Bradford Teaching Hospitals NHS Foundation Trust

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• 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

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained as good. This meant people were safe and protected from avoidable harm.

All wards were safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, and store medicines.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

In the 12 months prior to assessment there were no patient safety incident investigations at either Westwood Park Hospital or Westbourne Green Hospital. Staff told us that they were confident identifying incidents that should be reported, and they knew how to report them.

Staff understood the duty of candour. They were open, transparent and gave patients and families an explanation if things went wrong. There was evidence of lessons learnt following the outcome of investigations. Although there had been no recent incidents on either ward, staff told us how learning had been shared and implemented when patients or their families had raised concerns. Feedback was also given in various ways to ensure all staff were aware of concerns raised, including meetings, newsletters and emails.

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

We reviewed 9 care records in total. We found that records were comprehensive, there was evidence of risk assessments being completed, and there was a holistic approach to assessments.

The records showed that staff identified where patients required additional support from other communities and social care services. As rehabilitation wards, many patients were supported by physiotherapists, patients had activity booklets to support their process and ensured staff on the wards understood what activities and exercises they required to support their care. However, at times staff struggled to navigate the care plans to confirm that patients had been referred to and reviewed by additional teams. When this was shared during feedback, leaders discussed providing refresher training for the electronic records system.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. 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.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. The completion rate for training at both units was 100%, staff were trained in Levels 1, 2 and 3 depending on their role. Staff were also trained in level 1 and level 2 safeguarding children, at Westbourne Green 100% of staff had completed the training, and 97% of staff had completed training at Westwood Park, which was above the Trust goal of 85%.

Staff were confident in identifying adults and patients at risk of or suffering from significant harm, staff could give examples of potential safeguarding concerns that they would escalate. They could access support from senior staff, and the Trust’s internal safeguarding team, which the units had close links with.

100% of staff had training in the Mental Capacity Act, and staff we spoke to had a good understanding of the Mental Capacity Act, and consent.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

In the care plans we reviewed at both locations, there was good evidence of patient involvement in care planning and risk assessments, and risk assessments were completed with the patient. However, at Westwood Park the patient voice was less evident in the care plans, because they were less personalised. The care plans were not always written in a way that ensured that patients would be able to understand them, and risk assessments were not created in partnership with the patient.

Staff completed comprehensive risk assessments on admission to the ward, and staff used recognised tools to assess the risk to people, such as the Malnutrition Universal Screening Tool (MUST) and the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) which were used to monitor patients for deterioration.

Patients we spoke to on inspection mostly understood their care and treatment, and their rehabilitation goals. However, one patient did raise concerns about communication regarding their expected discharge, this was shared with staff who sat down and discussed this with the patient. Staff also fed back that they would consider different communication styles to support understanding.

Patients were able to give feedback on their care directly through staff, and through surveys. Patient feedback on both units had been positive.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Both Westwood Park and Westbourne had good accessibility for patients, the wards were clean, and equipment and furniture were in good repair. Both units also had kitchens onsite as they stood alone from the main hospital, the kitchens were clean and well equipped, and catering staff understood patient dietary requirements.

Westwood Park Hospital was on ground level, with an accessible garden for patients to use. The ward had a circular layout which staff used to help encourage mobility walking around the ward where it was appropriate. The ward had a large activity space that was also used as a dining room during meal times. There were also accessible bathrooms for patients to use, and a therapies kitchen for the therapies team to assess patient needs at discharge.

Westbourne Green’s ward was all on one level but was on the top floor of the community hospital, so managers ensured that visitors, bank and agency staff understood the process for evacuation. The ward had an activities room, separate dining space, a physiotherapy room with equipment and wet room bathrooms. One bathroom was noted to have damage to the wall, managers were aware and had escalated this to the Trust’s estates team, however, there were delays as the building is not owned by the Trust.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were no staff shortages at either Westwood Park or Westbourne Green. Both sites had low vacancy rates, only two bands had vacancies at either unit, effecting Band 5 and Band 2 roles. There were Band 5 vacancies of 0.99 Whole Time Equivalent (WTE) at Westwood Park, and 1.15 WTE at Westbourne. The Band 2 vacancy at Westwood Park was 2.87 WTE and at Westbourne Green it was 1.6.

In the 12 months before the inspection, daily staffing had not dropped below the establishment figures, and neither unit had required bank or agency staff to cover shifts. Matrons had daily oversight of staffing levels, actively monitoring and coordinating resources if a shortfall in staffing was identified. If bank or agency staff were required, they had an induction and completed a local checklist to ensure they were familiar with the ward.

The average staff turnover at both sites was low, and sickness absence was relatively low. Westwood Park recorded a total absence rate of 8.48%, which was due to long term sickness and Westbourne Green total absence was lower at 3.8%.

In our review of care records, patients were having regular one to one time with their named nurse. Staff told us that they felt the staffing levels on the ward were adequate to the patient levels and acuity of the ward.

Staff had received and were up to date with appropriate mandatory training, all training was above the 85% trust target for completion, and almost all training had a 100% completion rate. The training was appropriate for the patient group using the service.

We scored the service as 2. The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading promptly.

Staff did not always adhere to infection control principles. Staff at Westbourne Green were observed wearing gloves while cleaning and not removing gloves while entering different rooms or going between staff. Similarly, a staff member was observed not changing gloves as they delivered meals to different rooms on the ward.

All ward areas were clean, had good furnishings and were well-maintained. Staff maintained equipment well, and clean stickers were visible and in date. Cleaning records were also reviewed onsite, which showed regular cleaning and were signed off by a senior member of staff. The wards were visibly clean, although there was some high-up dust found at Westwood Park which was reported to staff as part of feedback.

Infection prevention control audits were completed at both units, and every 6 months, matron assurance audits were completed alongside an infection control nurse for an additional layer of assurance. At both Westwood Park and Westbourne Green audit compliance was over 95%.

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

Medicines including controlled drugs and medical gases were stored securely, and fridge temperatures were taken and recorded. However, we found that the clinic room’s temperature was not being monitored or recorded, at Westwood Park there was no air conditioning or windows in the clinic so there was no assurance that room temperatures were not over 25 degrees centigrade. This was raised with staff at the time of the inspection and addressed on the day, with room thermometers and daily checks implemented on both sites.

Bi-annual controlled drug audits were completed by the pharmacy team, using the electronic drugs audit system which allowed reports to be shared immediately with ward managers and pharmacists. No breaches of the Trust’s controlled drug policy had been found. At Westbourne Green these audits were clearly indicated in the controlled drug book, which was good practice as it showed evidence of audits.