UHBW Bristol Campus

Updated 30 October 2024

Our overall location rating for UHBW Bristol campus did not change following the assessment of urgent care in June 2024. The overall rating remains good.

Updated 11 June 2024

Date of assessment 11 June to 19 June 2024. We conducted an assessment of urgent and emergency care services at the adult emergency department at UHBW Bristol Campus (also known as Bristol Royal Infirmary). The assessment also included an unannounced onsite visit on 11 June 2024. This assessment was to follow up on concerns raised to us about the safety of the emergency department at Bristol Royal Infirmary. We rated the service requires improvement because medical staffing was insufficient to meet demand at weekends, there were not enough trained fire wardens, the quality of risk assessment and management of sepsis needed to improve. However, ambulance handover times had reduced, staff worked to mitigate the risks of overcrowding in the department, staff worked well together to deliver evidence-based care and leaders worked collaboratively to improve the service. We found 2 breaches of legal regulations in relation to safe care and treatment and safe staffing. We rated the service as requires improvement overall. We have asked the provider for an action plan in response to the concerns found at this assessment.

Updated 4 November 2021

Updated 16 August 2019

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

• Safe care was mostly being provided in children and young people’s service. Staff understood how to protect patients from abuse. Patient risk was well considered and there were clear processes for escalation and support should a patient deteriorate. Patient safety incidents and patient safety performance was monitored, managed and learning identified to make improvements to the service.

• There was effective care within the children and young person’s service. Care and treatment was based on national guidance and evidence of its effectiveness. The effectiveness of care and treatment was monitored, and the trust was generally performing similar when compared to other trusts. Patients' nutrition, hydration and pain was well managed. Teams worked extremely well together to deliver care which benefitted the patient.

• Excellent care was delivered to children and young people with dignity and respect. Staff were committed to giving the best care to patients and provided emotional support to those with physical or mental health needs. Patients were involved, informed and supported in the care and treatment provided, and relatives were included and involved too. Patients suffering pain were well managed within guidelines and protocols.

• The trust delivered responsive care and planned and provided services tailored to meet the needs of children, young people and their families to ensure flexibility, choice and continuity of care. Children and young people, and their families were engaged in the design and running of the service. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice. The service treated concerns and complaints seriously, investigated them and learned lessons from the results.

• The children and young person’s leadership team were clear about their roles and understood the challenges for the service. The leadership and culture of the service drove improvement and the delivery of high‑quality individual care. Innovation, high performance and the high quality of care were encouraged and acknowledged. There was excellent engagement with stakeholders and partners to improve and coordinate services. There were no barriers to innovation and development.

However:

• In some areas safety could be improved and brought in line with good practice. Improvement in mandatory training for medical staff, particularly in resuscitation and safeguarding training, would assist the service to meet trust targets.

• The service needed  to monitor staffing levels for neonatal intensive care unit (one to one) and supernumerary team lead role, in line with the British Association of Perinatal Medicine standards.

• The clarity of recording of sepsis monitoring, along with any interventions taken, could be improved along with further improvement of clear, up-to-date and coherent patient records. Further safety improvements could be made by following best practice when recording and storing medicines.

• Consideration could also be made to improve the environment for the children and young people’s recovery area in the eye hospital, although it is acknowledged that there is limited space to do so.

• To improve the effectiveness of the service further improvement in appraisal rates to meet compliance of trust targets needed to be focused on.

Updated 2 December 2014

Critical care services were judged to be good in the safe, effective, caring and well-led domains. The responsive domain required improvement.

The trust’s adult critical care services had a good patient safety record and performed better than other comparable trusts. We saw that there was a culture of learning from incidents and complaints. Risks were being managed appropriately. Staff were encouraged and supported to be involved in quality improvement projects and we were shown several examples of innovation. Arrangements for medicines were generally appropriate, but some improvements were needed.

Patients and relatives told us that staff were mostly caring and compassionate. There was appropriate medical cover for critical care wards and CICU. The imminent plan to recruit more experienced nurses will give greater assurance of the ongoing safety in both critical care and CICU.

Changes within the last 12 months to the leadership of both the critical care unit and CICU had been positive and were leading to improved opportunities for staff and an improved skill mix for nurses, which will enhance patient care. Clinical leadership from consultants within critical care was also seen to be good. However, there was a lack of clarity around governance arrangements from CICU consultants.

The forthcoming opening of the new critical care unit (ward 600) will provide both staff and patients with an improved care and working environment. There will be improved facilities for visitors and additional quiet rooms, which will afford greater privacy for distressed and grieving relatives. The new unit will provide one additional bed compared with current availability. It is highly likely that problems will continue relating to access to critical care beds, resulting in cancelled operations and delays in transfer to critical care due to the lack of available suitable beds.

Updated 2 December 2014

The specialist palliative care team had developed a range of tools and processes in order to deliver, monitor and evaluate care in line with current best practice. They regularly reviewed patients within multidisciplinary forums to promote coordinated, safe and effective care. Care records demonstrated that potential problems for patients were identified and planned for in advance with action plans. This information was recorded clearly in care plans.

We found that end of life care was effective and responsive to individual patient needs, particularly in the last days and hours of life. Improvements were needed to identify patients who were potentially in their last year of life in order to better plan care. End of life patients were not always able to be in their preferred place of care as the discharge-planning process was not fully effective. Intermediate improvements were required to the mortuary facilities while the planned redevelopment of this facility were completed.

All the patients and relatives we spoke with told us that they had been involved in decisions, care was good and staff were respectful and kind. Staff throughout the trust valued the expertise and responsiveness of the specialist palliative care team.

Updated 1 March 2024

Updated 2 March 2017

We rated this service to be good because:

• There was a good incident reporting culture and openness and transparency were encouraged. Lessons learnt were shared in both outpatients and diagnostic imaging to make sure action was taken to improve not just the affected service.
• There were clearly defined systems and processes to keep people safe and safeguarded from abuse. All staff we spoke with had a good awareness of safeguarding legislation and what to do if they had any concerns.
• People’s care and treatment in both outpatients and diagnostic imaging was planned and delivered in line with current evidence based guidance, standards, best practice and legislation. We saw evidence of audit to ensure that practice was monitored ensuring consistency
• Feedback from patients and relatives had been consistently positive. They praised the way the staff really understood their needs and involved their family in their care. Patients were treated as individuals.
• We found although people were waiting too long for appointments, there were innovative approaches to the appointment booking systems and the management of the capacity and demand of outpatient’s and diagnostic imaging clinics.
• In response to the last inspection and feedback from patients, each outpatient department had introduced waiting time boards which displayed the waiting times for each clinic for that day.
• Services were planned and delivered in a way that met the needs of the local population and took into account patient choice.
• There was a clear statement of vision and values, driven by quality and safety. It was translated into a credible strategy for outpatients with defined objectives that were regularly reviewed and relevant.
• Staff and patients were engaged in how care was delivered. Staff felt as if they were active contributors to how the service was developed.

However:

• Some medical records were not being stored securely in outpatient departments.
• There was a backlog of appointments and high levels of referrals meaning people were not able to access the services for assessment, diagnosis or treatment when they needed.
• We found doors to the MRI scanners were unlocked and were accessible to patients in the main waiting area.

Updated 16 August 2019

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

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so, and safeguarding incidents were reported and investigated. The service did have enough medical staff with the right qualifications, with vacancies in some specialties. There was safe provision of physiotherapy and occupational therapy for patients following surgery.
• Staff from different professions or departments worked together as a team to benefit patients. All necessary staff, including those in different teams and services, were involved in assessing patients’ care and treatment. The patient records showed input from dieticians, physiotherapists and occupational therapists and therapy technicians. Records also showed input from pharmacists, medical teams, and diagnostic and screening services.
• Feedback from people who used the service, those who were close to them and stakeholders was consistently positive about the way staff treated people. People thought that staff go the extra mile and their care and support exceeded their expectations. Staff delivered strong person-centred care, and were genuinely proud of the services they delivered.
• There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promotes people’s dignity. Relationships between people who used the service, those close to them and staff were strong, caring, respectful and supportive. These relationships were highly valued by staff and promoted by leaders.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Leaders were visible and available to staff, and we saw and heard about good support for all members of the team. The matrons and ward sisters were an experienced and strong team with a commitment to the patients who used the service, and to their staff and each other.
• Strategies and plans were fully aligned with plans in the wider health economy, and there was a demonstrated commitment to system-wide collaboration and leadership. It also included the national and local strategic context.
• There was a demonstrated commitment to best practice performance and risk management systems and processes. The organisation reviewed how they function and ensured that staff at all levels had the skills and knowledge to use those systems and processes effectively. Problems were identified and addressed quickly and openly.