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Inspection carried out on 17 January 2017

During a routine inspection

Horder Healthcare is the provider for The Horder Centre (THC), an independent provider of surgery and outpatient services. 

The centre mainly undertakes elective orthopaedic procedures and a small amount of procedures for the relief of pain, for example epidurals (a pain relieving medicine injected into the back).

The centre undertakes a variety of orthopaedic operations including, hip replacements, knee replacements, foot surgery, ankle surgery, shoulder surgery and hand surgery.

Surgery is only performed on patients aged 18 years and over.

There were 5,456 inpatient and day case episodes of care recorded at the centre between October 2015 and September 2016, of these 94% were NHS funded and 6% were other funded.

Forty five percent of all NHS funded patients and 55% of all other funded patients stayed overnight at the hospital during the same reporting period.

The most common procedure undertaken in this period was major hip procedure, which accounted for 17% of all procedures. Major knee procedure was the second most commonly performed procedure and accounted for 13% of all procedures.

There are 42 single inpatient bedrooms with en-suite facilities, a gym for patient use, a discharge lounge and three pre-assessment rooms.

There are three laminar flow theatres (a system that circulates filtered air to reduce the risk of airborne contamination) with a recovery area and a separate 16 bed day care unit.

There is also a therapy garden, which has been developed for the use of patients.

In addition, there is a theatre sterile supply unit (TSSU) that is also located alongside the theatres. This is used to clean and sterilise all the hospital’s surgical instruments.

The diagnostic imaging services is managed by Medical Imaging Partnership (MIP) a separate company, under a service level agreement (SLA) and therefore not included as part of this inspection.

The outpatient department had 17,167 total attendances in the period October 2015 to September 2016, which is an average of 1,406 a month. The majority of appointments were funded through the NHS accounting for 98% with the other 2% being insured or self-funded.

Referrals are accepted for the outpatient and diagnostic imaging departments for adults above the age of 18 only. The outpatient department had six consulting rooms and one treatment room. The physiotherapy department had five clinical rooms, four curtained cubicles and a gym/studio space over two floors. There were also three pre-assessment consultation rooms and a large room used for ‘Joint School.’

The outpatient physiotherapy service operated between 8am and 8pm Monday to Thursday, 8am to 6pm on Fridays and 8am to 12:30pm on Saturdays.

The outpatient facilities focussed on elective care with defined operational hours. The department opens from 7:30am to 6:30pm Monday to Friday. These hours were extended as and when required. The outpatient service specialises in orthopaedics, accounting for 88.1% patients. Pain and rheumatology patients accounted for the other 11.99%.

We visited all clinical areas during our inspection. We spoke with and observed the care given by more than 34 members of staff including nurses, doctors, allied health professionals, administrative staff and the executive team. We spoke with ten patients and received five patient comment cards with feedback from patients who had received care at the hospital. We reviewed 15 sets of patient records and a variety of data for example, meeting minutes, policies and performance data.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17th January 2017.

Inspection carried out on 20, 26 February 2014

During a routine inspection

During our visit to Horder Healthcare we spoke with six people who use the service and ten staff members. Staff we spoke with included nurses, healthcare assistants, housekeepers, a physiotherapist, a pharmacist and a consultant surgeon. Our visit was facilitated by the operations manager and the director of clinical services who was also the registered manager. We viewed departments including pre-assessment, out-patients, and in-patients.

People we spoke with told us they were very happy with the quality of care they received and we saw that people were involved in their treatment and care. One person told us "I cannot ring their praises highly enough, it's an exceptional service." Another told us "Staff are so approachable and welcoming. I've felt very well informed." We observed people being cared for in a way that demonstrated respect for their privacy and dignity. We observed medication management processes that ensured the safety and wellbeing of people and we viewed clinical governance systems that promoted learning and the development of practice.

We saw that appropriate checks were in place to identify the suitability of staff in line with recruitment processes. Staff we spoke with told us they were happy with the quality of care they were able to provide. One nurse told us "there's a good ambiance with good interaction." Another staff member told us "There's good quality of care and teamwork. We feel appreciated and there's an open culture."

Inspection carried out on 3 January 2013

During a routine inspection

People we spoke to told us they had received very good care from the point of initial consultation right through to follow up care once home. Two people told us they had requested referral to the Horder Centre for a second time as they had received such good care previously. People told us they felt involved at all stages of care and that they felt listened to and were treated with dignity and respect at all times.

We found that the hospital and all clinical areas were clean, tidy and well maintained and that patients all had single en-suite accommodation which provided optimum privacy and optimum potential for good infection prevention and control.

We found that there were robust policies and processes in place to ensure high standards of safety and care and to prevent and control infection and that staff adhered to these policies.

We found that staffing levels were appropriate and that staff were appropriately trained, updated and supported and that they worked and communicated well as a team in a way that offered high levels of visibility and availability to patients.

Inspection carried out on 24 January 2012

During a routine inspection

We spoke to people using the services and staff in each of the areas that we visited. People told us that their overall impression of the care they had received was very good.

Comments from patients about their experience included “The care is superb”, and “We are very pleased, we came into the centre and have been seen by various nurses, everyone is brilliant”. One person said “I was here three years ago and I will be back in two weeks time to have my other hip done. The care here is excellent and if you get the chance this is where to come”.

People told us that their privacy and dignity was maintained at all times.

People told us that they had been given information about the operation they needed and the risks that were involved. They said they had signed to give their consent to their operation.

People told us that they were involved in the decisions about their treatment and their care. One person said “The consultant went through all the options and left it up to me to make a decision”. Other comments received were “My wife was given all the information about what was going to happen, so that she could give her own consent” and “Everything was discussed at pre-assessment and then we were given a booklet about what was going to happen. Another person said “I have been given these patient’s guides with post-operative information and exercises that I need to do when I get home”.

People said that hand cleaning was carried out by staff in advance of any care being provided. Comments received were “Staff gel their hands every time they come into the room” and “Staff gel their hands all the time”.

People told us that the level of cleanliness was very good and that the wards were swept and cleaned on a regular basis. People had seen that beds and equipment were cleaned between uses.

Comments from patients included “The room was cleaned this morning and I have seen cleaners outside in the corridor” and “Look at this bowl it has a sticker on it to say ‘I have been cleaned 23/01/2012’.

Reports under our old system of regulation (including those from before CQC was created)