PERFORMANCE: The Care Quality Commission has ordered Great Western Hospitals Foundation Trust to make improvements to the safety of its operating theatres.

CQC inspectors visited the trust in December in response to reports of two never events, one of wrong site surgery and one of wrong implant. They found staff had begun to use the World Health Organisation surgical checklist more “regularly” and “thoroughly” since the never events but communication between staff was still poor.

They concluded patients were not “adequately protected from the risk of receiving unsafe treatment during surgical procedures”.