Benenden Hospital

Benenden Hospital is operated by The Benenden Hospital Trust. The hospital has 32 beds, three operating theatres, an imaging department and outpatient and diagnostic facilities.

The services provided by the hospital are surgery, endoscopy, outpatients and diagnostic imaging. We inspected these three core services using our comprehensive inspection methodology. We carried out the announced part of the inspection on 16th and 17th of January 2017 along with an unannounced visit to the hospital on 24th 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.

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.

We rated this hospital as outstanding overall.

• The service planned and delivered care and treatment in line with current evidence-based guidance, standards, best practice and legislation. The service monitored this to ensure consistency of practice and staffing levels and skill mix were reviewed to ensure patients were safe.

• Staff were suitably qualified and had the skills they needed to carry out their roles effectively and in line with best practice.

• Staff from different disciplines worked together to meet the needs of patients who used the service and treated people with dignity, respect and kindness. There was strong collaboration and support across all staff groups and a common focus on improving the quality of care and the vision and values were well embedded amongst staff.

• The hospital had consistently high levels of constructive engagement with staff at all levels. Leaders listened to staff and valued their input. The hospital demonstrated a strong commitment to staff wellbeing.

• Hospital data showed 100% of staff had an up-to-date appraisal at the time of our visit. The service supported relevant staff through the process of revalidation, and 100% of relevant medical and nursing staff had up-to-date revalidation.

• There were high levels of staff satisfaction across all staff groups and staff were proud of the organisation as a place to work and spoke highly of the culture.

• Patients had comprehensive assessments of their needs including clinical needs, wellbeing, and nutrition and hydration needs.

• The hospital had the facilities to meet patient’s individual needs. This included patients living with dementia, patients with learning disabilities and bariatric patients and expected outcomes were identified with regularly reviewed and updated care and treatment plans.

• Medical records were maintained accurately and securely in line with the Data Protection Act 1998 and medicines were stored in locked cupboards and administration was in line with relevant legislation.

• There were appropriate arrangements for unplanned returns to theatre, with 24 hours a day, seven day a week on-call availability.

• The endoscopy services demonstrated compliance with British Society of Gastroenterology (BSG) guidelines. The service was working toward Joint Advisory Group (JAG) on gastrointestinal (GI) endoscopy accreditation incorporating the endoscopy global rating scale, which is the quality improvement and assessment tool for the GI endoscopy service.

• The hospital had a comprehensive audit programme in place to monitor services and identify areas for improvement and outcomes for patients were similar to, or better than, other acute hospitals in England.

• The hospital had a good track record on safety. Openness and transparency about safety was encouraged and staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• The hospital took appropriate action to detect, control and prevent the spread of infections and infection prevention and control practices were in line with national guidelines. Areas we visited were visibly clean, tidy and fit for purpose.

• The service assessed monitored and managed risks to children and young people who used services on a day-to-day basis. These included signs of deteriorating health, medical emergencies and emotional wellbeing.

• The hospital responded to complaints by providing meaningful written responses to all complainants. The service shared learning from complaints with relevant staff to help drive improvement. The hospital tried to respond immediately to verbal feedback to avoid the need for escalation to a formal complaint. As a result, the number of complaints had reduced significantly.

• Patients and their loved ones were included to be partners in their care and the overall feedback from people who used the service and those who are close to them was positive about the way staff treated people.

We found areas of outstanding practice:

• The hospital’s commitment to staff wellbeing and their “Investors in People Silver Award”.

• The hospital’s work in enhanced recovery pathways to reduce the length of hospital stay for orthopaedic patients.

• The hospital was a finalist in the national award for innovations in anaesthetics in 2016. Innovations in this area included use of a multi-purpose anaesthetic breathing system which recycled anaesthetic gases and reduced pollution in theatres.

• We identified the infection prevention and control leadership of the hospital and staffs commitment was an area of outstanding practice, with staff inspired to provide a good service to patients.

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

• There were intermittent problems with the controlled access mechanisms on the doors into the theatre department. This created a risk of inappropriate access into theatres.

• The hospital did not stagger admission times for surgery. This meant patients at the end of an operating list waited a long time between admission and surgery when they could have been at home.

• The scheduling of operating lists according to consultant availability meant some day surgery patients were not fit for discharge on the day of surgery. As a result, the hospital frequently converted day case patients to overnight stays.

• Privacy and dignity could not be guaranteed in the mixed sex waiting area outside of the changing area for patients awaiting procedures.

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. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals