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Nuffield Health Cambridge Hospital Outstanding

Reports


Inspection carried out on 11 and 26 July 2016

During a routine inspection

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 carried out on 28 November 2013

During a routine inspection

People told us and records confirmed that staff members obtained people's consent before they received any treatment.

Treatments were explained and the consultations completed before people proceeded with their treatment. All of the people we talked with told us that they were happy with the treatment and care they had received whilst at the hospital. No-one that we talked to thought the service could be improved.

Appropriate actions had been taken to make sure that people were safe from infection or to resolve infection prevention and control issues when they were identified

Recruitment checks were carried out or obtained prior to new staff members starting work with the service to ensure the right people were employed. All of the people that we talked to were very complimentary about all of the staff at the hospital.

Systems were in place to effectively check and monitor the quality and safety of the hospital.

Inspection carried out on 26 November 2012

During a routine inspection

During our inspection we spoke with five people who were receiving treatment at the hospital or were attending an outpatient's appointment. We also spoke with seven members of staff, including a consultant, nursing and care staff.

People told us very positive comments about their experiences at the hospital. They said that they had been given a lot of information about their treatment and were able to ask questions if they needed additional information. People who were staying in the wards said that they had received a high standard of care and treatment. One person told us, "The staff were wonderful, it's terrific." Another said, "I can't praise them enough."

The records that we looked at confirmed that people were involved in the planning of their treatment and that they had signed to agree their consent to treatment. The records provided evidence that assessments had been carried out with clear care plans and risk assessments in place for staff to follow.

Staff told us that they received good induction and training to enable them to carry out their roles effectively. They also confirmed that appropriate recruitment checks had been carried out prior to them starting work at the hospital.

The hospital had an effective quality assurance system in place to ensure that the service was audited, with action taken to address any issues that were identified.

Inspection carried out on 31 January 2012

During a routine inspection

During our visit we spoke with four people who were receiving post-operative care and treatment. Following our visit we spoke with two former inpatients, via telephone.

All of the people we spoke with said that they were given the right amount of information, including risks, benefits and alternative (anaesthetic) options in a way that they were able to understand. This level of information supported their decision to consent to the proposed care and treatment.

People had positive views about the standard of care and treatment they had experienced during their pre-admission attendance at the hospital, during their inpatient stay and with their discharge arrangements and follow-up appointments. Staff were described as "Kind" and "Attentive". One person said that their hospital stay was, "Like being on a 5* cruise (liner)".

Some of the people described how staff had introduced them to the proposed surgical implants to be used as part of their treatment. This introduction included having the opportunity provided to see and handle these prosthetic devices. One person informed us that they were reassured that their intended breast implants were safe to use.

People were provided with opportunities to make comments about their experiences as patients. Each of them confirmed that patients' questionnaires were made available to them and were going to complete and submit these, if they had not already done so.

Each of the people we spoke with were aware of the steps they could have taken to make a complaint, if the issue had arisen. They all said that they had no reservations in following the hospital's complaints procedure although most of the people we spoke with were satisfied with their care and treatment. One person indicated to us that, where areas of their care did not fully meet their expectations, they intended to complete and submit their patients' questionnaire which would notify the hospital about these.