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Nuffield Health Guildford Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 18 July 2019

Guildford Hospital is operated by Nuffield Health. The hospital has 49 beds and is an independent hospital. Facilities include four operating theatres, oncology unit, outpatient and diagnostic facilities.

The hospital is located in Guildford and is sited close to the local NHS trust Hospital. The hospital provides surgery, medical care including oncology, services for children and young people, outpatients and diagnostic imaging.

We inspected the service using our comprehensive inspection methodology. We carried out an unannounced visit to the hospital on the 10 and 11th April 2019. We inspected surgery, medical care, services for children and young people and outpatients.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Services we rate

Our rating of this hospital stayed the same. We rated it as Good overall.

We found good practice in relation to:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well and had suitable premises and equipment and looked after the general environment well.

  • Staff completed and updated risk assessments for each patient and kept detailed records of patients’ care.
  • In all areas caring for adults the service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service provided best practice when prescribing, dispensing, recording and storing medicines.
  • The service managed patient safety incidents well by completing investigations and learning from outcomes. The service used safety monitoring results well and used them to initiate change of practice.
  • Staff gave patients enough food and drink to meet their needs and improve their health, the service made adjustments for patient’s religious, cultural and other preferences.
  • The staff assessed and monitored the patients regularly to see if they were in pain and audited outcomes to improve care.
  • The service provided care and treatment based on national guidance and a local audit plan was established to check effectiveness.
  • All staff had an appraisal and the service made sure staff were competent for their role and supported their professional development.
  • Staff of different kinds worked together as a team to benefit patients.
  • Staff understood how and when to assess whether a patient had the capacity to make their decisions about their care and followed procedure when a patient could not give consent.
  • Staff cared for the patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness and provided emotional support.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The service planned and provided services in a way that met the needs of patients. The service took account of patient’s individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results and shared these with staff.
  • Managers at all levels had the skills and ability to run a service and shared a corporate strategy, vision and values with the staff of what it wanted to achieve.
  • Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for clinical care to flourish.
  • The service engaged well with patients, staff and local organisations and collaborated with partner organisations effectively.

We found areas of outstanding practice in the oncology service, surgery and children’s and young people’s service.

  • Oncology patients could be referred to a personal trainer as part of the hospital’s ‘Recovery Plus’ initiative. This was a personalised training programme which was part of the patient’s care planning.
  • The implementation of monthly scenario training for all staff developed learning and auditing of clinical practice. Staff had put their scenario training into practice in a critical situation and the learning was shared nationally across the Nuffield hospitals.
  • Information for children and young persons was clearly displayed on the ward in books, information leaflets, on boards and addressed general wellbeing as well as specific hospital admission information. The information was current and in line with best practice.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South)

Inspection areas

Safe

Good

Updated 18 July 2019

Our rating of safe stayed the same. We rated it as Good because:

  • The service provided mandatory training in key skills to all staff and made sure all staff completed it. There was a good level compliance with mandatory training across the hospital, which used internal online system.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and knew how to apply it.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises visibly clean. They used control measures to prevent the spread of infection.
  • The service had suitable premises and equipment and looked after them well. The environment of all areas of the hospital appeared well maintained.
  • Staff completed and updated risk assessments for each patient to minimise the risk of harm. They kept clear records and asked for support when necessary.
  • In all areas of the hospital managing patients the service had enough nursing staff with the right qualifications and skills to keep the patient safe and provide the right care and treatment.
  • There were safe arrangements for medicines. Safe systems were in place to safely prescribe, administer, record and store medicines
  • All areas except outpatients managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • In outpatients substances subject to Control of Substances Hazardous to Health Regulations (2002) were not always stored securely. Following the inspection, the provider informed us that key pad locks were added to the sluice room doors.
  • Nasoendoscopes that were re-used on site were not leak tested in line with best practice. Following the inspection, the provider sent us adapted record sheets to enable leak testing to be documented as part of the decontamination process.
  • Data provided to us prior to and during the inspection indicated that no incidents had been reported for the outpatient department. However, following the inspection, the provider informed us that 26 incidents had been reported for the outpatients department between January 2018 and December 2018. This meant it was not clear if the outpatients department was aware of all the incidents that had been reported in the service.
  • Not all staff were consistent in their assessment and escalation of National Early Warning scores.
  • Not all patient’s rooms had intact flooring being seamless between walls and floors making cleaning easier.

Effective

Good

Updated 18 July 2019

Our rating of effective stayed the same.We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. New guidance was widely circulated and acted on.
  • Staff gave patients enough food and drink to meet their needs and improve their health. The service adjusted for patients’ religious, cultural and other preferences.
  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them using appropriate national and a comprehensive local audit plan.
  • Staff worked well as a team and with other health professionals in and out of the hospital to provide services for patients.
  • Competent staff provided the service and staff were engaged in developing their skills further. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • The service provided up to date health promotion information in the hospital and on their website.
  • Staff had an understanding of the Mental Capacity Act 2005 and how this applied in practice. They followed the hospital’s policy and procedures when a patient could not give consent.

Caring

Good

Updated 18 July 2019

Our rating of caring stayed the same. We rated it as Good because:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. We saw staff being friendly, approachable and professional with patients.
  • Staff provided emotional support to patients to minimise their distress. We saw staff interacting with patients in a supportive manner by offering sympathy and reassurance.
  • Staff involved patients and those close to them in decisions about their care and treatment. All patients received information in writing on the costs of their care or treatment prior to commencing treatment. Patients received full explanations about the procedures they were to have.

However:

  • The response rates for the outpatient survey were low. The service had recently included pre-paid envelopes to encourage feedback.

Responsive

Good

Updated 18 July 2019

Our rating of responsive stayed the same.We rated it as

Good

because:

  • The service planned and provided services in a way that met the needs of their patients. Services were suitable for the needs of all communities and could be accessed promptly.

  • The service took account of patients’ individual needs. Holistic needs assessments were carried for all patients at regular intervals throughout their treatment pathway and care planning. Services were adapted for some people, including patients with decreased mobility and hearing impairment.

  • People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff. We found that there were systems to listen to patients concerns and take appropriate action if required.

However:

  • The escalation of the complaints procedure was not made explicit in three out of the five response letters to complainants that we reviewed.

Well-led

Good

Updated 18 July 2019

Our rating of well-led stayed the same.We rated it as Good because:

  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. Staff told us the hospital director and matron were routinely visible and approachable.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action. Nuffield Health values were aligned to staff working practices by the staff appraisal and professional development system.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. All the staff we spoke with were proud to work for the hospital. Staff felt fully engaged with the success of the hospital and their role in making it happen.
  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for clinical care to flourish. The hospital had a governance framework which included policies, procedures and oversight by the senior management team and corporate provider.
  • The service had clear systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected. Services in the hospital had risk registers and risk management processes to monitor and manage risks.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. The hospital engaged well with patients, staff, the public and local organisations to plan and manage appropriate services.
  • The hospital was committed to improving services by learning from when things went well or wrong, and by promoting training and innovation.
Checks on specific services

Services for children & young people

Good

Updated 18 July 2019

Children and young people’s services was a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring and responsive and well led.

Surgery

Good

Updated 18 July 2019

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

Staffing was managed jointly with medical care.

We rated this service as good because it was safe, effective, responsive and well-led. Caring was found to be outstanding.

Medical care (including older people’s care)

Good

Updated 18 July 2019

Medical care services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring and responsive and well led.

Outpatients

Good

Updated 18 July 2019

Outpatients services were a significant proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, caring and responsive and well led. We do not rate effective in outpatients.