The Cherwell Hospital

Horton Treatment Centre, operated by Ramsay Health Care UK, is an independent hospital based in Banbury. The hospital is located on the site of an NHS acute trust. The hospital has 40 registered beds, across 28 single or double rooms. Facilities include three operating theatres, a purpose built ambulatory care unit, physiotherapy, and outpatient and diagnostic facilities including a radiography department.

The hospital provides elective (planned) orthopaedic and spinal surgery, outpatients and diagnostic imaging. We inspected all of these services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 December 2016, along with an unannounced visit to the hospital on 19 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.

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.

Services we rate

We rated this hospital as good overall.

• Staff knew the process for reporting and investigating incidents using the hospitals reporting system. They received feedback from reported incidents and felt supported by managers when considering lessons learned.
• Staffing levels and skill mix were planned and reviewed to keep people safe at all times. Although the service used agency staff, wherever possible regular bank and agency staff were employed who were inducted and familiar with the service procedures. Medical staff practicing privileges were monitored to ensure doctors were suitable and safe to work in the service.
• Patient’s care and treatment was planned and delivered in line with evidence-based guidelines.
• Feedback from patients about their care and treatment were mostly positive. We observed patients were treated with kindness, compassion and dignity throughout our visit. We saw patient information leaflets explaining procedures and after care arrangements.

We found good practice in surgery:

• Staff completed comprehensive patient risk assessments from the initial pre-assessment clinic through to discharge. Care was provided in-line with national best practice guidelines and outcomes for patients were better than average. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.
• Patients had assessments of their needs and access to different methods of pain relief. Staff monitored and responded to patients’ pain levels appropriately.
• The hospital treated 100% of NHS patients within 18 weeks of their referral from July 2015 to June 2016.

We found good practice in relation to outpatient and diagnostic services:

• There were efficient systems to keep patients safe and to allow staff to learn and improve from incidents.
• There was effective multi-disciplinary working with informative handovers, good record keeping and communication.
• The service was planned and delivered to meet people’s individual needs.
• The leadership, governance and culture promoted the delivery of high quality person-centred care.

We found areas of practice that require improvement in surgery:

• We were not assured that the World Health Organisation (WHO) five steps to safer surgery checklist was completed consistently with patients undergoing local anaesthetic procedures. This increased the potential risk of a patient safety incident occurring.
• In the theatre, the scrub area that facilitated two theatres was open to the main corridor. Staff were not aware this was not ideal as infection control standards could be compromised.

We found areas of practice that require improvement in outpatient and diagnostic services:

• Nursing staff had been applying plaster of Paris casts without formal competencies in place. There was no assurance that staff were competent to undertake this task.
• There was no evidence of an audit trail on the use of prescription pads.
• We were not assured that mandatory training completed elsewhere had been checked to ensure it covered the required elements.

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. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals