Cobham Day Surgery

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment, we rated this key question as good. At this assessment, the rating has remained as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Records showed patients received a comprehensive pre-operative assessment from the anaesthetist. During the assessment, we reviewed 4 patient care records. The records demonstrated staff carried out a review of medical history, allergies, current medicines, previous anaesthetic history, lifestyle factors, and any risks that could affect airway management or recovery.

Staff explored communication needs and any additional support requirements which demonstrated the service considered both clinical and individual needs when assessing people. Staff told us an interpretation service and braille information were available when needed. Word-free picture stories were used to support patients with a learning disability. We saw individual care plans for patients with learning or physical disabilities, showing that risks were considered on a personalised basis.[MO1] These plans reflected each person’s health status, wellbeing, communication needs, and any reasonable adjustments required. For example, we saw evidence that a highly anxious patient was requested to be first on the operating list. This showed staff adapted care in response to assessed needs.

We saw staff consistently checked patients’ identities when collecting them and recorded physiological observations in line with policy. Pre-assessment plans were thorough and provided a clear basis for safe and effective assessment.

We saw staff kept clear and up-to-date care records during surgery. They reviewed and amended plans where required to ensure care remained safe, appropriate, and effective throughout the patient’s journey.

We scored the service as 3. The evidence demonstrated a good standard. The service planned and delivered care and treatment with people, taking account of what was important to them. Care was provided in line with legislation, national guidance and current evidence-based standards.

The service developed and reviewed clinical guidelines and policies to ensure these were aligned with national guidance. Staff accessed clinical guidelines and policies via the intranet and staff knew where to find them. There were clear processes to ensure policies remained up to date, with regular review through service and management board meetings.

Care and treatment followed evidence-based practice. For example, patients undergoing surgery received fluids in line with national guidance and staff assessed them for nausea and vomiting to support safe recovery. The service had a Venous Thromboembolism (VTE) policy which followed national guidance such as including the use of anti-embolism stockings and clear discharge advice. VTE is a serious, potentially fatal medical condition where a blood clot forms in a vein, typically a leg.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The organisation had a large administrative bookings team, structured by specialty. Staff were responsible for arranging surgical lists and gathering detailed patient information at the point of booking. Administrative staff told us the service was well organised, and systems enabled them to collect and record relevant information, which was shared with the clinical team to support safe and effective care planning.

We saw evidence of regular multidisciplinary team (MDT) meetings within the service and communication with external healthcare providers. This supported joined up working and continuity of care. For example, we reviewed records showing the organisation liaised effectively with an external healthcare partner regarding a patient’s concerns about ongoing treatment being provided across two hospitals. This demonstrated coordinated working to support the patient’s overall care.

We observed detailed and structured handovers between theatre staff when patients moved into and out of surgery. Information shared included clinical needs, risks and any specific support requirements. Staff described positive working relationships across teams, including care co-ordinators and discharge teams. These effective handovers and communication processes supported continuity, safety and a smooth patient journey.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service provided pre-operative assessments for patients referred for surgery. They had strict criteria for patients who could be safely treated at the service. Staff gave general advice, but the service did not run specific pre-operative optimisation programs to prepare patients for surgery. Staff gave patients advice about preparing for surgery and fasting before coming in for surgery.

The service offered follow-up appointments when this was needed. Sometimes the referring NHS hospital carried out these appointments.

Where appropriate, staff provided lifestyle advice, including support with smoking cessation and reducing alcohol intake, to help lower risks before surgery.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service monitored outcomes through regular review of incidents, patient feedback, complaints, and compliments. They completed clinical audits to measure safety and effectiveness. These included audits of venous thromboembolism (VTE) risk assessments, surgical site infections, and unplanned re-admissions within 30 days of surgery. This enabled the service to identify risks, spot trends, and make improvements where needed. For example, feedback from one patient highlighted a lack of clear advice about how to access pre-procedure medication. Leaders shared this with staff through internal communication, and reviewed processes to improve information given to patients. This demonstrated that feedback was acted upon to improve patient experience.

The provider participated in 3 national audits and 33 local audits to monitor the quality of care. The service reviewed audit findings and used this to drive improvement. For example, the service completed audits to check the correct surgical site was marked before surgery and to ensure staff completed safety checklists before procedures. When audits identified areas for improvement, leaders developed action plans and monitored them to ensure changes were implemented. Staff shared learning from audits to improve practice.

The service monitored quality and effectiveness through established governance processes. Minutes from service lead and management board meetings showed that patient outcomes, audit results, and incidents were regularly discussed. The service shared learning from audits, incidents, and complaints with staff through daily meetings, training and newsletters to support consistent practice and ongoing improvement.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood their role and responsibilities regarding the Mental Capacity Act (2005). They understood the importance of consent when speaking with or delivering care to patients. Staff always assumed patients had capacity to speak with them or to make decisions unless they found evidence to suggest otherwise.

Staff gave patients clear information about what they were consenting to which included information about risks. Staff gave patients information leaflets and checked that patients had read and understood them. Staff also gave patients the opportunity to ask questions before giving consent.

The organisation had a clear consent policy, and staff completed training in relevant areas, including the Mental Capacity Act, Deprivation of Liberty, Mental Health, Dementia and Learning Disability. Mandatory training completion rates were high.

For patients who might have impaired mental capacity, a ‘best interests’ assessment was carried out by trained staff. When patients lacked capacity, the policy stated decisions were made in their best interests, taking into account the person’s wishes and feelings. This demonstrated that consent was sought and respected in line with good practice and legal requirements.