Buckshaw Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We found in the surgical service that patients and communities were at the centre of how care was planned and delivered. We assessed whether the service understood and responded to the health and care needs of patients and local communities, and whether patients were actively involved in planning their care. We also considered whether patients were able to access care in ways that met their individual circumstances, including those with protected characteristics.

At this inspection, we found the service planned and delivered care in a way that met patients’ needs. The service was organised effectively, and patients were able to access care in a timely and flexible manner. Staff took account of patients’ individual preferences and made reasonable adjustments where required.

At our previous inspection, this key question was rated as good. At this inspection, the rating has remained good. This meant patients’ needs were met through effective organisation and delivery of care.

We have not awarded this service a score for Responsive.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to support access to care.

The service had systems in place to support patients with complex needs, including those with mental health conditions, learning disabilities, dementia and sensory loss. Staff had access to colleagues with specialist training provided by the organisation. A mental health first aider was available on each shift to provide support and assess whether further input was required.

The service identified communication needs in advance. Information about interpreter requirements was requested before pre-operative appointments to allow sufficient time to arrange support. Where needs were identified at a later stage, staff were able to access interpreting services, including telephone-based systems.

Patients were provided with refreshments, including water, hot drinks and light food. Although there were no hot food facilities onsite due to the hospital providing day-case services, patients and those close to them were able to bring their own food and drink. Staff considered cultural and religious dietary requirements during pre-operative assessments and made appropriate arrangements.

The service ensured patients understood the financial aspects of their care where applicable. Private and self-pay patients were given clear information about costs, including potential additional charges for complications or further treatment. Written information outlining terms and conditions and payment arrangements was provided prior to treatment where possible, in line with national guidance.

Patients were informed that Buckshaw Hospital operated as a day-case unit. They were made aware during pre-operative assessment that if additional support or emergency care was required following a surgery, they would be transferred to an acute hospital. This information was included in pre-operative discussions and documentation to ensure patients understood their care pathway.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system to plan care.

The service worked with local partners to plan and deliver care that met the needs of the local population. Leaders engaged with the integrated care board (ICB) through regular bi-monthly contracting meetings and monthly clinical and quality meetings. Leaders told us this collaboration supported oversight of service delivery and ensured care was responsive to local needs. The ICB received regular performance and quality reports, including monthly and quarterly updates, which provided assurance regarding service delivery and patient outcomes.

Leaders also worked with local general practitioners to understand the needs of the community and adjust the service where required.

The service had systems in place to support patients who required additional support or specialist intervention. Patients’ needs were identified at all points of contact, including during pre-operative assessment, and recorded using an electronic alert system to ensure continuity of care. The hospital had link nurses with specialist skills in areas such as dementia, mental health and learning disabilities to support patients with specific needs.

The service monitored patients who did not attend appointments. Staff followed up with patients to understand the reasons for non-attendance and took action to support them. Where patients had additional needs or social barriers, staff worked with them and external services to facilitate attendance. This included offering alternative appointment times and providing support tailored to individual circumstances.

We saw examples where staff made reasonable adjustments to meet patients’ needs, such as arranging walkthroughs of surgery for anxious patients and adjusting appointment times to align with transport availability. These actions helped improve access and ensured patients were able to receive care in a way that met their needs.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided information in a way that patients could understand and access.

A range of information was available to patients to support their understanding of care and treatment. This was provided during pre-operative appointments and through the provider’s website. Information included details about surgery, post-operative care and advice on maintaining a healthy lifestyle. We found that information was up to date and regularly reviewed.

Patient information was also displayed throughout the hospital. We saw information boards relating to operations carried out at the hospital, including information about a healthy lifestyle post-operation, for example post-operative mobility after surgery.

Staff demonstrated a responsive and patient-centred approach by making appropriate adjustments to meet individual needs. This included simplifying explanations for patients requiring additional support, allowing sufficient time for discussion, and involving relatives or carers where appropriate to ensure understanding.

The service had systems in place to provide information in alternative formats and languages when required. Although we did not see information routinely displayed in languages other than English during the inspection, staff told us that translated materials and accessible formats could be requested through the organisation. Where patients required information in an alternative language or format, arrangements were made to meet their needs.

Patients were also given clear information on who to contact should they have any questions or concerns before or after their surgery, supporting continuity of care and timely access to advice.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously and used them to improve the service.

The service encouraged patients to share feedback. Information about how to provide feedback and raise concerns was displayed throughout the hospital. However, complaint forms were not always readily available in-patient areas and were stored behind reception. We escalated to management, who moved the forms into public areas, making the forms easily available.

Staff understood how to respond to patient concerns. They told us they would initially try to resolve issues at a local level before escalating to the formal complaints process where required.

Patients told us they were involved in decisions about their care and treatment. They said they received clear information and felt informed throughout their care. Patients reported being involved from admission through to discharge and said staff communicated well.

Managers told us they received both positive and negative feedback from patients. We reviewed examples of feedback and complaints and saw that many patients complimented staff on their professionalism, caring approach and the support provided.

For both services in the previous 12 months, the service had received 2 informal complaints and had 12 on-going formal complaints, at different stages. We reviewed 5 complaints and found responses were provided in a timely manner. Patients received an initial response within one week from the hospital manager, which was within the provider’s 28-day response timeframe. Responses were compassionate and addressed the issues raised.

Staff told us that feedback, including complaints, was shared during team huddles. This supported learning and improvements in practice.

Management described clear processes for escalation of unresolved complaints. Private patients could refer complaints to the Independent Sector Complaints Adjudication Service (ISCAS), and NHS patients could refer to the Parliamentary and Health Service Ombudsman (PHSO).

We saw evidence that patients were kept informed throughout the complaints process. Learning was identified from complaints and implemented within the service. Staff told us patients could be involved in improvements following incidents or complaints. The education

lead described how learning from complaints and incidents was used to inform staff training and improve practice.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Buckshaw Hospital did not provide sufficient data for Referral-to-Treatment (RTT). However, the service identified opportunities to improve efficiency, patient flow and access.

Buckshaw Hospital followed national RTT standards set out in the NHS Constitution, which require patients to be treated within 18 weeks from receipt of referral. The service undertook clinical triage and managed patient pathways in line with national guidance, including appointment booking under ‘reasonable offer’ rules and the management of cancellations, did not attend appointments and clock-stop criteria. However, the service was unable to provide data at the time of inspection to demonstrate compliance with RTT targets, which limited assurance regarding performance against national access standards.

The service monitored performance and theatre utilisation to understand operational efficiency. The hospital demonstrated an overall theatre utilisation rate of 69%, with activity primarily delivered through medium-length sessions lasting between 2.5 and 4.5 hours. Most theatre lists were scheduled as half-day sessions throughout the week.

Data showed that actual activity frequently exceeded planned bookings due to surgery overrunning their allocated time. However, there remained unused capacity at the beginning and end of theatre sessions, contributing to inefficiencies. Activity levels were highest mid-week, however the under usage of theatres remained high at 21%, indicating opportunities to improve productivity and better use available capacity.

Leaders recognised these challenges and had developed an improvement plan to optimise theatre utilisation and patient flow. This included reducing late starts, improving management of end-of-session overruns and reducing in-session downtime through clearer processes and the introduction of parallel patient flow.

The service also planned to reconfigure theatre session templates to reduce fragmentation, improve booking accuracy using realistic case-duration data and rebalance activity across the week to manage mid-week pressures more effectively. Leaders told us these actions aimed to increase productive theatre time, improve list reliability and deliver more consistent and efficient theatre operations.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to support access to care.

The service monitored patient access and outcomes to identify potential health inequalities. Systems were in place to gather feedback, which supported understanding of patients’ experiences and informed service planning and delivery.

Additional needs were identified at the pre-operative clinic. Staff recorded these on the electronic system, and alerts were created to ensure individual needs were recognised and addressed appropriately throughout the patient pathway.

Staff were aware of health inequalities within the local population and described how they addressed these through community engagement and health promotion activities. The service considered patients’ individual needs, including religious and dietary requirements, during pre-operative assessment. Patients with additional needs were discussed at multidisciplinary meetings prior to attendance to ensure appropriate support was in place.

Leaders told us that appointment times were flexible and could be adjusted to meet patients’ needs, including offering morning or evening sessions where required. People who did not speak English as their first language were able to access the service, and staff used interpreting services, including Language Line, to support effective communication.

Discharge arrangements were planned to optimise outcomes for patients, including those with protected characteristics. Where required, carers and community services were involved to support patients’ recovery and return to their usual level of independence.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

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

Patients told us they were supported to make choices about their care and treatment. At pre-operative appointments, staff encouraged patients to plan their care and recovery, involving those close to them where appropriate. Patients remained involved in planning their care throughout their time at the hospital.

Staff provided health promotion advice as part of the patient pathway. Within both services, information was available on common conditions and guidance on lifestyle changes, including reducing intake of certain foods and drinks. Staff discussed healthy lifestyles with patients in preparation for discharge and recovery.

Patients were provided with both verbal and written information to support their ongoing care. This included advice for recovery, information for their GP and details of follow-up arrangements. Follow-up appointments were arranged prior to discharge where required.

Patients received additional support following discharge. A member of the medical team contacted patients within 48 hours to review their recovery and provide further health and lifestyle advice where needed.