staff, healthcare assistants and other key roles, needed for each shift in accordance with national guidance. Managers could adjust staffing levels daily according to the needs of patients. Theatre and recovery staffing was planned, based on activity and the skills needed for everyday and emergency work, including out of hours cover.

We saw duty rotas for the last 3 months, which showed that managers had calculated the number and grade of nurses and healthcare assistants that were required. The number of nurses and healthcare assistants matched this number on all shifts.

The service had low vacancy rates. There were no vacancies at the time of the assessment.

There were low turnover rates. The service had low sickness rates. Sickness rate for theatres was 3.3% and 4.9% for the ward. This was below the average for the provider at over 5%.

Nurses were supported by other clinical staff that included surgeons who carried out the operations and the resident doctor (RD) The RD was employed by an agency who supplied medical cover services to the provider. The RD was on site for one week and then was off for a week. During the week on site the RD was on site 24 hours a day and available overnight if required. They had day to day duties such as daily ward rounds of the inpatients, writing prescriptions for pain relief and discharges, reviewing of results in preoperative clinic and the reviewing of patients of concern. The RD was available overnight if needed. If necessary, consultant surgeons could attend within 30 minutes.

Staff received role-specific training and had completed appraisals, to care for patients and attended team meetings for updates. There were opportunities to participate in additional training if requested.

All new starters received an induction. There was a provider training matrix for mandatory requirements. This included a combination of face to face and electronic training modules that were role specific such as infection, prevention and control, adult resuscitation, medicines management, moving and handling, the Oliver MacGowan training on learning disability and autism, care and communication of the deteriorating patient, care and communication of the deteriorating patient, information governance, conflict resolution, dementia awareness and safeguarding.

We spoke with the resident doctor who corroborated all the training that he had received.

Managers limited their use of bank and agency staff and requested staff familiar with the service. Where bank staff was needed, we saw records of their training.

Staff spoken to said they felt the service was safe. They were able to take breaks during their shift.

Patients spoken with felt their needs were met in a timely way and we observed staff responded quickly to call bells. We saw patients were attended to in a kind and supportive way. Patients appeared comfortable and were engaged in conversations because there were sufficient staff.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. For example, the provider had a competency and skills framework for staff to follow which included fluid balance training as a topic.

Managers made sure staff attended team meetings or had access to the information shared, when they could not attend. We saw notes from team meetings and other general information was shared on notice boards.

Managers supported staff to develop through constructive recorded, annual appraisals of their work and regular clinical supervision. If poor staff performance was identified, this was dealt with in a supportive way, with a view to improvement.

The service had enough allied health professional staff to keep patients safe and meet their needs. Patient pathways and their discharge was not delayed because of a lack of allied healthcare professional input. There was oversight of medicines optimisation and ward-based support for staff from a pharmacist.

The overnight and weekend provision was adequate, with access to the admitting consultant for advice or to attend, if necessary. The admitting consultant reviewed their patient’s daily, including at weekends.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. Infection and prevention and control data was collected and reviewed. Where required, actions were taken to improve shortcomings. Theatres and ward areas were visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained.

The theatre environment followed national guidance. Separate areas were identified which enabled flow from clean preparation areas through to the operating theatres and an area for dirty equipment and waste management post operatively.

There was storage for equipment including sterile instrumentation packs. There was sufficient space for laying up theatre trolleys under a ventilation canopy, if required. The main theatre had laminar air flow. This means that continuous streams of filtered air push contaminants away from the patient to reduce surgical site infections (SSIs) for high-risk procedures like joint surgery. Annual ventilation inspection and verification had taken place in both theatres.

Surgical instrumentation was managed off site under a service level agreement, which involved the processing of items, delivery of these and collection after use for cleaning and sterilising.

There was a provider infection and prevention and control policy and supporting guidance that was accessible to staff. The providers guidelines reflected national Infection Prevention Control (IPC) guidance from Public Health England (PHE), and the Royal College of Surgeons. Staff had access to expertise in infection control as needed.

There was a programme of infection, prevention and control audits including for example, hand hygiene. The service performed well in local IPC audits. In the most recent audits, the scores showed compliance with infection prevention and control measures in all clinical areas. Data showed that the most recent hand hygiene audit was 99%, aseptic non-touch technique audit was 99% and environmental cleaning audit was at 100%.

Staff we saw during our assessment were ‘arms bare below the elbows’ and dressed in line with the service’s uniform policy

Staff worked effectively to prevent, identify, and treat surgical site infections (SSI’s). Staff looked at infection data. There were procedures in place to reduce the risk and monitor for signs of SSIs in line with NICE CG 74 Surgical site infections: prevention and treatment. Patients who met the criteria were screened in pre-assessment for Methicillin-Resistant Staphylococcus Aureus before admission. The service completed SSI surveillance 30 days post-surgery for all patients who had had a hip or knee replacement. Between April 2025 and February 2026, there had been 9 SSI’s recorded, these were all graded as no or low harm. Data showed there were 0 suspected infections for hip and knee replacements in this same time period.

Hand-washing facilities and personal protective equipment (PPE) were available in all areas including hand sanitisers. There was an information board for patients, visitors and staff that showed hand washing instructions, appropriateness of wearing gloves, sharps disposal and audit information. We observed all sharps boxes were closed, dated and signed, they were disposed of in line with the hospitals policy.

Staff cleaned equipment after patient contact and labelled equipment to show when it was last cleaned.

There were processes to enable staff to respond to infection prevention and control risks such as transmittable infections.

There was appropriate testing of water outlets and air exchange systems in theatres. Hospitals must ensure that water used in their healthcare facilities, is safe to minimise the potential risk of infection to people receiving treatment within the hospital environment.

Staff supported infection prevention and control measures by following the uniform policy. Nail varnish and jewelry was not worn, and staff in clinical areas were bare below their elbows to allow for full hand decontamination.

The service made sure that medicines and treatments were safe and met patient’s needs, capacities and preferences. Staff involved patients in planning, including when changes happened.

The service used systems and processes to safely prescribe, administer, record and store medicines. Staff followed systems and processes to prescribe and administer medicines safely. For example, in theatres, drugs were not drawn up ahead of a list.

Doctors reviewed each patient’s medicines on admission and provided advice to patients and carers about any changes. A pharmacist was involved in patient medicines reviews. The service had clear guidance for staff about the safe use of antibiotics and opiates (Controlled medicines). Controlled medicines are substances regulated by law due to their potential for abuse, addiction, or harm, while still having legitimate medical uses.

There were facilities for patients who wished to manage their own medicines. Patients who were able and wished to manage their own medicines were encouraged to do so. The pharmacy team would discuss this with the patient on admission, using the hospitals medicines management policy.

Medicines including intravenous fluids were stored in line with local and provider policy and reduced the risk of misuse and errors. Keys to the controlled drug cupboard were held by the nurse in charge of the ward. In the operating theatres there were separate theatres for each room. Staff completed medicines records accurately and kept them up to date. There were accurate records of medicines administered in the operating theatre and recovery.

There was effective governance of medicines, for example, the service completed medicines audits. Compliance from March 2025 to August 2025 showed compliance of 99% to 100%. These looked at ensuring safe administration, appropriate medicine checks and that prescription charts were completed and signed for according to the medicines policy.

Staff assessed patients’ pain and used recognised tools to do so. Staff gave pain relief in line with individual needs and best practice and assessed how effective this was. Patients’ pain was addressed before they left the operating theatre. Pain relief medicine was timed for maximum effect before painful procedures or to allow the patient to sleep at night. Alternatives to pain relief medicines were considered and patients advised how to manage pain.

The service completed records audits that covered all the areas of the patient journey, including pain management. Compliance ranged between 90% and 96% in the 12 months prior to inspection.

Staff followed national practice to check patients had the correct medicines when they were admitted, discharged or they moved between services.

Staff learned from safety alerts and incidents to improve practice. There was a review of medicines errors and steps to prevent recurrence.

There was sufficient equipment such as intravenous pumps, subcutaneous and self-administration pumps to allow the correct management of patients’ medicines.

Oxygen was prescribed, when used. Air outlets were capped to prevent it being administered instead of oxygen.