The Droitwich Spa Hospital

Updated 23 April 2019

The Droitwich Spa Hospital is operated by BMI Healthcare Limited. The hospital opened in 1988. In 2013, the hospital opened an additional wing which provided extra bedrooms and consulting rooms. The hospital is located in the town centre of Droitwich and has its own private car park. The hospital primarily serves the communities of Worcestershire. It also accepts private patient referrals from outside this area.

The hospital’s registered manager has been in post since August 2013. The hospital is regulated to provide treatment of disease, disorder or injury: surgical procedures, family planning and diagnostic and screening procedures.

All patients are admitted and treated under the direct care of a consultant and medical care is supported 24 hours a day by an onsite resident medical officer (RMO). Patients are cared for and supported by registered nurses, health care assistants, allied health professionals, such as physiotherapists and pharmacists, who are employed by the hospital.

The most common procedures undertaken were phacoemulsification of cataract with lens implant (cataract removal) followed by colonoscopy and gastroscopy procedures.

We carried out an unannounced inspection on 22 and 23 January 2019 and a short-announced inspection on the 8 February 2019.

Updated 23 April 2019

The Droitwich Spa Hospital is operated by BMI Healthcare Limited. The hospital has 46 registered beds offering ensuite facilities, satellite television and telephone amenities. Facilities include three operating theatres, an endoscopy unit, 11 outpatient rooms and diagnostic services including X- ray and magnetic resonance imaging (MRI) and a physiotherapy department.

The hospital provides a range of surgical procedures, outpatient clinics and diagnostic imaging facilities. During our inspection we visited all services within the hospital. Services included surgical procedures and outpatient appointments for preoperative and postoperative review, as well as outpatient treatments such as naso-endoscope and dermatology procedures. In the reporting period of August 2017 to July 2018, there were 683 inpatient procedures, 3,823 day-case episodes of care and 18,731 outpatient attendances. The outpatient appointments were a combination of patients accessing treatment and surgical outpatient consultations.

We inspected this service using our comprehensive inspection methodology. We carried out unannounced visits as part of the inspection on 22-23 January 2019 and 8 February 2019.

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 will also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

Services we rate

Our rating of this hospital/service stayed the same. We rated it as Requires improvement overall.

We found the following issues that the service provider needs to improve:

• Not all risk assessments were completed effectively in line with the hospital policy. All consultants are required to complete the venous thromboembolism (VTE) decision box, following assessment, to ensure that patients at risk are identified and appropriately treated
• In the diagnostic imaging service, processes were not in place to ensure quality testing programmes were completed and that diagnostic reference levels were created and monitored.
• Clinical audits were not completed within the diagnostic imaging service.
• Outstanding recommendations following external audits within the diagnostic imaging service required completion and review.
• Appraisal reviews and mandatory training compliance for some staff was below the hospital target.
• Regular reviews of the backlog of NHS patient record coding to promote assurance that future obligations are met.
• Ensure that sinks and taps conform to Health Building Note 00-10 ‘Part C Sanitary Assemblies’, in clinical areas to allow correct hand hygiene practices.
• The World Health Organisation’ five steps to safer surgery’ checklist for all surgical procedures carried out in the operating theatres were not always completed within all operative specialties.
• Not all radiography staff had completed the appropriate training and competencies regarding radiation risks and regulations in line with IR(ME)R 2017.
• Processes and procedures are required to be in place to record and audit consent.
• Agency staff within the diagnostic imaging department require specific induction for radiographers.
• To maximise efficiency of operating department time and available staffing resources effective working processes should be developed across departments, within the hospital.

We found good practice within the services:

• Services within the hospital such as surgery, medicine and outpatients provided mandatory training in key skills to staff.
• The surgical and outpatient services followed best practice when prescribing, giving and recording medicines. Storage of controlled medicines followed best practice. Patients received the right medication, at the right dose, at the right time.
• Surgical services in the hospital provided care and treatment based on national guidance and there was evidence of its effectiveness.
• The hospital controlled infection risk well. Staff kept themselves, equipment and the premises clean.

• There was effective multidisciplinary working across the hospital. Staff in different teams worked together to benefit patients. Doctors, nurses and other healthcare professionals, supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients were treated with dignity, respect and kindness during all interactions with staff.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment. They were communicated with and received information in a way that they could understand.
• Hospital services were planned and developed to meet the needs of the local population for both private and NHS patients.
• The service had suitable premises and equipment. Hospital premises were clean, well maintained, and suitably equipped. There was an equipment replacement programme to ensure that all large items of equipment were replaced when they became outdated.

• All services within the hospital engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
• The hospital was committed to improving by learning from when things went well or wrong, promoting training and innovation.

• Managers across the hospital promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• People could access the service when they needed it. Waiting times from treatment were and arrangements to admit, treat and discharge patients were in line with good practice.

Following this inspection, we told the provider that it must take some actions to comply with the regulations. Additionally, it should make other improvements, even though a regulation had not been breached, to help the service improve. We issued the provider with three requirement notices that affected diagnostic imaging, outpatient services and surgery. Details are at the end of the report.

Amanda Stanford

Acting Deputy Chief Inspector of Hospitals (Central)

Updated 23 April 2019

Endoscopy services were a small proportion of hospital activity and will be reported under the medical care sub heading. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good in safe, responsive and well led. Effective and caring were not rated as there was not enough evidence to do so.

Updated 23 April 2019

We rated this service as inadequate in safe and well led. Caring and responsive key question were rated as good, the effective key question was not rated within this core service.

Updated 23 April 2019

We rated this service as good in safe, caring, responsive and well led. We do not rate effective in outpatients.

Updated 23 April 2019

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 in effective, caring, responsive and well-led. The safe key question was rated as requires improvement.