Royal United Hospital Bath

Updated 31 October 2024

We carried out an unannounced assessment of the Royal United Hospital Bath NHS Foundation Trust from 13th March to 14 June 2024 , which included a site visit on 20 and 21 March 2024. This was because we had received information of concern relating to specific wards regarding the safety and quality of the surgical service. For the purposes of the site visit we visited 3 surgical wards: Forrester Brown, Pulteney and Philip Yeoman Ward. We considered information and data regarding the surgical service received from the trust; information gathered onsite as well as feedback around the experience of patients that used surgical services. At our last rated inspection of surgery services in 2015, surgical care was rated good. At this assessment, the areas we rated were good. We found there was a shared vision, strategy and culture. The trust was in the process of its cultural improvement programme and the direction of travel was positive. The trust detected risks in the care environment, however, we have asked the trust to produce an action plan to assure us that all the risks identified in the fire risk assessments have been mitigated. The trust’s audit program monitored compliance with evidence-based good practice and care standards. The audits showed good compliance; however, we noted 2 areas where we expect to see improvement and have asked the trust to provide an action plan. These were to; improve the monitoring of patients' food and fluid intake and improve the timeliness of venous thromboembolism assessments when patients were admitted to the surgical wards. The trust had a proactive and positive culture of safety however, there was a backlog of safety incidents which required inspection. We have asked the trust to provide an action plan.

Updated 17 May 2024

We carried out an unannounced assessment of the Royal United Hospitals Bath NHS Foundation Trust from 13th March to 14 June 2024 , which included a site visit on 20 and 21 March 2024. This was because we had received information of concern relating to specific wards regarding the safety and quality of the surgical service. For the purposes of the site visit we visited 3 wards: Forrester Brown, Pulteney and Philip Yeoman Ward. We considered information and data regarding the surgical service received from the trust; information gathered onsite as well as feedback around the experience of patients that used surgical services. At our last rated inspection of surgery service in 2016, surgical care was rated good. At this assessment, the areas we rated were good. We found there was a shared vision, strategy and culture. The trust was in the process of its cultural improvement programme and the direction of travel was positive. The trust detected risks in the care environment, however, we have asked the trust to produce an action plan to assure us that all the risks identified in the fire risk assessments have been mitigated. The trust’s audit programme monitored compliance with evidence-based good practice and care standards. The audits showed good compliance; however, we noted 2 areas where we expect to see improvement and have asked the trust to provide an action plan. These were to; improve the monitoring of patients' food and fluid intake and improve the timeliness of venous thromboembolism assessments when patients were admitted to the surgical wards. The trust had a proactive and positive culture of safety however, there was a backlog of safety incidents, some of which required investigation. We have asked the trust to provide an action plan.

Updated 18 October 2023

Updated 26 September 2018

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

• There were clearly defined and embedded systems, processes, and practices, which kept children safe and safeguarded them from abuse. The whole team were engaged in these safeguarding processes, with effective leadership from the named nurse for safeguarding children. Lessons were learnt and themes identified, taking action and changing practice as a result of when things go wrong.
• There was exceptional multidisciplinary team working. Staff, teams and services, both internally and externally, were committed to working collaboratively. They had found efficient ways to deliver joined up care to the babies, children and young people, and their families.
• We observed and heard about exceptional care being provided to babies, children, young people and their families. Feedback from children and parents was overwhelmingly positive. People were truly respected and valued as individuals. They were empowered as partners in their care and kept involved and informed.
• The children and young people’s service was tailored to meet the needs of individuals. The services provided reflected the needs of children, young people and families. They were engaged and involved when improving the design and running of the services.
• The facilities and premises met the needs of people using the service. The Dyson neonatal unit was a purpose-built centre, this was conducive to providing high quality, safe, care and treatment to neonates. The children’s centre was being redesigned to improve access and flow for day surgery.
• There was a proactive approach to understanding the needs and preferences of children and young people. This ensured individual needs were met, promoted equality and enabled accessibility.
• The children’s service demonstrated how they could be accessible, flexible and responsive to meet an increasing demand on the service. The paediatric demand management project had helped to improve patient flow, manage paediatric referrals, and support primary care.
• There were clear responsibilities, roles and systems of accountability to support effective governance and management. The processes for managing risks, issues and performance were effective and well embedded.
• Leaders had the skills, knowledge and experience to lead the service. They had a clear vision for the service which was supported by the strategy. Staff were engaged with this vision and strategy.
• There was a highly positive culture. Staff were proud to work in the children and young people service, and came across as enthusiastic and motivated. They felt their input was valued and they worked as an inclusive team.

However:

• The children and young people’s service recognised a risk around their nursing and medical staffing. There were times when the nursing team were understaffed or there were non-compliant rotas. The medical cover at night and weekends needed improvement.
• Training for advanced paediatric life support required completion or updating to ensure more nursing staff could manage emergencies.
• The processes for cleaning toys did not evidence that children were protected from the risk of infection.
• There were no risk assessments for the environment or young people’s independent use of the adolescent room or quiet room. This posed a safety risk due to the number of ligatures and lack of staff supervision.
• The children’s theatre recovery area was not appropriately separated from the adult recovery area. We identified this as a concern at our previous inspection.
• Although pain was regularly assessed and managed, pain scores were not always clearly documented within patient records.

Updated 26 September 2018

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

• There were clearly defined and embedded systems, processes, and practices, which kept patients safe and safeguarded them from abuse.
• There was a positive and open incident reporting culture.
• Lessons were learned and themes identified. Action was taken and practice changed when things went wrong.
• There was good multidisciplinary team working. Staff on the unit and support services, such as physiotherapy, pharmacy, dietitians, and others were committed to working collaboratively to support patients.
• Patient flow in critical care had improved. There were limited delays for patients being admitted, discharged or moved to a ward at night.
• Leaders had the skills, knowledge, experience and integrity they needed. There was a strong commitment to delivering a safe service and saving lives.
• There were clear priorities for ensuring sustainable, compassionate, inclusive and effective leadership.
• Staff felt supported, respected and valued by senior managers in critical care and the surgical division. Staff we spoke with said there was a good team spirit, and were positive and proud to work for the unit
• The unit did not comply with modern building standards, which included adequate bed spaces and other safety features. This has been assessed and was well managed within the unit. There were plans to redevelop the unit in 2019.
• Not enough nurses had their post-registration qualification in critical care nursing.
• The unit did not offer a follow up clinic for patients admitted to critical care. This meant the unit was not fully compliant with National Institute for Health and Care Excellence (NICE) clinical guideline 83 “Rehabilitation after critical illness in adults”.

Updated 10 August 2016

We have judged end of life care overall to be outstanding because:

• Staff understood their responsibilities to raise and report concerns, incidents and near misses. They were clear about how to report incidents and we saw evidence that learning was shared across the teams.

• The staff in the palliative care team, bereavement and mortuary service were all up-to-date with their mandatory training.

• People’s care and treatment was planned and delivered in line with the latest guidance, standards and legislation. The trust had undertaken a range of service developments over the 18 months prior to our inspection to support the improvement of effective care for patients with end of life care needs. New documentation had been introduced to record a personalised care plan for a dying patient.

• The trust had undertaken a project over the 12 months prior to our inspection called the Conversation Project, whose objective was to improve the identification of the dying patient and their subsequent care.

• Patients were respected and valued as individuals and were empowered as partners in their care. The evidence was universally positive about the way they were treated by staff. Several patients and relatives stated they could not think of how the care could have been improved.

• We found that people’s individual needs and preferences were central to the planning and delivery of end of life care. The trust worked with services in the local community to provide continuity of care where possible and engaged with commissioners and community services to drive improvements. Staff were proactive in their approach to understanding individual patients’ needs and wishes and in their approach to meeting the needs of vulnerable people.

• We found some aspects of leadership, particularly that of the palliative care team to be outstanding. We found that nursing, medical and healthcare staff across the hospital were being engaged and motivated to improve the service they provided in respect of end of life care. There were clear governance structures for end of life care with the objectives of the end of life working group being clearly laid out and monitored. There was positive leadership at board level for end of life care.

• All staff we spoke with were very positive about the trust as a place to work.

Updated 27 March 2024

Updated 10 August 2016

We rated this service as good overall because:

• There were good systems in place for incident reporting and learning from when things went wrong.

• Systems were in place for the safe administration of medicines and for the prevention of infection.

• The departments were clean and tidy and they scored well within cleaning and hand hygiene audits.

• Nursing staffing was good in terms of numbers and skills within outpatients and diagnostic imaging departments,

• Staff were competent in the roles they were being asked to perform. There was good multidisciplinary working both within the trust and with other external organisations such as other health care providers. A comprehensive audit programme was in place across outpatients and diagnostic services.

• Staff treated patients as individuals, and showed them respect and treated them with dignity. Patients told us how professional, kind and caring staff were towards them and how they provided emotional support for their patients. The family and friends test showed very positive results. This was reiterated in the positive comments of the 40 patients we spoke with during our inspection.

• Good governance systems were in place across outpatients and diagnostic imaging. Staff told us how their immediate line managers and divisional managers were always available and felt their view were listened to and respected. Managers also told us how proud they were of their teams and the care they provided to patients. Staff put patients at the centre of everything they did and the trust supported them to do that with an open and honest culture. Staff and patients had opportunities to give their feedback on services and they felt listened to.

However:

• Staffing was more problematic with the medical staffing numbers. This was mainly because of senior doctors retiring and subsequent problems in recruiting suitably experienced and qualified staff.

• Within some specialties patients were waiting long periods of time for their appointments. The trust was working to resolve the waiting times and acknowledged they still had improvements to make. We saw evidence that complaints were discussed at departmental meetings and changes were made where necessary to help prevent further complaints. We observed good practice for patients with dementia and learning difficulties.

Updated 10 March 2021