Sulis Bath Hospital Limited Also known as Circle Bath

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. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

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

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. Leaders listened to concerns about safety and investigated these. Staff knew how and when to report safety events. Lessons were learned when incidents occurred, and leaders monitored how effective their responses were to ensure good practice.

The service used systems which encouraged early identification of concerns before an incident could occur. Staff reported a positive learning culture where incidents were discussed and shared learning took place. Investigation reports showed that leaders ensured staff wellbeing was checked immediately following a serious incident. Leaders met daily and used a structured, joined up approach to identify and action opportunities for shared learning and discussion.

We reviewed 26 patient complaints the service had received between October and December 2024. The service had engaged with patients in each case, in line with their own complaints process. This meant that appropriate action was undertaken, and learning identified for each of these incidents. Records showed that there was a healthy culture for fostering learning from errors and improving systems.

The service worked well with people and healthcare partners to establish and maintain safe systems of care. Staff managed and monitored people’s safety. Staff made sure there was continuity of care, including when people moved between different services.

There were 65 incidences of same day cancellation between October and December 2024 in the data we reviewed. The service had processes to ensure that patients were rebooked following cancellation of surgery. All patients were successfully rebooked unless they no longer required treatment or chose to receive treatment elsewhere.

Emergency equipment had been checked regularly with daily and weekly checks, according to best practice guidelines. However, staff were not always knowledgeable about where to find some emergency medications and equipment. In Theatres, some staff were unable to tell us where Intralipid, a medication used to treat local anaesthetic toxicity, was stored. Dantrolene sodium, a medication used for treating a rare emergency condition was stored separate to other equipment that might be urgently required. This could potentially delay effective and timely treatment. When this was raised with leaders, they promptly resolved this concern by delivering focused training sessions and created a malignant hyperthermia trolley.

The service ensured that there were safe transfer systems in place for when patients deteriorated and needed further care. There had been 6 transfers between January 2024 to 2025, which the service had reviewed and ensured that appropriate and timely escalation had taken place. Staff had access to resources like checklists and guidelines, which supported them to undertake the correct actions during an emergency. This supported staff to escalate concerns to the right people and services when under pressure.

The service worked with people and partners to understand what being safe meant to them and the best way to achieve that. Staff delivered safe care and treatment while protecting patients’ rights to live in safety. The service shared concerns quickly and appropriately.

Leaders encouraged staff to raise safeguarding concerns when there were doubts about a patients’ safety. There were effective systems for monitoring completion of safeguarding training which showed that staff received training specific to their role. There were high training completion rates for most modules of safeguarding training. However, there had been 1 staff member trained to an advanced level as safeguarding lead, despite the service identifying that 2 were required. The service had plans in place to train other leads to compensate for when these staff were not available. Staff knew who their safeguarding lead was and how to escalate concerns. If a safeguarding lead was not available, the service had arranged an advice line for staff to be supported by the local hospital trust.

The service had submitted no safeguarding referrals to their Local Authority in 2024 as no patients had met the formal criteria. The service communicated with relevant external stakeholders to discuss arrangements for patients with additional care needs. This ensured vulnerable patients could have their needs met following discharge.

In addition to this, there were 30 staff across the organisation who had undertaken training to become Dementia Champions. This demonstrated a commitment to promoting greater awareness and understanding of patients who lived with this condition.

The service worked with people to understand and manage risks. Staff provided care that met people's needs that was supportive and enabled people to do the things that mattered to them.

The service used nationally recognised tools for monitoring vital signs and sepsis screening. Leaders ensured staff received focused training to enable early recognition and identification of sepsis. This meant when patient observations triggered escalation processes, staff were able to deliver appropriate care in line with national best practice guidelines. Staff were able to identify when a patient had suspected sepsis and provide timely care and treatment. The service had not reported any incidents in relation to delayed recognition.

Patients were provided with detailed information about their care which was presented in an easy-to-understand format. They had positive experiences of being able to ask questions about their care and said staff had listened to their concerns, involving them in decisions about their care. Teams collaborated well with other departments to ensure that patients were familiarised with staff who would care for them later in the journey. Staff used systems to flag risks and alerts effectively, supporting effective multi-disciplinary working and person-centred care.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

Records indicated facilities, equipment and medical devices were appropriately managed in line with national standards, such as Health Technical Memoranda. The service held a central register of all assets that indicated when and how often medical devices were serviced. Individual medical devices were labelled with this information which meant staff could be assured they were safe to use.

When the service needed to replace equipment, consultants and staff were asked to give feedback as part of the trial process. This meant consultants and staff had opportunities to identify whether replacement equipment was suitable for their needs.

Staff used checklists to ensure equipment and working areas were safe to use. These were specific to their responsibilities and areas they worked in. Cleaning and equipment checklists reviewed in Theatres, showed that facilities and equipment had been cleaned according to scheduled times. Staff were observed checking an emergency equipment trolley. They identified expired equipment and took appropriate action to replace and escalate this. Patients felt that the facilities were well maintained and clean. However, dust had been observed in some low-level areas in Theatres such as in trollies and in drawers.

The endoscopy unit had achieved Joint Advisory Group accreditation in 2022, demonstrating the quality of the service reached a high standard. This meant they had met established standards set for clinical quality, patient experience and workforce training. The service demonstrated continued adherence by maintaining evidence logs to support compulsory annual review.

Flooring in different areas of the hospital was damaged. This had been recorded on local and hospital wide risk registers with plans for this to be fixed.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

Mandatory training completion rates mostly met the service’s benchmarked standards, with permanent staff achieving an average of 97% compliance and bank staff 83%. However, certain staff groups, like consultants with practising privileges and temporary clinical staff had significantly lower training completion rates averaging 62% and 80%. The service was monitoring this and had been using temporary staff less frequently due to increasing their numbers of permanent staff. Consultant doctors working on practicing privileges were reliant on their primary employer to share their most recent professional revalidation, medical appraisal and mandatory training records. This meant training completion figured were not always accurate and contributed to lower compliance rates. Leaders were managing this risk by actively engaging with primary employers to gain assurances.

Leaders provided planned and ad-hoc targeted training when shortfalls in learning were identified. This included table top exercises and simulation training.

The theatres staffing board indicated staffing levels were in line with, or exceeding Association for Perioperative Practice (AFPP) guidance. On the ward, the expected staffing ratio was 1 nurse to 7 patients. Staff and leaders told us it was rare for this threshold to be met and there were usually more nurses available to provide care. This meant staffing exceeded the expected staffing ratio. This was demonstrated in staffing data shared for the week commencing 13th January 2025, which showed there were enough staff to meet the needs of patients on the inpatient ward. Every morning, leaders used a monitoring tool to inform their discussions on safe staffing levels in each department. Patients felt there were enough staff to provide safe and responsive care.

Appraisals for consultants on practising privileges were structured and covered appropriate topics in line with the services’ policies. These followed the service’s processes and demonstrated constructive discussions had taken place to provide staff with training that met individual and service needs. Most staff positively reported being able to access training opportunities that supported career progression.

The service delivered induction packages tailored to staff role and responsibility. When temporary staff were required, these were usually staff who were already familiar to the service. Temporary staff received a basic induction package consisting of orientation, identification of key emergency equipment and processes.

Recruitment practices were safe, robust and impartial. The service used criminal records checks to screen all newly recruited staff. However, the service did not continue to perform regular criminal records checks following employment. This could pose a risk to patients accessing the service if staff withheld information about criminal conviction. Leaders were assured that this process was safe as staff were contractually obliged to declare fitness to practice annually. This meant that any potential risk could be identified by managers annually to prompt a re-check.

The service assessed and managed the risk of infection. Sharps bins were managed in line with waste management policies, with posters supporting safe use in nearby areas. Curtains between bedspaces were visibly clean and had been changed every 6 months in line with national standards. Staff had access to guidance including management of waste related to transmission of prion diseases and safe handling of specimens. Prion diseases are a group of rare, progressive and fatal diseases that could remain on some surgical equipment after standard decontamination methods. The service’s policy reflected national guidelines for risk management, such as Health Technical Memoranda (HTMs). However, some of these had not been fully reviewed in several years.

Staff detected and controlled the risk of infections, sharing concerns with appropriate agencies promptly. The service audited compliance with surgical site infection (SSI) best practice standards in areas like hand hygiene. This information was reported to leaders during governance meetings, highlighting areas of good practice and areas which required improvement.

The service reported a decrease in number of SSIs between 2023 and 2024, from 71 to 34 each year. Even so, there was an elevated number of patients who reported SSIs following joint replacement surgery. This was significantly higher than national data and this risk remained on the hospital’s risk register. However, leaders felt this was due to good quality preoperative education and patient awareness, which led to a higher incidence of patient feedback and vigilance.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened and stored medicines safely. Medicines were not always administered safely.

The service reported 15 prescribing errors in October 2024. In 9 of these, medicines were administered to patients despite incomplete prescription records, but no patients were harmed. Leaders were taking a multidisciplinary approach to reduce these incidents. However, medicines optimisation was not included in staff mandatory training, induction or competency assessment when joining the organisation. The service did not follow their own medicines management policy stating, ‘All staff will be provided with training’. This meant leaders could not be assured that staff were trained or competent to safely manage medicines.

However, we looked at seven medicines administration records and found that all had allergies and weight documented so that medicines could be prescribed safely. Patients received their medicines including pain relief safely and in a timely manner.

There were robust processes in place to ensure patients received their medicines on discharge both during pharmacy opening hours and out of hours.