Nuffield Health Haywards Heath Hospital

Updated 21 December 2017

Surgery is the main inpatient activity within Nuffield Health Haywards Heath. Surgical services cover a range of specialties including orthopaedics, urology, cosmetics and general surgery. The most common surgical procedures included cataract surgery and total hip replacements.

The hospital is set over three floors and has 27 beds, and a two-bedded area for closer post-operative observation. There are two main theatres (one with laminar flow) and a third theatre used for endoscopy and pain procedures without anaesthetic.

Outpatient activity comprised on average 60% of the total activity with inpatients and day cases comprising on average 40%. The majority of patients were adults aged 18 -75. The outpatient department, located on two floors of the hospital, comprised five general consulting rooms, two

ophthalmic (eye) rooms and two minor operation or treatment rooms, plus office and storage areas. The diagnostic imaging department, on the ground floor, included two x-ray rooms, an image viewing room, offices and stores. The physiotherapy department was located on the second floor and had three treatment rooms, an office, an equipment store and an exercise area.

Services for children and young people at Nuffield Health Haywards Heath consisted of outpatient appointments for children aged between three and 15. There were no inpatient stays for this age group. Patients aged 16 and 17 who attended the hospital were cared for under the adult pathway. The majority of patients accessed the service through a referral from their general practitioner (average of 80%) and were funded privately or through insurance policies.

The hospital had one ward and is registered to provide the following regulated activities:

• Diagnostic and screening procedures.

• Family planning.

• Surgical procedures.

• Treatment of disease, disorder, or injury.

Updated 21 December 2017

Nuffield Health Haywards Heath Hospital is operated by Nuffield Health. The hospital has 27 beds. Facilities include three operating theatres, including one with laminar flow, a two-bedded area for closer post-operative observation, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected all four core services. Because of the low numbers of patients receiving medical care at this service, we have reported this under the surgery section.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 07 – 09 November 2016.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated this hospital as good overall because:

• Staff confidently escalated any risks that could affect patient safety and we saw effective systems for reporting, investigating and learning from incidents.
• There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training for their roles. Completion rates for mandatory training including key topics such as safeguarding were better than the target set by the Nuffield Group.
• The hospital was visibly clean and there were appropriate systems to prevent and control healthcare associated infections. We saw that rooms were equipped with sufficient equipment and consumable items for their intended purpose. The waiting areas were spacious and well-appointed with amenities for refreshments and comfortable seating, including a variety of seat heights available to assist those recovering from surgery.
• Medicines were managed safely in accordance with legal requirements and checks on emergency resuscitation equipment were performed routinely.
• Staff responded compassionately when people needed help and support to meet their basic personal needs. Staff also respected people’s privacy and confidentiality at all times. Patients’ feedback through interviews and comment cards was positive.
• People were always made aware of waiting times and meals were offered to those delayed or in clinic over meal times. Any concerns or complaints were listened and responded to and feedback was used to improve the quality of care.
• We saw strong leadership at the location with an open and transparent culture. The hospital director used the Heads of Departments forum as a governance and performance management tool to maintain and improve the quality of the service. There was a clear vision and focused strategy to deliver good quality care.
• The governance framework ensured staff responsibilities were clear and that quality, performance and risks were all understood and managed. Services continuously sought to improve and develop novel approaches to enhancing care, such as exercise courses offered to the public.
• Staff were overwhelmingly positive about their experience of working at the hospital and showed commitment to achieving the provider's strategic aims and demonstrating their stated values. Staff told us they were supported by the hospital director and the new matron, both of whom were visible and approachable.
• We found evidence of multidisciplinary team (MDT) working across all of the areas we visited and we saw good collaborative working and communication amongst all staff in and outside the department. Staff frequently reported they worked well as a team and liked the “family” feel of the organisation.
• There were no delays in accessing surgical intervention once the patient was identified and had accessed the hospital’s booking systems. The hospital offered rapid access to diagnostic imaging and physiotherapy services, usually within a week. The hospital was above the 90% national referral to treatment (RTT) waiting time target for the majority of the year.

However, we found an area of practice that requires improvement in outpatients and children and young people’s services:

• During our inspection, we observed a number of outpatient records kept in a lockable filing cabinet in a utility room. We saw that these folders contained care notes for patients attending the clinic for dressings or other interventions. These records were stored separately from medical files we had previously viewed and were treatment notes held loosely in clear plastic wallets. Some had been labelled with a patient’s name and all were stored in an alphabetic filing system.
• Health and Social Care Act 2008 (Regulated Activities) Regulations 201417 (2) (c)states the provider must “maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided.”
• Keeping separate file notes in this manner did not meet the requirement of the regulation and because of this, our rating lowers to ‘requires improvement’ for safety. The way the records were kept added to the risk that papers could be separated or misfiled, which was an unsafe practice. We noted that this had occurred in a file our colleagues from the children’s team viewed. In addition, separating the medical records in this way made it harder for the consultant to monitor the results of treatments and the patient’s progress.

We found an area of practice that requires improvement in services for children and young people:

• Services did not meet the needs of their young patients fully because many facilities were shared inappropriately with adults, resulting in a lack of privacy and dignity for young patients, and there was a lack of resources available for this patient group.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected outpatients and children and young people’s services. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 24 March 2017

Children and young people’s services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as requires improvement because we found the way records were kept was insufficient and staffing levels and safeguarding training for all HCAs did not meet intercollegiate guidance.

• Health Care Assistants were only mandated to train to level one in child safeguarding, despite intercollegiate guidance recommending that level two is the minimum level required for non-clinical and clinical staff who have some degree of contact with children and young people and/or parents/carers.

• Although nurses working with children had experience, there were no paediatric nurses employed at the hospital.
• A Children and Young People’s Committee had been established with nine members but had yet to formally agree their terms of reference.
• The resuscitation trolleys were not equipped with a paediatric blood pressure cuff.

• Paediatric equipment kept on the resuscitation trolley was stored in an unsealed rucksack.

• There was little to do for children waiting for appointments other than use the colouring pencils that were kept behind the reception. There were no toys available for younger children.

However,

• We found that processes and protocols around child safeguarding were well embedded. All staff we spoke with had a good understanding of what they needed to do in the event of a safeguarding concern. This knowledge was further reinforced through clear flow charts being placed in prominent positions across the hospital. Furthermore, all staff received level one child safeguarding training annually.

• Mandatory training compliance was above 90% in all but one area and reached 100% in some key areas including safeguarding children at level two and three.

• The hospital was able to tailor care to the individual needs of the patient they were seeing. This was particularly evident in the way they worked to manage patients with special needs to attend dental appointments.

• The hospital had access to telephone interpreters if a patient or parent required it. Although this facility was available, no staff we spoke with had had cause to use it.

• The introduction of the children’s and young people’s (CYP) committee, which included staff from across the hospital, and the appointment of a CYP lead nurse, had given the services offered to children and young people a sharper focus.

Updated 24 March 2017

Outpatients and diagnostic imaging services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was caring, responsive and well led, although we found the way records were kept requires improvement.

• Overall, patients were protected from the risk of abuse and avoidable harm. Staff could confidently escalate risks that could affect patient safety and we saw effective systems for reporting, investigating and learning from incidents, which included the duty of candour if necessary.

• There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training for their roles. Completion rates for mandatory training including key topics such as safeguarding were better than targets set by the Nuffield Group

• Staff in all areas had a good awareness of Nuffield Health policies, which were based National Institute for Health and Care Excellence (NICE) guidelines and other national standards, such as the imaging practices agreed by the College of Radiology.

• Staff had undertaken local and national audits to monitor the quality, safety and effectiveness of care. Care was delivered by a range of skilled staff who participated in annual appraisals and had access to further training as required.

• We saw a variety of processes described to measure and audit patient outcomes in physiotherapy and radiology. For example, these included the use of patient-reported outcome measures (PROMs), a method of capturing the patient's opinion on the impact of their disease or disorder and the effect of the treatment.

• We found evidence of multidisciplinary team (MDT) working across all of the areas we visited and we saw good collaborative working and communication amongst all staff in and outside the department. Staff frequently reported they worked well as a team and liked the “family” feel of the organisation.

• For NHS patients, referral to treatment times were better than the England average. Outpatient and physiotherapy services offered extended hours during the week and outpatients also ran clinics on Saturdays if needed. Evening and weekend appointments allowed patients who worked to access healthcare that suited their circumstances

• People’s concerns and complaints were listened and responded to and feedback was used to improve the quality of care. There was an effective system for capturing learning from complaints and incidents, and there was good local ownership of any problems with teams working together to resolve issues that arose.

Updated 24 March 2017

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

We rated this service as good because it was safe, effective, caring, responsive to people’s needs and well-led.

Incidents, accidents and near misses were recorded and investigated appropriately. Incidents were discussed during departmental meetings and at handover, so shared learning could take place. Staff were familiar with the process for duty of candour and carried it out in practice.

• Risk assessments were completed at each stage of the patient journey from admission to discharge, with an early warning scoring system used for the management of deteriorating patients. The Five Steps to Safer Surgery checklist was completed and monitored appropriately.

• Although the hospital did not use a recognised staffing acuity tool, there were processes to ensure safe nurse staffing levels. All departments were appropriately staffed. Staff were flexible in working patterns to meet the needs of the service and patient requests. Staff turnover and sickness rates were low.

• Patients received care and treatment in line with national guidelines such as the National Institute for Health and Care Excellence (NICE) and Royal Colleges. The hospital participated in national audit programmes including performance related outcome measures (PROMS) and the National Joint Registry. Results showed patient outcomes were within expected levels when compared to national averages.

• Results from the Friends and Family test showed 99% of patients attending for surgery would be extremely likely to recommend the service to friends and family.

However,

• There was no compartmentalization in the roof space above the theatres. This meant in the event of a fire all theatres would need to be evacuated immediately rather than isolating the individual theatre.