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CQC inspectors find University Hospitals Bristol caring and effective – although some services require improvement
England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of services provided by University Hospitals Bristol NHS Foundation Trust.
Overall the trust has been rated as Requires Improvement. The Care Quality Commission has found that the trust provided services that were effective and caring. Improvements were needed in the safety, responsiveness and leadership of some services.
During the inspection in September, a team of 51 people visited all seven hospitals which make up the trust’s main site in the centre of Bristol. Accident and emergency, critical care, maternity and family planning, end of life care and services for children were rated Good. Medical care, surgery and outpatients were rated Requires Improvement.
All services provided by South Bristol Community Hospital, and the Central Health Clinic are rated Good. Full reports are available here.
Inspectors found every service to be caring, with staff who provided kind and compassionate care and treatment, involved patients in their care and treated them with dignity and respect. People were receiving support and treatment that led to good outcomes, and there was an open culture where the staff were encouraged to report incidents or concerns.
But the high demand was particularly affecting urgent and emergency services, surgery, medical care, critical care and outpatient services. Issues with the flow of patients through the hospital meant that patients often waited too long in accident and emergency and were not always cared for on the most appropriate ward for their condition or had to be moved between wards when there was no medical need.
Too many operations were cancelled. Outpatient services were struggling to meet the demand for their services and they were not meeting the 18-week referral to treatment targets. There were long waiting times for people in clinics, with inconsistency in the information provided about those waits.
Overall, inspectors identified a number of areas of outstanding practice, including:
- Teamwork in the A and E department was exceptional, with committed and motivated staff working well together and with other departments.
- The maternity service at St Michael’s Hospital was particularly impressive. Staff worked hard together, and flexibly to manage with fewer midwives than is normally ideal.
- The children’s hospital had outstanding safeguarding procedures in place, and with links in every department where children were seen.
- The arrangements for young people to transition from children’s to adult services, such as in oncology, were good.
- In addition to the statutory requirements, a process to review the death of any child had recently been implemented. A full review and debriefing of the case occurred within 24 hours of the child’s death, with parents involved in the reviews.
There were areas of poor practice where the trust must make improvements:
- The trust must take action, with others, to improve the flow of patients through the Bristol Royal Infirmary, ensuring that patients are treated in the most appropriate place and supported to leave hospital when they are ready.
- The trust must ensure that staffing levels meet the needs of patients at all times in wards and operating theatres.
- Patients whose surgery is cancelled must have their nutritional needs met.
- Patient accommodation on the A and E observation ward must be improved in line with guidance on same sex accommodation.
- The trust must ensure that all medicines including controlled drugs are stored safely.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“University Hospitals Bristol is a large and complex organisation which provides a vital and effective service, not only to Bristol but to a wider population of six million people in the South West and South Wales.
“Throughout the hospitals, my inspectors came across caring and committed staff, who were prepared to go the extra mile on behalf of their patients. Aspects of the maternity services and children's services were outstanding, with staff from all disciplines working together well to ensure good continuity of care. Staff talked with real pride about their colleagues and about the services that they provided.
“Outpatient services were struggling to meet the demand, with long waiting times for people in clinics, and the admin staff under a lot of pressure. Patients were not kept informed of the delays, or the reasons for them.
“There is no doubt that the high occupancy rate and the staff shortages we found in places have been affecting the patients’ experience. The delays in moving on patients who no longer need a hospital bed meant that other patients were waiting too long to be admitted, or their operations cancelled or they were being cared for on the wrong wards.
“I know that significant work has been undertaken by the trust to increase capacity and improve patient flow. The trust will need to work closely with all the other local agencies to ensure that people who are ready to be discharged from hospital get the support they need as soon as possible. I will continue to monitor this closely.”
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- Last updated:
- 30 May 2017
Notes to editors
Bristol’s main site includes seven hospitals: the Bristol Royal Infirmary, Bristol Royal Hospital for Children, Bristol Heart Institute, Bristol Oncology and Haematology Centre, St Michael’s Hospital, Bristol Eye Hospital and The University of Bristol Dental Hospital. The trust also provides services from the South Bristol Community Hospital and the Central Health Clinic, both of which are located within the city of Bristol.
The trust was inspected by CQC in September under its new inspection regime. The inspection team included doctors, nurses, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent three days at the trust. Inspectors also returned unannounced.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. By the end of 2015, CQC will have inspected all acute NHS Trusts in the country with its new inspection model.
The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.
Links to reports: