The Care Quality Commission
  • Hospital
  • Independent hospital

Nuffield Health North Staffordshire Hospital

Overall: Good read more about inspection ratings

Clayton Road, Newcastle, Staffordshire, ST5 4DB (01782) 625431

Provided and run by:
Nuffield Health

All Inspections

23 November 2021

During a routine inspection

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We only inspected the surgical core service this time. We rated surgery as good because:

  • Managers regularly reviewed and adjusted staffing levels and skill mix to keep patients safe from avoidable harm and to provide the right care and treatment. The service used agency staff and bank staff and gave staff a full induction.
  • Staff had access to training in key skills however compliance levels were low due to a pause in training due to the COVD-19 pandemic, staff understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and mainly kept good care records. They mainly managed medicines well. The service managed safety incidents well and learned lessons from them.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Compliance with mandatory training was low in some areas due to a pause in training due to COVID-19.
  • Recruitment and retention of staff remained a challenge for the service.
  • Staff did not always keep accurate records around the prescribing and administration of patients’ medicines.
  • Patient records were not always stored securely.
  • Policies such as the safeguarding adults and children’s policy and the medicines management policy did not always have enough detail or contain any local adjustments.
  • Ward areas did not display details for patients on how to make a complaint.
  • All Nursing staff should be confident and competent to assess a patients’ capacity.

14 and 15 August 2019

During a routine inspection

Nuffield Health North Staffordshire Hospital is operated by Nuffield Health.

The outpatient department has 12 consulting rooms, a clinical room for minor procedures, a treatment room and a phlebotomy room. A phlebotomy room is a room used to collect blood from patients.

Diagnostic services including; X-ray, mammography, fluoroscopy and ultra sound services are completed from this location. MRI and CT services are also available within the hospital but are performed by another organisation and were therefore not inspected during this inspection.

The hospital also has 38 individual patient bedrooms each with ensuite facilities. Facilities include three operating theatres, two with ultra clean air flow systems and one general theatre.

The hospital provides services to adults and children and young people. These services include outpatient services, diagnostic and imagining services, surgery and medical care. We only inspected outpatients and diagnostics during this inspection.

We carried out an unannounced visit on 14 and 15 August 2019 and inspected outpatients and diagnostic and imaging which are two core services at this location. We did not inspect the surgery or medical care core services during this inspection. As we only inspected two core services we are not able to aggregate ratings at location level.

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.

For the purposes of this inspection, the main service provided by this hospital was outpatients. Where our findings on outpatients for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the outpatient service report.

Services we rate

As we only inspected two core services we are not able to aggregate ratings at location level. However, the two core services we inspected during this inspection were both rated as Good overall.

  • The service had enough staff to care for patients and keep them safe. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well and followed safe infection prevention and control practices. Safety incidents were reported and investigated in an open and transparent manner and lessons were learned and shared with the wider team. Staff collected safety information and used it to improve the service. Staff had training in key skills and understood how to protect patients from abuse. Some staff were not up to date with all their training needs. However, a recovery plan was in place to address this.
  • Staff provided effective care and treatment and supported people to manage their pain. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and key services were available six days a week. A proactive approach to health promotion and education was followed and staff supported people to make decisions about their care. However, staffs’ understanding of the Mental Capacity Act 2015 should be improved to ensure that if people who were unable to make decisions about their care attended the hospital, they would be consistently supported in accordance with the Act.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

We found areas of outstanding practice in outpatients:

  • The service used creative and innovative methods to plan care to meet the long-term health and wellbeing needs of local people. Staff worked well with other services and used a proactive approach to ensure people’s individual needs were met. People could access the service in a very timely manner and waiting times from referral to treatment were consistently better than national standards. An inclusive approach was used to manage complaints and staff used complaints as an opportunity to redesign services to improve patient care.

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

  • The provider should explore how to evidence that all staff have understood and can apply the requirements of the Mental Capacity Act 2005.

  • The provider should continue to make improvements to the outpatient and diagnostic department environments so they are dementia friendly.

  • The provider should continue with the implementation of the observational audit of the Five Steps to Safer Surgery checklist to improve staffs’ compliance.

  • The provider should consider monitoring and recording the number of appointments patients did not attend (DNA) in diagnostics and imaging.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals

9 – 10 February 2016

During a routine inspection

Nuffield Health North Staffordshire Hospital was opened in 1978 and is one of 31 in the Nuffield Health Group. The hospital provides mostly surgical services but also carries out some chemotherapy services. We did not specifically inspect this service but have included some aspects of the service delivery in our report on outpatients and diagnostic imaging.

At the time of the inspection, the hospital was in the process of opening a new CT/MRI scanning facility, in partnership with a private diagnostics service provider. Catering and estates management services are outsourced.

We inspected this service as part of the comprehensive inspection programme and visited the hospital on 9 and 10 February 2016 as part of our announced inspection. We also visited unannounced to the hospital on 23 February 2016.

Overall, we have rated the hospital as good, with one requires improvement rating in the safe domain for surgery.

Are services safe at this hospital?

  • Staff were able to demonstrate they understood their responsibilities under Duty of Candour regulations. We were provided given specific examples of where Duty of Candour had been used following incidents to be open and transparent with patients.

  • There were clear policies and procedures in place in regard to safeguarding. All staff we spoke to were aware of what to do if they were concerned about a child or vulnerable adult. The outpatient sister and hospital matron were trained to level 3 in both adult and child safeguarding.

  • There had been 331 clinical incidents reported between October 2014 and September 2015. We saw that staff were encouraged and supported to report incidents. All incidents were investigated and reported to the quality and safety committee so that lessons could be learnt and learning applied. Staff received feedback.

  • The World Health Organisation (WHO) Five Steps to Safer Surgery checklist was not embedded in theatre daily practice and not consistently adhered to. Audit processes to confirm compliance with the checklist were not robust, observational audits were not routinely completed.

Are services effective at this hospital?

  • Hospital staff followed local policies and procedures such as wound care pathways and specific consultant post-operative preferences. NICE guidelines were reviewed and discussed at the hospital quality and safety meetings and departmental meetings.

  • The hospital had a well-established governance system for signing off policies and procedures. We observed that the Medical Advisory committee had clear over-sight of changes to practice and the introduction of new drugs or procedures.

  • The hospital participated in patient reported outcome measures (PROMS) audits. Knee and hip replacement (primary) were both within the expected range of the England average relating to five questions about their health.

  • All readmissions either to the hospital or an NHS trust were recorded on an electronic data collection system, the hospital reported six unplanned readmissions within 29 days of discharge between October 2014 and September 2015.

  • There were 166 doctors working under practising privileges at the hospital The hospital used an electronic database to monitor compliance, with due dates identified for doctors’ appraisals, revalidation, renewal and indemnity, as a part of the practising privileges process. We looked at nine randomly selected personnel files for medical practitioners and found all the relevant documentation in place.

  • Staff were aware of their responsibilities about informed consent and they were clear about the procedures to follow for those patients who lacked capacity including involvement of those close to the patient. Staff demonstrated an understanding of the mental capacity assessment process

Are services caring at this hospital?

  • Patients spoke highly of staff in areas across the hospital. Patients described caring staff that were supportive and treated them with dignity and respect. We observed that staff were courteous, polite and friendly when responding to patients’ individual needs. Patients told us they were given good explanations of their treatments and were given opportunity to ask questions. Survey data confirmed that patients had confidence in being treated at the hospital.

Are services responsive at this hospital?

  • Services were planned and delivered in a way that took people’s needs and preferences into account. There were regular monthly meetings with the local clinical commissioning group to discuss service provision for NHS patients. We saw minutes of these meetings where quality and service delivery issues were discussed.

  • Patients told us they had received all the information they required prior to their procedure or surgery. They told us they understood the reason for their admission to hospital and staff had clearly explained the risks and benefits to them.

  • The needs of patients living with dementia or those who had a learning disability were identified at pre-assessment. Patients with complex needs were risk assessed by physiotherapists and occupational therapists and their care plans were then based on the risk assessments and professional advice.

  • There were effective systems and processes to respond to and learn from complaints

Are services well led at this hospital?

  • There was a clear vision and strategy for the hospital, held by the senior management team and shared widely with the hospital staff. The hospital director used a range of mechanisms to communicate the vision and strategy to staff and keep them updated. Staff we spoke with understood the vision and their role in achieving it.

  • Governance, risk management and quality measurement processes were well established. There was a clear line of sight for the senior management team from the ward to the board and the MAC were well engaged in the hospitals quality management processes. The MAC maintained oversight of the process for agreeing and reviewing practising privileges.

  • The senior management team had been in post for approximately three years and provided stable and cohesive leadership at the hospital. The matron and hospital director had a clear grip on hospital issues and were well known to the staff.

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

Importantly, the provider must:

  • Ensure that surgical safety procedures are consistently carried out in theatre and theatre documentation and observational audits are routinely carried out and staff are made fully aware of the findings to provide ongoing assurance.
  • Ensure that all medication is secure in theatre.

In addition the provider should:

  • Ensure that learning from audits is disseminated to staff including the process, outcomes and the risk register progress.
  • Ensure that the findings of the privacy, dignity and well-being 2015 PLACE score are addressed.
  • The hospital should ensure that out of date radiology equipment is replaced as soon as possible.

Professor Sir Mike Richards

Chief Inspector of Hospitals

13 January 2014

During a routine inspection

All the people we spoke with told us that the care at Nuffield Health was very good. One person told us, "I am really happy with everything about the service". Another person said, 'All the staff are very kind and efficient". We observed staff treated people with dignity and respect. One person told us, 'The staff make a real effort to get to know you and how you like things done".

We found that care records were clear and provided comprehensive information about each stage of their care. People told us they were fully involved in all aspects of their treatment and care.

We saw that the accommodation was clean. We found that there were systems and procedures in place to protect people from the risk of infection. People told us that the hospital was very clean.

We found the provider could not provide evidence that staff in theatres had completed assessments of competence in some areas. Staff were also not clear about the policy regarding extended roles. We agreed immediate action with the provider to ensure the safety of people.

People we spoke with told us that they were aware of the complaints process. They told us they felt confident about the process. We saw that complaints received by the provider had been appropriately investigated and responded to.

6 February 2013

During a routine inspection

The people we spoke with were very satisfied with their care and treatment at the hospital. Everyone we spoke with had confidence in the doctors and nursing staff looking after them. One person told us, 'The treatment would be no different anywhere else, but the experience and quality of care is very different.' Everyone had detailed care plans in place to ensure that they received the right care, at the right time.

People told us that they had been informed of what would happen during their treatment or operation. They also told us that any substantial risks involved had been discussed before they gave their consent for anything to take place. One person said, 'I own my treatment.'

All the staff we spoke with had a good understanding of what steps they would take if they had any concerns with people's safety. All the necessary checks had been completed to ensure that doctors, nurses and other staff working in the hospital were appropriately qualified,competent and suitable to be working in the hospital.

10 January 2012

During an inspection looking at part of the service

We had not visited this service for sometime and did not have any recent information about the service. We visited this service to check that people were being cared for safely.

An Expert by Experience took part in this inspection and spent time talking with patients about their experience of the care they received. They took some notes and wrote a report about what they found and details were included in this report.

People were involved in discussions about their care and treatment and had been given

the opportunity to ask questions. People said that were given information about the risks and benefits of treatment. People said that their consent to treatment was was always sought.

People were positive about the care and treatment they received. They felt that the staff were caring, friendly and polite. People felt that they were treated with respect and that their privacy and dignity were promoted.

People said they had a choice of food and that the menu was varied and catered for special diets. One person told us that they could have food not on the menu if they wished.

People said there were enough staff on duty and that in most instances the nurse bell was answered promptly. Any delay was only of a short duration and people were confident that staff would come as soon as they were available.

The provider had a range of systems in place to review and monitor the care they provided. Where areas for improvement were identified action plans were in place.