Southmead Hospital

Updated 15 November 2024

North Bristol NHS Trust is an acute trust located in Bristol that provides acute hospital services and some community services to people in Bristol, South Gloucestershire and North Somerset. We undertook an unannounced on-site assessment of 2 medical and surgical wards and the Intensive Care Unit at Southmead hospital on 22 January 2024 in response to concerns we received about the training of current staff and whether the trust ensured all new staff received ongoing training. We also sought assurance from the trust through discussion with the senior leadership team, we reviewed evidence submitted and looked at what action the trust had taken to date and what action the trust intended to take to address the concerns. The assessment was focused on the patient pathway and the wards we visited were mixed with medical and surgical patients. Therefore, the 2 assessment service groups (ASGs) for medical care and surgery will produce identical reports.

Updated 12 January 2024

North Bristol NHS Trust is an acute trust located in Bristol that provides acute hospital services and some community services to people in Bristol, South Gloucestershire and North Somerset. We undertook an unannounced on-site assessment of 2 medical and surgical wards and the Intensive Care Unit at Southmead hospital on 22 January 2024 in response to concerns we received about the training of current staff and whether the trust ensured all new staff received ongoing training. We also sought assurance from the trust through discussion with the senior leadership team, we reviewed evidence submitted and looked at what action the trust had taken to date and what action the trust intended to take to address the concerns. The assessment was focused on the patient pathway and the wards we visited were mixed with medical and surgical patients. Therefore, the 2 assessment service groups (ASGs) for medical care and surgery will produce identical reports.

Updated 12 January 2024

North Bristol NHS Trust is an acute trust located in Bristol that provides acute hospital services and some community services to people in Bristol, South Gloucestershire and North Somerset. We undertook an unannounced on-site assessment of 2 medical and surgical wards and the Intensive Care Unit at Southmead hospital on 22 January 2024 in response to concerns we received about the training of current staff and whether the trust ensured all new staff received ongoing training. We also sought assurance from the trust through discussion with the senior leadership team, we reviewed evidence submitted and looked at what action the trust had taken to date and what action the trust intended to take to address the concerns. The assessment was focused on the patient pathway and the wards we visited were mixed with medical and surgical patients. Therefore, the 2 assessment service groups (ASGs) for medical care and surgery will produce identical reports.

Updated 11 February 2015

Neonatal services at Southmead Hospital were rated as good across all five areas. Staff were caring and compassionate and worked in partnership with parents to provide family-centred care. Care was evidence-based and in line with national good practice. Systems were in place for incident reporting and investigation. Incidents were reported and investigated. Where lessons had been learnt, these were fed back to staff. The unit was clean, there had been no recent issues of cross infection and the staff had achieved 100% in the hand hygiene audits. Medicines were stored appropriately. A double-checking system had been introduced to reduce the number of medication errors. Medication errors had reduced as a result. The NICU had robust safeguarding processes in place and a clear process of referral for staff when concerns were identified. Nurse staffing was funded to establishment, but did not meet the standards set by the British Association of Perinatal Medicine. The parents were extremely complimentary about the staff and the care their babies received. No complaints had been received since before September 2013, but a complaint management system was in place. The NICU had good governance arrangements in place. Staff were aware of these arrangements and how these linked to wider trust committees. The unit was well led by its ward sisters and head of nursing.

Updated 6 April 2016

We have judged the critical care unit to be good for safety, and as requiring improvement for responsiveness. Because this inspection was focused on the areas that required improvement following our inspection in November 2014, we did not inspect against the caring, effective and well-led domains. The overall rating for the service is good because:

• The most pressing issue for the safety of the unit in November 2014 was the low numbers of nursing staffing, and the lack of skill and experience of the nursing staff group. During this inspection we found the unit had increased staffing numbers, improved its skill mix and supported staff development in achieving a post-registration qualification in critical care. Although there were still some gaps in staffing, for example supernumerary cover, detailed recruitment plans had been agreed and a full establishment of staff was expected to be in place by the end of March 2016.
• The critical care unit was designed to accommodate patients in single rooms, called ‘cubicles’. Our November 2014 inspection reported challenges with this design because patients were not visible at all times. A new standard operating procedure had been introduced to help staff adapt their practice. This had helped to improve observations of patients most of the time, but a challenge remained at times; for example, when staff were taking rest breaks.
• Incident reporting, learning and improvements to practice following incidents had improved, with daily safety conversations being introduced.
• There was an improving picture in relation to the incidence of patient harm. In November 2014 we found an unusually high incidence of falls, pressure ulcers and patients removing their own medical devices. The unit had responded to this with increased staffing and education, and a reduction of 50% was expected to be achieved by the end of the year. However, the majority of the mandatory training topics, including falls training, were below the trust’s target for 85% of staff to have completed their training.
• Our previous inspection in November 2014 found the responsiveness of the unit required improvement. This was because the poor flow of patients through the hospital affecting the ability of critical care to respond effectively. During this inspection we found there were still a very high number of delayed discharges, despite the unit working hard to identify patients who could be discharged in the early morning. Bed occupancy also remained high, affecting access for patients requiring intensive care.
• The length of stay for patients remained much higher than the NHS national average and was not optimal for patient social and psychological wellbeing.
• There was no critical care outreach team (a recommendation of the Core Standards for Intensive Care Units (2013)) to provide a response to deteriorating patients elsewhere in the hospital, or to follow-up patients who had been discharged from the critical care unit.

Updated 18 February 2021

Updated 25 September 2019

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them 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, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. In all areas of end of life care we visited, we saw that staff were truly person centred. As much emphasis was placed in the caring for and about those close to patients as patients themselves.
• People’s individual needs and preferences were central to the delivery of tailored services providing end of life care. The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it. There was a clear drive to increase the presence of the palliative care team at the trust, and clear actions were planned to achieve this.
• Leaders had a deep understanding of issues, challenges and priorities in their service, and beyond. They ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. All staff we met were clearly inspired and motivated by the clinical lead for end of life care, and this translated into the delivery of high-quality end of life care. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The environment in the mortuary – specifically around storage fridges - did not meet the needs of the service and presented risk to the identification of some types of the deceased.
• The documentation of capacity as part of the “Do not attempt cardio-pulmonary resuscitation” was not clearly recorded.

Updated 16 February 2024

Updated 8 March 2018

We rated this service as good because:

• There were processes to keep patients safe, which were backed up by comprehensive training. This included comprehensive infection control processes and checks, safeguarding processes, and the management of patient risks.

• There were sufficient staff to ensure outpatients ran safely.

• During this inspection we found 9% of patients were seen in outpatients without their full records being available. However, this was an improvement from the last inspection. There was a digital plan to reduce the reliance on paper records which was ongoing during the inspection.

• Patients were receiving care in line with evidence based practice and guidance.

• Feedback from people who used outpatients, and those who were close to them, was continually positive about the way staff treated people.

• Services provided by the outpatient clinics reflected the needs of the local population. Staff were finding different and innovative ways to manage patient care to improve the efficiency of clinics.

• The service was able to identify and meet the information and communication needs of people living with a disability or people with mental ill health. This included the management of dementia, learning disabilities and patients with self-harming or suicidal thoughts.

• People could access the service when they needed it. Most patients were able to access the service in a timely way, with most specialties in line or close to the national averages for waiting times.

• Leaders within outpatients had the skills, knowledge, experience, integrity and enthusiasm to lead effectively. Governance processes were innovative, and focused on improving safety, quality, and patient experience specifically for outpatients. The transformation plans for outpatients had a clear vision for the service.

However:

• Not all staff were trained in meeting the needs of patients living with dementia.

Updated 25 September 2019

Our rating of this service stayed the same. We rated it as good because:

• We rated the safe and effective key questions as good and the caring and well-led key questions as outstanding. We rated the responsive key question as requires improvement.

• Staff assessed patients promptly on their arrival in the emergency department to ensure those with serious or life-threatening illness or injury were prioritised. Staff identified and quickly acted upon patients at risk of deterioration and staff were alert to those conditions where time-critical investigations were necessary. There were robust systems to ensure oversight of patient safety when the emergency department was crowded.

• The emergency department was well laid out, well maintained, well equipped and clean. Patients’ records were clear, up-to-date, stored securely and easily accessible to staff. Staff followed best practice when prescribing, giving, recording and storing medicines and complied with good hand hygiene practice. Staff had training on how to recognise and report abuse, and they knew how to apply it.

• The emergency department had enough staff with the right qualifications, skills, training and experience to care for patients and keep them safe. Staff were expected, encouraged and supported to develop new skills.

• The service had a good track record on safety, monitored safety performance and managed incidents well. There were well-embedded risk management processes to ensure that incidents, including deaths and unexpected outcomes, were reviewed and learning shared.

• The service provided care and treatment based on national guidance and best practice. Regular audit provided assurance that staff followed guidance. Patient outcomes were generally in line with other similar services and results were used to drive improvement.
• Staff regularly checked patients’ comfort and ensured they were given adequate pain relief, food and drink. They supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Most key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. Feedback from patients and those close to them was consistently positive. We saw and heard about numerous examples of care where staff had ‘gone the extra mile’. This included many examples where staff had undertaken fund-raising events in their own time to provide things that would make a difference to patients’ experience.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. The service provided excellent support to patients with complex needs and those in vulnerable circumstances. Staff champions had developed resources to support patients with dementia and those with learning difficulties. Premises in the emergency department had been adapted to meet the needs of people living with dementia.

• Managers had the right skills and abilities to run a service providing high quality and sustainable care. They were highly respected by the workforce as inspiring leaders and role models. They promoted a positive culture. Staff felt supported and valued; they had a positive and optimistic attitude and spoke about their department and their colleagues with pride and passion. There was a strong emphasis on staff wellbeing and there were numerous examples of initiatives designed to support staff.

• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services. There was a vision statement, supported by a series of objectives and workstreams to achieve these objectives and staff were engaged in numerous projects to realise the vision and objectives.

• The service used a systematic approach to continually improve the quality of its services and safeguard high standards of care. There were well-embedded and effective governance and risk management systems, supported by effective data collection systems and information streams. Quality and improvement were everybody’s business and staff in the emergency department were proud of their achievements and of a proactive culture, which encouraged and supported learning and innovative practice. There were many examples of recent and current research and quality improvement projects, some of which had been locally and nationally recognised.

However:

• People could not always access the service when they needed it and did not always receive the right care promptly. Waiting times were not in line with national standards. The trust was consistently failing to meet national standards in relation to the time patients spent in the emergency department, the time they waited for their treatment to begin and the time they waited for transfer to an inpatient bed.

• Facilities and premises in the emergency department were not wholly appropriate for the services being delivered. Demand for services frequently outstripped the availability of appropriate clinical spaces to assess and treat patients. This meant the emergency department frequently became crowded and patients had to be accommodated in the corridor. There were inadequate bathroom facilities in the emergency department observation unit.
• The service did not have consistent 24-hour access to mental health liaison and specialist mental health support if they were concerned about a patient’s mental health.
• Daily checks of specialist equipment in the emergency department did not take place consistently.
• Medical staff reported good working relationships with some specialties, but others were not considered to be responsive when patients in the emergency department required specialist review. There were internal professional standards to ensure swift review of specialty patients in the emergency department, but compliance was not routinely monitored.
• Training data provided in respect of intermediate and advanced life support training was incomplete and some staff were overdue for refresher training.
• The service did not comply with recent guidance regarding advanced training to safeguard adults.
• There was limited understanding and application of the policy which requires services to meet the communication and information needs of patients with a disability or sensory loss or patients whose first language was not English.