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Sulis Bath Hospital Limited Good Also known as Circle Bath

Inspection Summary


Overall summary & rating

Good

Updated 24 April 2017

Circle Bath is an independent hospital operated by Circle Hospital Bath Ltd. The hospital has 30 inpatient beds and 22 day surgery unit ‘pods’. Facilities include four operating theatres, and outpatient and diagnostic facilities (including magnetic resonance imaging (MRI), x-ray, ultrasound and computed tomography (CT) scanner).

The hospital provides surgery and outpatients and diagnostic imaging. We inspected both services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 and 21 December 2016, along with an unannounced visit to the hospital on 7 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.

Services we rate

We rated this hospital as good overall.

We found good practice in relation to surgery:

  • The service managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
  • Patients spoke of high quality, compassionate care by all staff.
  • The service carried out thorough root cause analysis and learning when things went wrong.
  • Patients had good outcomes in line with national average, and care and treatment was planned and delivered in line with evidence-based guidance, standards and best practice.
  • Staff provided care that was compassionate and treated patients with dignity and respect at all times.
  • Services were planned and delivered in a way that met the needs of the local population.
  • The service had an effective system to effectively investigate, monitor and evaluate patient’s complaints and concerns, and learning was shared throughout the hospital.
  • Comprehensive governance arrangements were in place.

However, we found areas of practice that required improvement:

  • We observed patients’ notes unattended outside a patient’s room while nursing staff attended a patient.
  • The service was not meeting its target of 90% of patients receiving treatment within 18 weeks of referral.

Across the hospital staff were overwhelmingly positive about the strong and visible leadership. Staff felt engaged.

We found areas of outstanding and good practice in outpatients and diagnostic imaging:

  • There was outstanding care provided to patients. Staff treated patients with dignity, kindness and respected. Feedback from patients was overwhelmingly positive, and patients and those close to them were involved as active partners in their care.
  • The outpatients and diagnostic imaging service had a good track record on safety. Staff were encouraged to report concerns and incidents, and investigated them to identify and share learning.
  • People’s needs were assessed and their care and treatment delivered in accordance with legislation, standards and evidence-based guidance.
  • Services were responsive to the needs of the population and ensure flexibility, choice and continuity of care, and premises and facilities were appropriate for the services that were planned and delivered.
  • The local leadership team was well respected, visible and accessible. Staff were inspired by and supported by a strong and cohesive leadership team.

However, we found areas of practice that required improvement:

  • The availability of chaperones to accompany patients during consultations and examinations was not publicised in outpatient departments.
  • There was no private space available in outpatients, which could be used by, for example, breast feeding mothers or people who wished to have private conversations.

  • Patient information on medical conditions and treatments was available in English only.
  • The outpatient department had not recruited to the unit lead position, which had been vacant for over 12 months. The deputy lead had taken over managerial responsibilities but had little protected time to fulfil these responsibilities.

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 Edward Baker

Inspection areas

Safe

Good

Updated 24 April 2017

We rated safe as good because:

  • The hospital had a good track record on safety. There was an open culture; staff were encouraged to report concerns and incidents. Incidents were investigated and learning was shared to improve safety.
  • There were robust systems, processes and practices in place to protect vulnerable adults and children from abuse. Staff were trained in these safe systems and demonstrated a good understanding of their responsibility to identify and act on suspected abuse.
  • Risks to patients were assessed and appropriately managed. There was a comprehensive pre-operative assessment process to ensure that any risks associated with surgery and anaesthesia were identified and appropriately managed. There were protocols in place to ensure that patients were not unnecessarily exposed to radiation.
  • The hospital had a ‘stop the line’ policy, which empowered any member of staff to stop a procedure or process if they felt something wasn’t quite right to ensure patients were kept safe.
  • Processes were in place to respond to a deteriorating patient, with clear escalation procedures.
  • Departments were staffed appropriately to provide safe and effective care and the hospital had lower than average use of bank and agency staff
  • Staff complied with safe systems in relation to the storage, prescription and administration of medicines.
  • Premises and equipment were well organised and maintained and visibly clean. Staff complied with safe systems to prevent and protect people from healthcare-associated infection.

However

  • We observed patient notes unattended outside a patient room, on a drugs trolley while the nursing staff was attending a patient.

Effective

Good

Updated 24 April 2017

We rated effective as good because:

  • Patients had good outcomes in line with the national average, and there were a low number of patients that required to be transferred to other hospitals. There were low numbers of unplanned readmission of patients.
  • Treatment by all staff was delivered in line with best practice and took account of evidence based standards and procedures.The hospital reported, reviewed and benchmarked patient outcomes against other hospitals within the Circle group.
  • The staff were competent to carry out their roles.Staff were given time to undertake training, and their competence was checked. Staff received regular supervision and appraisal to ensure that they were competent to fulfil their roles. Staff were up-to-date with role-specific competencies.
  • All necessary staff, including those in different teams and services, were involved in assessing, planning and delivering patient’s care and treatment.
  • Patients were given pain relief and the effectiveness of this was checked. There was an audit of pain assessment and medicine administration.
  • Staff used an effective system for monitoring patients for signs of deterioration after surgery.
  • Services were provided across seven days, there was access to the resident medical officer and consultants when required.
  • Staff demonstrated knowledge and understanding of consent and the requirements of the Mental Capacity Act 2005 in relation to those patients who may lack capacity to make decisions.

The effectiveness of outpatients and diagnostic services was not rated due to insufficient data being available to rate these departments’ effectiveness nationally.

We found:

  • Pre-operative assessment took place to ensure that patients were medically fit and prepared for surgery.
  • The hospital had developed a comprehensive care pathway for patients undergoing joint replacement surgery. Patients were supported to maximise recovery and reduce post-operative complications which may require a return to theatre.

Caring

Outstanding

Updated 24 April 2017

We rated caring as outstanding because:

  • There was a highly visible and strong person centred culture. Staff consistently provided compassionate care to patients and those close to them. Staff went above and beyond their duties to ensure patients experienced high quality care
  • Patients consistently told us that staff were always helpful and kind. The outpatients department received overwhelmingly positive feedback from patients.
  • Medical and nursing staff we spoke with were positive about developing and promoting relationships with patients and having the time to care for them to high standards. Staff communicated with patients so that they understood their care, treatment and condition.
  • Patients who were concerned about surgery were given time and information, their individual needs and were taken into consideration. Staff recognised when patients and those close to them needed additional support to help them understand and be involved in their care and treatment.
  • Patients were empowered and supported to manage their own health, care and wellbeing and to maximise their independence.
  • The needs of the patient’s families were also taken into consideration and staff understood and respected patient’s personal, cultural, social and religious needs.
  • Staff ensured that patient’s privacy and dignity was respected.

However:

  • The availability of chaperones to accompany patients during consultations and examinations was not publicised in departments.

Responsive

Good

Updated 24 April 2017

We rated responsive as good because:

  • Patients received timely access to care and treatment. The hospital consistently met the NHS standard which measures the time that people wait from referral by their GP to consultant-led treatment.
  • Services were planned and delivered in a way that met the needs of the local population. Outpatients’ clinics took place so that, as far as possible, patients were able to access care and treatment a time that suited them. Patients discharge was planned for as soon as they were admitted to hospital, and their length of stay was flexible if required.
  • Medical staff were available to provide care for patients 24 hours a day.
  • Clinics mostly ran to time so that people were not inconvenienced and cancellations rarely occurred.
  • Premises were mostly appropriate for the services that were planned and delivered. There was ample free car parking; good signage and waiting areas were light, airy and comfortable.
  • Staff took steps to support people’s individual needs, including disability. Care plans recorded patient’s individual needs and preferences.
  • There was a dementia strategy in place to ensure the hospital adapts to the needs of dementia patients. The hospital had two dementia champions in place who were integral to developing and delivering dementia training on site.
  • Patients told us that they knew how to make a complaint or raise concerns, and these were reviewed by the hospital every month.

However:

  • The hospital monitored patient waiting times; these showed that below 90% of patients began treatment within 18 weeks of referral.
  • There was no private space available in outpatients, which could be used by, for example, breast feeding mothers or people who wished to have private conversations.
  • Patient information to support them through the pre- and post-operative period on medical conditions and treatments was available in English only.

Well-led

Good

Updated 24 April 2017

We rated well-led as good because:

  • Circle Bath had a clear vision and quality strategy to deliver good quality patient care. The hospital’s strategy was to focus on becoming a centre of excellence, starting with musculoskeletal services, and a purpose to do their best for every patient, every day. Visions and values were designed in partnership with staff.
  • This was underpinned by an eight point plan, which encapsulates feedback from partner organisations to create a joined up approach to design and deliver streamlined pathways for the benefit of patients and to ensure financial sustainability.
  • The local leadership team was well respected, visible and accessible. Staff were inspired by and supported by a strong and cohesive leadership team.
  • There were effective governance arrangements. Information was regularly monitored to provide a holistic understanding of performance, including safety, quality and patient experience.
  • A quality dashboard was produced each month which recorded performance against key performance indicators, incidents, complaints, patient outcomes and audit results. These were monitored and discussed at monthly clinical governance and risk management meetings.
  • Teamwork was cited by many staff as the best thing about working at Circle Bath. We saw excellent cooperative working within and between different departments and staff groups.
  • Patients and the public were engaged and involved. Their views were captured and acted upon to shape and improve the service.
  • Staff were empowered to speak up when they had concerns. A system known as “stop the line” enabled staff of any designation to stop a procedure if they felt that it was unsafe or detrimental to patient wellbeing.

However,

  • The outpatient department had not recruited to the unit lead position, which had been vacant for over 12 months. The deputy lead had taken over managerial responsibilities but had little protected time to fulfil these responsibilities.
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 24 April 2017

We rated this service as good because it was safe, effective, responsive to people’s needs and well-led, and outstanding in caring.

  • The service had a good track record on safety. There was an open culture; staff were encouraged to report concerns and incidents. Incidents were investigated and used to identify learning.
  • Risks to patients were assessed and appropriately managed. Comprehensive pre-operative assessment ensured patients’ suitability for surgery at Circle Bath.
  • Departments were appropriately staffed to keep people safe.
  • Staff were trained in and complied with safe systems to protect people from avoidable harm.
  • People had their needs assessed and their care planned and delivered in line with evidence-based, guidance, standards and best practice, including during assessment, diagnostics and referral to other services
  • Staff, including those in different teams, worked together to provide seamless and coordinated care.
  • Staff were suitably qualified and experienced to undertake their roles and received regular supervision and appraisal.
  • Feedback from patients and those close to them was consistently positive. The department received overwhelmingly positive feedback from patients and this was consistent with the feedback we received during our inspection. Patients we spoke with were fulsome in their praise for staff. We heard of numerous examples where staff had “gone the extra mile” to support people.
  • Staff treated patients with dignity, respect and kindness during all interactions. Patients told us that staff took time to listen to them and felt supported by them.
  • Patients and those close to them were involved as partners in their care. Patients told us that their conditions and treatment options were explained to them in a way they could understand.
  • Staff showed compassion when people were distressed or anxious.
  • Patients could access care and treatment at a time which was convenient to them. Cancellations and delays were minimal.
  • Premises were accessible and comfortable.
  • People’s complaints and concerns were listened to and responded to. Learning from complaints was used to improve the quality of care.
  • The local leadership team was well respected, visible and accessible. Staff were inspired by and supported by a strong and cohesive leadership team.
  • Staff enjoyed working at Circle Bath. Staff morale was high; they expressed pride in their service and they were optimistic for the future.
  • Team work was cited by many staff as the best thing about working at Circle Bath. We saw excellent cooperative working within and between departments.
  • There were effective governance arrangements. Information was regularly monitored to provide a holistic understanding of performance, including safety, quality and patient experience.
  • Patients and the public were engaged and involved. Their views were captured and acted upon to improve the service.
  • Staff embraced the hospital’s improvement plan and were encouraged and empowered to raise concerns and drive improvement.

However:

  • There was no private space available in outpatients which could be used by, for example, breast feeding mothers or people who wished to have private conversations.
  • Patient information on medical conditions and treatments was available in English only.
  • The availability of chaperones to accompany patients at consultations was not publicised in departments.
  • The outpatient department had not recruited to the unit lead position, which had been vacant for over 12 months. The deputy lead had taken over managerial responsibilities but had little protected time to fulfil these responsibilities.  

Surgery

Good

Updated 24 April 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 because it was good for safety, effective, caring, responsive to people’s needs and well-led.

  • Staff supported and treated patients with dignity and respect, and patients were involved in decisions about their care and treatment.
  • Patients spoke of a high standard of compassionate and competent care by nurses, allied health professionals and medical staff.
  • Staff monitored patient safety and investigated incidents and shared learning from reported incidents to improve care.
  • All areas we observed were well organised and visibly clean.
  • Staffing levels were sufficient and were planned and maintained to safely meet the needs of patients. The hospital had competent staff who worked as an effective team to care for patients. Staff told us that they were supported with training and were given time to attend. Staff were up to date with their mandatory training and understood the safeguarding policies and procedures for vulnerable adults.
  • Staff responded compassionately when patients needed help.
  • We observed patient notes unattended outside a patient room, on a drugs trolley while the nursing staff was attending a patient.