17th and 18th October 2016
During a routine inspection
The McIndoe Centre is operated by Horder Healthcare. The hospital has 19 beds. Facilities include three operating theatres, although one was decommissioned and under refurbishment at the time of inspection and outpatients. The hospital offers a wide range of surgical procedures, including, orthopaedics, general surgery and ophthalmology,
We inspected surgery and outpatient services.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17th and 18th October 2016 along with an unannounced visit to the hospital on 21st October 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.
Horder Healthcare had a strategy in place. At the McIndoe Centre the strategy included the provision of a therapeutic location by carrying out a full refurbishment of the hospital, to provide an orthopaedic service along similar standards to that of the Horder Centre, the other location at which services are provided ) and to invest in the staff to provide appropriate training and development to support practice.
The Interim clinical services manager and executive lead were visible on the floor and used a variety of strategies to communicate the vision such as staff forums, weekly communications bulletins, staff meetings, and individual objective setting as part of appraisal process
Staff knew the vision for the hospital and plans to develop it. The refurbishment programme in theatres was underway and staff were aware of the introduction of the orthopaedic service.
All the staff we spoke with on the ward,in theatre and in outpatients told us they were encouraged to report incidents using the electronic reporting system. Lessons learnt from incidents were regularly communicated through handovers, staff meetings, weekly communications bulletin, and information being placed in the ward communications board.
The Medical Advisory Committee (MAC) meetings took place quarterly and practicing privileges, quality assurance and new national guidelines were discussed along with key points from the Governance meetings.
The hospital has one employed Resident Medical Officer (RMO) and an agency RMO covering alternate weeks They are onsite 24-hours day seven days a week, on a rotational basis. The RMO undertook regular ward rounds to make sure the patients were safe.
The ward manager completed duty rotas two weeks in advance and any change on the day was clearly documented. Staff worked flexible hours to cover the rota and shifts included day, night, and twilight. Staff told us that extra patients can be added to the ward list up until the last moment which meant the ward was not always staffed safely.
At the quarterly Clinical Governance meeting the Director of Clinical Services, senior Clinical Managers, the Medical Director, the Chairman of the MAC, the lead Consultant Anaesthetist, the Resident Medical Officer and, where appropriate, other staff members and healthcare professionals review complaints and any trends identified. A summary of the Clinical Governance report was shared with the Medical Advisory Committee. Clinical complaints were reviewed at the Clinical Focus Group.
We saw a strong safety culture with policies and systems in place, and we saw that staff reported incidents appropriately.
There were robust governance systems that were known and understood by staff and which were used to monitor the provision and to drive service improvements.
We observed the staff on the unit being very kind, caring, and compassionate towards their patients. All patients and relatives we spoke with told us staff always introduced themselves, were polite, and treated them nicely.
We found areas of practice that required improvement in surgery.
In anaesthetic room one we saw the anaesthetic machine had incomplete checks on at least three occasions. This was not in line with the guidance for daily pre use checks from the Association of the Anaesthetists of Great Britain and Ireland (AAGBI) which provides assurance that anaesthetic machines work safely. The anaesthetic machine in theatre one also showed missed checks.
Professor Edward Baker
Deputy Chief Inspector of Hospitals (London and the South East)