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Nuffield Health Brighton Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 8 February 2018

We carried out a comprehensive inspection of Nuffield Health Brighton Hospital on the 11, 12 and 22 July 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of medical care (including older people’s care), surgery, services for children and young people, outpatients and diagnostic imaging as these incorporated the activity undertaken by the provider, Nuffield Health, at this location.

We did not inspect the magnetic resonance imaging (MRI) or computerised tomography (CT) scanning services, or ophthalmology outpatient services as these are provided and managed by another registered provider.

We rated the hospital overall as good, and rated the core services of  surgery, outpatient and diagnostic services and medicine as good. Although we inspected the children's and young peoples service we did not have enough evidence to give this a rating.  This was because at the time of the inspection the hospital treated low numbers of children. 

Are services safe at this hospital?

We found services were safe at this hospital. This was because:

  • There were systems for the reporting and investigation of safety incidents that were well understood by staff.

  • Staff could demonstrate their understanding of the duty of candour and provide examples of its implementation.

  • Patients were assessed prior to admission to ensure that hospital could safely meet their needs. There were arrangements to transfer patients whose care needs exceeded what the hospital could safely provide, and saw that staff used these processes when patients’ conditions required this.

  • There was suitable medical cover at all times from a resident medical officer and on-call consultants and noted arrangements for consultants to provide cover for absent colleagues.

  • There were sufficient numbers of nursing and support staff to meet patients’ needs.

  • There were efficient and effective methods for the handover of care between clinical staff.

  • However, medicines management did not always reflect best practice. We identified some concerns in the maintenance  of controlled drug registers and the storage and management of medical gases.

  • There was no provision for the reporting of emergency imaging out of hours.

Are services effective at this hospital?

  • There were arrangements to review guidance from national bodies such as the National Institute for Health and Care Excellence (NICE) and that care was delivered in line with best practice.

  • There was a system for reviewing policies and these were discussed at the medical advisory committee (MAC) and other governance forums at the hospital.

  • Care was continually monitored to ensure quality and adherence to national guidelines to improve patient outcomes and the hospital participated in relevant national audits and benchmarking activities.

  • Patient outcomes were good when benchmarked against national standards. There were no concerns regarding rates of unplanned admission, return to theatre or transfer to another hospital.

  • Patient’s received adequate pain control. They were provided with sufficient food and drink to meet their individual needs although some patients had complained about the quality of food offered.

  • There were systems to grant and review practicing privileges to consultants that ensured they were qualified and competent, and of good character. There were systems to ensure that staff registered with professional bodies retained current registration, including through revalidation.

  • Consent procedures followed national guidance and staff acted within the Mental Capacity Act 2005 when patients lacked capacity to make decisions for themselves.

Are services caring at this hospital?

  • Patients were treated with dignity and respect and their privacy was maintained. Patients who share their views said they were treated well, with compassion, and that their expectations were met or exceeded.

  • Results of the NHS friends and family test and other patients satisfaction surveys demonstrated that patients would recommend the hospital to others.

  • There were arrangements to ensure patients with complex needs such as those undergoing gender reassignment surgery or chemotherapy had access to appropriate psychological support.

Are services responsive at this hospital?

  • Services were planned to meet the needs of patients. We saw some flexibility in the organisation of services that allowed patients convenient access to care and treatment.

  • We saw examples of systems to support patients living with dementia and learning difficulties. The environment was appropriate for patients with physical disabilities and was accessible.

  • The hospital was exceeding national referral to treatment time standards and waiting lists were minimal.

  • There was a robust complaints procedure, which was well publicised and understood by staff. Complaints were investigated, actions taken to resolve issues and there was learning evident from the content of complaints.

  • There were arrangements that enabled staff to meet the need of people from diverse ethnic backgrounds. While there were facilities to enable translation, staff did not always follow best practice in this area.

Are services well led at this hospital?

  • Nuffield Health has a clear, corporate statement of vision and values which staff at this hospital knew and understood.

  • There were clearly defined and visible local leadership roles and managers provided visible leadership and motivation to their teams. Staff spoke well of the management team and of each other. The provider was responsible for ensuring that those in director level roles fulfilled the fit and proper person test

  • There were arrangements to engage patients through invitations to a patients’ forum. Nuffield Health had arrangements for collecting patients views and the hospital’s performance was benchmarked against peers

  • We noted the management team actively sort out novel ways of working that improved standards of safety and quality. The leadership team also developed new services to meet the needs of patients in the local community and beyond.

  • There were governance systems, overseen by Nuffield Health to monitor quality and safety of services. However, these systems had not been effective for ensuring management of medicines met legal requirements. We noted that some corporate policies had passed their review dates and were in the process of being revised.

Our key findings were as follows:

  • There were adequate systems to keep people safe and to learn from incidents.

  • The hospital environment was visibly clean and well maintained and there were sufficient measures to prevent the spread of infection.

  • There were adequate numbers of suitably qualified, skilled and experienced staff (including doctors and nurses) to meet patients’ needs. There were arrangements to ensure staff had and maintained the skills required to do their jobs.

  • There were arrangements to ensure people received adequate pain relief and adequate food and drink that met their needs and preferences.

  • Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked against national audits and other independent hospitals we hold data for.

  • Robust arrangements for obtaining consent ensured legal requirements and national guidance were met.

  • The individual needs of patients were met including those in vulnerable circumstances such as those with a learning disability or dementia.

  • Patients could access care when they needed it.

  • Patients were treated with compassion and their privacy and dignity were maintained.

  • The hospital was managed by a team who had the confidence of their teams. Staff felt motivated by the management team.

  • Governance systems were not always effective in identifying where services were not meeting legal requirements, or at monitoring the quality and safety of services for children and young people.

We saw several areas of outstanding practice including:

  • The hospital worked with the local university to offer a joint Resident Medical Officer (RMO) post. Five RMOs covered the hospital over the 24 hour period and also undertook teaching anatomy and practical subjects to students at the local university. This was an innovative and practical way to attract skilled RMOs to the post and was working well.

  • The hospital was a centre of excellence for transgender surgery performing over 300 procedures each year attracting patients from all over the UK and internationally. Feedback received from the gender reassignment service (GRS) was continually positive about the way the staff treated people. Patients thought that staff went the “extra mile” and the care they received exceeded their expectations. Within the GRS there was a proactive approach to understanding the needs of this patient group, which included people who are in vulnerable circumstances or who had complex needs and care was delivered in a way that met patients’ needs and promoted equality.

  • The hospital had a strong ophthalmology pathway and was a leading independent provider of ophthalmology services in the area. The hospital offered innovative ophthalmic surgery with successful outcomes.

  • The hospital had taken steps to become “greener” in its operation and had reduced its carbon footprint by the use of solar panels and light-emitting diode (LED) lights

However, there were also areas of where the provider needs to make improvements.

The provider should:

  • Ensure there is a planned preventative maintenance plan for medical gas regulators and that there are suitable safe storage facilities for larger cylinders not required for the medical gas manifolds.

  • Consider keeping individual laser registers for each laser in a hard copy format.

  • Review access in the pharmacy dispensary where there was lack of confidentiality and disability access to the dispensary hatch.

  • Review the prescription tracking system to minimise the possibility of mis-use.

  • Ensure that controlled drugs records are managed in line with legal requirements.

  • Make adequate arrangements to report on emergency medical imaging out of hours.

  • Take action to address patient feedback on the quality of food.

  • Review maintenance and refurbishment plans to ensure the clinical environment meets national guidance.

  • Ensure regular risk assessment of oncology patients for venous thrombo-embolism.

  • Make arrangements for the transfer out of acutely unwell oncology patients

  • Consider how best practice in the interpreting services could be achieved.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 8 February 2018

Effective

Good

Updated 8 February 2018

Caring

Good

Updated 8 February 2018

Responsive

Good

Updated 8 February 2018

Well-led

Good

Updated 8 February 2018

Checks on specific services

Services for children & young people

Not sufficient evidence to rate

Updated 8 February 2018

We were not able to rate this service due to the low numbers of children being treated at the hospital.  However, we found

Staff understood their responsibilities regarding incident reporting and there was a culture of learning from incidents. There were plans in place to respond to emergencies and major incidents. Staffing levels and skill mix were planned, implemented and reviewed to keep children and young people safe.

The hospital managed patients’ records in accordance with the Data Protection Act 1998.

Appointment times were flexible and offered around school hours. Facilities were suitable for children and young people.

The hospital had clear structures, processes and systems of accountability in place.

Medical care (including older people’s care)

Good

Updated 8 February 2018

We rated medical care services as good overall because:

The hospital had systems and processes in place to keep patients free from harm. Infection prevention and control practices were in line with national guidelines. The environment was visibly clean, tidy and fit for purpose.

Staff kept medical records accurately and securely. Medicines were stored in locked cupboards and administration was in line relevant legislation.

The endoscopic services demonstrated compliance with British Society of Gastroenterology (BSG) guidelines. Oncology services demonstrated compliance with National Institute for Health and Care Excellence (NICE) guidelines.

Medical care services had an appropriate level of competent staff to meet patients’ needs. Staff completed appraisals regularly and mangers encouraged them to develop their skills further.

Managers were visible, approachable and effective. Staff overwhelmingly reported the hospital had a ‘family feel’.

Staff interacted with patients in a kind and caring manner. Patients told us they felt relaxed when having their treatment and were overwhelmingly positive about their experience of care.

Outpatients and diagnostic imaging

Good

Updated 8 February 2018

We rated the Nuffield Brighton Hospital outpatient and diagnostic imaging service as good because:

Systems were in place for keeping patients safe and staff were aware of how to report incidents and safeguarding issues. Staffing levels were sufficient to meet the needs of patients. The waiting areas and consulting rooms were visibly clean, tidy and free from clutter.

Imaging equipment was appropriately maintained and legislative requirements relating to the safe use of ionising radiation were met. Laboratory facilities were accredited by a nationally recognised external body.

Staff worked as part of multi-disciplinary team and sought consent from patients in accordance with corporate policy and legislation, including the Mental Capacity Act.

Staff were enthusiastic and caring and there were positive interactions between staff and patients who spoke well of their experience.

There were clearly defined local leadership roles in each speciality within the outpatients and diagnostic imaging areas. Managers and the senior leadership team provided visible leadership and motivation to their teams and there was appropriate management of quality and governance at a local level.

However:

There was no effective process for the monitoring of prescription pads and not all members of staff were trained to an appropriate level in safeguarding children.

Surgery

Good

Updated 8 February 2018

We rated surgical services as good because:

The hospital had effective systems and processes in place to deliver evidenced based care and treatment. This included robust systems for reporting and learning from incidents. Audits were conducted to provide assurance that staff and clinicians worked according to the evidence-based guidance.

Patients received surgical interventions, care, treatment and support that achieved good outcomes. Their needs were assessed with individual care and treatment planned and delivered appropriately. Patients told us of the excellent care and attention they had received at the hospital.

Leadership was visible and responsive. Staff had confidence in both their immediate team leader and the hospitals senior management team. All staff were fully engaged with the strategic vision and values of the hospital.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the patients admitted to the hospital. Staff were appropriately inducted and had the training, learning development and supervision through appraisal to deliver safe care.

There were robust arrangements in place to monitor the competence of consultants with practicing privileges and action was taken where concerns were identified.

There were good infection control systems in place managed and monitored by the infection control team. The general environment was maintained to a high standard.

However;

Medicines management did not always reflect best practice or meet legislative requirements. We identified a number of concerns in the governance of medicine management and the management of medical gases.

There was no provision for the reporting of emergency imaging out of hours.

The hospital kept one laser register for the three lasers currently in use which did not provide a robust method of detailing the use of each individual laser.