Great Western Hospital

Updated 25 July 2025

Great Western Hospital NHS Foundation Trust provides a range of NHS hospital services. This assessment looked at Surgery services which we rated as good and Urgent and Emergency services which we rated as requires improvement. The rating from surgery and urgent and emergency care has been combined with ratings of the other services from the previous inspections. See our previous reports to get a full picture of all other services at Great Western Hospital NHS Foundation Trust. The rating of Great Western Hospital NHS Foundation Trust remains requires improvement. 

Updated 9 July 2025

On 18 and 19 March 2025 we carried out an inspection of surgical services at The Great Western Hospital NHS Foundation Trust. We inspected due to an increased number of reported incidents in the surgical service.

We inspected 31 quality statements across safe, effective, caring, responsive and well-led key questions. We have combined the scores for these areas with scores from the last inspection to give the rating.

There were improvements following the breaches reported in the previous inspection of surgery in 2020.

The trust’s Surgery, Women and Children’s Division manages the surgery core service at Great Western Hospital. The trust has 15 operating theatres, including day-case facilities, which provides care for people undergoing a range of surgical procedures not requiring an overnight stay.

We spoke with 17 patients and 2 relatives/carers. We reviewed a sample of patient records including nursing notes, prescription charts and theatre records. We spoke with more than 40 staff which included: consultants, surgeons, anaesthetists, resident doctors, nurses, physiotherapists, occupational therapists, senior leaders, healthcare assistants, administration staff, housekeeping staff and volunteers.

Safe:

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment did not always meet the needs of people. However, they were clean, well-maintained and any risks were mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

Effective:

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. People always had enough to eat and drink to stay healthy. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent.

Caring:

People were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. People had choice in their care and were encouraged to maintain relationships with family and friends. Staff responded to people in a timely way. The service supported staff wellbeing.

Responsive:

People were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. People were involved in planning their care and understood options around choosing to withdraw or not receive care.

Well-led:

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. People with protected characteristics felt supported. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

Updated 9 July 2025

On the 8th of April we carried out an inspection of urgent and emergency care services at The Great Western Hospital (GWH) NHS Foundation Trust. We inspected due to increased number of reported incidents in the urgent and emergency service.

Urgent emergency care (UEC) sat within the division of medicine at GWH. Following a recent build project which was completed in November 2024, services had linked geographically to form an integrated front door (IDF). UEC was managed across the emergency department (ED), children's emergency unit (CEU) and urgent treatment centre (UTC) collaboratively, serving the population of Swindon and its surrounding communities. The department received patients from both the ambulance service and individuals self-presenting to the front door.

The trust had relocated to a new ED in September 2024 followed by the move into the new CEU in early November. Each of the areas was comprised of the following.

Emergency department: 16 bays in majors, 3 rapid assessment areas, 6 resus cubicles, 7 ambulatory assessment rooms (incorporating 3 majors conversion cubicles), ambulatory majors with 41 chairs plus 2 wheelchair spaces and a 4 bedded observation unit.

Children’s emergency unit – 3 fast-flow assessment spaces, 13 patient spaces including resus room x1, high acuity bays x2, baby room x1, sensory room x1

Urgent treatment centre: adult – 14 consult rooms, plaster room x1, treatment Room x1, designated waiting area. children (Separate area) – 4 consult rooms, designated waiting area

We spoke with 15 patients and 18 staff and reviewed 20 patient care and treatment records.

The service was in breach of the legal regulation relating to safe care and treatment, dignity and respect and governance.

Updated 9 September 2024

Date of assessment: 16 May to 28 June 2024. Medical care sits in the Division of Medicine at Great Western Hospital NHS Foundation Trust. Unscheduled care in the NHS refers to medical treatment that cannot be planned or scheduled in advance. There were 320 beds located across 10 wards. The medical care service was provided for adults. We visited 4 wards, including medical wards and the surgical wards where patients are placed when medical wards are over capacity/full. We spoke with 9 patients or their relatives and 21 staff. We looked at quality statements across all 5 key questions: Safe, Effective, Caring, Responsive and Well-Led. The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care. Staff treated patients, their relatives and visitors with compassion and kindness. The service prioritised patients’ individual needs. Leaders mostly ran services well using reliable information systems. However, patient records were not always stored securely, patient pathways and corridor waits did not always ensure patient dignity, and the service did not always manage infection prevention and control well. The provider was informed of these concerns and acted immediately to resolve them.

Updated 21 December 2018

Our rating of this service improved. We rated it as good because:

• Patient safety was a priority for this service. Staff numbers had been low but were improving and managers had a strategy to recruit and retain staff to the children’s service to create stability. Where there were gaps in rotas, these were filled with bank and agency staff.
• Managers used trust governance processes to assess quality of care delivered and passed information to staff on areas needing improvement.
• Staff followed infection control processes and monitoring showed infection rates were low.
• Staff working in children’s specialty areas were trained to care for children. Support was provided for children and families when they left the hospital and outreach staff communicated well with community and children’s services colleagues.
• Safeguarding processes were followed by staff and staff were knowledgeable about how to identify and manage potential abuse for children. Support was offered to staff with supervision and training.
• There were enough medical staff to care for children in the hospital.
• There was a noticeable change in culture, compared with our previous inspection. Staff felt supported, able to contribute ideas and voice concerns if they needed.
• Leaders and managers were aware of the challenges to the service and that quality needed to be improved. They were using trust structures to monitor progress and using their own ideas to contribute to improvement.

However

• Mandatory training modules did not always meet trust targets for staff attendance. This included medical staff in the children’s unit and some staff who cared for children in other parts of the hospital such as radiology, outpatients departments and surgical areas. There was, however a plan to improve this compliance.
• A limited oversight of shift patterns meant that bank and agency staff could work long hours and shifts which did not give them enough rest.
• Oxygen administration for children who needed it was not consistently prescribed.
• GPs did not always receive discharge summaries about a child’s care in a timely way.
• There was no non-executive lead to champion children’s services at the trust board.

Updated 4 August 2017

​We rated this service as good because:

• There was a good incident reporting culture, learning was identified and staff received feedback from incidents.
• There were safe nursing and medical staffing levels to deliver effective care and treatment.
• The service provided care and treatment in line with evidence-based guidance.
• There were experienced nursing and medical staff who received annual appraisals and were supported with training and professional development.
• The service monitored patient outcomes and these were good when compared nationally and to other similar units.
• Staff cared for patients with compassion and kindness. Staff treated patients with respect and dignity at all times.
• The provision of the service met the needs of most people.
• Patients’ individual needs were met wherever possible.
• There were clear governance and risk management processes.
• There was strong leadership and teamwork.

However:

• Provision for therapy services did not meet national guidelines. There was not sufficient physiotherapy and dietitian support, and limited support from other therapies.
• There was a slightly higher than national average of delayed discharges for patients. However, this did not result in any significant delays in admitting new patients.
• There was only one junior doctor in the unit at night, when standards recommended a unit of this size should be covered by two at all times.
• Junior medical staff were not all ‘airway competent’ with skills in advanced airway techniques.
• Patients were occasionally transferred to general wards at night, which was not optimal for their care.

Updated 19 January 2016

We judged the overall service provision of end of life care as good. We found the service to be safe, effective, caring, responsive and well-led.

End of life care was seen as a priority for the trust. There was a clear overarching strategy for the service and plans to improve the delivery of care had already begun to take place with good results Education programmes had been developed and delivered, new documentation had been successfully introduced to the trust improving the pathway for patients although there was also some , yet to be fully embedded.

Staff, patients and relatives spoke in high regard for the specialist palliative care team; they were seen as responsive to the needs of both patients and staff. Out of hours there were good resources for staff to access including a 24 hour advice line managed by specialist palliative care nurses at a local hospice.

End of life care was responsive to the needs of patients and relatives. The end of life service was flexible and provided choice and accommodated individual needs for the patient and carers.

The specialist palliative care team had been involved in looking at complaints and incidents, as part of a wider team, and were keen to ensure training and teaching sessions were tailored and disseminated to ensure future complaints were minimised and care of patients was enhanced.

The specialist palliative care team were dedicated members of a cohesive team working to deliver effective care and treatment plans for patients, offering advice and acting as a resource for clinical teams.

Updated 8 March 2024

Updated 21 December 2018

• We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.
• We rated it as good because:
• Staff understood how to protect patients from abuse; there were clear processes for reporting safeguarding concerns and staff knew how to access support to do this.
• There were systems and processes in place to protect patients and visitors from the risk of infection.
• There were systems in place for managing the planned maintenance of equipment and when faults were identified.
• Staff could identify and respond to a deteriorating patient within the outpatient environment, including medical emergencies.
• Patient records were accessible and staff had the information they needed to make informed assessments of care needs.
• Medicines and prescription pads were appropriately managed to keep people safe in line with national guidance and legal requirements.
• Staff understood their responsibilities to report near misses, patient safety concerns and incidents.
• The physical, mental, and social needs of patients were holistically assessed. The care and treatment provided was underpinned by the relevant standards, legislation and evidence-based guidance.
• Nutrition and hydration was considered as part of the patient assessment. Refreshments were also available to patients in the outpatient setting.
• There was an established audit programme to monitor the outcomes of patients’ care and treatment within the outpatient setting.
• Staff had the qualifications, knowledge and skills to be able to assess and meet the care needs of patients. Staff were encouraged to develop through accredited learning and training programmes developed by the organisation.
• Professions worked together to provide seamless patient care, including when care was provided across different specialisms.
• Patients were treated with compassion, kindness, dignity and respect throughout their visits to outpatient services.
• Clinical consultations and conversations regarding people’s health and well-being needs were conducted within clinical areas with the door or curtain closed to maintain confidentiality.
• Patients with mental health needs were treated with compassion and without judgement.
• Staff provided emotional support to patients to minimise their distress including when a life-changing diagnosis was given.
• Patients were signposted to sources of further information, including other providers and community services that could support their care.
• When patients were finding decisions difficult, staff supported them to understand the complex information about their condition.
• Those close to the patient were made to feel part of the conversations and able to contribute to discussions regarding health needs and care plans.
• The services provided reflected the needs of the local population by offering choice, flexibility and continuity of care.
• The trust was performing better than the operational standard for people being seen within two weeks of an urgent GP referral, to receive treatment within 31 days of diagnosis and the standard for patients to receive their first treatment within 62 days of GP referral.
• The trust had instigated an outpatient transformation programme, which aimed to improve the services delivered to the local population. This included offering additional clinics and establishing more efficient ways of working.
• The trust identified where a system-wide approach was needed to meet the needs of the local population. Within endocrinology, rheumatology and dermatology, work was ongoing with commissioners and partners in primary care to find solutions to the demand for services.
• Staff supported patients with additional needs such as patients living with dementia. An alert was placed on patients’ records and early appointment times allocated to reduce anxiety.
• Translation services were available for patients whose first language was not English.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
• There was a clear strategy for outpatient services to deliver a transformation programme. Staff were highly engaged with this and understood their role in delivering the vision.
• There was generally a positive culture within outpatient services, except for one area reporting low morale. Many staff, of all grades, told us they felt part of a team and described a supportive and respectful working environment.
• The board and other levels of governance in the organisation functioned effectively. There were clear lines of accountability and information was shared effectively.
• Senior nurses had joined together to create an outpatient nursing forum with representation from specialities across the organisation. The purpose of the group was to establish more uniform ways of working across divisions to improve quality and efficiency.
• From speciality to board level, risks and issues were recorded, reviewed, escalated and managed to reduce the likelihood of patient harm.
• Information was used as part of decision-making and to monitor performance. A divisional dashboard had been developed to provide an overview of service provision and monitor potential issues.
• Senior staff had taken steps to improve staff engagement. An outpatient forum had been set up for staff nurses to attend.
• There was a focus on learning, improvement and innovation throughout outpatient services, driven by the outpatient transformation project.
• However:
• Not all nursing and medical staff were up to date with their required mandatory training, including safeguarding.
• Lack of space was identified as an issue in several areas we visited, including the Coate Water Unit, oncology/ haematology clinics, endoscopy, cardiology, and the breast clinic.
• We found unattended patient records in an unlocked room in the orthopaedic clinic and Wren Unit.
• We did not observe the use of ‘I am clean’ stickers or a similar system to notify staff that equipment was cleaned and ready for use.
• We were not assured that all staff could identify if equipment was fit for clinical use. Servicing labels did not contain the next service date and the responsibility for maintenance of specialist equipment was not clearly understood by staff.
• Seven-day services were not routinely offered to outpatients due to a lack of resources to extend services beyond the working week.
• We raised concerns that privacy was not maintained within the blood test clinic, where doors were left open and curtains were not used to hide patients from the view of others.
• Waiting times meant people did not always have timely access to an initial assessment or treatment. The trust had developed processes for managing the risk and prioritising patients.
• Despite improvements made through a space utilisation programme, the premises were not sufficient to deliver the number of appointments required to meet demand.
• Complaints were not always investigated within national time frames. At the time of our inspection 17 investigations regarding complaints were overdue.
• We raised concerns a long-term sustainable plan for outpatient services had not yet been developed. The trust was evaluating the ability of demand predication tools to capture both new and follow-up appointments.
• Governance meetings were not consistently organised to follow a set template, the detail of discussion was not always captured in the minutes to allow retrospective comparison.
• Patient feedback was not consistently engaged or reviewed to measure level so satisfaction.