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Nuffield Health Leicester Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 14 March 2017

Nuffield Health Leicester Hospital is an independent hospital based in Leicester and part of the Nuffield Health corporate group. The hospital has 38 beds all single rooms with en-suite facilities. Facilities include two operating theatres, X-ray, outpatient and diagnostic facilities.

The Nuffield Health Leicester provides surgery, services for children and young people, and outpatients and diagnostic imaging. This service is for NHS, self- funded and insured patients. We inspected surgery, outpatients and diagnostic facilities and services for children and young people.

Children’s facilities at the hospital include dedicated ward and play areas, pram park facilities and designated parent and child car parking. A consultant paediatrician and lead paediatric nurse lead the children’s service. A nurse adviser for children also supports the children’s service whose remit covers children’s services within the Nuffield group of hospitals.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20th and 21st September 2016, along with an unannounced visit to the hospital on 29th September 2016 and 20th January 2017.

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.

Services we rate

We rated this hospital/service as good overall.

We saw some areas of good practice including:

  • Patients were protected from avoidable harm and abuse.

  • There was a good incident reporting culture throughout the hospital.

  • Staff were supported to be open and transparent and they understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • The service was responsive to inspection findings and provided ‘This is me’ and ‘hospital passports’ to support people living with dementia and learning disabilities.

  • Emergency equipment checking was up to date in all areas.

  • Staff had good access to online and extended training.

  • Managers were supportive and visible.

  • A family atmosphere was apparent throughout the service.

We found good practice in relation to outpatient care:

  • The staff treated patients with dignity and respect and maintained confidentiality.

  • Attempts were made to tailor appointment times to suit patient needs.

  • Notes were stored confidentially throughout appointments.

We found areas of good practice in surgery:

  • Staff addressed concerns over fasting times by developing an aide memoir system for patients.

  • Equipment was checked and ready for use at all times.

  • Evidence based risk assessments were performed throughout surgery.

  • Staff were flexible and where possible adapted care to the individual’s needs.

We found areas of good practice in children’s and young person’s services:

  • Efforts were made to tailor care to the individual child’s needs.

  • The needs of children, young people and families were considered throughout their care.

  • Staff were suitably trained to care for the needs of the children.

  • Auditing was used to inform practice.

  • Practice emergency training was performed to simulate potential emergency situations.

  • Children and young people received kind compassionate care.

However, we also found the following issues that the service provider needs to improve:

  • The sepsis policy was not up to date and iLeaflets were not routinely available in languages other than English.

  • There were gaps in mandatory training due to sickness.

  • Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Ellen Armistead.

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 14 March 2017

We rated safe as good because:

  • People were protected from avoidable harm. Staff were confident in how and when to report incidents. No serious incidents involving outpatients had been reported. They also demonstrated shared learning and a good knowledge of incidents that had taken place.

  • Audits were completed and actions developed to maintain appropriate levels of hand hygiene and cleanliness. All areas we inspected appeared visibly clean and uncluttered.

  • Safeguarding vulnerable adults, children and young people was given sufficient priority.

  • Equipment had been checked in line with hospital policy. There was a comprehensive equipment log and servicing process.

  • Staffing levels and skill mix were planned, implemented and reviewed to ensure patients received safe care and treatment at all times.

  • Arrangements for managing medicines including storage kept people safe from avoidable harm.

  • Patient’s risks were assessed to determine their fitness for surgery. The service had protocols and guidelines in place to assess and monitor patient risk in real time.

  • Safer surgery checklists were routinely used and based on current guidance.

  • Patient records were stored securely and readily available for patient appointments.

  • Surgical and diagnostic cleaning was thorough and adhered to recommended guidance.

  • The children’s service had sufficient numbers of medical staff and children’s nurses with the appropriate skills.

  • Paediatric early warning scores were in use with appropriate escalation.

  • A modified adult early warning system was currently in use.

  • Named doctors and nurses for safeguarding were available for staff and delegated appropriate roles.

However:

  • Staffing within the outpatients department left no leeway to cover sickness or an excessive demand for clinic.

  • National Early Warning Score (NEWS) as recommended by the Royal College of Physicians was not yet part of clinical practice. The current use of the modified early warning score (MEWS) meant there was a potential risk some patients may not get appropriate risk screening for sepsis should they meet the criteria. Plans were in place to implement the NEWS post training.

  • There was no sepsis policy available on the staff intranet. No episodes of sepsis had occurred in the last twelve months.

  • There were carpets in the ward corridor, which did not comply with HBN 00-09 Infection control in the built environment states in clinical areas where spillages are anticipated (including patient rooms, corridors and entrances) carpets should not be used in these areas.

  • There were four fire/emergency unsecured exit doors situated in the ward area with no means of alerting staff if they had been opened. Modifications were in progress to improve the security of the doors.

  • There were gaps in the mandatory training due to staff sickness.

Effective

Good

Updated 14 March 2017

We rated effective as good because:

  • Care and treatment was planned and delivered in line with current evidence-based guidance, including the Royal Colleges and National Institute for Health and care Excellence (NICE) guidance.

  • Most nursing and healthcare staff received meaningful appraisals and were supported in identifying and meeting their training needs.

  • Multi-disciplinary procedures were in place to ensure staff managed patients’ on-going care effectively. Multi-disciplinary team working within and outside of the children’s service resulted in positive outcomes for children.

  • Staff supported patients to make decisions. They provided clear information about surgical procedures.

  • Staff had the right qualifications, skills, knowledge and experience to do their job.

  • Staff could access information they needed to assess, plan and deliver care to people in a timely way.

  • Auditing systems had informed practice, introduced changes and lessons learnt to improve outcomes throughout the hospital.

However we also found;

  • Less than 75% of theatre staff had received an appraisal of their performance in the same reporting year. We were told that they were currently on course for the completion of all theatre staff appraisals by the end of 2016.

Caring

Good

Updated 14 March 2017

We rated caring as good because:

  • Feedback from patients and those important to them was extremely positive about the care they had received and the way staff treated them. There was evidence of some staff going above and beyond to accommodate certain situations.

  • All staff treated patients with dignity and respect as well as helping them to cope emotionally

  • Staff made every attempt to provide individualised patient centred care.

  • Within children’s and young people’s services, families and patients were respected and valued as individuals and empowered as partners in their care.

  • Patients were supported and involved as partners in their care. Staff explained care and treatment in a way patients understood.

  • The provider had achieved high scores in patient feedback from both the NHS Friends and Family test and the hospital’s satisfaction survey.

  • The multi-disciplinary team provided support throughout the child’s or young person’s admission, stay and in preparation for their discharge home.

However we found that;

  • In outpatients and diagnostics, during our initial visit, staff told us they would use family members to interpret for people for whom English was not their first language.

Responsive

Good

Updated 14 March 2017

We rated responsive as good because:

  • Services were planned and delivered in a way which met the needs of the local population.

  • The needs of specific patient groups were considered. The service provided information and support tools for the care of patients living with dementia.

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

  • Patients were admitted on a planned basis for elective surgery, this included self-funded patients and NHS patients.

  • Staff provided care in a timely way and NHS and private patients’ experienced the same quality of care.

  • The complaints process was in place and easy to use.

  • The needs of different people were taken into account when planning and delivering services, for example those who had a learning disability or those living with dementia were identified at the earliest stage of the referral process.

However we found ;

  • There was no clear written policy or treatment criterion for patients living with dementia or patients with a learning disability.

  • We did not see provision made available for patient information leaflets in large print and formats other than written English.

Well-led

Good

Updated 14 March 2017

We rated well-led as good because:

  • There were clear statements of visions and values that were driven by quality and safety. Staff in all areas understood the vision, values and strategy of the service.

  • The leadership and governance within the hospital functioned effectively and interacted with each other appropriately.

  • Clinical strategies and priorities were in place against which were action plans and progress updates. A clear leadership structure was in place within the service. Individual management of the different areas providing acute children’s services were well led.

  • There was an effective and comprehensive process in place to identify, understand, monitor and address current and future risks.

  • The service proactively engaged staff and the public to comment and be involved with the development of the service.

  • There were clearly defined and visible leadership roles in place with senior staff providing motivation to their teams.

  • All staff spoke positively about the matron and the hospital director and commented they feel listened to, as actions had been followed through as pledged.

  • Changes had been made to service delivery following feedback from staff, patients and consultants.

Checks on specific services

Services for children & young people

Good

Updated 14 March 2017

Children and young people’s 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, responsive and well led.

  • The hospital met the Royal College of Paediatrics and Child Health (RCPCH) standards for paediatric consultant presence. Nurse staffing met the Royal College of Nursing (2013) guidelines and shortfalls in trained nurse provision within children’s services were managed through escalation pathways.

  • There was good access and flow within the children’s service. Children received evidenced based care and treatment and good multi-disciplinary working existed between the children’s services, external providers and the rest of the hospital.

  • Monitoring records of resuscitation equipment showed that monitoring of this equipment had taken place daily.

  • Staff were caring, compassionate and respectful. Children’s emotional and physical wellbeing was central to everything staff did.

  • All staff worked hard to ensure children and young people felt included and were active partners in their care.

  • Staff were positive about working in the service and there was a culture of flexibility and commitment.

  • The service was well led and a clear leadership structure was in place. Governance processes had been reviewed, clinical risks monitored, and feedback from staff, parents and children and young people had resulted in changes to aspects within the service.

However we also found ;

  • The security doors with access to the ward were unsecured.

Outpatients and diagnostic imaging

Good

Updated 14 March 2017

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

  • Learning from incidents was communicated throughout the hospital to support improvement in all areas.

  • Patient records were stored securely and available for provision of care.

  • Staffing levels were sufficient to perform care, although there was no leeway to cover sickness or increased demand in clinics.

  • Staff appraisals were completed and training requirements met.

  • Consent to care and treatment was obtained in line with legislation and guidance.

  • Care from a range of services was co-ordinated. Staff worked collaboratively to understand and meet the range and complexity of people’s needs

  • People were supported, treated with dignity and respect, and were involved in their care.

  • Waiting times and cancellations were minimal.

  • The service took complaints and concerns seriously, responded in a timely way and listened to service users.

However we found that;

  • Staffing within the outpatients department left no leeway to cover sickness or an excessive demand for clinic.

  • There were some gaps in the mandatory training due to staff sickness.

  • Complaints leaflets were not visible in the outpatients and radiology area.

  • Staff told us they would use family members to translate if required.

Surgery

Good

Updated 14 March 2017

Surgery was the main activity of the hospital.

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

  • Staff reported incidents of harm or risk of harm and appropriate actions and learning occurred as a result.

  • The ward we visited was visibly clean and systems were followed to ensure that cleanliness of the environment was maintained. Effective infection prevention and control measures routinely took place on the ward.

  • Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and adequately. There were effective handovers and shift changes to ensure staff managed risks to patients who used services.

  • Staff delivered care and treatment in line with nationally recognised evidence-based guidance. Policies and guidelines were developed to reflect national guidance.

  • Feedback from patients about their care and treatment was consistently positive. We observed that patients were treated with kindness and compassion throughout our visit. Patients told us they felt informed about their treatment and had been included in decisions about their care.

  • The hospital was flexible and adaptable and ensured specific individual needs were met. Patients were able to choose their surgery date or appointment time to suit their needs.

  • Staff across the service described an open culture and felt well supported by their managers. They were passionate about the roles they performed in the hospital and felt they worked well as a team.

However;

  • There were carpets in the ward corridor, which did not comply with HBN 00-09 Infection control in the built environment states in clinical areas where spillages are anticipated (including patient rooms, corridors and entrances) carpets should not be used in these areas.

  • There were four fire/emergency unsecured exit doors situated in the ward area with no means of alerting staff if they had been opened. However, this had been identified as a risk and actions were being taken to rectify this.