Nuffield Health Bristol Hospital - The Chesterfield

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• 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 safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

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.

However, the service was in breach of legal regulations as recruitment records were not always complete and safeguarding training policies were not always aligned.

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 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.

Staff understood what incidents to report and how to report them. Managers encouraged staff to raise concerns when things went wrong. Incidents were discussed with managers and learning and improvement actions reduced the risk of recurrence.

The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others. Staff described a culture of openness, transparency and learning, and understood their responsibilities under the duty of candour.

There were 49 incidents reported in the 12 months before our inspection. Staff were involved in learning from incidents and could give examples of improvements to processes. For example, the service developed a patient information sheet at pre-assessment to reduce cancelled surgery due to changes to patient’s skin.

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 all essential information about the patient was collected to determine if the patient’s needs could safely be met. There was an admission criteria policy for patients who used the service, which helped ensure patients’ needs could be safely met by the organisation.

The service worked effectively with other hospital services, including physiotherapy and the pre‑assessment clinic. During our site visit, we observed 4 consultations. Patients were seen by their chosen consultant unless a referral to another specialist was clinically appropriate.

The service carried out medical tests to assess a patient’s risk before their pre-admission appointment. Most pre-admission appointments could then be carried out over the phone rather than in person. Senior staff told us this was set up to reduce the number of surgery cancellations and increase the number of patients they see. They could identify any problems prior to preadmission clinic, so the patient could receive treatment or take appropriate actions, to ensure the operation would not be delayed.

Patients, post-surgery, had follow up appointments with the relevant consultant to ensure there were no post operation complications. Patients had their wound checked by the outpatient nurses or visited their GP. The service shared relevant information with GPs to ensure the continuity of care.

The service used an electronic computer system to record patient notes. These were either typed up or scanned in. The service conducted audits to monitor whether clinic letters were uploaded within the required timescales. Results from the March 2026 audit showed 38 consultants were below 80% compliant. The service had emailed the medical secretaries to remind them of the importance of uploading clinic letters on time and there was ongoing monitoring of feedback and trends to identify any areas for improvement.

The outpatient’s service was responsible for the pre-assessment clinic. Patients attended this clinic prior to any surgery. Depending on the criteria some patients were able to have a telephone consultation with a nurse, whereas other patients attended face to face. Staff showed us the criteria they had to follow to make sure a patient was suitable for surgery at this location. Preadmission staff were able to refer patients for a review by an anaesthetist if they had any concerns.

The evidence showed some shortfalls. Staff were not all trained to the correct level of safeguarding. However, the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Provider policies covering safeguarding training requirements were not aligned. The safeguarding policy stated all non-clinical staff, who have contact with children no matter how frequently, must be trained to level 2 for safeguarding children and young people. However, the mandatory training policy stated health care assistants and support workers should be trained to level 1. Records showed healthcare assistants and support workers were only trained to level 1. We were told this was an administrative error where staff were not allocated the correct level of training to complete.

Staff were trained to level 2 for safeguarding adults. Records showed all staff had completed this training. Nursing staff were trained to level 2 for safeguarding children and young people. Records showed 67% of staff had completed the training as 2 bank staff members training had recently expired. Healthcare assistants and support workers were trained to level 1 for safeguarding children and young people. Records showed all staff completed the training. We were told this was an administrative error where staff were not allocated the correct level of training to complete.

The service had up-to-date procedures in line with national guidance and staff knew how to access them. Staff understood the safeguarding process and knew how to identify and raise safeguarding concerns. Expert safeguarding advice was available to support staff. Staff could access a level 4 trained person within the provider’s wider organisation.

There was information about the patient’s right to a chaperone clearly displayed in clinic rooms and the waiting room. Consultants had a buzzer in the consultation room they could press should they require a chaperone.

The service carried out checks with the Disclosure and Barring Service (DBS) for both adults and children barred lists.

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.

The service worked well with people to understand and provide care which met their needs in a safe and supportive manner. Risks were documented and managed, and patients said the consultant gave them information about their care which meant they felt fully informed.

Patients told us they were actively involved in decisions about their treatment and felt well informed about both the care they were due to receive, and the care already provided. Our observations of outpatient appointments reflected this.

Consultants allowed patients time to ask questions, conducted consultations at an appropriate pace, and clearly explained treatment options to support informed decision making. They also gathered the necessary information to assess potential risks and provided clear explanations about any associated concerns.

The service had a deteriorating patient policy which clearly set out roles and responsibilities for the health care team. It was clear in an emergency the patient should be transferred to the local NHS trust.

The resuscitation trolley had daily checks undertaken. Paediatric and adult resuscitation policies were available as well as resuscitation council guidance. Staff received training in life support and training data indicated 100% of staff were trained in basic life support.

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.

Outpatients had undertaken a structured assessment of environmental risks. We reviewed documentation showing that identified risks were clearly recorded, along with the actions taken to mitigate them.

The service had sufficient and suitable equipment to support safe patient care. Staff were trained in its use, and equipment was maintained appropriately, and consumables were in date. Electrical equipment had been safety tested, and servicing schedules were clearly displayed. We carried out random checks of consumable items in the consulting rooms and saw that they were all within their expiry dates.

The environment was clean, well maintained, and appropriate for its intended purpose. Curtains were replaced every six months, or sooner if soiled. There was swipe card entry to the department. Chemicals or substances hazardous to health were stored securely. Fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction.

Clinical waste was managed safely and in line with required standards. Domestic and clinical waste bins were clearly labelled, appropriately segregated, and emptied regularly, while sharps and other hazardous waste containers were stored correctly. During our observation of a minor procedure in outpatients, we saw that all post procedure clinical waste was disposed of appropriately, with sharps bins readily available and used correctly.

The evidence showed some shortfalls. The service did not have complete recruitment checks. However, the service made sure there were enough staff who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The hospital did not have complete recruitment records for all staff. The provider is required under the Health and Social Care Act to complete and retain specific recruitment information to ensure staff are fit and proper to perform their roles. During our assessment, 3 out of the 8 files we reviewed had missing information. This included 1 file that was missing references, and 2 files were missing full reasonable adjustment checks.

We also checked practicing privileges which grant authority for a medical professional to practice at a specific location. We found 3 of 6 records had information missing. This included 1 file that was missing safeguarding training information, a different file was missing up to date appraisal information, and another file was missing reference checks.

Staff had received and were up to date with appropriate mandatory training. Mandatory training completion rates were 97%. Training was monitored and staff were prompted by emails and at team meetings. Staff had a full induction when they started work. This included orientation of the service, responsibilities within the service, and competencies to use specific equipment. Staff we spoke with said they had an induction to the service.

The service used a mixture of permanent staff supported by bank staff. Managers used planning tools to plan staffing levels depending on activity. The service had processes to monitor and manage staff absences. In the 12 months prior to our assessment, the service had an absence rate of 2%. Managers knew the reasons for absences and used the providers policies to manage and support staff absence. The turnover rate for the service was 17% in the 12 months prior to our assessment and this was mainly due to turnover of staff nurses.

Staff and consultants worked well together to provide safe care that met patient’s individual needs. There was adequate medical cover provided by a resident medical officer. Outpatient staff told us the medical team were approachable and readily available to answer any queries.

There were processes to deal with poor performance. Managers knew their responsibilities in managing performance and had support from the provider when required. Staff received regular appraisals. At the time of inspection all staff had received an appraisal. Staff said they felt supported by their managers.

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.

Staff protected patients from the risk of infection by maintaining the environment and equipment to ensure they remained visibly clean and tidy. The overall clinic environment, including the toilets, was visibly clean. We observed effective infection prevention and control practices, alongside safe management of hazardous waste and sharps. Cleanliness was maintained by both the dedicated housekeeping team and clinical staff.

A five-star rating system was used to assess overall cleanliness, with five being the highest rating. Over the past 5 months, the service consistently achieved five stars. Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date.

The service monitored and reviewed standards of infection prevention and control. There was a programme of audits, including hand hygiene and environmental audits. Records showed the service was performing well achieving a score of at least 95% in the 12 months before our assessment.

There were processes to enable staff to respond to infection prevention and control risks such as transmittable infections. Staff followed the uniform policy. Nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows to allow for full hand decontamination.

In 2 of the appointments we observed, the consultant did not wash their hands after patient contact. This was raised immediately with the managers and senior leaders at the time of the inspection, who took prompt action. The managers provided immediate feedback to staff. Senior leaders told us the issue would be escalated through the Medical Advisory Committee and reinforced through consultant communications and newsletters. They also informed us of plans to refresh infection prevention and control messaging and confirmed that ongoing monitoring of consultant compliance would continue through audits.

The provider participated in Patient-Led Assessment of the Care Environment, which is a review of the care environment from patients and staff. In 2025 the hospital scored higher than the national and provider average for cleanliness.

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 had access to the Summary Care Record to support them when undertaking medicines reconciliation (a process to confirm the accurate list of a person’s current medicines). National and local guidance was available to staff to inform decisions about medicines. For example, staff were able to access local antimicrobial guidance to inform treatment decisions. Antimicrobial audits monitored prescribing compliance with these guidelines.

There were processes to ensure staff could access medicines, including out of hours. Medicines in the emergency trolley were available and staff knew where to locate these. We reviewed emergency trolleys in outpatients. There were systems for daily checks and records were fully completed. All items were present and in date.

Pre-assessment clinics reviewed patients' current medications, which supported clinical decision-making and helped ensure safe and appropriate surgical care.

There was a system of medicines audits, and we saw examples of changes being made to practice because of these. The Pharmacy Manager was working on an improvement programme in relation to controlled drugs following previous audit findings. The most recent audit results showed that improvements had been made. Results of medicines audits were discussed at the Hospital Medicines Management & Medical Gas Committee, resulting action plans were monitored via this committee. This committee also monitored the hospitals compliance with medicines safety alerts and took action to ensure compliance with these alerts.