Nuffield Health Wessex Hospital

Nuffield Health Wessex Hospital opened in 1977 and has been upgraded and extended on several occasions since. During 2012-14 an £8 million scheme was undertaken to refurbish the hospital site.

The hospital now has 46 beds suitable for inpatient and day case care. There are two high dependency beds available for level one and two care. Admission for surgery follows strict referral criteria for people aged 18 years and over who require routine-urgent surgery.

The hospital provides elective surgery to patients who pay for themselves, are insured, or are NHS patients. Surgical specialities offered include orthopaedics, ophthalmology, general surgery, gynaecology and cosmetic surgery. There are four main theatres and a dedicated 7 bed recovery ward located within the main theatre complex. There is also an endoscopy unit which is separate from the theatre complex.

There is an outpatient department for routine pre and post-operative appointments. Radiology provides static MRI and CT scanners, ultrasound, x-ray, bone densitometry, mammography and fluoroscopy.

We carried out a comprehensive announced inspection of Nuffield Health Wessex Hospital on 1 and 2 December 2015, and an unannounced inspection on 3 December 2015.

We inspected the following three core services:

• medicine (endoscopy)
• surgery
• outpatients and diagnostic imaging.

The overall rating for this service was ‘Good’.

The services at this hospital were mainly safe, effective, caring, responsive and well led. The hospital took into account individual patient needs and preferences when designing the delivery of well-planned services to its’ patient population. There were sufficient staff, and mainly robust processes, ensuring the appropriate provision of timely and compassionate care.

Our key findings were as follows.

Are services safe?

By safe, we mean that people are protected from abuse and avoidable harm.

• The hospital protected patients from the risk of abuse and avoidable harm. There were clear, open and transparent processes for reporting and learning from incidents. Staff reported incidents, and managers shared learning locally and within the wider organisation.
• Ionising radiation (medical exposure) regulations 2000 (IR(ME)R) incidents were all within normal ranges. The hospital was not an outlier for under or over reporting of IR(ME)R incidents
• The departments were visibly clean and there were good infection prevention and control policies to reduce the risk of infection. However, some clinical practices did not consistently adhere to the organisations policies.
• While nursing staff were bare below the elbow in clinical areas, a few medical staff did not always adhere to this requirement. Nursing staff described some difficulties in ensuring some medical staff followed the policy.
• Regular infection control audits were completed. However, there was a lack of clarity regarding the benchmark for the audits and a delay in the development of action plans to address areas for improvement.
• Patients were risk assessed to ensure they were suitable for treatment and staff monitored them appropriately during their stay.
• The NHS Safety Thermometer is a local improvement tool for measuring, monitoring and analysing patient harms and 'harm free' care. The surgical ward participated in the NHS Safety Thermometer for NHS patients.. Senior staff conducted monthly audits in respect to patient falls, pressure ulcers, catheters and urinary tract infections. Information about the audits was not displayed. This is not mandatory, but is considered good practice.
• The hospital maintained and tested equipment appropriately.
• Medicines were stored securely and handled correctly. The hospital also used a system to report and store patient images. Nurse staffing levels were sufficient to meet the needs of patients. Managers calculated nurse-staffing levels around the planned workload using a recognised staffing tool. Ward staff used a daily workload analysis tool which calculated staffing levels, and adapted these to meet the needs of the patients and the type of surgery they had received. Some Agency staff were used in theatres, but they were employed on block contracts to ensure the provision of on-going high quality care.
• There was good access to medical support at all times. A resident medical officer (RMO) was available 24 hours a day, and lived on-site for immediate access in an emergency.
• Staff undertook appropriate mandatory training for their role. All staff we spoke with knew where to access policies, procedures and guidance to follow in the event of a major incident. Senior staff were also aware of their individual responsibilities in the event of a serious or untoward incident on the premises.

Are services effective?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

• Outcomes of people’s care and treatment were not always monitored within endoscopy.
• The endoscopy service was progressing towards achieving Joint Advisory Group (JAG) accreditation standards. The recovery area was a small room and male and female patients were not separated; this prevented the standards being met. The hospital was planning to work through an endoscopy action plan put in place in November 2015 to improve the service.
• Surgical staff delivered care and treatment that was took account of current legislation and nationally recognised evidence based guidance. Corporate policies and guidelines were developed to reflect national guidance
• IR(ME)R audits were undertaken in line with regulatory responsibility. Copies of these audits, outcomes, actions and results were seen during our inspection and were compliant with national standards.
• Patients received appropriate pain relief during and after a procedure or investigation.
• Staff had regular appraisals and supervision, and were encouraged and supported to take part in training and development.

• Staff had attended training relating to the Mental Capacity Act best practice guidelines and Deprivation of Liberty Safeguards (DoLS). Staff we spoke with were aware of the DoLS policies and procedures, and demonstrated appropriate understanding.

• Patients told us clinical staff had sought their consent before any examination, care or treatment.

Are services caring?

By caring, we mean that staff involve and treat patients with compassion, dignity and respect.

• In all departments, patients and relatives commented positively about the care provided by all the staff, including those who were non-clinical.

• Patients told us were treated with kindness, compassion and dignity throughout our visit.
• Patients’ privacy and confidentiality was respected at all times.

• Patients told us they felt informed about their treatment and had been included in decisions about their care.

• Staff on the main reception and the outpatient department reception were highly praised by patients and relatives for their welcoming attitude, discretion and attention to detail. Reception desks were a sufficient distance away from waiting areas so patients could speak to reception staff in confidence.

• Reception staff were observed to deliver excellent and timely care to a patient who had presented for an appointment, but who were in considerable pain. The actions of the reception staff contributed immediately to his wellbeing and comfort.

Are services responsive?

By responsive we mean that services are organised so they meet people’s needs.

• Staff took into account the needs of different people, for example, patients living with dementia, or with a learning or physical disability. Relatives and assistance dogs were allowed into clinical areas to provide extra support to individuals.
• Surgical and outpatient services were responsive to the needs of local people. Patients were able to influence the choice of date for their surgery during outpatient consultations.
• Patient admissions for surgery were staggered throughout the day so they did not have to wait a long time after their admission.
• The NHS gastroscopy service was aimed at non-urgent (non-two week wait) referrals.
• The service provides GPs with an open access diagnostic gastroscopy service. Before their first attendance, the outpatients department sent patients appropriate information: this contained information such as the consultant or clinic they were to see, length of time for the appointment and written information on any procedures which may be performed at the first appointment, including the cost of the appointment and subsequent procedures (for self-funding patients).
• Patients could be given an outpatient appointment on the same day, but generally appointments were given within a week of contacting the hospital. The outpatient department was meeting the referral to treatment time for the incomplete pathway, with 96% of patients seen within 18 weeks.
• In diagnostic imaging, the department was meeting its target to see patients within 6 weeks. Most patients were given an appointment for x-rays, scans or ultrasounds within one week
• Patients were actively encouraged to leave comments and feedback via the patient satisfaction survey. The data was collated and results displayed in waiting areas.
• Nuffield Wessex Hospital received low numbers of formal and informal complaints: there were 35 complaints in 2014 which was a slight increase on the 33 complaints received in 2013.
• Monthly or quarterly reports had been produced to help identify any trends or issues which required further investigation. Action plans were devised to address any concerns along with lessons learnt. For example, staff told us call bell volume on the ward had been reduced after 11pm as a response to complaints from patients.

Are services well-led?

By well-led, we mean that the leadership, management and governance of the organisation, assure the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

• The process for identifying, understanding, and monitoring risks in the endoscopy suite needed to be improved. An operational risk was created in relation to endoscopy following our inspection. An action plan had been created in November 2015, to address risk identified at local management level. This did not capture all specific local risks within the service.
• The arrangements for governance, and issues with poor performance with regards to the outcome of infection control audits, were not always dealt with in a timely way. There was a lack of clarity regarding the benchmark for infection control audits and a delay in the development of action plans to address areas for improvement. This had the potential to put patients at risk of developing a hospital acquired infection.
• A systematic approach to the completion of the World Health Organisation (WHO) surgical safety checklist had not been fully embedded across all surgical specialities.
• The senior management team were highly visible across the hospital, and based their offices within the clinical environments to make them more accessible to staff. Staff described a “flat and open” culture, and said senior managers were approachable at all times.
• The Medical Advisory Committee Chair described robust governance arrangements and good leadership from the Matron and Hospital Director
• The Medical Advisory Committee met quarterly. The MAC had contributed positively to influence clinical practice where necessary. An example of this was the recent decision to stop admitting children and young people to the hospital. This was discussed at the interview with the Chair of the MAC.
• Staff spoke highly about their departmental managers, and about the support they provided to them and to patients. All staff said managers supported them to report concerns. Their managers would then act on them. They said their managers regularly updated them on issues that affected the unit and the whole hospital.
• Staff from all departments had a clear ambition for the service and were aware of the vision for the department. The vision was to provide the highest standards of care, ensuring a patient’s experience was as comfortable as possible.
• There was a hospital-wide risk register. This had been created in April 2015. The register detailed nine risks which were identified as a potential risk to the hospital as a whole. Action taken to mitigate identified risks was detailed with time plans for review dates
• Governance processes at department, hospital and corporate level allowed for monitoring of the service and learning from incidents, complaints and results of audits across surgical services. There were however, delays in reporting and actioning infection control audits in the surgical service.
• Patients were regularly asked to complete satisfaction surveys on the quality of care and service provided. The results of the survey were used by departments to improve the service. However, although outcomes were displayed in waiting areas, actions for making improvements were not available for patients to read.

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

Action the hospital MUST take to improve

The hospital should ensure

• Patient’s privacy and dignity is not compromised in the recovery area in the endoscopy unit.

Action the hospital SHOULD take to improve

The hospital should ensure

• An operational policy for the endoscopy suite is produced as per hospital action plan.
• A review of the management of the endoscopy procedure lists, in respect of male and female patients being on the same list.
• A risk assessment is undertaken regarding the movement of endoscopes from main theatres to the decontamination room in the endoscopy suite.
• Emergency medicines are always available in the endoscopy unit.
• The positioning of resuscitation equipment during endoscopy procedures is reviewed.
• Tamper evident tags are used to ensure resuscitation equipment always available for use.
• A review of pre assessment health record to include younger people who may have a dementia.
• Staff are aware of when to use an interpreter.
• The hazard of trailing wires in the endoscopy treatment room risk assessment, is reviewed.
• Compliance with WHO checklist is documented.
• Cleaning schedules are displayed for public and staff.
• There is a cleaning checklist for items cleaned by theatre staff in the endoscopy unit.
• The storage of oxygen cylinder in the endoscopy unit is reviewed.
• Clinical performance outcomes are used in endoscopy.
• Local risks in the endoscopy suite are recorded on a risk register.
• Infection control audits are completed and actioned in a timely manner.
• All staff adhere to the hospital infection control policies and procedures.
• Patient consent for surgical procedures is obtained prior to the day of surgery.
• Safety thermometer audits results are displayed.

Professor Sir Mike Richards

Chief Inspector of Hospitals