Nuffield Health Bristol Hospital - The Chesterfield

On this page

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

At our last assessment for this key question there was not sufficient evidence to rate. At this assessment the rating is good. This meant people’s outcomes were consistently good and people’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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Daily huddles were held to review patient lists and share relevant information with staff. This supported forward planning and ensured staff were aware of any specific patient needs, including when children and young people were due to attend the service.

We reviewed 3 care records for young people who had attended for surgical procedures. All records were fully completed and demonstrated assessment and care planning in line with provider guidance.

Pre-admission assessments for young people (aged 16 and 17 years) who were referred for surgery were undertaken by the bank registered children’s nurse (RCN) or an RCN from another location. This was in line with established clinical pathways.

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.

Care and treatment were planned and delivered in accordance with relevant legislation and evidence‑based guidance. Young people who underwent surgical procedures were managed in line with the adult surgical pathway.

Staff adhered to current policies and procedures, supported by monthly safety bulletins which provided updates on clinical practice and corporate matters. Updates to clinical guidelines were routinely reviewed and discussed through established governance arrangements.

The service maintained a programme of audit activity, including hand hygiene, cleaning and the national early warning score (NEWS2). (NEWS2 is the standard clinical tool used in the UK to identify, score, and respond to acute physical deterioration in patients.) This provided ongoing assurance that practice was monitored and aligned with required standards.

Staff received regular appraisals. Records showed the percentage of staff who had an appraisal in the 12 months prior to our visit was 100% with the exception of those staff who were on maternity or sick leave.

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.

Doctors, nurses and allied health professionals worked collaboratively to meet the needs of children and young people.

Daily huddles, attended by senior staff, were used to identify when children and young people were due to attend the service and to highlight any specific needs or considerations to support their care.

Where required, consultants provided written communication to other services, including GPs, detailing diagnoses, treatment plans and prescribed medicines to support continuity of care.

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 supported children, young people and their families to manage their health and wellbeing. Staff provided advice during pre-operative assessment appointments and guidance relevant to their health condition.

The service promoted healthier lifestyles and, where possible, helped reduce future care needs.

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

Staff used recognised tools to identify and respond to clinical deterioration, supporting patient safety and outcomes. Young people undergoing surgery were managed on the adult surgical pathway, with observations recorded using the national early warning score NEWS2. (NEWS2 is a nationally recognised tool to identify deteriorating patients and escalate them as required.)

Managers completed regular audits to review outcomes and drive improvements in care, for example, hand hygiene, cleaning and the national early warning score (NEWS2). Audit findings and outcome data, including activity for children and young people, was shared with staff, for example in staff meetings and monitored to ensure sustained improvement.

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

Staff told us they assessed if the young person was able to consent and understood the procedure.

All staff at the service received mandatory training in consent and data provided showed the service was 98% compliant.

Consent forms were signed by 16 and 17 year old’s undergoing surgery at pre-operative assessment appointments, and then again at point of surgery. Parents or guardians were asked to counter-sign.

We reviewed 3 patient care records which showed consent was documented, all notes were electronically scanned, and follow up was arranged.