Buckshaw Hospital

On this page

• 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

We found in the surgical service that patients achieved the best possible outcomes because their needs were appropriately assessed, and care, treatment and support were delivered in line with those needs. We also considered whether patients with protected characteristics were supported and whether care was person centred. In addition, we reviewed whether leaders promoted a culture of continuous improvement, where outcomes were monitored and best practice was embedded into everyday work.

At our previous inspection, this key question was rated as good. At this inspection, the rating has remained good. This meant patient outcomes were consistently positive, and feedback from patients 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.

We followed a patient journey from booking through to their operation and discharge. Throughout the pathway, staff used structured communication tools, including SBAR, to support safe and effective handovers. Patients attended the hospital for short periods, and their care was discussed at daily handover meetings. We observed staff handing over patients between teams using SBAR as shifts changed during the day.

Where concerns were identified pre-operatively, such as abnormal blood test results, patients were referred to their GP or appropriate specialists before proceeding. Staff also assessed wider needs, including cultural, religious, communication and nutritional requirements. These were recorded on the electronic system, with alerts created where necessary to ensure continuity of care.

Staff reviewed patients’ needs throughout their time at the hospital. Pain was assessed at each stage of the pathway. Anaesthetic staff discussed pain management with patients on admission, and this was reviewed before and after surgery. We saw evidence of pain assessments and management documented in patient records.

The service had a pain management working group and undertook regular audits. Recent audit results showed a compliance of 98%. Actions identified through audits were shared with the group and implemented by managers to improve practice. During the inspection, patients appeared comfortable, calm and able to mobilise, indicating pain was well managed.

The service also monitored nutrition and hydration. A recent audit showed compliance of 77%, with shortfalls identified in documentation, including completion of malnutrition universal screening tool (MUST) assessments and fluid balance charts. The MUST is a nationally recognised screening tool used to identify adults who are malnourished, at risk of malnutrition, or obese. It supports staff to assess patients’ nutritional status and implement appropriate care plans to mitigate risks associated with poor nutrition. A 3 month plan was shared by the service, to be 100% compliant with the National Institute for Health and Care Excellence (NICE) guidelines.

On the day of inspection, we reviewed 5 patient notes, the risk assessments and care plans were not consistently completed. We escalated the concern, and we have been provided with audits completed on paperwork with action plans. Patients who were nil by mouth, had appropriate prescriptions prescribed, example intravenous fluids.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high-quality care in line with national guidance and best practice.

Clinical outcomes and updates were reviewed at weekly meetings, where learning and improvements were shared with staff.

Clinical staff demonstrated awareness of relevant national guidance, including standards from Royal Colleges and the National Institute for Health and Care Excellence (NICE). Staff told us they received regular updates and alerts from the regional clinical lead to ensure practice remained current.

The service submitted data to the Private Healthcare Information Network (PHIN), and performance data was monitored by hospital management. The hospital had completed 555 private and 7,710 NHS procedures; this number includes endoscopy. As the hospital operated as a day-case unit, patient stays were supported by a neighbouring hospital where required.

The service monitored care and outcomes through Patient Reported Outcome Measures (PROMs). PROMs are standardised tools used to collect patients' views on their health status and the outcomes of the care they have received. They provide insight into the effectiveness of treatment from the patient's perspective, including improvements in symptoms, quality of life, and overall wellbeing.

PROMs data were received for patients undergoing nasal and hand surgery. The findings demonstrated positive outcomes and a low re-attendance rate, with 9 out of 10 patients reporting a good outcome following their treatment. This suggests that the service was effective in delivering care that met patients' needs and expectations.

The Buckshaw Hospital operated as a day-case unit, due to this reason there was limited inpatient outcome data available. Patients requiring admission were transferred to a neighbouring hospital within the organisation.

We reviewed a number of policies and found these were up to date and had clear review dates. A policy and surgery group, which included the regional clinical lead and hospital management team, met regularly to review and update local and organisational policies. National policies from the provider were shared and implemented through this process.

Information about policy updates and changes was displayed on noticeboards throughout the hospital.

The service followed standardised pathways for admission and treatment, and there was no variation between NHS and private patients. Pre-operative checklists were completed consistently, and we saw evidence of this in patient records.

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.

Staff worked well together within the surgery service. Clinicians, nurses, healthcare professionals and support staff communicated effectively, shared information and treated each other with respect. We observed positive working relationships across the team during the inspection.

The service held a morning handover within the surgery team and a wider hospital safety meeting later in the day. A structured template was used to identify key roles, including safeguarding leads, health and safety leads, pharmacy support and departmental leads. This supported clear communication and accountability across the service. We observed a safety huddle where both risks and positive feedback were discussed. Additional information on alerts, training opportunities and wellbeing support was available in staff areas. Staff who could not attend were given access to the information verbally and by email.

Discharge planning began at the pre-operative stage. Staff told us they could access support from other professionals, including physiotherapy, pharmacy and safeguarding leads, if additional needs were identified prior to discharge.

Multidisciplinary meetings were held prior to patients attending the hospital, typically in the week before treatment. These meetings involved consultants, the resident doctor, lead nurses, theatre coordinators and housekeeping lead, to plan care and address any additional requirements. The service liaised with external partners, including integrated care boards and NHS referrers, to support safe and coordinated care.

Throughout the patient pathway, we saw evidence of multidisciplinary input. Consultants, anaesthetists, nurses and other professionals documented care clearly in patient records. Any changes to care or treatment plans were recorded and communicated to patients.

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, reduce their future needs for care and support.

Staff gave patients practical support and advice to lead healthier lives.

Information was provided to patients about their surgery through printed leaflets and digital content available on the provider’s website. Staff explained discharge information clearly, including advice on post-operative care and recovery.

The service engaged with the local community to promote health and wellbeing. This included attending GP practice events, hosting face-to-face “meet the consultant” sessions and participating in community events where staff provided health advice, such as blood pressure checks.

The wider organisation also used social media platforms to share information about medical conditions, surgical operations and how to access services.

The service promoted healthy lifestyles. Free fruit was available to patients and staff, and food options provided were in line with healthier choices, including low fat, low salt and low sugar options.

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.

Staff monitored the effectiveness of care and treatment through an extensive programme of clinical audit. The hospital participated in a range of provider-led audits including infection prevention and control, surgical site infection prevention, medicines management, medical records, safeguarding, resuscitation, falls prevention and surgical safety audits.

Audit results were routinely reviewed through governance processes and used to improve the quality, safety and effectiveness of care. Leaders monitored compliance, identified areas for improvement and used re-audit to assess the impact of actions taken.

For example, compliance with the Wound Management audit improved from 66% to 97% following a repeat audit. This demonstrated improvements in wound assessment, care planning and documentation, supporting the delivery of safe and effective patient care. Compliance with the Medical Records: Venous Thromboembolism (VTE) audit also improved from 79% to 100%, providing assurance that patients were consistently assessed for the risk of developing blood clots and that appropriate preventative measures were considered and documented.

Improvements were seen in infection prevention and control practices. Compliance with the Surgical Site Infection (SSI) Practice Review, undertaken as part of the One Together programme, improved from 86% to 100%, demonstrating enhanced adherence to evidence-based measures designed to reduce the risk of surgical site infections. In addition, compliance with the Local Safety Standards for Invasive Procedures (LocSSIPs) and Five Steps to Safer Surgery audit was 100%, providing assurance that recognised surgical safety standards were embedded in practice and consistently followed by staff.

Leaders regularly audited compliance with the National Safety Standards for Invasive Procedures (NatSSIPs) to ensure patients underwent the correct procedure, in the correct part of the body, with the appropriate equipment and documentation. Audit results showed high levels of compliance across all NatSSIPs measures. Compliance with ‘Stop Before You Block’, swab count, instruments and histology standards were 100%, while compliance with prosthesis checks improved from 90% to 100% following audit review. This demonstrated that leaders used audit findings to identify opportunities for improvement and strengthen patient safety within surgical services.

These findings demonstrated that staff used audit outcomes to drive continuous improvement, improve compliance with clinical standards and support positive patient outcomes.

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 supported patients to make informed decisions about their care and treatment and followed national guidance to obtain consent.

Staff demonstrated a good understanding of consent processes and described how consent was obtained in line with legislation and national guidance. The service had a mental capacity assessment form in place, aligned with national requirements, to support decision-making.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed policies relating to consent, the Mental Capacity Act and restrictive practice. Where patients lacked capacity, staff involved those close to them and made decisions in the patient’s best interests.

Consent for surgery was obtained by appropriately qualified clinicians. This included clear discussion of risks, benefits, potential complications and alternative options. Consent was checked at multiple stages of the patient pathway, including immediately prior to surgery. The service undertook consent audits, and findings were shared with staff to support improvement.

Patients told us they were involved in decisions about their care and treatment. They were able to describe the risks and benefits explained to them prior to surgery. Relatives said they were kept informed where patients were unable to consent.

We observed staff seeking verbal consent before delivering care. Patients were involved in decisions about their care at all levels, including everyday choices such as food and drink.

The service made reasonable adjustments to meet patients’ individual needs. Requests for same-sex care or theatre teams were accommodated where possible, and chaperones were available when requested. Interpreters, including British Sign Language and face-to-face interpreting services, were used to support patients to give informed consent.

Staff supported patient independence where appropriate. Patients were assessed for their ability to self-administer medicines using a structured assessment process.

Staff sought permission before sharing patient information with family members or others involved in their care.