Nuffield Health Brentwood Hospital

Brentwood Hospital is operated by Nuffield Health. The hospital/service has 42 beds. Facilities include four operating theatres (three laminar flow and one state of the art digital), one endoscopy theatre, 16 consulting rooms, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, services for children and young people, and outpatients and diagnostic imaging. We inspected all three services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 February 2017, along with an unannounced visit to the hospital on 10 March 2017.

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.

Services we rate

We rated this hospital as Good overall.

• There was evidence of incident reporting, a good level of understanding of duty of candour amongst staff and actions and learning from incidents were discussed at the service’s Quality and Safety Committee meetings and Heads of Department meetings, and staff gave examples of where learning had occurred.
• For the period October 2015 – September 2016, 100 per cent of patients were risk assessed for venous thromboembolism (VTE) and there were no cases of hospital-acquired VTE.
• The pharmacy lead had recently ran a teaching session for nursing staff within the service to ensure good practice in medicines management. We were given examples of learning from these sessions such as clearer labelling of medications.
• Staff knew how to report a safeguarding concern and who the safeguarding lead for the hospital was. The safeguarding lead ran training days each month. Training included ‘Prevent’ training to help staff identify individuals at risk of radicalisation and female genital mutilation (FGM) awareness.
• mandatory training records which showed a current compliance rate of 97% overall for the whole hospital
• We observed the World Health Organization (WHO) ‘Five Steps to Safer Surgery’ checklist being undertaken, alongside record completion, both of which were completed appropriately.
• Staffing levels were assessed on a daily basis using the ‘professional judgement’ model and Nuffield Health at provider level was assessing the most appropriate acuity tool to use at the time of our inspection
• The resident medical officer (RMO) attended each nurse handover which took place three times a day, between shifts, to ensure they were informed about patient conditions and progress.
• Policies were updated in line with national guidance and best practice and shared at provider level.
• The hospital responded to audits to improve patient outcome. For example the implementation of education and training to improve post operative analgesia prescribed before discharge from recovery, which increased from 60% compliance in September 2016 to 100% compliance in February 2017.
• The hospital could access nutritionists from the community where more specialist advice or input was required.
• PROMs results from November 2016 for NHS-funded patients receiving a primary knee replacement showed the service was within the estimated range of the England average. 
• PROMs results from November 2016 for NHS-funded patients receiving a primary hip replacement showed the service was within the estimated range of the England average.
• Funding had been agreed to improve the environment of the endoscopy department.
• The service was compliant with referral to treatment (RTT) times for NHS patients admitted within 18 weeks of referral, with over 90% of patients admitted within this timeframe between October 2015 and September 2016.
• The service had a structured process in place for the medical advisory committee (MAC) and Practising privileges were routinely discussed as part of the MAC.
• The hospital had a risk register which was detailed with updates, progressions dates and actions to mitigate risks.
• Service leads displayed strong leadership and management and there was a drive to promote a positive, open and transparent culture.
• The service had recently refurbished their theatres department, including a development of a new digital theatre of which staff were proud of.

We saw several areas of outstanding practice including:

• We saw evidence of the application of “Human Factors” approach, when the hospital investigated incidents. For example we reviewed one investigation which considered the training and competency of staff as well as custom and practice, as part of the review process. 
• There was evidence of innovative work to improve and engage all staff in infection prevention and control, such as running lab experiments with staff to show the difference in bacteria levels with good hand hygiene practice, and an anti-microbial awareness week.
• In January 2017 “Think Like a Customer” (TLC), was rolled out across the hospital and was part of the Nuffield organisations aspiration to become “one Nuffield” , with an aim to improving patient experience. There was a monthly newsletter published which included results from quality indicators, complaints and net promoter score, and also reviewed feedback from patients to improve the overall patient experience.
• The hospital had a clear strategy to improve services for children and young people with evidence of progress completed in the last twelve months and with a clear progression for future developments.
• The Senior Management Team ran a number of staff engagement strategies in the hospital to improve patient experience, to engage staff and to consistently review the leadership of the service. These included the “have you say make a difference” monthly meetings, and the annual “leadership MOT” review.

Professor Sir Mike Richards

Chief Inspector of Hospitals