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.

We have not previously rated effective for this service. This key question has been rated 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 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.

During our assessment we reviewed 5 care records and followed 2 patients through their surgical pathway. All health records were completed and care plans met patients’ needs. Risk assessments such as venous thromboembolism (VTE), pain assessments and skin assessments were documented in all care records.

Staff told us pre-assessment clinics reviewed highlighted any areas of concern so the team can plan and ensure all patient needs are met. For example, patients with additional needs or mobility issues were highlighted to the ward team in advance so adjustments could be made. Patients requiring additional support were also highlighted in the daily safety huddle, so all staff were aware and could make adjustments as required.

The physiotherapy team assessed patients before surgery in an enhanced pre-assessment clinic to plan and support patients before and after surgery. Patients underwent assessments and received support based on their outcomes. For example, patients were offered support with dietary and lifestyle changes and set achievable exercise goals. Following surgery, the physiotherapy team would assess patients to ensure they were mobile and safe to return home.

Care plans were personalised to meet the individual’s needs. Multidisciplinary input and daily ward rounds were evidenced in all care plans. Patients pain levels were documented in all care records and managed in line with individual needs. Patients told us they were ‘monitored regularly’ and in ‘very little pain.’

Quality statement score 3. 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 and procedures according to best practice and national guidance. They used surgical checklists to ensure safe, effective care and treatment.

The service participated in benchmarking including the National Joint Registry (NJR) and completed internal clinical audits for VTE (venous thromboembolism) safe surgery audits and endoscopy safety checklists. NJR dashboards showed patient outcomes were within the national average for both hip replacement surgery and knee replacement surgery.

The service achieved the joint advisory group (JAG) accreditation for its endoscopy service. The JAG accreditation is the formal recognition an endoscopy service has demonstrated its competence to deliver against the measures detailed in the endoscopy standards.

We scored the service as 3. 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.

Multidisciplinary discussions were documented in patient care plans and information was shared at daily handover meetings. We observed a daily huddle, where all heads of department attended and highlighted any concerns. Relevant patient information was shared and leaders cascaded information to their team.

Leaders told us they had a good team and staff worked well together. Recent changes had taken place in theatres to encourage a positive working environment. The changes were effective and staff were happy in their jobs. We observed a positive working environment with clear communication.

Staff worked together to prepare patients for surgery and what to expect post-operatively. Plans for discharge were discussed at an early stage as a multidisciplinary team to ensure safe and appropriate discharges. Staff told us they worked well as a team and enjoyed working together.

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 supported patients live healthier by providing advice, guidance and support from an early stage. Pre-assessment provided patients with dietary support, coaching and lifestyle guidance to reduce future health risks and maximise surgery outcomes.

Patients undergoing surgery were provided with information and educational videos before and after their procedure. These resources helped patients understand their condition and how to manage their symptoms and recovery, supporting them to achieve the best possible outcomes.

All patients had access to post-operative physiotherapy to support their recovery and rehabilitation. This included group knee classes, which provided guidance on exercises, promoted mobility, and helped reduce the risk of future complications. The service was looking to implement a hip class in the near future.

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.

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.

The service had a range of audits to monitor the quality and safety of the care provided. They audited the use of clinical assessment tools. Records showed the service performed well for audits of NEWS2, Consent and endoscopy safety checks.

Audit processes and outcomes were monitored. The service participated in National Joint Registry (NJR) data submission and benchmarking and achieved a Gold certificate for commitment to patient safety through the registry. NJR data demonstrated the hospital was within national average control limits.

The service monitored and adhered to Referral to Treatment (RTT) waiting time standards to ensure patients were booked appropriately and received treatment within NHS waiting time targets. This helped to support timely access to care and effective patient flow through the service.

We scored the service as 2. 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. 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 that training had been completed.

The service ensured patients had the opportunity to ask questions and make an informed decision about their surgery. The consultant met patients prior to surgery to answer questions and ensure they understood the process. They also had a pre-operative assessment to ask any further questions and were provided with a telephone number to call if they had further questions.
Patients told us enough information was provided to them verbally, via leaflets and online to support their decision making. The consent process was discussed during their outpatient appointment, pre-assessment and on the day of surgery. Consent was confirmed again during the world health organisation (WHO) checklist in theatres. Written consent was obtained and kept on patients records.

Interpreters were available for patients whose first language was not English, helping to ensure they understood information provided and could give informed consent. This could be arranged in an outpatient clinic and on the ward.