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Nuffield Health Cambridge Hospital Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 9 November 2016

We carried out an announced inspection visit on 11 July 2016 and an unannounced inspection on 26 July 2016.

Our key findings were as follows:

Overall the hospital was rated as outstanding.

Are services safe at this hospital

  • There was a good incident reporting, investigation and feedback system and staff recognised how to respond to patient risk with arrangements to identify and care for deteriorating patients.
  • Appropriate infection control procedures were in place and the environment was clean and utilised well. All areas were staffed appropriately by a skilled, supported and competent workforce.
  • Staff recognised how to respond to patient risk and there were arrangements to identify and care for deteriorating patients.
  • Venous thromboembolism, falls and urinary catheter care assessment audits were consistently undertaken to a good standard.
  • Staff were aware of their responsibility to safeguard vulnerable adults and children from abuse. There were clear internal processes to support staff to raise concerns.
  • Staffing levels were appropriate and planned in line with capacity. Agency staff were used when required with the same nurses used to maintain continuity for the service and the children.
  • Staff received mandatory training and there was an excellent level of completion.

Are services effective at this hospital

  • Policies and procedures were developed using relevant national best practice guidance.
  • Patients had access to appropriate nutrition and hydration.
  • The provision of pain relief was well managed with prescribing being done by the anaesthetist and/or the resident medical officer (RMO).
  • The service had a high rate of consent to the National Joint Registry.
  • The service performed above average in the Patient Reported Outcome Measures for hip and knee surgeries.
  • Unplanned readmissions were low compared to other providers.
  • Staff were supported with learning and development to ensure they were competent in their role.
  • Staff appraisal rates were high between 96% and 100%.
  • There was physiotherapy, radiology and pharmacy on call rotas to ensure that support was available to the ward seven days a week.
  • Consent was consistently well recorded and audited.
  • Staff were aware of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Are services caring at this hospital

  • Patient care was at the heart of the service and we saw several areas of outstanding practice. This included the emphasis on supporting people emotionally and socially with the on-site Maggie’s Wallace charity.
  • The feedback we received from people using the service was overwhelmingly positive with people describing the care they had received as, “Amazing” and, “First class.”
  • The service was scoring in the top 10 of all Nuffield Health hospitals for patient satisfaction and positive feedback.
  • People had their privacy and dignity maintained at all times.
  • Patients were listened to and actively involved in their care and treatment.
  • People’s emotional needs were highly valued by staff and we were given examples of how these needs would be met.
  • The emotional needs of the children were embedded in the care provided. Parents were able to accompany their child to theatre and be present in recovery to give extra emotional support.

Are services responsive at this hospital

  • The service was planned and delivered to meet the needs of the patient groups it served.
  • Access to the service was straightforward and timely. Patient flow was seamless and without delay.
  • An average of 98% of patients were treated within 18 weeks of referral each month.
  • Patients living with dementia received one to one care.
  • Staff worked with families to support the needs of patients with learning disabilities.
  • Systems and processes were in place to ensure patients’ individual needs were met. This included the outstanding initiative to support patients following their treatment with a 12 week integrated cancer rehabilitation programme.
  • We found an innovative approach to reduce anxiety in younger children with a small electric car used for the theatre transfer.
  • The service had received eight complaints in the six months preceding our inspection but there were clear systems in place so that, should a complaint be received, learning could take place.

Are services well-led at this hospital

  • The hospital had a clear vision and staff were aware of this.
  • The leadership team were proactive and looked for opportunities to improve patient care.
  • There was an open door culture at the hospital and staff were encouraged and felt empowered to raise concerns.
  • There was an effective governance structure and learning and improvement was evident.
  • The hospital was well supported by an active medical advisory committee.
  • There was a robust and comprehensive competency scrutiny process in place through the medical advisory committee before practicing privileges were granted to medical staff.
  • The hospital had a strategy to improve services for children and young people and the set objectives were being met.
  • We saw that the hospital worked in close collaboration with the local NHS trust.

We saw several areas of outstanding practice including:

  • The hospital leadership team were outstanding in how they led the service and continually strived to further improve the service for patients.
  • We found an innovative approach to reduce anxiety in younger children with a small electric car used for the theatre transfer.
  • Systems and processes were in place to ensure patients’ individual needs were met. This included the outstanding initiative to support patients following their treatment with a 12 week integrated cancer rehabilitation programme.
  • An average of 98% of patients were treated within 18 weeks of referral each month.
  • Patient care was at the heart of the service and we saw several areas of outstanding practice. This included the emphasis on supporting people emotionally and socially with the on-site Maggie’s Wallace charity.
  • The feedback we received from people using the service was overwhelmingly positive with people describing the care they had received as, “Amazing” and, “First class.”
  • The service was scoring in the top 10 of all Nuffield Health hospitals for patient satisfaction and positive feedback.
  • The service had a high rate of consent to the National Joint Registry.
  • The service performed above average in the Patient Reported Outcome Measures for hip and knee surgeries.
  • Staff achievements in completing mandatory training were excellent.The completion of training was seen as a priority for the service.

However, there were also areas of where the provider may wish to consider making improvements.

The provider should consider:

  • There was limited opportunity for the service to assess its effectiveness and make improvements because the 2016 audit plan only contained four audits.
  • Not all staff were up to date with basic or intermediate life support training. Particularly bank staff.
  • Auditing the effectiveness of pain relief did not take place.
  • There was limited opportunity for the service to assess its effectiveness and make improvements because the 2016 audit plan only contained four audits.
  • Oncology nurses did not work seven days a week, which meant patients being cared for on the ward during the weekend, did not have access to specialist nursing.
  • There was no formal transition arrangements for patients moving through their cancer pathway to be transitioned back into NHS care for the end of their life.
  • Consent forms had been signed by children and their parents but could not find documented evidence that “Gillick competence” had been considered or assessed formally if required.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 9 November 2016

  • There was a good incident reporting, investigation and feedback system and staff recognised how to respond to patient risk with arrangements to identify and care for deteriorating patients.
  • Appropriate infection control procedures were in place and the environment was clean and utilised well. All areas were staffed appropriately by a skilled, supported and competent workforce.
  • Staff recognised how to respond to patient risk and there were arrangements to identify and care for deteriorating patients.
  • Venous thromboembolism, falls and urinary catheter care assessment audits were consistently undertaken to a good standard.
  • Staff were aware of their responsibility to safeguard vulnerable adults and children from abuse. There were clear internal processes to support staff to raise concerns.
  • Staffing levels were appropriate and planned in line with capacity. Agency staff were used when required with the same nurses used to maintain continuity for the service and the children.
  • Staff received mandatory training and there was an excellent level of completion.

Effective

Good

Updated 9 November 2016

  • Policies and procedures were developed using relevant national best practice guidance.
  • Patients had access to appropriate nutrition and hydration.
  • The provision of pain relief was well managed with prescribing being done by the anaesthetist and/or the resident medical officer (RMO).
  • The service had a high rate of consent to the National Joint Registry.
  • The service performed above average in the Patient Reported Outcome Measures for hip and knee surgeries.
  • Unplanned readmissions were low compared to other providers.
  • Staff were supported with learning and development to ensure they were competent in their role.
  • Staff appraisal rates were high between 96% and 100%.
  • There was physiotherapy, radiology and pharmacy on call rotas to ensure that support was available to the ward seven days a week.
  • Consent was consistently well recorded and audited.
  • Staff were aware of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Caring

Outstanding

Updated 9 November 2016

  • Patient care was at the heart of the service and we saw several areas of outstanding practice. This included the emphasis on supporting people emotionally and socially with the on-site Maggie’s Wallace charity.
  • The feedback we received from people using the service was overwhelmingly positive with people describing the care they had received as, “Amazing” and, “First class.”
  • The service was scoring in the top 10 of all Nuffield Health hospitals for patient satisfaction and positive feedback.
  • People had their privacy and dignity maintained at all times.
  • Patients were listened to and actively involved in their care and treatment.
  • People’s emotional needs were highly valued by staff and we were given examples of how these needs would be met.
  • The emotional needs of the children were embedded in the care provided. Parents were able to accompany their child to theatre and be present in recovery to give extra emotional support.

Responsive

Outstanding

Updated 9 November 2016

  • The service was planned and delivered to meet the needs of the patient groups it served.
  • Access to the service was straightforward and timely. Patient flow was seamless and without delay.
  • An average of 98% of patients were treated within 18 weeks of referral each month.
  • Patients living with dementia received one to one care.
  • Staff worked with families to support the needs of patients with learning disabilities.
  • Systems and processes were in place to ensure patients’ individual needs were met. This included the outstanding initiative to support patients following their treatment with a 12 week integrated cancer rehabilitation programme.
  • We found an innovative approach to reduce anxiety in younger children with a small electric car used for the theatre transfer.
  • The service had received no complaints in the six months preceding our inspection but there were clear systems in place so that, should a complaint be received, learning could take place.

Well-led

Outstanding

Updated 9 November 2016

  • The hospital had a clear vision and staff were aware of this.
  • The leadership team were proactive and looked for opportunities to improve patient care.
  • There was an open door culture at the hospital and staff were encouraged and felt empowered to raise concerns.
  • There was an effective governance structure and learning and improvement was evident.
  • The hospital was well supported by an active medical advisory committee.
  • There was a robust and comprehensive competency scrutiny process in place through the medical advisory committee before practicing privileges were granted to medical staff.
  • The hospital had a strategy to improve services for children and young people and the set objectives were being met.
  • We saw that the hospital worked in close collaboration with the local NHS trust.
Checks on specific services

Medical care (including older people’s care)

Outstanding

Updated 9 November 2016

We rated medical care services at Nuffield Health Cambridge Hospital as outstanding. We rated safe, effective and responsive as good whilst we rated caring and well-led as outstanding.

There was a good incident reporting, investigation and feedback system and staff recognised how to respond to patient risk with arrangements to identify and care for deteriorating patients. Appropriate infection control procedures were in place and the environment was clean and utilised well. All areas were staffed appropriately by a skilled, supported and competent workforce. Patient care was at the heart of the service and we saw several areas of outstanding practice. This included the emphasis on supporting people emotionally and socially with the on-site Maggie’s Wallace charity. The feedback we received from people using the service was overwhelmingly positive with people describing the care they had received as, “Amazing” and, “First class.”

Policies and procedures were developed using relevant national best practice guidance and patients had access to appropriate nutrition and hydration including specialist advice and support. Patient access and flow was seamless and without delay and staff were aware of their responsibility to ensure patients’ individual needs were met. This hospital provided an outstanding cancer rehabilitation programme. Patients were offered a 12-week programme as part of their treatment at a local Nuffield Gym, which was supported by fitness instructors who had received specialist oncology training. The purpose of the programme was to improve quality of life following cancer treatment by improving physical function and psychological and social wellbeing. The hospital had a clear vision and staff were aware of this. The leadership team were proactive and promoted an open door culture. The service was supported by a clear governance structure and an active medical advisory committee, which encouraged learning and improvement.

Services for children & young people

Outstanding

Updated 9 November 2016

We rated this service outstanding overall. Safe and effective were rated as good with caring, responsive and well-led rated as outstanding because the service had robust incident reporting systems and there was evidence of learning from incidents. We found assessments and procedures in place to safeguard children and young people from harm. There were measures in place to monitor and manage children and young people including signs of deteriorating health. Staffing was planned and continually monitored and agency staff were used when required with the same nurses used to maintain continuity to the service and patients. Children and their families reported that staff were kind and compassionate. Staff consistently included their patients and families in the care delivery and promoted their dignity. Young children had the option of driving a small electric car to theatre to reduce anxiety levels. The hospital had a service level agreement with the local NHS trust to give 24-hour consultant support and the transfer of an unwell child. The hospital had a strategy to improve services for children and young people and the set objectives were being met.  There was a clear governance structure and this demonstrated a proactive approach to managing risk and quality improvement of services. The leadership team drove continuous improvement actively seeking feedback from staff and service users. We found there was strong leadership from the hospital director down to department managers. Staff were committed and cared about the services they provided and were supported by their managers.

Outpatients and diagnostic imaging

Outstanding

Updated 9 November 2016

Overall, we have rated the outpatients department as outstanding. Safety was rated as good, we do not have sufficient evidence to rate outpatient services effectiveness at this time. Caring, responsiveness and well-led were rated as outstanding.

Staff were clear on how to report an incident and had received training in this area. Incidents were discussed both locally and with senior management. Infection prevention measures were in place and we saw staff adhering to ‘bare below the elbows’ guidelines.  Equipment within the department was regularly serviced and checked. Medical records were held securely, with a tracking tool in place to locate and prevent missing notes. Staff could access NHS notes and images through the NHS portal.  Clear processes were in place to escalate concerns in the event of deteriorating health of a patient. Robust systems were in place with regard to the granting and renewal of practising privileges within the department. Patient feedback was extremely positive about the hospital premises and treatment from staff.  Patients told us that staff were kind and caring. The outpatient and diagnostic imaging department met and exceeded its target for referral to treatment times (RTT) during April 2015 to March 2016.  There were robust systems in place surrounding complaints and the management of complaints. The Nuffield Health Cambridge Hospital complaint rate was significantly lower than other acute independent hospitals. The hospital had a clear strategy and values, which were embedded with staff. There were clear governance structures in place within the outpatients and diagnostic imaging department, with effective information sharing between the senior management team.

Surgery

Outstanding

Updated 9 November 2016

Surgery services at Nuffield Health Cambridge were rated as outstanding overall. Safe, caring and responsive were rated as good with effective and well led rated as outstanding. Incidents were investigated and learning shared from heads of department meetings to team brief meetings. Infection control practice was in line with hospital policy and was regularly audited. Equipment required to provide safe care was regularly safety checked and serviced.  Nurse staffing was managed so that there were enough staff to provide safe care. There was access to consultants both in working hours and out of hours in the event of a patient deteriorating, with the additional support of a resident medical officer if more urgent support was required.  The service had a comprehensive audit plan in place to assess the provision of care. Outcomes on these audits were outstanding. Patients received pre-loading of pain relief where clinically appropriate.  Patient feedback during our inspection was very positive and patients felt informed and involved in their own care. As a service the Nuffield Health Cambridge Hospital performed in the top 10 of all Nuffield hospitals for positive patient feedback and satisfaction.  Patients were consistently treated within 18 weeks of referral. Patients living with dementia received one to one care. Staff worked with families to support the needs of patients with learning disabilities. Surgery related complaint numbers were low with no identifiable trends, and learning from complaints was a regular discussion at team briefs. There was a structured leadership in place that was well respected by staff. Staff felt the leadership was supportive, visible, and that they listened to staff. There was a well established and well run medical advisory committee (MAC) in the service, as well as senior meeting sand governance meetings to monitor quality. The leadership team locally as well as the senior management team were outstanding and demonstrated real passionate and committed leadership to delivering their service.