Rivers 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. 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 remains 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 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Leaders promoted a positive learning culture that supported safety and continuous improvement. Staff listened to concerns about safety and reported and investigated incidents appropriately. The service had an up‑to‑date incident reporting and investigation policy in place.

Managers reviewed incidents involving both patients and equipment. They ensured actions were identified, implemented and monitored. Staff understood how to recognise, report and record incidents. They used an electronic incident management system to do so.

Leaders held weekly risk and safety meetings, attended by multidisciplinary teams and senior leaders. Staff reviewed incidents collaboratively to determine whether after‑action reviews were required. They identified learning, agreed action plans and shared learning with the wider team to reduce the risk of recurrence.

The service involved people in learning following incidents. Senior staff contacted patients affected by incidents to understand outcomes, provide reassurance and identify further learning to improve safety.

We scored this quality statement as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had safe systems in place to manage referrals and ensure people received coordinated care. Staff processed information relating to new patients effectively. Before appointments, patients completed a questionnaire about their medical and social history, allergies and current medicines. Administrative staff reviewed the questionnaires and escalated information that required further consideration to clinical staff for assessment before appointments.

The service provided care to both private and NHS patients. Overall, 56% of patients received their first appointment within 14 days of referral. A dedicated team processed NHS referrals and reviewed them against the hospital’s acceptance criteria. When referrals did not meet the criteria, staff returned them to the referrer with a clear explanation.

Staff told us waiting times were longer for NHS patients than for private patients. This reflected wider system factors, including funding limits and agreed care pathways set by the Integrated Care Board. The service monitored waiting times and managed referrals in line with these arrangements to help ensure people received safe and appropriate care.

Staff followed a clear discharge policy, and they sent discharge reports to GPs to support a safe and well‑planned transfer of care. The service had identified the need to strengthen its approach to managing patients who did not attend appointments and was in the process of developing a formal follow-up policy at the time of inspection.

We scored this quality statement 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.

Staff received safeguarding training and understood how to recognise safeguarding risks and raise concerns. Clinical staff were trained to safeguarding adults level 3, while non-clinical staff completed training to level 2. At the time of inspection, compliance with level 3 safeguarding training was 100%, while compliance with level 2 training was 70%. Training was delivered face to face. The provider had recognised the impact this delivery method could have on completion rates and had developed plans to revise training arrangements to improve compliance.

Staff we spoke with knew how to escalate concerns promptly to the safeguarding lead and were able to describe situations where they had raised concerns. Managers responded appropriately and involved other services when needed to keep people safe.

The service had a designated safeguarding lead who coordinated safeguarding arrangements and provided oversight and support to staff. When a local safeguarding lead was not available, staff escalated concerns to national safeguarding leads for advice. The service clearly displayed safeguarding escalation pathways on staff posters, which supported staff to take timely action.

National safeguarding leads reviewed safeguarding cases and provided assurance that staff took appropriate action. Staff told us they could access safeguarding advice and support when needed and rarely experienced any difficulties in doing so.

Staff gave an example of an adult safeguarding concern where a person did not attend an appointment due to domestic circumstances. Staff managed the concern appropriately and contacted the police to help keep the person safe.

We scored this quality statement 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.

People were involved in identifying and managing risks to their safety. Staff worked with people to understand their individual needs and took appropriate action to manage risks in a safe and proportionate way.

Before attending the hospital, people completed an online health and medical history questionnaire to help identify any risks or additional needs. Administrative staff reviewed this information and escalated concerns to clinical staff for further assessment before the appointment. This helped ensure people received care that was safe and responsive to their needs.

People were supported to be involved in decisions about their care and treatment. We spoke with 5 patients who told us they felt listened to and involved in discussions about their care.

We scored this quality statement 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was safe, accessible and well maintained. Patients and visitors accessed the hospital through an accessible entrance with direct links to the car park. The reception area was staffed, clearly laid out and easy to navigate. Wheelchairs were readily available at the entrance for people who required additional support.

The premises were well maintained and risks were managed appropriately. Fire safety equipment was in place, clearly labelled and within service dates. Electrical equipment had been safety tested and was appropriately labelled. Flooring was even and free from trip hazards, supporting people’s safety.

Equipment was visibly clean and well maintained. Staff told us cleaning arrangements were clearly defined between housekeeping and clinical teams, which supported effective infection prevention and control.

We scored this quality statement 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.

The service employed sufficient clinical staff, including nurses and support staff, with the right skills, qualifications and experience to meet people’s needs. The outpatient department reported an overall sickness rate of 6.4% over the past year. Leaders monitored sickness levels to support workforce planning and maintain safe staffing levels.

Leaders used an internal bank workforce to cover staffing gaps. Bank staff completed a full local induction and competency checks before working in the service. Bank usage was 23% for clinical staff and 20.8% for non‑clinical staff, which helped maintain continuity and safety.

The Registered Manager oversaw consultants working under practising privileges through a robust process. This included annual reviews and re‑accreditation every 5 years. The governance team monitored incident trends and met as needed to review performance and address concerns.

Mandatory training compliance for outpatient staff was 82% which was below the providers target compliance rate of 85%. Training was role‑specific and monitored by department leads. Staff completed required modules before undertaking further development. Staff also accessed role‑specific training, including phlebotomy, medicines safety, wound care, respiratory care and the use of specialist equipment. This helped ensure staff were competent to deliver safe care.

We scored this quality statement 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Infection risks were assessed and managed effectively. There were systems in place to identify potential infection risks, prevent the spread of infection and escalate concerns through appropriate governance arrangements.

Infection prevention and cleaning policies were in place and up to date. The service undertook audits of equipment and environmental cleanliness to support infection prevention and control. The most recent audit showed 91% compliance. During the inspection, staff were observed to be bare below the elbows in clinical areas, in line with infection prevention and control requirements.

Clinical areas were clean, organised and well maintained. Cleaning responsibilities were clearly defined between housekeeping and clinical staff, which supported effective infection prevention and control.

Equipment was available, clean and well maintained. Electrical equipment had been safety tested and was appropriately labelled. Emergency equipment and call bell systems were checked regularly, and staff were familiar with the procedures to follow, which helped to keep people safe.

We scored this quality statement 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 happen.

The service had arrangements in place for outpatient prescriptions to be dispensed by the onsite pharmacy, supporting oversight of medicines supply and controlled drugs governance.

Patients were also able to have prescriptions dispensed by other NHS pharmacies where they wished. Pharmacy processes supported monitoring and oversight of private and NHS prescriptions, including site-level checks and corporate review of prescribing activity.

Hospital-wide medicines governance systems, including incident reporting and corporate cascade of Medicines and Healthcare products Regulatory Agency (MHRA) alerts, applied to outpatient activity and supported a consistent approach to medicines safety across services.