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Nuffield Health Ipswich Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 30 November 2016

We carried out an announced inspection visit on 16 August 2016 and an unannounced inspection on 25 August 2016.

Our key findings were as follows:

Overall, the hospital was rated as good, with surgery and outpatients rated as good overall and children’s and young people’s services rated as outstanding overall.

We have rated surgery as good overall with effective and caring as outstanding but due to being requires improvement in the key question of safe we have rated the service as good overall.

The key questions of effective and caring for the hospital overall have been rated as outstanding, with well led and responsive rated as good. Overall safe has been rated as requires improvement, and the responsiveness of the service has been rated as good. Whilst we note that the children’s and young people’s service has been rated as outstanding in responsive we acknowledge that the numbers of children seen by the service is very small in comparison to the overall numbers treated by the service. Therefore, we have rated responsive as good overall.

We saw several areas of outstanding practice including:

  • Staff, teams and other services worked exceptionally well together as a multidisciplinary team.
  • Care provided to patients was outstanding.
  • The range and selection of home cooked food available to patients, and the ability to provide a patient’s dedicated food request was outstanding.
  • The hospital provided regular training events for local GPs, which demonstrated outstanding practice.
  • Outcomes for people who used the service were outstanding. The hospital participated in certain national audits, including the National Joint Registry (NJR), which showed 100% consent rate.
  • Outcomes from the Oxford Hip and Knee score, as well as PROMS outcomes were outstanding.

However, there were also areas of where the provider needs to make improvements.

The provider should:

  • Ensure medical notes are always available for staff who are treating patients in the outpatients department.
  • Ensure that assessment of Gillick competence is recorded in the patient record.
  • Consider further development of the vision and strategy for the future of children’s services.
  • Improve the process for treating patients with learning difficulties.
  • Review the plans for the endoscopy suite to ensure it meets the Medicines and Healthcare products Regulatory Agency (MHRA) requirements as soon as reasonably practicable.
  • Undertake further audits on the World Health Organisation (WHO) ‘Safer Surgery’ checklist.
  • Consider the need for an admission policy setting out safe and agreed criteria for selection and admission of people using the service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 30 November 2016

  • There was a robust incident reporting system in place and lessons were learnt and improvement made when things went wrong.
  • Safety performance was measured and reviewed regularly, against set goals and compared with similar organisations. The safety performance track record was very good.
  • There had been no reported healthcare-associated infections (HCAIs) in the past 12 months.
  • Medicines were stored securely, checked regularly and administered to people as prescribed.
  • The equipment we saw was in date and clean, processes were in place to ensure equipment was well maintained.
  • There were safeguarding policies and procedures to guide staff, and staff were familiar with them.
  • Comprehensive risk assessments were undertaken for each person who used the service.
  • There was a sufficient number of appropriately skilled nursing and medical staff on duty at all times. However; there was no formal evidence or audit that the World Health Organisation (WHO) ‘Safer Surgery’ checklist was being assessed at all steps.
  • The endoscopy suite was not fully compliant with the Medicines and Healthcare products Regulatory Agency (MHRA) requirements because of the clean to dirty flow of endoscopes. However, refurbishment plans had been discussed and managers were in the process of developing a business plan to submit.
  • The hospital did not have an admission policy setting out safe and agreed criteria for selection and admission of people using the service.
  • There was no single patient record held on site, which meant that records of outpatient appointments were not available when patients saw their consultant.

Effective

Outstanding

Updated 30 November 2016

  • All doctors who had practising privileges at the hospital were at consultant level and were registered with the General Medical Council (GMC).
  • People’s needs were assessed and care and treatment was delivered in line with legislation, standards and evidence-based guidance.
  • Regular local audits were carried out and audit outcomes were used to improve patient outcomes and service quality.
  • People’s pain relief was assessed and managed effectively.
  • Outcomes for people who used the service were outstanding.
  • We also found that clinical outcomes were robustly monitored and compared monthly with other Nuffield Health hospitals, showing outstanding outcomes for people overall.
  • Staff appraisal rates were high.
  • There were systems and processes to ensurepeople’s consent was sought in line with relevant legislation and guidance.
  • However, we also found that 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.

Caring

Outstanding

Updated 30 November 2016

  • We saw that people using the service were consistently treated with dignity, respect and compassion.

  • Inpatient survey results were consistently high. For example, in May 2016, 96% of people who used the service answered highly satisfied when asked about overall satisfaction of care and treatment received.

  • People who used the service consistently told us that all staff were caring and supported them, and that they felt involved in and understood their care and treatment.

  • Staff told us they had received customer service training, and were encouraged and went, “that extra mile” to improve customer service. We saw examples of this.

  • People who used the service could speak with a member of staff at all times, for advice and support.

  • There was a strong patient centred approach to care, which included children and their parents in decision-making. Staff valued the strong professional relationships built with children and their families.

Responsive

Good

Updated 30 November 2016

  • Referral to treatment times (RTT) were above 90% for all months except October (89%) for NHS patients between April 2015 to March 2016.
  • Access and flow through the service was seamless, and admission times were flexible dependent on patient request.
  • Numbers of cancelled operations were low.
  • People’s care and treatment was tailored to their individual needs. There was an extensive range of additional facilities available.
  • There was a low number of complaints received and complaints were handled effectively, with lessons learnt identified and improvements to practise made where required.
  • There were two dementia ambassadors, who were trained in dementia and provided people living with dementia with additional support during admission.
  • One-stop clinics were available for breast care to minimise the amount of attendances for patients.
  • Outpatient and diagnostic imaging offered evening appointments for patient convenience.
  • However, we found that there was no defined process for treating patients with learning difficulties.
  • There was a five week waiting time for a dermatology clinic appointment.

Well-led

Good

Updated 30 November 2016

  • There was a clear vision and strategy for the hospital, which staff were aware of.
  • Robust governance, risk management and quality measurement systems and processesensured quality, performance and risk was understood and managed.
  • Leaders at all levels were visible, approachable and pro-active.
  • Staff spoke highly of their seniors, and described an open and honest culture.
  • Staff and the public were engaged with the service and there were numerous systems to support this.
  • There was evidence of innovation and improvement in relation to Nuffield Health programmes such as, “Recovery Plus”, which was offered to people who used the service.
  • There was a focus on quality of services provided for children and young people.
  • However, we also found that there was no vision or innovation for future development for the children’s service.
  • No action had been progressed with regards to ensuring that patient records were available for outpatient appointments.
Checks on specific services

Services for children & young people

Outstanding

Updated 30 November 2016

We rated services for children and young people (CYP) at Nuffield Health Ipswich Hospital as Outstanding overall. The safe, effective, and well-led domains were rated good; caring and response were rated as outstanding.

The service had a robust incident reporting system and there was evidence of learning from incidents. Risk assessments were in place to safeguard children and young people from abuse and staff had completed appropriate safeguarding training. Staffing levels were planned in accordance with patient needs.

Care for children and young people was planned and delivered in line with evidence-based guidance, standards, best practice, and legislation. Comprehensive child assessments were completed accurately. Staff had the necessary skills, competencies and support from managers to provide effective care. There was evidence of multidisciplinary team (MDT) working to maximise patient outcomes.

Children and their families were treated with compassion, dignity and respect at all times. There was a strong patient-centred approach to care that involved children and their parents in decision-making. Staff supported children and their families emotionally.

The service was flexible to meet the needs of children and their families and ensure continuity of care. Children had timely access to appointments and procedures, which were arranged at a convenient time for children and their parents. There was a robust complaints procedure and the service had received no formal complaints in the last 12 months.

There was a clear governance structure and proactive approach to managing risk and quality improvement. Staff were engaged with the service and their work.

However, although consent forms had been signed by children and their parents, there was a lack of documented evidence that ‘Gillick’ competence had been considered or assessed formally if required.

Outpatients and diagnostic imaging

Good

Updated 30 November 2016

We rated outpatients & diagnostic imaging (OPD) at Nuffield Health Ipswich Hospital as good overall. We rated safe, caring, responsive and well-led as good. The effective domain for this core service was inspected but not rated.

There was good evidence of learning from incidents and staff were aware of the duty of candour regulation. Infection control procedures were robust and the areas we visited were visibly clean. Staffing levels were appropriate for the service provision and for patient acuity.

Care and treatment was planned and delivered in line with current evidence-based guidance, standards and best practice. Policies were up-to-date and based on best practice and national guidelines. Multidisciplinary team (MDT) meetings took place with input from external colleagues. Patient consent was obtained in line with legislation and guidance, including the Mental Capacity Act 2005 (MCA).

Patients were treated with dignity and respect and gave consistently positive feedback about their care.

Services were planned and delivered to meet the needs of the local population and the hospital regularly performed better than national target referral to treatment times (RTT). Appointments were flexible to patient need. There was good evidence of learning from complaints.

However, medical notes were not always available for staff treating patients in the department. There was also a lack of patient information available in the waiting areas. There was no defined process for treating patients with learning difficulties.

Surgery

Good

Updated 30 November 2016

We rated surgery at Nuffield Health Ipswich Hospital as good overall. We rated the service as requires improvement for the safe domain; good for effective; outstanding for caring; good for responsive; and good for well-led.

There was a robust incident reporting system in place and lessons were learnt and improvement made when things went wrong. There had been no reported healthcare-associated infections (HCAIs) in the past 12 months, and medicines were stored securely, checked regularly and administered to people as prescribed. Comprehensive risk assessments were undertaken for each person who used the service. There was a suitable number of appropriately skilled nursing and medical staff on duty at all times. Regular local audits were carried out and audit outcomes were used to improve patient outcomes and service quality. People’s pain relief was assessed and managed effectively, and nutrition and hydration availability and choice was outstanding. People who used the service were treated with dignity, respect and compassion. Inpatient survey results consistently showed that people were highly satisfied with the service received. People’s care and treatment was tailored to their individual needs. Robust governance, risk management and quality measurement systems and processes were in place which ensured quality, performance and risk was understood and managed.