New Hall Hospital

On this page

• 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

We assessed all the quality statements in the safe key question and found areas of good practice. Our rating for this key question has remained good. We found the service provided and maintained safe systems of care which were managed and monitored effectively. The service ensured there were enough staff to meet people’s needs, and they were competent, skilled and experienced. People who made complaints or raised concerns about their experience of care were listened to and leaders investigated these. Risks were well managed with staff and leaders acting to manage these in a timely manner. The service encouraged multidisciplinary working, with committed teams working well together to provide safe care.

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.

People said they were aware of how to give feedback and raise concerns as they had received leaflets, had been informed by staff or had observed posters describing how to do this.

Staff and leaders expressed there was an open culture of speaking up and people felt empowered and supported by leaders to challenge. This was especially noticeable in theatres, where staff of varying grades consistently spoke of a focus on patient safety and evidence-based care which enabled them to challenge if they had concerns. Staff were able to tell us about departmental, hospital-wide and national shared learning when things did not go well. They described a shared accountability, how incidents were reported and learnt from and their responsibilities to duty of candour. For example, we were given an example of shared learning on female genital mutilation, following a discussion on safeguarding. Staff described being able to raise concerns directly to senior leaders which resulted in improvements being made to improve patient care. When preoperative assessment clinic times were reduced from 60 minutes to 30 minutes, staff felt this was a compromise to patient care. They were able to meet with leaders to raise concerns, which resulted in appointment times being increased to 45 minutes. This demonstrated a good working system in learning from feedback. Leaders told us when concerns were raised, or an incident escalated, these were not overlooked or ignored, lessons were learned and shared, changes implemented and monitored.

There were clear processes for identifying and managing patient safety incidents with consistent delivery of a structured learning and improvement loop. When necessary, these were escalated via notifications to the relevant external bodies. Records demonstrated clear oversight of areas for improvement in each area of the hospital with ownership of learning and action plans delegated to named individuals. When things went wrong, learning was identified with consideration to system improvement and involvement of key stakeholders. Staff were supported where required, with improvements, learning opportunities and third-party employee support available. Patients were involved in discussions around learning and outcomes.

People said they were ‘always given a clear plan of care’ and they knew how to ask for help when they needed it.

Staff we spoke with said the multidisciplinary team worked well together to deliver consistency of care across the patient journey. They felt leaders, systems and processes supported them to deliver safe care. Staff could describe the process to transfer a patient who needed further care to another hospital, although this had happened rarely in the previous 12 months. Leaders recognised when improvements needed to be made. For example, on the ward, some routine procedures, like male catheterisation, were not being undertaken by nursing staff which meant that the resident medical officer had been attending to these. A programme was introduced to upskill and develop nursing staff to perform these routine procedures, enabling the resident medical officer to utilise their time more effectively.

External stakeholders said the hospital engaged with them to support care pathways across the network. They acknowledged systems working positively impacted on health and wellbeing of populations served.

The service had effective processes in place to ensure problems that could result in same-day cancellation were flagged early. This meant there had been no incidences, of same-day cancellation, in the June 2024 data we reviewed. They monitored cancellations and ensured re-booking of patients when this was appropriate. This service complied with National Institute for Health and Care Excellence (NICE) guidelines on frequency of consultant review, delivering a minimum of a daily clinical review following surgery. A doctor was always available on site to ensure monitoring and escalation of concerns. Emerging concerns could be escalated to the responsible consultant doctor out of hours. There were safe systems and supportive documentation enabling transfer of patients who required further care at the closest NHS Foundation Trust. For example, when patients needed medical care not provided at this service. When this happened, the service performed daily calls with the hospital, keeping in touch with the patient and providing updates to relatives as necessary. Following discharge, patients had follow-up appointments to monitor progress. There were arrangements that enabled patients to have queries or concerns addressed. The effectiveness of these processes was assessed in regular hospital governance meetings. Minutes of these meeting demonstrated oversight of incidents, how they occurred and what improvements were needed to mitigate these.

People felt comfortable to raise concerns if it was necessary and were involved in decision-making about their care.

Staff told us they understood how to raise and escalate safeguarding concerns. They were able to access relevant policies and procedures on the intranet and in local areas. A member of staff told us they had raised concerns about informed consent and had acted as an advocate, thereby safeguarding the best interests of the patient concerned. Leaders said planned and remote access to professional translation services were available, but not all staff we spoke with were aware of this. This meant that there could be lost opportunities for staff to engage with patients who did not speak English and were at risk of abuse or neglect. However, there were no safeguarding incidents reported in the last year.

The pre-assessment clinics assessed patient using specific inclusion/admission criteria to determine if the patient could be safely treated at the hospital. Patients with additional needs, like sensory and mobility impairments, were identified early at the pre-operative stage of the pathway. This enabled staff to manage any potential barriers to access, providing tailored person-centred care to match the needs of patients. Staff received safeguarding training specific to their role. However, training completion rates for some modules of safeguarding training did not reach the hospital’s benchmark target of 90% completion. For example, safeguarding adults level 2 face to face was 83% and safeguarding adults’ level 3 e-learning was 84%, but there was an action plan in place to address this. There was no onsite access to specialist mental health support, but should a patient require acute mental health crisis support, there was access to an in-hours onsite GP and the option for inpatient transfer to the local Trust.

Patients told us they were informed of risks related to their care and this was being managed in a safe way. During the pre-operative period, information and advice was provided to support people’s health, care and support needs. People were able to ask questions about this.

Staff understood and described how to identify, assess and reduce risks. There were routine ward handovers, local and twice daily hospital-wide team briefings enabling leaders to proactively review potential and actual risk. When there was a sudden deterioration in the condition of patients, staff felt well equipped to escalate concerns in a timely manner. They were able to tell us how they utilised nationally recognised tools, like National Early Warning scores, training opportunities and escalation pathways to respond. Leaders told us about a recent initiative to improve the experience of those who lived with sight and hearing impairments. Patients with lived experience were invited on site to raise awareness on specific accessibility needs in the hospital environment, meeting with staff and leaders to improve patient centred care.

The service had a policy that considered the diverse backgrounds and needs of people they served. This included processes for the assessment of environmental factors, the use of Dementia champions to support people and capacity assessments which helped staff to manage specific risks. At pre-assessment, processes were in place to ensure patients who had additional needs were involved in developing their care plans. This meant that patients and their relatives worked with healthcare professionals to manage risks and their expectations of surgery.

People told us they felt safe as staff responded quickly to call bells. If they needed any equipment or aids, these were made available to them.

Staff said they had received practical training to use specialist equipment. They were aware of the limitations of the equipment they used and how to check and maintain them. If there were any concerns around facilities or damaged and faulty equipment, staff knew how to report this. Some staff had raised risks around safe access to one of the operating theatres which meant mitigations were put in place. Simulation exercises were scheduled once a month, where teams undertook practiced activities which enhanced response planning and emergency preparedness. This tested the safety and effectiveness of existing systems and processes, enabling multidisciplinary shared learning. For example, a faulty piece of equipment was identified during simulation, despite recent servicing by an external contractor, and appropriate action was taken to rectify it.

We observed staff carrying out safety checks, such as completing daily safety checklists for the theatre environment, to ensure working environments were safe for use. These were specific to their responsibilities and the areas they worked in. The areas we visited in the hospital were visibly clean and corridors were free of clutter. We saw “I am clean” stickers were in use, but noted these were not consistently signed and dated in all areas which we visited. Staff could therefore not be assured equipment were clean and ready for use. We raised this with the manager who confirmed a reminder had been sent round to all staff to follow the correct process so staff would know which equipment was clean and available for use. Staff had described significant challenges around storage. In theatre areas, we observed several large pieces of surgical positioning equipment stored in the corridors, but leaders had mitigated these risks appropriately. The storage issue was also confirmed to be on the estates risk register to address.

Records indicated facilities, equipment and technology were well maintained and supported staff to deliver safe and effective care. Maintenance logs were kept, detailing estates faults, equipment asset registers alongside a department and hospital-wide risk register. The endoscopy unit had achieved Joint Advisory Group accreditation for the next 5 years, demonstrating the quality of the service reached a high standard. This meant they had met established standards set for clinical quality, patient experience and workforce training. The service demonstrated continued adherence by maintaining evidence logs to support compulsory annual review. Information regarding implanted medical devices, like hip and knee replacements, had been recorded on electronic patient records and shared with national reporting programmes. This complied with mandatory requirements for implantable medical device registry. The National Joint Registry had awarded quality data provider status to the service in 2023, recognising the standard of data shared. Audits were undertaken by leaders in different areas of the hospital which reduced the risk of bias. Facilities audits indicated compliance to Health Technical Memorandum standards in areas like fire safety, ventilation systems and water management. One standard in the Health and Safety audit had been marked as non-compliant and logged to the risk register. However, this exceeded fire safety standards was an additional standard according to organisational policy. Where a concern had been raised about the safety of a piece of equipment, this had been escalated from department to national level with a response shared and actioned within 12 working days. Patient safety risk management and mitigation were placed at the centre of decision-making. Key stakeholder views were represented and addressed at all stages of the process.

People told us they thought staff were well trained, appeared knowledgeable and were able to perform their job well.

Leaders in each area managed the staffing rota according to established safe staffing guidance. Shift rotas were planned based on the expected number of patients, their complexity and type of surgery planned. These were booked several weeks in advance, to ensure appropriate cover and skill mix was in place and in turn supported staff to maintain a healthy work-life balance. Safe staffing levels were reviewed by leaders twice daily and as the day progressed. When staffing levels were deemed to be below the expected standard, departments supported each other and were able to request extra staff to ensure continued safe delivery of care and appropriate skill mix. Staff could see their own mandatory training dashboard, access eLearning modules and undertake additional training that was of interest to them. Leaders told us they had a live view of training compliance, from a department to hospital wide view, enabling comparison across different areas of the hospital. The service had invested in upskilling their workforce, with leaders encouraging and supporting staff to access learning opportunities, growth pathways, mentor and buddy support.

We observed staffing levels displayed on boards in various areas of the hospital. The theatres staffing board indicated staffing levels were in line with or exceeding Association for Perioperative Practice (AFPP) guidance. Staff did not appear to be busy or rushed, undertaking tasks with a relaxed working atmosphere. Patients appeared to be at ease and satisfied with their level of care.

Data provided by the hospital showed staff were now up to date with most of their mandatory training modules, with compliance above 90% except for safeguarding. Departments used staffing tools to identify optimal staffing ratios according to demand and acuity as appropriate. Staff induction and orientation processes were supported by a detailed competency assessment programme, covering all clinical staff roles. This included competency assessments for temporary staff prior to independent practice. Preceptorship programmes were profession and registering body specific, lasting 6 weeks. These were also connected to the wider ongoing personal development plan. Education and development at the service was supported by external practice assessors and supervisors who linked in via the nursing student University programme. The service maintained low vacancy rates, utilising proactive recruitment processes to build resilience. Leaders reviewed practising privileges process for consultants working at the hospital. This provided assurance of consultant competency and transparency by comparison of surgical logbooks against declared volume of clinically coded procedures.

Patients told us the areas they had been in appeared to be clean and well-maintained.

Staff understood their roles and responsibilities towards infection prevention and control. They had access to an onsite infection prevention and control trainer and felt that leaders gave serious consideration when they raised concerns about infection prevention and control. Leaders reviewed all incidents of surgical site infection, comparing the service’s performance against organisational and national benchmarks. They met with key stakeholders to ensure they took appropriate actions when care was not delivered as expected and made improvements. For example, in October 2023, the service was not fully compliant with temperature monitoring for patients undergoing surgery in line with national best practice. Surgical site infection investigation records identified that during surgery, staff did not always record patient temperature every 30 minutes. This could impact on wound healing after surgery but had so far not impacted patient recovery. However, compliance with temperature recording had improved between October 2023 and April 2024 and it was no longer a concern.

We observed good clinical practice where staff completed appropriate hand hygiene techniques and followed correct procedures when preparing for and delivering patient care. In clinical areas, staff generally adhered to bare below the elbow, although we had observed some members of staff wearing wrist watches. Where there were no dedicated clinical handwashing facilities available, hand sanitisers were available and full. The operating theatre environment was fully compliant with national infection prevention and control building standards. This meant surgery took place in purpose-built facilities which were designed to support high standards of environmental hygiene.

The service had infection control policies and procedures which reflected NICE guidelines. Staff were able to access these on the service’s intranet system when they needed to. Audits had been undertaken at departmental and hospital level, covering areas such as handwashing practice, infrastructure and decontamination process including consultants, nursing and allied health professionals. In response to infrastructure audit reports, leaders actioned estates repairs and ordering of chemical spillage kits to resolve areas of concern.

The service monitored surgical site infection (SSI) data and reported this to the UK Health Security Agency. The data indicated normal performance for hip and knee SSIs against national benchmarks. Data for spinal SSIs was collected and monitored, although no national benchmark was in place at the time of this assessment.

Patients told us staff were responsive to request for pain relief.

Staff and leaders told us there had been a period of transition with the pharmacy service where there had been no onsite pharmacist support which made management of medicines stocks challenging. The service had employed a lead pharmacist since then and staff reported they now felt well supported.

Medicines cabinets were noted to be locked when not in use as per provider policy. The controlled drugs registers, medicines and medical gas cylinders we checked were compliant, stored securely and well organised, despite storage limitations. Fridges for storage of medicines were manually monitored, with temperature logs completed daily. Ambient room temperature records in storage rooms held temperature audits which had been completed daily. Substances hazardous to health were safely stored in locked cabinets, reducing risk of harm to people. On review of patient records, medicines charts were fully compliant, which included prescriptions for oxygen. Sealed sharps bins were not always labelled with appropriate identifying information, such as place of origin or usage date. This meant the service could not always ensure traceability of hazardous waste in accordance with duty of care. This was raised with leaders who addressed this immediately.

Medicines policies were standardised nationally across all hospital sites. When the service did not have a lead pharmacist in post, they utilised support from other Ramsay hospital sites to manage medicines safely. The service developed standardised antibiotics protocols across all surgical specialities, involving stakeholders within the service and external stakeholders like the local NHS Trust. These followed national best practice guidelines on safe prescribing and surgical site infection prophylaxis, reducing variation in practice. The service developed standardised antibiotics protocols across all surgical specialities, involving stakeholders within the service and external stakeholders like the local NHS Trust. These followed national best practice guidelines on safe prescribing and surgical site infection prophylaxis, reducing variation in practice.