Nuffield Health Bristol Hospital - The Chesterfield

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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

We looked for evidence that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patients were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment this key question was not rated. At this assessment we rated outpatient services as good. This meant patient’s outcomes were consistently good, and patient’s feedback confirmed this.

However, the service was in breach of legal regulations as staff did not always have the training required for their role.

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 evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Outpatient appointments were personalised and holistic. We observed 3 consultations and a treatment procedure, during which staff took time to understand each person’s lifestyle and worked to provide treatment that complemented their individual needs. We reviewed 5 patient care records and found these were complete and met patients’ needs.

Daily safety huddles were used to review the patients due to attend and to identify any additional needs, ensuring reasonable adjustments were planned. This included arranging additional support for wheelchair users or interpretation services for patients who required them. Staff used a telephone translation service when required for patients whose first language was not English. Staff described how they made further adjustments for patients with mental health needs or a learning disability, including providing access to a quiet room to reduce anxiety and support engagement.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed up to date policies to plan and deliver high quality care in line with best practice and national guidance. Policies were developed and reviewed centrally by the provider and were easily accessible through the hospital’s system. New policies and standard operating procedures were discussed with staff during meetings. Our review of outpatient meeting minutes showed clear records of these discussions when new policies were introduced.

The medical advisory committee met regularly to oversee patient safety, quality of care and regulatory compliance. It reviewed incidents and adverse events, as well as mortality and morbidity data, to identify areas for improvement and strengthen patient safety.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service demonstrated effective collaboration with wider hospital teams. Leaders held daily heads-of-department meetings to exchange information, which was then cascaded to staff. Staff attended monthly meetings where updates, learning and key messages were shared.

Consultants spoke positively about working at the hospital. Clear systems allowed them to easily identify their allocated room and review the number of patients booked for each clinic. Staff were scheduled to support consultants in advance, helping clinics run smoothly.

The teams had effective working relationships with each other and with other specialist teams, and staff we spoke with reported good teamwork.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service provided a range of written information to support patients attending outpatient appointments, including guidance on smoking cessation and healthy diets. The service also provided patients with clear information on how to pre optimise for surgery, helping them understand the steps they could take to improve their health and readiness ahead of their procedure.

The service had developed a bowel information leaflet to provide more information to patients about what to expect following surgery and when to seek advice after an incident where a patient was admitted to hospital 16 days after surgery as they had not opened their bowels.

The service had a range of health promotion information available on the provider’s website. This included mental health, men’s health, women’s health, and cancer awareness. Private health assessments were available to patients who were able to pay.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Patients were seen in a timely manner. The NHS Constitution states that people should wait no longer than 18 weeks for non-urgent referrals and no longer than 2 weeks for suspected cancer. The service carried work out for the NHS which was approximately 40% of its overall work. Staff told us that patients did not experience long waits to be seen in outpatients, and patients confirmed that the service had been proactive in providing them with prompt appointments.

Staff participated in clinical audit, benchmarking, and wider quality improvement activity. As a national provider operating multiple hospitals, the organisation used comparative data across its sites to benchmark performance and identify areas for development. It also gathered feedback from a range of external customer review platforms to support ongoing improvement.

The service had an audit process to monitor service performance. There were audits to cover safety and quality of the imaging service. Managers acted on audits findings to make improvements to the quality of care. For example, the service completed clinic letter audits which reviewed whether clinic letters were being uploaded to the Electronic Patient Record within the required timescales. The most recent audit showed 38 consultants were below 80% compliant which was an improvement on the previous audit.

The evidence showed some shortfalls. Not all staff had the required training to enable them to assess whether patients had capacity to make informed decisions about their care. However, the service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Training records showed healthcare assistants and healthcare support workers had not completed mandatory training in Mental Capacity Act and Deprivation of Liberty, as per the provider policy. After the onsite assessment the provider told us this was due to a technical reporting issue within the learning management system and their review of training identified the required training had been completed. However, further evidence was not provided to CQC to demonstrate training had been completed.

Staff discussed risks and benefits of procedures so patients could give informed consent. Our review of patient records showed that consent had been appropriately documented for all patients. Patients we spoke with also confirmed they had been asked for consent. The service had an up-to-date consent policy. Staff received training in consent. Records showed all staff had completed this training.

The service routinely audited consent documentation, demonstrating strong compliance. In the 2 most recent audits the service achieved scores of 93% and 96% respectively, indicating consistently good practice.