South Bristol NHS Community Hospital

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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 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 we rated this key question good. At this assessment the rating remains good. This meant people’s outcomes were consistently good and people’s feedback confirmed this.

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.

We scored the service as 4. The evidence showed an exceptional standard.

The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed comprehensive health assessments of patients in a timely manner. Care plans were personalised and met patients’ needs identified during assessment.

As part of the preadmission process, patients were informed by telephone and letter of their appointment date, time and location. Some patients were contacted by the pre-assessment team, for example, patients taking bowel prep, or patients who were diabetic or had Parkinson's Disease. Instructions regarding fasting, medication and preparation for procedures were provided by patient information leaflets and the pre-operative team. Patients were asked questions, designed to identify patients who might require further support or optimising prior to their procedure. (Optimisation is the process of preparing patients’ physical and mental health to the best possible prior to surgery.) An additional telephone pre-assessment appointment would then be made with an endoscopy specialist nurse.

The service addressed barriers faced by some patients which could include, for example, anxiety, learning disabilities, autism, and communication difficulties, or a history of trauma. Staff offered tailored emotional and practical support to meet individual needs. Some patients presented with complex health and social needs, which may be compounded by socio-economic challenges. Additional barriers included dementia, substance misuse, lack of fixed accommodation, and the transition from paediatric to adult services for those under 18 years of age.

Care was personalised and delivered in collaboration with learning disability, autism, and mental health teams to ensure a coordinated and inclusive approach. They adopted a trauma-informed model of care, prioritising patient safety, respect, and reassurance, particularly for those with post-traumatic experiences.

The service had created care navigator roles to address inequalities in access and ensure every patient receives an individualised, safe and inclusive pathway to the service. The role had enhanced patient experience, was more personalised and patient-centred. All patients were asked about additional needs at the time of booking endoscopy appointments, enabling timely and appropriate adjustments. The number of patients who did not attend (DNA) and last minute cancellations had reduced and in turn had reduced waiting times. Staff told us they had received positive feedback, for example, patients and carers felt heard and supported through their journey.

Holistic coordination was central to the service, with close liaison across specialties ensuring patients with complex needs were supported effectively. They worked in partnership with community services, particularly to support individuals with addiction and those on the cirrhosis surveillance pathway. For patients with dementia, they collaborated closely with carers and family members to minimise distress and ensure appropriate consent processes were followed.

The service had developed, and enhanced, the clinical pathway for oncology patients requiring flexible sigmoidoscopy. They had collaborated with the paediatric gastroenterology team to streamline and improve the transition from paediatric to adult care. They had also established a dedicated pathway for patients with stable cirrhosis.

Clinical audits ensured relevant endoscopy documentation was recorded in patients’ clinical notes. The last audit showed, overall, staff were commended on their good documentation. However, staff were reminded of the importance of accurate and timely documentation.

Patients were reviewed following surgery to check if they were safe to go home or to arrange follow up in clinic, and care plans were updated as necessary.

Patients told us information about their care and treatment was clearly explained and they received pain relief when required.

We scored the service as 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 were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. The team included or had access to the full range of specialists required to meet patient needs.

Managers provided new staff with induction and support to develop through regular clinical supervision and constructive appraisals of their work. In addition, all new staff in the service underwent an orientation programme, worked with senior staff and were supported by mentors.

Managers provided staff with supervision (meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development). There was a trust appraisal (annual check-in) policy to provide staff with a framework for conversations, including wellbeing, performance, and personal development. Appraisal compliance in April 2026 was 94.1%.

There was a revalidation policy supporting medical appraisal and revalidation, and the requirements set by the general medical council (GMC) and NHS England and Innovation (NHSEI). Revalidation is the process by which medical staff demonstrate they are up to date and fit to continue practising. It is mandatory for maintaining a medical license and ensuring patient safety. Managers ensured staff had access to regular team meetings. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers also ensured staff received the necessary specialist training for their roles.

All endoscopy staff completed competencies through the Joint Advisory Group (JAG) endoscopy training system (JET). Competencies were checked during annual appraisals. Competencies are the specific combination of skills, knowledge and behaviours required to safely and effectively perform a job. They are the measurable standards used to ensure healthcare professionals are qualified and safe in their roles.

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.

Staff held regular and effective multidisciplinary meetings and shared information about patients at effective handover meetings. We observed a daily morning huddle (meeting) which was attended by staff from all departments. Huddles were well run and had clear purpose and learning was discussed.

Leaders told us surgical lists could be affected if the main hospital in the trust required additional staffing support. Staff could rotate across the 3 trust sites and leaders viewed the consistency of training and equipment familiarity as important. However, some staff had anxiety about working in different locations. Taxis were sometimes booked to transfer staff between sites. However, leaders had started discussions with the transport team as an alternative.

Care navigators supported patients with learning disabilities and autism through liaison with carers and the trust’ learning disabilities team.

The teams had effective working relationships, including good handovers, with other relevant teams within the trust. There was an information board in the staff corridor providing names of all the link nurses who were available to be contacted to support staff. These included link nurses for dementia, resuscitation, diabetes tissue viability and safeguarding.

We scored the service as 3. 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.

Leaders told us the hospital was built to support the local population. Historic factors such as local tobacco factories may have affected the health of local communities, for example, cardiovascular disease and cancer. They took opportunities to talk about smoking cessation and described signposting conversations, such as asking patients if they would like more support or referral to a GP. When appropriate, doctors and nurses discussed alcohol consumption with endoscopy patients, including advice on recommended alcohol units.

Community health promotion was described through bowel cancer screening work. The service worked closely with the bowel cancer screening programme team who carry out health promotion with community visits to talk about bowel health. The team recognised lower uptake among some groups and identified that bowel health could be a sensitive topic in certain cultures. In response, they targeted engagement and education in communities where these conversations were less common.

There were public engagement open days at the hospital with education activities, including inviting people in and running resuscitation scenarios with the public and showing the public what they do in theatres.

The area had poor public transport which could make access to central hospital services difficult. This was part of a rationale for developing and moving services closer to the community, including potential future services at the South Bristol site.

Leaders described a health equity-related project in cardiology involving an access coordinator who telephoned patients, aiming to better support all groups of patients needing targeted support.

We scored the service as 3. 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.

At our last assessment we said the service should collate information and data about patient outcomes so they could be reviewed. At this assessment leaders told us activity undertaken in day surgery was not subject to inclusion in any of the national clinical audits in terms of clinical outcomes. In endoscopy, the main source of outcomes would be those aligned with JAG (Joint Advisory Group) accreditation for which they were awaiting assessment and renewal of JAG accreditation in July 2026.

Leaders told us there was an increasing use of data to understand differential access and outcomes for patients such as differences by socio-economic group and did not attend rates. There was a health, equity and diversity group (HEDG) with staff networks designed to eliminate discrimination, reduce health inequalities, and foster inclusive, culturally competent environments for both patients and medical staff.

There was an organisational challenge to monitoring patients due to multiple specialties, with follow-up managed within sub-specialties. For endoscopy, they described a system for monitoring patients needing follow-up care and theatre sub-specialties followed up patients in their relevant clinical pathways.

At time of discharge from the unit, patients would be aware of their follow-up plans and where relevant, patients were given information about support services, for example, specialist nurses.

Audits were conducted on the service and the names of staff leading audits were displayed on a notice board on the staff corridor. These included decontamination, documentation, bowel preparation and infection control.

Patients told us they were informed of their next steps for recovery and follow up care. They spoke positively about the quality of care and treatment they received.

We scored the service as 3. The evidence showed a good standard.

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

Staff took all practical steps to enable patients to make their own decisions. The trust had a consent to examination or treatment policy to support staff to gain informed consent. Patients were provided with written information about the consent process prior to attending appointments. However, the policy was overdue for review and consent audits were not undertaken.

Staff received mandatory training in consent and data provided showed the service was 96.2% compliant.

Leaders described staged information provision to patients. Information and leaflets were provided prior to attending to give patients time to read leaflets to absorb what had been explained.

There were repeated safety and identity checks through the patient journey to protect patient welfare during invasive endoscopic procedures. Staff gained consent before patients changed into gowns. Written consent was obtained prior to procedures, with opportunities for patients to ask questions and discuss the risks and benefits of proceeding or not proceeding with treatment. At this point, patients had an opportunity to withdraw. For day surgery, consent was discussed during outpatient appointments and again with the surgeon. Consent was also confirmed as part of the world health organisation (WHO) checklist which was followed in theatres.

If patients withdrew consent, for example, due to anxiety, this was respected and risks were discussed with the doctor to confirm the patient’s wishes. Most 16 and 17 year old patients attending endoscopy day services were accompanied by a parent. The consent process could be the same as the adult process and depended on the individual. There was a tailored approach and staff took into account the young person’s wishes.

There was also a withdraw consent process. During some endoscopy procedures a standard patient safety policy dictated a non-verbal "raise hand" signal was used to indicate the withdrawal of consent. If a patient raised their hand, the endoscopist would pause, assess the patient's capacity and concerns, and immediately remove the camera.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Staff knew where to access current polices and understood how and when to assess whether patients had capacity to make decisions about their care. The trust’s mental capacity act (MCA) policy directed staff to operate in compliance with the legislation of the Mental Capacity Act 2005 and the deprivation of liberty safeguards (DoLS). The trust’s mental health act (MHA) policy was currently under governance review.

Leaders informed us there were no specific consent audits undertaken at the unit.