Chippenham Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this registered service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

The service maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff ensured patients received effective care and treatment through assessment and regular review of their health, wellbeing, and communication needs.

We looked at 13 care records and personalised treatment plans. These were clearly documented following admission and kept up to date to reflect identified needs.

We observed ward rounds where staff reviewed results collaboratively, discussed treatment options, and involved patients in decisions about their care.

Staff used risk assessment tools effectively, with clinical risk assessments. These were completed on the day of admission and reviewed as necessary, during the length of stay on the wards. Daily nursing handovers included discussion of risks, and care plans were adjusted as needs changed and onward referrals completed where required. Managers were able to implement enhanced observations where required to maintain patient safety.

Patient records demonstrated nutritional needs were accurately assessed and monitored using detailed food and fluid charts.

The service planned and delivered people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff planned and delivered care and treatment in line with current legislation, evidence-based practice, and national standards ensuring safe, effective, and person-centred care.

Staff used nationally recognised assessment and screening, including NEWS2 scoring to identify and respond to patient deterioration, the Malnutrition Universal Screening Tool (MUST), falls risk assessments, and pain assessment tools to support safe clinical decision‑making.

Staff protected the rights of patients subject to the Mental Health Act and Mental Capacity Act and followed the relevant Codes of Practice.

Therapy staff used standardised cognitive assessments to support patient evaluation and care planning. At handover meetings, staff routinely discussed the psychological and emotional needs of patients, their relatives and carers.

Care records and observations consistently demonstrated clear documentation of assessment, evaluation and care planning.

There was a clear escalation policy for deteriorating patients, and managers could deploy enhanced care in line with risk management policies. Environmental risk assessments were completed. Staff upheld the rights of patients subject to the Mental Health Act and made appropriate referrals to Mental Health services when required.

Key clinical guidance, documentation, and risk assessment templates were displayed across wards to support consistent practice and act as visual prompts.

The service worked effectively across teams and services to support people, making sure they only needed to tell their story once by sharing their assessment of needs when they moved between different services.

Staff worked well across teams and services to support patients and shared information effectively when patients moved between services.

We observed good communication and coordination between staff of all roles and grades. Patient information was shared promptly, supporting continuity of care. Staff spoke positively about their teamwork and collaborative work.

Managers held daily multidisciplinary meetings, promoting shared learning and collaborative decision-making. Inspectors attended these as part of this assessment.

Attendance at handovers, nurse safety huddles and ward rounds varied appropriately by speciality, ensuring relevant staff were present. Multidisciplinary input included medical staff, therapists, advanced clinical practitioners and healthcare assistants.

We observed open and positive communication during ward rounds, safety huddles, and handovers. This supported timely escalation of issues, effective risk management, and coordination of care. Staff were encouraged to problem solve collaboratively.

Staff worked well with other teams, including bed management and speciality therapy services, physiotherapy and occupational therapy to coordinate admissions and transfers. Examples included positive collaborations between speech and language therapists and effective joint working with ambulance crews during emergencies.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients effectively to manage their health and wellbeing, promoting healthy lifestyles and provided practical advice to encourage recovery and independence.

Staff completed patients’ fluid and nutrition charts fully and accurately where required.

Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition.

The service provided access to specialist support, including dietitians and speech and language therapists, for patients who needed it.

Physiotherapy staff focused on preventing deconditioning by promoting mobility, exercise and independence throughout patients’ hospital stays, supporting recovery and improved outcomes.

We observed a range of patient information materials, including leaflets, posters, and display boards. These promoted healthy living, discharge planning, and signposted patients to local and national support services and charities.

Ward activities helped promote a healthy lifestyle for patients – for example, a member of the physiotherapy team told us the garden space was used as part of their programmes to support and improve patients’ mobility.

The service routinely monitored people’s care and treatment to continuously improve it and to ensure that outcomes were positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

The service routinely monitored patient care and treatment to ensure outcomes were positive, consistent and aligned with clinical standards and patient expectations.

Outcomes for patients were positive, consistent and met expectations. For example, patients told us how staff were supporting them to get home again. A relative told us how their loved one could not get up on their own when they first arrived on the ward, but now they were walking with the walking frame and help from the physiotherapists.

Staff used audit results, incident data and patient feedback to identify areas for development and drive continuous improvement.

The service participated in relevant national clinical audits, including the National Audit of Inpatient Falls (NAIF), alongside internal clinical audits tracking safeguarding, medicines management, and hand hygiene. Managers used information from the audits to improve care and treatment.

Managers carried out regular clinical and environmental audits, with clear oversight of actions, named leads and progress monitoring. The quality and safety of the service were monitored through governance structures, including quality and governance meetings, provider quality boards and staff meetings.

Data from the service showed there was a higher-than-expected readmission rate back to the local acute hospital following inpatient stays on these wards. The registered manager told us the service’s Advanced Nurse Practitioner (ANP), and a local General Practitioner (GP) had examined the re-admissions for the local area along with the local ICB, as they were seeing the same re-admissions. They looked at case reviews and checked the action taken at the time was the correct course of action. Partnership work took place with the local ambulance service and out of hours to improve patient outcome. Lessons learned, included reviewing the advance planning on the wards.

The service told people about their rights around consent and respected these when we delivered person-centred care and treatment.

People were supported to understand their rights with giving consent to care and treatment, including the right to advocacy. They understood they had the right to change their mind and withdraw their consent and staff respected this. Consent was clearly documented in people’s records.

Staff supported patients to make informed decisions and followed national guidance to gain consent. They demonstrated a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), acting in patients’ best interests where capacity was lacking, and taking into account the person’s wishes, feelings, culture, and history.

Consent was documented in care records. MCA assessments, DoLS applications, and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were completed accurately and reviewed in line with national guidance.

We observed positive shared decision making with patients providing verbal consent before examinations, treatments, or personal care. Staff communicated respectfully, including giving people more time to understand the discussion and writing down the information.

Training compliance for MCA was high for nursing and medical staff.