St Anthony's 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

This means we looked for evidence that people were protected from abuse and avoidable harm.
At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant that people were protected and kept safe. The facilities and equipment met the needs of
people, were clean and well-maintained and medicines were stored securely.

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 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.

In the last 12 months, St Anthony’s hospital reported 6 near miss incidents. No never events were reported within the critical care unit. The service did not report adverse events specific to critical care. Rather, they were submitted as a single dataset with surgery to PHIN network. Between October 2024 and October 2025, the service reported 0 serious injuries, 7 unplanned transfer, 7 unplanned readmissions and 0 readmissions in critical care.

There were systems in place to investigate, and report concerns on safety events both internal and external to the service. Staff understood their responsibilities to report incidents and apply the duty of candour. However, some staff told us they did not always receive feedback from investigations or had opportunities to discuss learning. Some staff also raised concerns that incident grading did not always reflect the level of harm, which could affect whether duty of candour processes were triggered. Also, some told us that when concerns were raised, senior managers became defensive and no feedback was always communicated.

Staff knew how to handle complaints appropriately, reporting them through the right channels within the hospital. They also said that incidents reported on DCIQ were sometimes framed in a way to prevent the duty of candour being triggered. This information corroborated the intelligence we received prior to the inspection.

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’s referral and admission processes ensured that all essential information about patients were received to determine if the patients' needs could safely be met. Patients came from surgery within the hospital and the most complex cases were transferred to nearby NHS hospitals. Patients’ cases and care plans for the day were discussed during the daily huddles and handovers to ensure continuity of care.

We observed staff discussing patients due to be transferred to the critical care unit, and their discussions included any specific arrangements required to ensure a smooth transition of patients. During the discussion, relevant medical and allied health professionals, including physiotherapy, were involved in planning patients’ care. This supported continuity of safe care within the service when moved to the ward and when discharged.

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 were trained in safeguarding, knew how to raise safeguarding concerns and did so when appropriate. Records showed 100% compliance with adult and children level 1 safeguarding training. However, the service did not provide evidence of compliance with the level 2 and level 3 safeguarding training by staff group. As a result, we were not assured that staff working in critical care had completed safeguarding training appropriate to their role.

Safeguarding policies for adults and children were comprehensive and up to date. Although the critical care unit did not provide services to children and young people, an up-to-date safeguarding referral flowchart for children and young people was displayed in the unit.

The policies identified different form of abuse, including self-neglect and sexual abuse. The safeguarding policy also included information on action to take when staff identified safeguarding concerns. Staff knew how to make safeguarding referrals through the internal safeguarding process and identify patients at risk of abuse, neglect or significant harm and report them to the safeguarding lead. Staff gave us examples of how to protect patients from harassment, bullying and discrimination, including people with protected characteristics under the Equality Act.

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 supported patients to understand their care and treatment, and they adapted how information was shared to meet individual needs. The service provided a range of resource to support this, including information leaflets in different languages, interpreter services, hearing loops and signage explaining how to request chaperone. We observed staff explaining care and treatment clearly to patients. Although we did not meet any patients with additional communication needs during our assessment, staff described how they would access appropriate support when required.

Staff enabled patients to make advance decisions on their care, including the decision to refuse treatment (a living will) when appropriate. The service had access to outreach support such as nutritionists to help manage patients’ nutrition and diet, including assessing and identifying any nutritional risk to patients, and allergies. The service provided daily access to allied health professionals such as physiotherapy, and we observed a physiotherapist assessing patients ready to be moved to the ward.

We observed the daily ward rounds which was consultant led and we saw a good multidisciplinary interaction during these rounds. Nursing staff were encouraged to be involved in patient’s care discussions and patients were also involved. Every step of their care was fully explained and the medical staff answered questions patients were asking.

The service made provisions such as QR codes, comment boxes, and online links to enable patients to give feedback on the service they received and make suggestions. Patients were encouraged and had access to advocacy service if they wanted to raise concerns about their care and treatment through the ‘Ask to Escalate’ system.

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 design of the environment aligned with relevant national guidance for safe healthcare environments.

It was visibly clean and well maintained. The layout of the critical care unit reduced risks of harm and included safe flooring and window restrictors.

Access to the critical care environment was secure, with swipe cards to access the premises, restrict entry and keep patients protected. We also checked the resuscitation trolley, and it was fully functioning, its record was up to date and content reviewed regularly.

The design, maintenance, facilities, premises and equipment supported the delivery of safe care. Staff were trained to use equipment in the critical care unit and to manage waste safely. However, compliance with management of medical devices training was 60% below the provider target of 90%. This reduces assurance that all staff had completed training relevant to their role.

During the assessment, we found a broken socket in the room of a patient that was recently transferred from critical care to the ward, which we escalated to the senior nurse in critical care. By the end of the assessment, we were told that the maintenance team were on their way to fix the issue.

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 were experienced and had the right skills and knowledge to meet the needs of patients in line with evidence based best practice. Managers ensured staff had regular meetings to discuss the management of care, treatment and to reflect on and learn.

Although staff received appropriate mandatory training, these were not always up to date. We reviewed the mandatory training completion rates, and they showed 60%, 63% and 67% for Management of Medical Devices, ILS and Listen Up respectively, which is below the 90% hospital target and therefore, should monitored.

Managers provided new staff with appropriate induction and supervision meetings to discuss care management and appraisal of their work performance. However, staff we spoke with told us that their performance was not regularly appraised and there were few opportunities for development available.

The data provided by the hospital showed that the percentage of staff that had had an appraisal in the last 12 months was 100% in the critical care unit. However, some staff told us that they have not had an appraisal for the past 2 years. They also told us that there have been few management changes over the last few years, which have put more pressure on the senior nurses and impacted on staff appraisals. At the time of the assessment, the new manager has been in post for the past 3 months and staff said they were hopeful that this would bring more stability.

Managers calculated the number and grades of nurses and healthcare assistants required. The service used a staffing flow chart system to ensure the right level of staff and patient ratio for level 2 and level 3 care.

We reviewed the nurse staffing data provided by the service and it showed that they had 3 active vacancies, 2 permanent and 1 FTC to cover maternity leave. We also reviewed the rota data for the past 3 months and the number of nurses and healthcare assistants matched on all shifts. The staff turnover over the past 12 months was 23.8%, and the sickness rate was 3.9%, which was lower than the group average of 5.1%.

The ward manager could adjust staffing levels and skill matrix daily to take account of case mix and when necessary, managers deployed bank and agency nursing staff to maintain safe staffing levels. Between March 2025 and March 2026, the service used an average of 0.44 FTE agency staff and 0.95 FTE bank staff and 15.68 FTE contracted staff. The nurses in charge told us that there was usually enough staff to cover both day and night shifts and the provider
contracted staff, alongside bank and agency nursing staff where required. They told us that the level of cover, including healthcare assistant requirement, would depend on the number of patients in the unit, those expected to arrive from surgery and the level of care patients required. The service used contracted bank and agency staff where required, to ensure appropriate staffing cover.

Bank and agency nursing staff received an induction. The nurse in charge told us that it was usually the same agency nursing staff that would provide services and therefore they were familiar with the unit, information we corroborated when we reviewed the staffing rota.

The team of consultants worked within the practising privileges framework. The hospital director or registered manager, with the approval of the Medical Advisory Committee (MAC), were responsible to review consultants’ practising privileges at least once every 2 years.

In the critical care unit, there was a 24-hour medical cover, 7 days a week and included an intensivist, a pharmacist, and anaesthetist. Consultants were present in the unit each day and an on-call consultant, who could attend the hospital within 30 minutes in an emergency, was available overnight.

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.

Equipment in the critical care unit was clean and well maintained. We reviewed a range of equipment and found them to be visibly clean with in-date ‘clean’ stickers attached. Any equipment was taken to a designated decontamination area after patient use. Equipment was subject to regular checks and maintenance to ensure they remained safe and fit for purpose. In the past 12 months, there had been 1 device related infection report. However, staff told us it could take time for broken equipment to be replaced. For example, the unit had been without an ECG machine and weighing scales for a prolonged period and both equipment were shared with theatre, which staff said could delay patient assessments.

Privacy curtains were all clean and labelled with up-to-date information. Cleaning staff were visible during our assessment and the cleaning policy summary was on display.

All areas of the critical care unit were clean and well maintained. Furnishings were in good condition, cleaning records were up to date and there was sufficient space to support safe movement of patient and equipment.

The service and staff adhered to infection control principles, including the use of personal protective equipment (PPE). We reviewed the IPC audit, and they achieved over 95% overall, including 100% compliance in hand hygiene, which was better than the 90% target. We observed that staff were adhering to infection control principles national guidelines, including ‘bare below the elbow’ and good hand hygiene.

To prevent cross infection, patients were routinely screened prior to admission to the hospital for infections such as Methicillin-resistant Staphylococcus aureus (MRSA) and there were 2 isolation rooms available to help prevent the spread of infection.

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.

Staff followed systems and processes to prescribe and administer medicines safely. The service had clear guidance for staff about the safe use of antibiotics and controlled drugs (CDs). CDs, including patients’ own-controlled drugs, were all locked away and the keys kept securely. The medicine management audit for patients own CDs showed 94% compliance, which was better than the 90% provider’s target and the fridge was at a temperature which complied with the summary of product characteristics (SmPC) guidance.

Medicines records were completed accurately and kept up to date, with audit compliance of 99%, against the provider’s target of 90%. Consultants and pharmacists reviewed patients’ medicines on admission and advised patients and carers of any changes.

Medicines, including intravenous fluids, were stored in line with local guidance. The provider policy provided clear guidelines to reduce risks of misuse and errors. Keys to the CD cupboard were locked in a safe and managed by the nurse in charge of the critical unit.

Medicines that had been opened or nearing their expiry date, were clearly labelled. Processes were in place to support the safe disposal of unused medicines, with an oversight from the pharmacy team where required.

There was good governance of medicines management. The service undertook several medicines management audits, such as CD register audit, receipt and recording of patients own CD audits, and storage and security of medicines audits. We reviewed the medicines management audit and staff achieved 95% compliance, which is over the 90% provider’s target.

Staff followed national practice to check and ensure that patients had the correct medicines when they were admitted, discharged or moved between services. Staff learned from safety alerts and incidents to improve management and administration of medicines. There was a review of medicines errors and steps were in place to prevent recurrence.

The pharmacy team made provision for access to medicines needed in an emergency or at short notice at night and at the weekend.

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