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Nuffield Health Exeter Hospital Good

Reports


Inspection carried out on 10,11 May and 9 June 2016

During a routine inspection

We carried out this inspection as part of our programme of independent healthcare inspections under our new methodology. The comprehensive inspection was carried out through announced visits on 10 and 11 May and 9 June 2016. We did not carry out an unannounced inspection.

Our key findings were as follows:

We rated the hospital as good overall, with surgery and children and young people's services rated as good in all domains. Outpatients and diagnostic imaging services were rated as good in responsive, caring and well led domains and requires improvement in the safe domain. We did not rate effective for outpatients and diagnostic services due to insufficient evidence being available.

  • Risk was managed and incidents were reported and acted upon with feedback and learning provided to staff.

  • Treatment and care were effective and delivered in accordance with best practice and recognised national guidelines. There was excellent multidisciplinary team working within the service.

  • Patients were at the centre of the service and the priority for staff. Innovation, high performance and the high quality of care were encouraged and acknowledged. Patients and their relatives were respected and valued as individuals. Feedback from those who used the service had been exceptionally positive. Patients spoke highly of the approach and commitment of the staff who provided a service. Staff went above and beyond their usual duties to ensure patients received compassionate care.

  • Patients received excellent care from dedicated, caring and well trained staff who were skilled in working and communicating with patients and their families.

  • Staff understood the individual needs of patients and designed and delivered services to meet them.

  • There were clear lines of local management in place and structures for managing governance and measuring quality. The leadership and culture of the service drove improvement and the delivery of high-quality individual care.

  • All staff were committed to patients and their relatives and to their colleagues. There were high levels of staff satisfaction with staff saying they were proud of the departments they worked in. They spoke highly of the culture and levels of engagement from managers.

  • Staff worked in an open and honest culture with a desire to get things right.

Are services safe at this hospital/service

  • The hospital promoted a culture of reporting and learning from incidents. Incidents were fully investigated with actions for improvement identified and put into place.

  • The management of medicines and infection control was in place with audit tools used to monitor practice.

  • Staff were clear about safeguarding practices and knew what actions to take if they had concerns.

  • Records were stored securely and audited for compliance with protocols. However in the outpatients department some confidential information was left unattended in unlocked treatment/consultation rooms.

  • Nursing and medical records had been completed appropriately and in line with each individual patient’s needs.

  • Surgical safety checklists were completed as required and a modified early warning score system was in place to support staff to recognise a deteriorating patient.

  • The service had not yet achieved  Joint Advisory Group (JAG) accreditation or Endoscopy Global ratings Scale (GRS)  for its endoscopy service.

  • The provider had a compliance level of mandatory training target of 90%. Most mandatory training achieved 100%

  • Equipment specific to children’s needs was available for use.

  • Staffing levels met the RCN guidance on defining staff levels for children and young people’s services.

  • Infection rates were monitored.

  • In the outpatients department not all hand wash basins or flooring in clinical areas were compliant with Department of Health 'health building notes' (HBN) which give best practice guidance on the design and planning of new healthcare buildings and on the adaptation/extension of existing facilities

Are services effective at this hospital/service

  • Needs were assessed and treatment was provided in line with legislation and using National Institute for Health and Care Excellence (NICE) guidance. Staff were aware of the guidance relevant to their area of work.

  • Policies and procedures incorporating national guidance were in place and available to all staff. Staff knew where to access guidance and policies.

  • Staff were trained to ensure they were competent to provide the care and treatment needed. Staff training and appraisal was ongoing. Consent to care and treatment was discussed and obtained in line with legislation and guidance.

  • Patients had good outcomes as they received effective care and treatment to meet their needs.

  • Regular audits were carried out to monitor performance against national patient outcomes and to maintain standards.

  • Patients were at the centre of the service and the priority for staff. High quality performance and care were encouraged and acknowledged and all staff were engaged in monitoring and improving outcomes for patients.

  • Children and young people’s needs were assessed and care and treatment was delivered in line with legislation, standards and evidence-based guidance.

  • Staff skills and competence were examined and staff were supported to obtain new skills and share best practice.

Are services caring at this hospital/service

  • Patient feedback about the service was positive. Patients said staff were kind, caring and supportive. We saw staff were kind and caring, their focus being excellent patient care. They praised the way the staff really understood their needs and involved their family in their care. Patients were treated as individuals. Staff described occasions when they had been flexible at short notice to ensure patients had their procedures carried out.

  • Between July and December 2015 there were high   satisfaction scores (85% and above) with the NHS Friends and  Family Test

  • Patients said staff were caring and compassionate, treated them with dignity and respect, and made them feel safe. Staff went above and beyond their usual duties to ensure patients experienced high quality care.

  • Staff were skilled to be able to communicate well with patients to reduce their anxieties and keep them informed of what was happening and involved in their care.

  • Relatives were encouraged to be involved in care as much as they wanted to be, while patients were encouraged to be as independent as possible. They were able to ask questions and raise anxieties and concerns and receive answers and information they could understand.

  • We observed staff treating patients with kindness and warmth. They were polite, calm and reassuring. The departments were busy and professionally run, but staff always had time to provide individualised care.

  • Staff talked about patients compassionately with knowledge of their circumstances and those of their families.

  • Paediatric staff used age appropriate distractions for their patients to relieve anxiety.

  • Comments from patients and their parents specified the positive effect staff attitude and approach had on their stay.

  • Staff responded to parent’s and children’s emotional needs by recognising and responding to anxieties. They did this by providing information and reassurance appropriate for age and understanding.

Are services responsive at this hospital/service

  • Services were planned to meet patients’ needs. The flow of patients through the hospital was well organised. Patients felt well informed about the procedure and what to expect during their recovery.

  • Services were tailored to meet the needs of individual patients and were delivered in a flexible way.

  • Complaints were responded to in a timely manner and any  learning was taken forward to develop future practice. Staff actively invited feedback from patients and their relatives and were very open to learning and improvement.

  • There was level access into the building and a passenger lift to all floors ensuring patients could move around the building.

  • The hospital had reviewed the quality of the service and made reasonable changes where required, to ensure they could provide a safe service in a way that would suit the needs of children and young people.

  • Where young people may feel sensitive about a procedure, arrangements were made to provide an advocate who was independent of their family or professionals providing direct care.

Are services well led at this hospital/service

  • The hospital had a vision for developing the service and shared this with their patients.

  • There were clear governance processes in place to monitor the service provided.

  • Risks were identified and ways of reducing the risk investigated. Any changes in practice would be introduced, shared throughout the hospital and monitored for compliance.

  • Leadership at each level was visible. Staff had confidence in leadership at each level and felt they would be listened to.

  • The leadership, governance and culture were used to drive and improve the delivery of high-quality care. The clinical managers were committed to the patients in their care, their staff and the unit.

  • Frontline staff and managers were passionate about providing a high quality service for patients with a continual drive to improve the delivery of care.

  • There was a high level of staff satisfaction with staff saying they were proud of the departments as a place to work. They showed commitment to the patients, their responsibilities and to one another. All staff were treated with respect and their views and opinions heard and valued.

  • Patients were able to give their feedback on the services they received; this was recorded and acted upon where necessary

  • Actions were monitored through audit processes and reported to leadership and governance committees.

  • The service ensured they were using skills and experience of organisations and specialists independent of the hospital.

Importantly, the provider MUST take action to:

  • Ensure the outpatient department was cleaned effectively.

  • Make sure the flooring and clinical hand-wash basins in the outpatient department complied with infection prevention control in accordance with Health Building Note (HBN) 00-09: Infection control in the built environment.

The hospital SHOULD take action to:

  • Continue to investigate and monitor the occasional infestation of cluster flies in the roof space above the operating theatre.

  • Continue to ensure staff complete mandatory training as required to reach the organisations target of 90% compliance.

  • Ensure there was a decontamination policy for laryngoscope handles and blades in line with the Medicines and Healthcare Products Regulatory Agency (MRHA) Alert 2011.

  • Gain Joint Advisory Group (JAG) accreditation or Endoscopy Global ratings Scale (GRS) (recognition granted to organisations which meet standards that require continuous improvement in structures, processes and outcomes) for its endoscopy service.

  • Consider how children are protected from scald injuries wherever possible.

  • Consider close monitoring of hygiene standards in all areas children and young people attend.

  • Consider close monitoring of staff compliance with hospital protocols including chaperone policies.

  • Closely monitor the cleaning of all areas to ensure they are dust free.

  • Closely monitor compliance with hand hygiene protocol for all staff including consultants.

  • Make sure all confidential records are stored securely.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 19 February 2014

During a routine inspection

The hospital includes outpatients, x ray and sonography, a day care unit, operating theatres and two in-patient wards. About 80% of patients who were treated at the hospital were privately funded and 20% were funded by the NHS, who had elected to have their surgery at Nuffield Health Exeter Hospital through the �Choose and book� scheme.

We spoke with six patients and two relatives. We spoke to 14 members of staff which included cleaners, a radiographer, medical secretary, head of department, nurses, kitchen staff, pharmacists, and an infection control lead nurse.

Patients told us about their overall experience of staff working in the hospital. Comments included, �Professional�, �polite and helpful� and one patient said, �Made the whole experience smooth and not stressed.� Other comments included �They are all lovely here� and �They looked after me fantastically well�.

We found patients obtained the treatment and support they needed. The hospital had thorough practices and systems in place for control of infection and medicines management. Equipment used at the hospital was well maintained and fit for purpose. There were effective systems for monitoring the quality of the services provided including obtaining and acting upon patients� opinion and experiences. The most recent audit of patient satisfaction survey showed high levels of patient satisfaction with the care and treatment offered at the hospital.

Inspection carried out on 28 February 2013

During a routine inspection

Three inspectors visited Nuffield Health (Exeter) unannounced on 28 February 2013. We toured the building and spent time in the theatre department and looked at key documents such as recruitment, care plans and risk assessments and looked at quality assurance.

During our inspection we spoke with 13 patients who were either in the hospital receiving treatment or who were attending consultancy meetings prior to receiving treatment. We also spoke with three people visiting patients in hospital. All patients we spoke with were complimentary about the way staff treated them with dignity and respect and how their privacy was maintained throughout their stay. Everyone we spoke to was positive about the care they received throughout their experience with Nuffield Health (Exeter).

Staff were well trained and supported to be able to deliver good quality care ad there were robust recruitment processes to ensure that people were safe.

The hospital is slowly undergoing refurbishment but the systems for ensuring that smaller maintenance issues were addressed in a timely way and to ensure that theatre checks were carried out according to national guidelines were not fully effective. However, overall, the provider had an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 1 February 2012

During a routine inspection

People who had undergone surgery stated that they felt well informed about their care, treatment and costs and that both doctors and nurses were good at keeping them up to date. They told us they were involved in the decision making regarding their care and treatment options and confirmed they had signed consent forms prior to gong to theatre and were made aware of the risks and benefits of surgery including post operative care and discharge.

People we spoke with were very complimentary about the staff at Nuffield Exeter. They told us that the care staff were helpful and caring in their approach and responded quickly when called. Privacy and dignity practices were good and the written information provided to people receiving the service was helpful.

There were good auditing and quality assurance systems in place. However, some record keeping is not as detailed or up to date as it could be to ensure that any risks are minimised and that checking systems are followed.

Reports under our old system of regulation (including those from before CQC was created)