Nuffield Health Bristol Hospital - The Chesterfield

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

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 remains good. This meant people were safe and protected from avoidable harm. However, the service was in breach of legal regulation as safeguarding training polices 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 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.

The service had a current incident policy to support systems to report, investigate and learn when things went wrong. Managers told us they encouraged staff to report all incidents as these enabled them to prevent reoccurrence. They said reports of incidents were used to improve safety for everyone.

There were no dedicated staff purely working only with children and young people due to the limited services offered. However, staff in outpatients, surgery, and diagnostics and imaging who looked after children and young people knew how to report incidents and there was a current incident policy, which reflected the provider and national guidance.

We saw evidence of incidents having been investigated, and action taken to reduce the risk of recurrence. We looked at the electronic system for managing incidents. In the 12 months prior to our assessment, there were 6 incidents involving children and young people. The incidents were investigated and one theme linked 4 of those events, relating to equipment availability which were addressed at the time of the incidents. Senior staff had reviewed all incidents and determined no harm had occurred to the young people involved. Staff told us they received feedback from investigation of incidents.

Staff understood their responsibilities regarding duty of candour and were open, honest and transparent with people when things went wrong with their care.

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 relevant information was obtained to assess whether children and young people’s needs could be safely met. The service had defined eligibility criteria and inpatient services were restricted to young people (aged 16 and 17 years) to be treated under adult services. Surgical procedures for were offered if the young person met the admission criteria which included a satisfactory risk assessment. Where required, staff followed the adult surgery pathway for young people admitted for surgery.

Staff directed patients to other services when required, for example, when young people did not meet the service’s criteria for elective surgery.

Before and after surgery diagnostic and imaging services were available for children and young people between the age of 8 and 18 years, including plain X-ray, ultrasound, CT and MRI scans. Staff contacted patients ahead of time with parents or guardians to explain the process.

Staff worked collaboratively with other healthcare providers to maintain continuity of safe care during admission and following discharge. There were clear procedures and pathways with a local NHS acute trust, setting out roles and responsibilities for both organisations when transfer of an unwell child or young person was required. Guidance supported timely and safe transfers of care and included guidance regarding ambulances and other transfer services.

The service did not always train their staff who provided care and treatment to children and young people to the recommended level of safeguarding children to protect them from the risks of abuse. However, 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.

Not all staff who provided support to children and young people were trained in line with the provider’s safeguarding training policy. The policy stated all non-clinical and clinical staff who had any contact (however small) with children or young people should be trained to level 2. Data provided showed some staff, for example, healthcare assistants and support workers, receptionists and administrators were only trained to level 1. The safeguarding training policy did not align with the service’s mandatory training policy which said health care assistants and support workers should be trained to level 1. Therefore, the policies did not clarify what levels of training some levels of staff should have. We were told this was an administrative error where staff were not allocated the correct level of training to complete.

Other levels of staff for example, staff nurses, clinical leads and senior physiotherapists, were trained to level 2 safeguarding children as directed by the provider’s policy. However, this was not in line with national guidance (Intercollegiate document (2025) safeguarding children and young people & children and young people in care competencies for health care staff). The guidance says clinical staff working with children, young people, and/or parents/carers who could potentially contribute to assessing, planning, intervening, or reviewing the care of a child or young person must be trained to level 3. Following inspection the provider told us they had interpreted the guidance differently, however they said all relevant registered clinical staff who work with children and young people will now be required to complete Safeguarding Children Level 3 training. A Nuffield wide implementation programme was being rolled out.

The provider’s policy stated staff must work more than 75% of their time with children and young people to be eligible for safeguarding children level 3 training. At this location, the provision of services for children and young people were limited, and no individual staff member met this threshold. However, national intercollegiate guidance relates to the nature of clinical roles undertaken when providing care to children and young people, rather than the proportion of time spent delivering care. Leaders were assured they had measures to safeguard children and young people from the risk of abuse.

The provider had a safeguarding leadership structure. This included 2 leaders trained to level 3 at the location and access to levels 4 and 5 trained staff within the providers wider organisation. These staff were accessible for advice, escalation and oversight. Staff received regular safeguarding training, demonstrated awareness of their safeguarding responsibilities and understood how to escalate concerns. Data provided after our visit showed staff were 100% compliant in level 1 safeguarding children training and 96% compliant in level 2.

There had been no safeguarding referrals to the local authority involving children and young people in the 12 months prior to our assessment. Despite no referrals, leaders were confident staff could identify safeguarding concerns and knew how to report if required.

Safeguarding across the hospital was discussed routinely in team meetings and supervision, and any potential concerns would be managed in line with local safeguarding procedures. The hospital produced an annual safeguarding report.

Staff followed safe procedures for children visiting the service. Information regarding chaperones was available in the outpatient’s waiting area. Staff were available to act as chaperones if required.

Staff were trained in learning disabilities and autism and were able to identify adults and children at risk of harm. Data provided following our visit showed staff were 97% compliant with this training. They understood how to safeguard people from abuse, harassment and discrimination, including those with protected characteristics.

The service carried out recruitment checks, including Disclosure and Barring Service (DBS) checks against the adults and children’s barred lists. There was a process to review and assess any risks identified through recruitment checks.

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 with people to understand and manage risks. This supported the provision of safe care which met people’s needs and enabled them to do the things which mattered to them.

Risk assessments were carried out during the pre-operative assessment process by a registered children’s nurse (RCN) for all 16 and 17 year olds for planned elective surgery.

Staff received training to enable them to recognise and respond to the sudden deterioration of a child or young person. This included annual resuscitation scenario training across departments, including a simulated emergency exercise. Records showed, 94% of staff had completed mandatory Paediatric Basic Life Support (PBLS) training.

Resuscitation trolleys with paediatric medication and equipment were located on the ward and in the diagnostic and imaging department. Trolleys were checked daily to ensure they were ready for use.

Young people (aged 16 and 17 years) admitted for elective surgery followed the adult pathway, with their vital signs recorded and monitored using the National Early Warning Score (NEWS2) chart. NEWS2 is the standard clinical tool used in the UK to identify, score, and respond to acute physical deterioration in patients.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There was a designated waiting area in the main reception for children and young people, including those attending outpatient services. Child table, chairs, toys and play mat were provided. Refreshments were located nearby with a hot water caution notice by the drinks machine for the safety of children.

The outpatients department appeared visibly clean and well maintained. The environment was accessible to prams or wheelchairs. Children and young people were not separated from adult patients in the outpatients department. However, there was a designated waiting area in the ground floor reception.

In the outpatients departments we observed chemicals or substances hazardous to health (COSHH) were safely stored and locked. Printed COSHH files were signed and dated.

The inpatient ward appeared well maintained, visibly clean and well equipped. For young people undergoing surgery, staff told us they were able to have their parent, carer or guardian to stay with them as beds were provided in the same room.

The provider participated in Patient-Led Assessment of the Care Environment (PLACE), 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 (100%) and condition, appearance and maintenance (100%).

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 missing references, and 2 files were missing full reasonable adjustment checks.

As the location provided a limited range of services for children and young people, there were no paediatric nurses or staff designated specifically to work with this group. However, there was one registered children’s nurse (RCN) who worked on a bank basis to support young people when they attended for surgery. If the nurse was unavailable then a nurse from another site would attend. Surgery was scheduled to ensure the RCN (or a RCN from another of the provider’s locations) was available to support the young patient on the day of surgery.

Staff had received training in the patient safety incident response framework (PSIRF) and participated in regular safety huddles, which facilitated timely incident reporting and promoted shared learning.

Data provided showed the service’s permanent staff were 97% compliant with mandatory training (permanent and bank staff combined were 92% compliant). Staff told us they were given enough time to complete mandatory training and received reminders before it was due to expire.

There was adequate medical cover day and night. A resident medical officer (RMO) (doctor) could attend the ward quickly in an emergency, access the pharmacy for medication or contact a consultant for advice or support if required. If children required bloods to be taken in outpatients these would be carried out by the resident medial officer on duty.

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 environments and equipment. There were up to date infection prevention and control (IPC) policies and staff were aware of where to find them. Records showed staff were 96% compliant with infection prevention and control mandatory training.

We observed effective infection prevention and control practices, alongside safe management of hazardous waste and sharp instruments. Consulting rooms were spacious and pram and wheelchair friendly, and curtains were replaced every six months, or sooner if soiled.

The provider participated in Patient-Led Assessment of the Care Environment (PLACE), 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 main reception and children’s area appeared clean, uncluttered and equipped with well-maintained furnishings. However, we observed the cleaning toys checklist in the designated children’s area was dated as last being cleaned on 4 November 2025. This was raised with staff at the time. We were told the area was cleaned but the checklist was not completed. This was rectified on the day and completion of the checklist was added to the main reception cleaning schedule for improved monitoring.

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 for use in an emergency were available, and staff knew where to locate these. Patients were given both verbal and written information about medicines in relation to their surgical procedures.

There was a system of medicines audits at the hospital, and we saw examples of changes being made to practice because of these. The pharmacy manager was currently 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 and 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.

We reviewed emergency trolleys for adults and children in the outpatients department, on the ward, and in the diagnostic imaging department. There were systems for daily checks and the records were fully completed. All items and equipment were present, in date, and ready to use if an emergency occurred. The emergency trolleys on the ward and in the diagnostics and imaging department, stored medication and equipment to treat young people. Young people (aged 16 and 17 years) undergoing surgery would follow the adult surgical pathway and medicines would be adjusted accordingly. Laminated guidance sheets were provided for staff.