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Nuffield Health Chichester Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 11 November 2016

Overall, we rated surgical services at Nuffield Health Hospital Chichester as good. This was because:

  • The hospital had a good track record on safety. The hospital had one serious injury, no patient deaths or never events between April 2015 and March 2016.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents. The hospital fully investigated incidents and shared learning from them to help prevent recurrences.
  • The hospital had effective systems to assess and respond to patient risk. This included a comprehensive use of the modified early warning system (MEWS) track and trigger flow charts to identify deteriorating patients and respond appropriately.
  • The hospital participated in relevant local and national audits and contributed to national data to monitor performance such as the National Joint Registry (NJR).
  • We found there were arrangements to ensure that staff were competent and confident to look after patients. Mechanisms were in place to support staff and promote their positive wellbeing. Staff were supported to maintain and further develop their professional skills and experience, and were passionate about working at the hospital.
  • Staffing levels and skill mix were planned, implemented and reviewed to keep patients’ safe at all times. Any staff shortages were responded to quickly and adequately.
  • Staff encouraged patients and their relatives or supporters to be partners in their care. Patients told us staff had time to answer questions and that they made sue that they had been understood.
  • It was easy for people to complain or raise a concern and they were treated compassionately when they did so. We saw evidence the service learnt from complaints and made improvements to working practices where appropriate.
  • Waiting times, delays and cancellations were minimal and the service managed these appropriately.
  • The leadership team was knowledgeable about quality issues and priorities, and understood what the challenges were and took action to address them.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • The endoscopy suite was working toward Joint Advisory Group (JAG) on gastrointestinal (GI) endoscopy accreditation incorporating the endoscopy global rating scale, which is a quality improvement and assessment tool for the GI endoscopy service.
  • The endoscopic services demonstrated compliance with British Society of Gastroenterology (BSG) guidelines

However;

  • We saw examples of poor compliance with infection control policies within theatres. Infection control procedures were not given sufficient priority at all times. There was concern that theatre staff did not understand the risks associated with these issues.
  • We saw poor completion of the World Health Organisation (WHO) Surgical Safety checklist in theatres.
  • We saw instances where theatre practice was below expected levels.
  • Relatives were used to interpret for patients during the consent process rather than an official interpreter.
Inspection areas

Safe

Requires improvement

Updated 11 November 2016

We found there were suitable arrangements to keep people safe. This included systems for the reporting and investigation of safety incidents. Staff could demonstrate their understanding of the duty of candour and provide examples of its implementation. There were robust 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. The management of patients whose condition was deteriorating was a particular strength. We found 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 appropriate safeguarding arrangements in place for adults and children.

Effective

Good

Updated 11 November 2016

We found 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 groups 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 although the size of the service meant that feedback from national audit programmes was limited. There were no concerns regarding rates of unplanned admission, return to theatre or transfer to another hospital. We found arrangements that ensured that doctors and nurses were compliant with the revalidation requirements of their professional bodies. All consultants had clear practising privileges agreements which set out the hospitals expectations of them, and ensured they were competent to carry out the treatments they provided. Systems for obtaining consent were compliant with legislation and national guidance, including the Mental Capacity Act (2005) and these were adhered to by staff.

Caring

Good

Updated 11 November 2016

We observed that patients were generally treated with dignity and respect and their privacy was maintained. Patients who shared their views were very positive about the care that they received and spoke of kind and welcoming staff. We saw that results of the friends and family test and other patients satisfaction surveys demonstrated that patients would recommend the hospital to others. We did identify that the dignity and privacy of patients being prepared for operations in the operating theatres could have been considered more by staff and that appropriate covering should have been used.

Responsive

Good

Updated 11 November 2016

Services were planned to meet the needs of patients. We saw that some outpatient services operated in the evenings and at weekends to give patients flexible access to these services. The environment allowed for patients with physical disabilities to be safely cared for. The hospital was exceeding national referral to treatment time standards. Patients were assessed prior to admission to ensure that the hospital could safely meet their needs. 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.

Well-led

Good

Updated 11 November 2016

We found that staff were conversant with the corporate vision and values and strove to demonstrate these in their daily work. There was an appropriate system of governance and managers knew the key risks and challenges to the hospital and were taking steps to mitigate the impact of these. However, the management team had limited awareness of the Workforce Race Equality Standard (WRES) which the provider is required to publish information about by July 2017. Practising privileges were received, authorised and granted in conjunction with the MAC and kept under review. There was effective governance and oversight of the consultants performance and behaviours through the MAC and by close working with the local NHS trust, where many of them worked.

There were clearly defined and visible local leadership roles and managers provided visible leadership and motivation to their teams. We saw examples of initiatives that were introduced to improve the patient experience and to ensure the safety and quality of care kept pace with new developments and growing expectations. We also saw that the provider and local executive team were aware when they could not provide a service that complied with the required guidance that they made a full assessment and a clearly planned decision to stop the service.

Senior managers were visible and had a thorough understanding of how services were provided at the hospital. They were open and honest about what they did well and where they knew there were areas for improvement. The executive team knew and understood their main market very well and ensured that services were developed to meet the needs of the local community.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 11 November 2016

We rated the outpatients and diagnostic imaging services provided at Nuffield Health Hospital Chichester as good, because:

  • There was a focus on patient safety within outpatient services. Medicines were stored safely and checks on emergency resuscitation equipment were performed routinely. Incidents and adverse events were reported and investigated through robust quality and clinical governance systems. Lessons arising from these events were learned and improvements had been made when needed.

  • There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training specific for their roles. Staff had appropriate safeguarding awareness and people were protected from abuse

  • People’s privacy was always protected in outpatient and diagnostic areas. Staff knocked on doors before entering rooms, used curtains appropriately and were careful to avoid conversations in corridors.

  • Patients’ treatment and care was delivered in accordance with their individual needs. Patients told us they felt involved in decisions about their care and they were treated with dignity and respect.

  • People’s concerns and complaints were listened and responded to and feedback was used to improve the quality of care.

  • The leadership, governance and culture within the departments promoted the delivery of person centred care. Staff were supported by their managers and were actively encouraged to contribute to the development of the services.

  • The method for tracking medical records was reliable and we saw innovative practice concerning sharing physiotherapy treatment notes between the hospital and the Nuffield Health Fitness & Wellbeing Centre, in Chichester as part of an integrated outpatient physiotherapy and rehabilitation service.

Surgery

Good

Updated 11 November 2016

Overall, we rated surgical services at Nuffield Health Hospital Chichester as good. This was because:

  • The hospital had a good track record on safety. The hospital had one serious injury, no patient deaths or never events between April 2015 and March 2016.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents. The hospital fully investigated incidents and shared learning from them to help prevent recurrences.

  • The hospital had effective systems to assess and respond to patient risk. This included a comprehensive use of the modified early warning system (MEWS)track and trigger flow charts to identify deteriorating patients and respond appropriately.

  • Consultants and the Resident Medical Officer (RMO) provided 24 hour medical cover to respond to any clinical issues.

  • The hospital participated in relevant local and national audits and contributed to national data to

  • We found there were arrangements to ensure that staff were competent and confident to look after patients. Mechanisms were in place to support and promote positive wellbeing amongst staff who were supported to maintain and further develop their professional skills and experience, and were passionate about working at the hospital.

  • Staffing levels and skill mix were planned, implemented and reviewed to keep patients’ safe at all times. Any staff shortages were responded to quickly and adequately.

  • Nursing and medical staff were caring, compassionate and patient centred in their approach. We observed ward staff maintained patients respect and dignity at all times.

  • It was easy for people to complain or raise a concern and they were treated compassionately when they did so. We saw evidence the service learnt from complaints and made improvements to working practices where appropriate.

  • Waiting times, delays and cancellations were minimal and the service managed these appropriately.

  • We saw that staff wanted to learn, develop and improve their skills; they were given protected time, resources and encouragement to do so.

  • The leadership team was knowledgeable about quality issues and priorities, and understood what the challenges were and took action to address them.

  • The endoscopy suite was working toward Joint Advisory Group (JAG) on gastrointestinal (GI) endoscopy accreditation incorporating the endoscopy global rating scale, which is quality improvement and assessment tool for the GI endoscopy service. Endoscopic services also demonstrated compliance with British Society of Gastroenterology (BSG) guidelines.

  • The method for tracking medical records was reliable and we saw innovative practice concerning sharing physiotherapy treatment notes between the hospital and the Nuffield Health Fitness & Wellbeing Centre in Chichester as part of an integrated outpatient physiotherapy and rehabilitation service. The Health and Fitness centre does not provide regulated activities but is within the Nuffield Healthcare group and was used to extend access to physiotherapy services to improve patient outcomes.

However;

  • We observed some systems and procedures in theatre that were not best practice for example adherence to infection control policies and the use of the World Health Organisation (WHO) checklists.

  • We saw examples of poor compliance with infection control policies within theatres. Infection control procedures were not given sufficient priority at all times. There was concern that theatre staff did not understand the risks associated these issues.

  • Staff hand washing facilities on the wards and pre assessment fell below recommended standards.

  • Staff did not comply with local infection control and prevention policies.

  • We saw poor completion of the ‘Five steps to safer surgery’ (WHO) checklist in theatres.

  • There was not a robust system in place for checking that emergency equipment was available on Northgate ward.

  • Relatives were used to interpret for patients on wards and during the consent process rather than an official interpreter.