South Bristol NHS Community Hospital

Updated 2 December 2014

University Hospitals Bristol NHS Foundation Trust comprises eight hospitals and is one of the largest NHS trusts in the country. It is an acute teaching trust and became a foundation trust in June 2008.

The trust had 1,085 beds and employed 8,442 staff. Sixty of the beds were provided at the South Bristol Community Hospital. In the financial year 2013/14, the trust had an annual turnover of £554 million and reported a £6 million income and expenditure surplus. After adjustments for technical items, a net deficit of around £5 million was declared. The trust had a healthy cash position at the end of the year. This was the 11th successive year of reported surplus for the trust.

Acute services at South Bristol Community Hospital were provided to the local population of around 300,000 in south and central Bristol.

The 2010 Indices of Deprivation showed that Bristol was the 79th most deprived local authority out of 326 local authorities. Life expectancy for men, at 78 years, was close to the England average of 78.5 years. Life expectancy for women, at 82.6 years, was very slightly better than the England average of 82.5 years. Bristol was significantly worse than the England average for the proportion of children living in poverty, levels of violent crime, long-term unemployment and educational attainment. There were significant variations in levels of deprivation within the city of Bristol and there were areas of prosperity within the city and the immediate surrounding area. Census information showed that 16% of Bristol’s population was non-white, with 6% declaring their ethnic origin as Black, 5.5% as Asian and 3.6% as mixed race.

At the time of this inspection, there was a relatively stable executive team. The chief executive had been in post since 2011 and the chair since 2008. The chief nurse was the most recent appointment and had joined the trust in January 2014. There was a full complement of non-executive directors, some of whom had been in post since 2008 and some of whom had been appointed within the last 12 months. There were two non-executive board observers who had been appointed to enable continuity and an ordered succession when non-executives reached the end of their term.

We inspected the trust as part of our in-depth inspection programme. The trust had been identified as a medium-risk trust according to our ‘intelligent monitoring’ system and had moved from the low- to the medium-risk category between March and July 2014. Concerns had also been raised about the trust.

Our inspection of South Bristol Community Hospital was carried out on 10 and 11 September 2014.

Updated 2 December 2014

South Bristol Community Hospital was situated in the Hengrove area of Bristol to the south of the city centre. It provided acute services to a population of approximately 300,000 in central and south Bristol.

We carried out this comprehensive inspection as part of our in-depth inspection programme. The trust moved up two bands in our ‘intelligent monitoring’ system from a low risk to a medium risk between March 2014 and July 2014. We inspected South Bristol Community Hospital on 10 and 11 September 2014.

South Bristol Community Hospital provided day surgery, outpatient clinics and a rehabilitation service where people were able to stay as inpatients. The hospital also provided a community dental service. There was an urgent care centre for minor illnesses and injuries on the site; however, this was managed by another NHS trust.

Overall, this hospital was rated as good and provided a safe, effective and caring service to patients. The hospital was responsive to patients’ needs and was well led.

Our key findings were as follows:

• We found that services were safe.
• There was good awareness among staff of how to report incidents and there was evidence of feedback and learning being disseminated.
• Actions as a result of serious incidents and never events occurring within the trust were implemented in the hospital. There was heightened awareness of and focus on the use of the World Health Organization surgical safety checklist within operating theatres.
• The hospital was clean and staff observed infection control procedures throughout the hospital.
• There were sufficient nursing and medical staff to meet patients’ needs in all areas of the hospital.
• National best practice and clinical management guidelines were reviewed and incorporated into local guidance to ensure that patients’ needs were met. Guidance from the National Institute for Health and Care Excellence (NICE) was specialty-based within each department. We saw copies of the relevant guidance for staff to access on the wards and in departments.
• Although the trust collated data on patient outcomes, this was not in sufficient depth to reflect the outcomes for patients at South Bristol Community Hospital.
• Patients received appropriate pain relief and nutrition and hydration to meet their needs.
• Staff throughout the hospital were kind and seen to provide compassionate care.
• Patients had access to outpatient services within times set by national guidelines. Patients were kept informed of waiting times in outpatient departments. There were systems in place for patients to leave the department and return later if their appointment was delayed.
• There was a high bed occupancy rate within the hospital, and this had an effect on the ability of the hospital to respond to the demand for inpatient beds. This meant that patients could not be transferred from the Bristol Royal Infirmary in a timely manner to South Bristol Community Hospital to continue their rehabilitation following a stoke.  
• The operating theatres within the hospital were being used for only a quarter of the available time and the outpatient department was used for only approximately 55% of the available sessions.
• There were governance systems in place to monitor risks and the quality of the service.
• We observed good local leadership on the wards and in departments, with senior nurses demonstrating a commitment to patient safety and the management of risk. Staff reported feeling supported by managers.

We saw several areas of outstanding practice. These included the following:

• Patients waiting for outpatient appointments were given a bleep if their appointment was delayed. This meant that they could be contacted effectively by staff if they wished to leave the department and so were not restricted to staying in one place for long periods of time.
• Frail, elderly patients waiting for hospital transport home were given pressure-relieving cushions to sit on and provided with food and drink.

However, there were also areas where the trust needs to make improvements.

The trust should:

• Collate information and data about patient outcomes so that outcomes for patients at South Bristol Community Hospital can be reviewed
• Utilise more effectively the operating theatres and outpatient departments in order to support other areas of the trust.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 2 December 2014

There was a good culture of incident reporting. Feedback and learning from incidents were evident within the service. Risks were identified, assessed and mitigated.

There was access to therapists and allied healthcare professionals who provided appropriate input as required. Patients told us that they felt informed about and included in decisions about their care and treatment.

Although the trust collated data on patient outcomes, this was not in sufficient depth to reflect the outcomes for patients at South Bristol Community Hospital.

Staff were caring and compassionate and interacted with patients in a respectful manner.

Patients had their individual needs met. Although there was a high bed occupancy rate within the hospital, which had an effect on the hospital’s ability to respond to the demand for inpatient beds, patients were rarely moved to another ward.

We observed good local leadership on the wards, with senior nurses demonstrating a commitment to patient safety and the management of risk. Staff reported feeling supported by managers.

Updated 2 December 2014

Although there was a low level of incident reporting within outpatient departments, staff were clear about the process and the importance of reporting incidents. Staff said that they received feedback about incidents in team meetings but there were no formal minutes to provide evidence of this. 

Infection control practices were observed within the department and staff had a focus on safeguarding both vulnerable adults and children.

We observed staff interacting in a caring and considerate manner with patients.

There were governance systems in place to monitor risks and the quality of the service. However, there was underutilisation of the outpatient facilities within the hospital; only approximately 55% of the possible number of sessions were used. There was ongoing monitoring of this to see where improvements could be made.

Updated 2 December 2014

Surgery services were provided in a clean and hygienic environment in line with recognised guidance, which helped protect patients from the risk of infection, including healthcare acquired infections.

Clinical management guidelines were reviewed and incorporated into local guidance to ensure that patients’ needs were met.

Although the trust collated data on patient outcomes, this was not in sufficient depth to reflect the outcomes for patients at South Bristol Community Hospital.

Patients told us that they felt that they received good-quality care and were informed of any treatment required.

We found that staff were responsive to people’s individual needs. Appropriate assessments were carried out to ensure that patients were able to provide valid consent before their planned surgery. However, theatre usage was not optimal; the operating theatres were being used for only a quarter of the available time.

There was good leadership at local levels within the surgery services at South Bristol Community Hospital.