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Inspection Summary


Overall summary & rating

Outstanding

Updated 11 May 2017

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

Inspection areas

Safe

Good

Updated 11 May 2017

We rated safe as good because:

  • The service planned, implemented and reviewed staffing levels and skill mix to keep patients safe.

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

  • The service took appropriate action to detect, control and prevent the spread of infections.

  • There were effective systems in place to report incidents. Incidents were monitored and reviewed and staff gave examples of learning from incidents. Staff understood the principles of duty of candour regulations, were confident in applying the practical elements of the legislation.

  • Patients were cared for in a visibly clean environment that was well maintained.

  • There were adequate supplies of appropriate equipment that was properly maintained to deliver care and treatment and staff were competent in its use.

  • There was good medicines storage, management and administration. There were systems that ensured patient’s medicines were given safely, on-time and according to the consultant prescription. Medicines were stored securely as per national guidelines.

  • We found there were systems to identify patients whose condition may be deteriorating to allow early intervention.

  • There were sufficient numbers of medical, nursing and diagnostic staff to deliver care safely. Patient risk was assessed and responded to. There was a major incident plan in place, and a recent exercise had been undertaken.

  • Staff were aware of their responsibilities with regard to the protection of people in vulnerable circumstances. All staff had received appropriate training in adult safeguarding.

  • Records were stored safely, up to date, legible, and were available for staff. Emergency equipment was in place. Medicines were well managed within the department.

  • The environments were visibly clean.

However:

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

  • Staff did not consistently print names with a legible signature in patient records in line with guidance issued by the professional regulatory bodies for doctors and nurses.

  • There were inconsistencies in the suitable number of staff receiving training at the appropriate level for safeguarding children and vulnerable adults.

  • 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.

Effective

Good

Updated 11 May 2017

We rated effective as good because:

  • The service planned and delivered care and treatment in line with current evidence-based guidance, standards, best practice and legislation, including National Institute for Health and Care Excellent (NICE) guidance. The service monitored this to ensure consistency of practice with formal systems in place for collecting comparative data regarding patient outcomes.

  • Outcomes for patients were similar to, or better than, other acute hospitals in England.

  • Patients had comprehensive assessments of their needs. These included consideration of clinical needs, wellbeing, and nutrition and hydration needs. The expected outcomes were identified and staff regularly reviewed and updated care and treatment plans.

  • Staff were suitably qualified and had the skills they needed to carry out their roles effectively and in line with best practice. Patients were cared for by staff who had undergone specialist training for the role and who had their competency reviewed.

  • The service supported staff with supervision and appraisal. Hospital data showed 100% of staff had an up-to-date appraisal at the time of our visit and the hospital supported them through the Nursing and Midwifery Council’s (NMC) revalidation process. All of relevant medical and nursing staff had up-to-date revalidation.

  • There was a good multidisciplinary team approach to care and treatment. Staff had the right qualifications, skills and knowledge to do their job. Staff from different disciplines worked together to meet the needs of patients who used the service.

  • The hospital had an on-going, comprehensive audit programme which monitored areas for improvement regularly.

  • Staff worked with other healthcare professionals in and out of the hospital to provide services for patients.

  • Patients provided informed, written consent before commencing their treatment. Where patients lacked capacity to make decisions, staff were able to explain what steps to take to ensure relevant legal requirements were met.

  • Patients had access to appropriate nutrition and hydration.

  • Patients and their relatives we spoke with were pleased with the care they had received.

Caring

Outstanding

Updated 11 May 2017

We rated caring as outstanding because:

  • The hospital allocated the time necessary for nursing staff to build positive relationships with patients and their families.This enabled the nurses to provide reassurance, information and support to patients and families.

  • Overall feedback from people who used the service and those who are close to them was positive about the way staff treated people. Patient’s surveys and assessments reflected the friendly, kind and caring patient centred ethos.

  • Staff encouraged patients and their loved ones to be partners in their care.

  • Staff respected people’s privacy and confidentiality at all times.

  • Staff provided sensitive, caring and individualised personal care to patients. Staff supported patients to cope emotionally with their care and treatment as needed.

  • Patients commented positively about the care provided from all staff they interacted with. Staff treated patients courteously and with respect.

  • Patients felt well informed and involved in their procedures and care, including their care after discharge.Patients understood the care and treatment choices available to them and were given appropriate information and support regarding their care or treatment.

  • Interactions between staff and patients were welcoming, caring and supportive.

Responsive

Outstanding

Updated 11 May 2017

We rated responsive as outstanding because:

  • Services were planned and delivered to meet the needs of the local population.

  • The hospital responded appropriately and had the facilities to meet patient’s individual needs. This included patients living with dementia, patients with learning disabilities and bariatric patients.

  • The hospital completed the first phase of an extensive redevelopment in 2016, which included new theatres, a new ward and a new ambulatory care unit. Staff and patients we spoke with were very positive about the new building.

  • The hospital responded to complaints by providing meaningful written responses to all complainants. The hospital 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.

  • There were systems to ensure that patient complaints and other feedback was investigated, reviewed and appropriate changes made to improve treatment of care and the experience of patients and their supporters.

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

  • Services operated at times that allowed patients to access care and treatment when they needed it.

  • There were a variety of mechanisms to provide psychological support to patients and their supporters. This range of service meant that each patient could access a service that was relevant to their particular needs. For example those whose first language was not English, or support for people living with dementia or learning disabilities.

  • Patients could choose appointments that suited them.

  • Patients were kept informed of any disruption to their care or treatment.

  • Patients did not experience long waiting times to see their chosen consultant.

However:

  • 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.

Well-led

Outstanding

Updated 11 May 2017

We rated well-led as outstanding because:

  • Leaders drove continuous improvement and organisational growth.

  • There was clear and highly visible leadership provided by senior management and within the departments. Staff spoke positively of their managers, who told us they were visible and approachable, and told us the senior management team had an ‘open door’ approach, and visited departments daily.

  • The vision and values were well embedded amongst staff.

  • The hospital’s vision was embedded in the departments and staff embraced the values in the work they undertook.

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

  • 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.

  • The hospital had robust governance arrangements. Governance and performance management arrangements were proactively reviewed and reflected best practice.

  • Governance processes were evident at departmental, hospital and corporate level. This allowed for monitoring of the service and learning from incidents, complaints and results of audits

  • The hospital had a risk register and was reviewed at the governance committee meetings.

  • We saw strong collaboration and support across all staff groups and a common focus on improving the quality of care.

  • Staff asked patients to complete satisfaction surveys on the quality of care and service provided. Departments used the results of the survey to improve services.

  • Leaders actively encouraged staff to raise concerns. There was a culture of openness, and all staff we spoke to could describe their responsibilities relating to Duty of Candour.

  • The management structure at the hospital meant there were clear lines of leadership and accountability. The senior management team were highly visible and accessible across the hospital. Staff described an open culture and said managers were approachable at all times.

  • Staff had a good understanding of the vision for the development of their services.

  • We saw staff were focused on providing the best service for all patients, and were proud to work at the hospital

  • Staff spoke highly about their departmental managers and the support they provided to them and patients. All staff said managers supported them to report concerns and their managers would act on them. They told us their managers regularly updated them on issues that affected the separate departments and the whole hospital.

  • Projects such as the productive outpatients were in place to provide data on performance and improve teamwork.
Checks on specific services

Medical care (including older people’s care)

Outstanding

Updated 11 May 2017

Medical care 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 outstanding because it was good for safe, effective and responsive, and outstanding for caring and well led.

Outpatients and diagnostic imaging

Outstanding

Updated 11 May 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 outpatient and diagnostic imaging as outstanding because it was good for safe and caring, and outstanding for responsive and well led.

Surgery

Outstanding

Updated 11 May 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.

Staffing was managed jointly with medical care.

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