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Nuffield Health York Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 14 June 2017

Nuffield Health York Hospital is operated by Nuffield Health. The hospital has 40 beds and facilities include three operating theatres (two of which have laminar flow), a surgical unit for ambulatory care, radiology, outpatient and diagnostic facilities. The hospital provides surgery and outpatients with diagnostic imaging services and we inspected both of these services.

We inspected this hospital using our comprehensive inspection methodology. We carried out the announced part of the inspection on the 6th and 7th September 2016 with an unannounced visit to the hospital on 13th September 2016.

We rated both core services and the hospital as good overall.

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 core service.

Services we rate

We rated this hospital as good overall because:

  • There were systems and processes in place to promote practices that protected patients from the risk of harm. Openness and transparency about safety were encouraged. When something went wrong, people received an explanation, and a sincere and timely apology.
  • There were sufficient and appropriately qualified and experienced staff working in all departments to meet the needs of patients. We saw that equipment in all areas was well maintained and kept clean to minimise the risk of infection. Staff were able to respond to signs of a deteriorating patient and medical emergencies.
  • Patient feedback demonstrated that staff strived to make the patient experience as positive as possible. Staff recognised and responded to the individual needs of their patients throughout the patient journey.
  • The hospital had systems in place to provide care and treatment in line with national guidance. There was effective multi-disciplinary working and good communication between teams within the hospital and with external healthcare partners.
  • There was a stable leadership team who were highly regarded by staff. Staff felt proud to work within the hospital and were very positive about the culture and the quality of teamwork.
  • There was a clear governance structure and a comprehensive reporting framework in place that provided timely information to the hospital board, medical advisory committee and to the corporate team.

We found areas of practice that required improvement in both surgery and outpatients services.

  • We did not identify a clear mechanism to share learning from unplanned transfers and patient safety incidents with the Resident Medical; Officer. This was acted upon at the time of inspection and at the unannounced inspection, communication systems had been improved.

In surgery:

  • None of the ten surgical case notes reviewed for consultant entries recorded daily consultant visits as per the requirements of practising privileges. Two sets of notes had documentation about the consultant’s visit from the nurse in charge of the patient’s care.
  • Two patients receiving oxygen did not have oxygen prescribed on the medication record. This was raised at the time of inspection and immediately actioned.

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

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)

Inspection areas

Safe

Good

Updated 14 June 2017

We rated safe as good because:

  • There were systems for the reporting and investigation of safety incidents that were well understood by staff.
  • Staff could demonstrate their understanding of the duty of candour and provide examples of its implementation.
  • Internal patient satisfaction surveys indicated 96% satisfaction for cleanliness and the service had a low rate of hospital acquired infection.
  • There were arrangements to transfer patients whose care needs exceeded what the hospital could safely provide, and we saw that staff used these processes when patients’ conditions required this.
  • We found suitable medical cover at all times from a resident medical officer and consultants and noted arrangements for consultants to provide cover for absent colleagues.
  • There were sufficient numbers of nursing and support staff to meet patients’ needs.
  • We saw there were efficient and effective methods for the handover of care between clinical staff.
  • There was a designated lead for safeguarding children and vulnerable adults. Staff were trained appropriately to recognise and report suspected abuse in children and vulnerable adults.

However:

  • None of the ten surgical case notes reviewed for consultant entries contained entries to demonstrate daily visits as per the requirements of practising privileges. Two sets of notes had documentation about the consultant’s visit from the nurse in charge of the patient’s care.
  • Two patients receiving oxygen did not have oxygen prescribed on the medication record. This was raised at the time of inspection and immediately actioned.
  • Patient specific directives (PSD) for bowel preparation did not always evidence that the patient had been assessed by the prescriber before it was supplied. We informed management who initiated a review of the dispensing process at the time of inspection.

Effective

Good

Updated 14 June 2017

Are services effective?

We rated effective as good because:

  • We saw hospital policies and procedures had been developed in line with national guidance and staff were aware of how to access them.
  • 100% of staff had completed an appraisal. The hospital encouraged staff to participate in training and development to enable them to develop their clinical skills and knowledge.
  • We saw evidence of effective multidisciplinary team working between allied health professionals, nursing staff, medical staff and administration staff.
  • Staff had access to all the information they needed to deliver care and treatment to patients in an effective and timely way.
  • A variety of hot and cold food was available. The hospital had access to food for patients out of hours and there was a good choice for patients including vegetarian, gluten-free, lighter options and multi-cultural food choices.
  • The hospital had a dedicated lead for professional development who managed the processes for ensuring all staff had received the training and competency assessments applicable to their roles. Staff on the ward and in theatres had link roles and provided training sessions and resources to support their link role.

However:

  • We saw that checks were made to ensure patients had adhered to fasting times before surgery went ahead, but at the time of inspection, the hospital did not undertake audits to identify actual fasting times and whether these met the expected standard.

Caring

Good

Updated 14 June 2017

Are services caring?

We rated caring as good because:

  • The hospital achieved a score of 100% for NHS funded patients who stated they were very likely or likely to recommend the hospital to family and friends in May 2016.
  • During the inspection, we observed warm, open and positive interactions between staff and patients.
  • All patients we spoke with were happy with their care and we received universally positive written feedback from patients during the inspection.
  • Patient-led assessments of the care environment (PLACE) for privacy, dignity, and wellbeing within the hospital scored 93%; higher than the England average of 87%.
  • Patients felt fully informed about their care and treatment. All the patients we spoke with had a good understanding of their condition and proposed treatment plan, as well as where to find further information.
  • Staff provided support to patients in a timely, professional way. We observed staff giving reassurance to patients who were anxious when awaiting surgery and responding compassionately to patients with pain and discomfort.

Responsive

Good

Updated 14 June 2017

Are services responsive?

We rated responsive as good because:

  • There were effective arrangements in place for planning and booking of surgical activity including waiting list initiatives through contractual agreements with the clinical commissioning group.
  • Patients had a choice for booking the dates and times of outpatient and diagnostic imaging appointments. Patients we spoke with confirmed appointments were offered that suited their needs. None of the patients we spoke with raised any concerns about being able to access appointments in a timely manner or delays in clinic.
  • There was an effective system in place to provide trained chaperones and staff were familiar with ensuring chaperones were made available for patients.
  • Between April 2015 and March 2016, the hospital received 12 complaints. The number of complaints was lower than the average of other independent acute hospitals for which CQC hold data. Complaints were dealt with in a timely manner and no complaints were referred to the Ombudsman or the Independent Sector Complaints Adjudication Service.
  • The hospital held a daily meeting of department leads to discuss staffing levels and clinical needs. Ward nursing staff and the nurse manager reviewed planned patient discharges in handovers throughout the shift to assess on-going availability of beds.
  • The rate of unplanned transfers of care from this hospital to a nearby NHS trust, unplanned readmissions and unplanned returns to theatre was similar to or better when compared to independent hospital performance data held by CQC.

Well-led

Good

Updated 14 June 2017

Are services well-led?

We rated well-led as good because:

  • We saw strong leadership of services and staff spoke positively about the culture within the organisation. During our inspection, it was clear that the quality of patient care and treatment was a high priority. Staff were proud of the job they did and without exception, the staff we spoke with enjoyed working at the hospital. Staff were familiar with the corporate vision and values and opportunities to develop leadership skills were supported.
  • There was a clear governance structure and a comprehensive reporting framework in place that provided timely information to the hospital board, medical advisory committee and to the corporate team. Consultants we spoke with felt there was a good working relationship and strong engagement with the hospital leadership team and that consultants were involved with clinical governance issues. There was evidence that the senior management team were responsive to and ensured action was taken to mitigate identified risks. There were effective arrangements in place to ensure the conditions of practising privileges were met.
  • All departments had regular staff meetings. We reviewed the minutes of meetings in each department and noted good attendance and discussion of key items such as information governance, the risk register, audit outcomes, complaints, incidents and infection control.
  • The hospital held focus groups between staff and patients to enable patients to share their experiences. These provided opportunities for learning and were valued by the staff and patients.
  • The senior management team made themselves accessible to hospital staff by being visible in the departments and engaging with staff. Their approach included holding open invitation breakfast and afternoon tea sessions with staff. Staff said they felt able to raise concerns and were confident that they would be dealt with appropriately.
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 14 June 2017

We rated this service as good because it was safe, caring, responsive and well-led. We did not rate effective as we are currently not confident that we are collecting sufficient evidence to rate effectiveness for Outpatients & Diagnostic Imaging.

The service had reported no never events or serious incidents and no incidents had been reported to the CQC in accordance with the Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R). Staff were encouraged to raise concerns and report incidents. We saw evidence of lessons learnt from safety incidents and changes to clinical practice.

Medications including contrast media used in radiology were stored securely in appropriately locked rooms and fridges. There was an effective process in place for monitoring the use of prescription charts.

Policies and procedures were accessible to staff and had been developed and referenced to the National Institute for Health and Care Excellence (NICE) and national guidance.

All staff had completed an appraisal and they described being supported in undertaking further learning to develop their skills and knowledge.

All patients spoke positively about the care and treatment they had received and we observed staff acting in a compassionate manner. Patients were treated with dignity and respect. Patients were given appropriate information and support about their care or treatment.

The service was responsive to patients’ needs. Access and flow in the Outpatient department (OPD) and radiology departments was well managed. Patients could be seen quickly for urgent appointments if required and patients told us their appointments were on time. Patient records were available for appointments and the department had timely access to test results.

People using the service could raise concerns and complaints were investigated and responded to in a timely manner.

Surgery

Good

Updated 14 June 2017

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.

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

The service had reported no never events or serious injuries. Learning was cascaded via the governance committees and received at staff team meetings.

Internal patient satisfaction surveys indicated 96% satisfaction for cleanliness and the service had a low rate of hospital acquired infection.

The hospital target for mandatory training completion was 100% compliance; training data we reviewed showed a compliance rate of 95% at the beginning of September 2016.

Integrated care records covered the entire patient pathway from pre-operative assessment to discharge and included comprehensive care plans for identified care needs.

We reviewed 25 sets of medical and nursing care records whilst on site and records were legible, complete and contemporaneous.

Staffing was reviewed on a daily basis for the forthcoming shifts and adjusted according to clinical need and theatre activity. A weekly capacity meeting was held each Thursday morning to review the following week’s activity and staffing levels.

The hospital had an out-of-hours rota for anaesthetists to provide 24-hour cover for patients post-operatively and there was a service level agreement (SLA) for emergency transfer arrangements with the local NHS trust.

The rate of unplanned transfers of care from this hospital to a nearby NHS trust, unplanned readmissions and unplanned returns to theatre was similar to or better when compared to independent hospital performance data held by CQC.

Staff told us they had been supported with personal development through attending degree-based training programmes, national vocational qualifications and care certificate programmes.

During the inspection, we observed warm, open and positive interactions between staff and patients. All patients we spoke with were happy with the care they received and we received universally positive written feedback from patients during the inspection.

The hospital achieved the overall referral to treatment indicators of 90% of NHS patients admitted for treatment from a waiting list within 18 weeks for the reporting period. It also achieved better than the indicator of 92% of incomplete admitted patients beginning treatment within 18 weeks of referral in the reporting period.

A dementia “champion” provided additional support and training for staff on the inpatient ward. Patient- led assessments of the care environment (PLACE) scoring for the hospital showed dementia assessment as scoring 85%, which was better than the England average of 81%.

Inpatients had access to physiotherapy sessions several times a day, which allowed for quicker mobility and shorter stays in hospital.

In the last 12 months, the hospital cancelled 28 procedures. All patients received another appointment within the next 28 days.

The inpatient ward and theatres had regular staff meetings. We noted good attendance and discussion of key items such as the risk register, audit outcomes, complaints, incidents and infection control.

However:

We did not identify a clear mechanism to share learning from unplanned transfers and patient safety incidents with the RMO. This was acted upon at the time of inspection and at the unannounced inspection, communication systems had been improved.

None of the ten surgical case notes reviewed for consultant entries recorded daily consultant visits as per the requirements of practising privileges. Two sets of notes had documentation about the consultant’s visit from the nurse in charge of the patient’s care.

We saw that checks were made to ensure patients had adhered to fasting times before surgery went ahead; however, at the time of the inspection, the hospital did not undertake audits of actual fasting times and whether these met the expected standard.

Two patients receiving oxygen did not have oxygen prescribed on the medication record.

We noted that patient specific directives (PSD) for bowel preparation did not always evidence that the patient had been assessed by the prescriber before it was supplied.