Nuffield Health Warwickshire Hospital

Updated 10 March 2017

Nuffield Health Warwickshire Hospital is operated by Nuffield Health. The hospital opened in 1981. It is a private hospital in Leamington Spa, Warwickshire. The hospital primarily serves the communities of Warwickshire. It also accepts patient referrals from outside this area.

The hospital has had a registered manager in post since February 2016.

The hospital also offers cosmetic procedures such as dermal fillers. We did not inspect these services.

Updated 10 March 2017

Nuffield Health Warwickshire Hospital is operated by Nuffield Health. The hospital has 42 beds. Facilities include three operating theatres, an endoscopy suite 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 of these services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 and 7 December 2016, along with unannounced inspections to the hospital on 14 and 21 December 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.

Services we rate

We rated this hospital as good overall.

We found good practice in relation to medicine:

• Staff understood their responsibilities to report incidents and were aware of the duty of candour regulation of being transparent, open and honest. Lessons learned from incidents were shared among the team.
• Areas were visibly clean, tidy and staff complied with infection prevention and control policies, such as hand washing.
• Equipment was appropriately maintained and cleaned in line with guidance.
• Staff monitored patients appropriately during procedures and used the national early warning scores to detect clinical deterioration.
• Patients were pleased with the care received and were kept informed and involved in the treatment plans. We saw patients being treated with dignity and respect.
• Staff we were able to describe their responsibilities related to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and patient’s consent was obtained in line with hospital policy.
• We found there was appropriate local leadership, a positive working culture and a governance meeting structure within medical services.

We found good practice in relation to surgery:

• Incidents were reported, there was feedback for staff and lessons were learnt.
• There were processes in place to ensure that the hospital was clean.
• Patients were appropriately assessed prior to surgery and there were processes in place to transfer patients should they require a higher level of care.
• Comprehensive risk assessments were carried out for patients and risk management plans were developed in line with national guidance.
• The service had an effective system to regularly assess and monitor the quality of its services to ensure patient outcomes were monitored and measured.
• Patients were treated with dignity, compassion and empathy.
• Theatres managed operating lists with flexibility, to meet patient’s individual needs.
• There were no waiting lists and patients were seen within one to two weeks from their referral.
• There was a clear governance structure in place with committees for medicines management, infection control and health and safety.
• Staff we spoke with were motivated and positive about their work, and described all members of the senior management team as approachable and visible.

We found good practice in relation to services for children and young people (CYP):

• Investigations of incidents, comments and complaints identified where improvements were needed and these were acted upon in CYP services.
• Staff complied with infection prevention procedures and healthcare-associated infection rates were low.
• CYP had their needs assessed, care planned and delivered in line with national guidelines.
• Policies and procedures reflected current guidelines and adherence was monitored with a schedule of local audits.
• CYP were assessed through pre-assessment clinics for their suitability to undergo treatment at the hospital.
• Staff were aware of their responsibilities surrounding consent and staff understood their responsibilities under the Mental Health Act 2005 and the Children Act’s 1989 and 2004.
• Governance arrangements ensured appropriately trained staff cared for CYP at all times.
• Parents and children we spoke to told us how caring and supportive staff were and how staff went out of their way to make the hospital ‘child friendly’. This was also reflected in the positive feedback in patient satisfaction surveys completed by children and their parents.

We found good practice in relation to outpatients and diagnostic imaging:

• There was a good track record of safety in the outpatients and diagnostic imaging departments.
• There was a positive attitude towards learning from incidents and sharing learning with other departments.
• All staff had an understanding and awareness of duty of candour principles.
• There were good processes in place to ensure that equipment was stored, maintained and used safely.
• Care was planned and delivered in line with national guidance and best practice guidelines.
• There was an effective process of cyclical audits to identify areas for improvement and best practice.
• Staff worked together to plan and assess care for patients.
• Patients we spoke with told us that staff were kind, caring and respectful.

We found areas of outstanding practice in surgery and services for CYP:

• The hospital held regular open events for the public, whereby, they could visit the hospital and attend sessions about a variety of procedures or conditions, such as varicose veins.
• A consultant surgeon would hold ‘lunch and learn’ sessions with the local GPs, to discuss what procedures they carried out at the hospital.
• A large toy car was stored in the play area for children who wanted to drive themselves to theatre for their operation rather than walking or being transported on a hospital bed.
• CYP attending pre-assessment were shown the type of equipment that would be used when they were admitted to hospital. For example, syringes, cannulas and blood pressure cuffs. Younger children had the equipment demonstrated on ‘Nuffy Bear’ (Nuffield Heath toy bear) and were able to familiarise themselves by playing with the equipment.
• A CYP satisfaction survey had been developed to capture service user feedback from children, young people of all ages and their parents. The survey responses were small (six) as this was a pilot of a small service. All responses were positive and praised the care and support of all the staff the child and their parent had come in contact with throughout their care episode. The survey encouraged younger children to draw their experiences on the form. For example, a child had depicted themselves as having ‘new super powers’ following their surgery. The survey had been piloted, and following a review would be circulated to all CYP attending the hospital in early 2017.

We found areas of practice that require improvement in medicine:

• Audit results for the endoscopy and oncology patients were not captured separately in the hospital’s local audit programme. This meant that information for medical services to assess the effectiveness of care and treatment they provided, was not available.
• We were not assured that the oncology service routinely collected and monitored information about the outcomes of patient’s care and treatment to ensure that the intended outcomes were achieved.
• Medicines were not always stored at an appropriate temperature in the clinical room on the oncology unit. However, actions were being taken to reduce the risk of reduced efficacy of medicines.
• There were inconsistencies with the documentation of the World Health Organisation safer surgery checklist in endoscopy.

We found areas of practice that require improvement in surgery:

• Not all risks were identified on the hospital risk register.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ted Baker

Deputy Chief Inspector of Hospitals

Updated 10 March 2017

Medical care 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.

Medical care at this hospital included endoscopy and oncology services.

The endoscopy service provided upper and lower gastrointestinal endoscopy, urological endoscopic investigations and urodynamic investigations.

The oncology service offered an ambulatory chemotherapy service to patients who attended for treatment on a day case basis.

We rated this service as requires improvement. It was rated requires improvement for effective and well-led, and good for safe, caring and responsive.

• Audit results for the endoscopy and oncology patients were not captured separately in the hospital’s local audit programme. This meant that information for medical services to assess the effectiveness of care and treatment they provided, was not available.

• We were not assured that the oncology service routinely collected and monitored information about the outcomes of patient’s care and treatment to ensure that the intended outcomes were achieved.

• The provider recognised that the oncology service was not meeting the national guidance regarding improving outcomes for patients with haematology cancers. We saw that appropriate actions were being taken to address this situation.

• Medicines were not always stored at an appropriate temperature in the clinical room on the oncology unit. However, actions were being taken to reduce the risk of reduced efficacy of medicines.

• There were inconsistencies with the documentation of the World Health Organisation safer surgery checklist in endoscopy.

However:

• Staff understood their responsibilities to report incidents and were aware of the duty of candour regulation of being transparent, open and honest. Lessons learned from incidents were shared among the team.

• Areas were visibly clean, tidy and staff complied with infection prevention and control policies, such as hand washing.

• Equipment was appropriately maintained and cleaned in line with guidance.

• Staff monitored patients appropriately during procedures and used the national early warning scores to detect clinical deterioration.

• Patients were pleased with the care received and were kept informed and involved in the treatment plans. We saw patients being treated with dignity and respect.

• The oncology service offered pre-assessment appointments for patients before they started chemotherapy treatment.

• Healthcare records were easy to access, well completed and included the use of care pathways and risk assessments.

• The endoscopy service used an electronic management system, which enabled on-going audit and procedure reports to be provided to the patient at the end of the endoscopy.

• Staff we were able to describe their responsibilities related to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and patient’s consent was obtained in line with hospital policy.

• We found there was appropriate local leadership, a positive working culture and a governance meeting structure within medical services.

Updated 10 March 2017

Children and young people’s (CYP) 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 outstanding. We rated it outstanding for caring and responsive. Safe, effective and well-led were rated good.

• A large toy car was stored in the play area for children who wanted to drive themselves to theatre for their operation rather than walking or being transported on a hospital bed.

• CYP attending pre-assessment were shown the type of equipment that would be used when they were admitted to hospital. For example, syringes, cannulas and blood pressure cuffs. Younger children had the equipment demonstrated on ‘Nuffy Bear’ (Nuffield Heath toy bear) and were able to familiarise themselves by playing with the equipment.

• A CYP satisfaction survey had been developed to capture service user feedback from children, young people of all ages and their parents.

• Parents we spoke with felt informed and their children were treated as individuals.

• Staff provided information for parent and children in suitable formats.

• Parents and children we spoke to told us how caring and supportive staff were and how staff went out of their way to make the hospital ‘child friendly’. This was also reflected in the positive feedback in patient satisfaction surveys completed by children and their parents.

• Investigations of incidents, comments and complaints identified where improvements were needed and these were acted upon in CYP services.

• Staff complied with infection prevention procedures and healthcare- associated infection rates were low.

• CYP had their needs assessed, care planned and delivered in line with national guidelines.

• Policies and procedures reflected current guidelines and adherence was monitored with a schedule of local audits.

• CYP were assessed through pre-assessment clinics for their suitability to undergo treatment at the hospital.

• Areas used were not dedicated solely for use by CYP. However, CYP had their individual needs assessed and plans were put in place to meet those needs wherever possible. This was to make the hospital stay less traumatic.

• Staff were aware of their responsibilities surrounding consent and staff understood their responsibilities under the Mental Health Act 2005 and the Children Act’s 1989 and 2004.

• Governance arrangements ensured appropriately trained staff cared for CYP at all times.

• There were processes and procedures in place for staff to manage CYPs pain and to ensure their hydration and nutrition needs were met.

• There was CYP representation at leadership and local meetings at the hospital.

• CYP champion roles were in place in all departments to ensure engagement and understanding of CYP issues across the hospital.

• There were systems in place to ensure staff were competent to provide effective care. Annual appraisal and registration checks were carried out. Emergency scenario training to care for the sick child had been implemented hospital wide.

Updated 10 March 2017

Overall, we rated the outpatients and diagnostic imaging service as good because:

• There was a good track record of safety in the outpatients and diagnostic imaging departments.

• There was a positive attitude towards learning from incidents and sharing learning with other departments.

• All staff had an understanding and awareness of duty of candour principles.

• There were good processes in place to ensure that equipment was stored, maintained and used safely.

• Care was planned and delivered in line with national guidance and best practice guidelines.

• There was an effective process of cyclical audits to identify areas for improvement and best practice.

• Staff worked together to plan and assess care for patients.

• Patients we spoke with told us that staff were kind, caring and respectful.

• There were effective governance arrangements in place to support the delivery of quality care and the hospital’s strategy.

Updated 10 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.

Staffing was managed jointly with medical care.

We rated this service as good because it was safe, effective, caring, responsive and well-led.

• Incidents were reported, there was feedback for staff and lessons were learnt.

• There were processes in place to ensure that the hospital was clean.

• Patients were appropriately assessed prior to surgery and there were processes in place to transfer patients should they require a higher level of care.

• There were safe systems in place to manage medicines.

• Staff we spoke with were able to tell us what steps they would take if they were concerned about potential abuse to their patients or visitors.

• Comprehensive risk assessments were carried out for patients and risk management plans were developed in line with national guidance.

• Pain was assessed and managed pre and post operatively. Effective tools were used.

• The service had an effective system to regularly assess and monitor the quality of its services to ensure patient outcomes were monitored and measured.

• Patient records showed there was routine input from nursing and medical staff and allied healthcare professionals, such as physiotherapists.

• Patients were treated with dignity, compassion and empathy.

• Theatres managed operating lists with flexibility, to meet patient’s individual needs.

• There were no waiting lists and patients were seen within one to two weeks from their referral.

• There was a clear governance structure in place with committees for medicines management, infection control and health and safety.

• Staff we spoke with were motivated and positive about their work, and described all members of the senior management team as approachable and visible.

  However:

• Staff turnover was higher than the average for independent hospitals. This had been recognised by the hospital and had plans in place.

• Not all risks were identified on the hospital risk register.