Background to this inspection
Updated
10 November 2017
Fitzwilliam Hospital is operated by Ramsay Health Care UK. The hospital opened in 1983. It is a private hospital in Peterborough, Cambridgeshire. The hospital cares for adults aged 18 years and over from the communities of Peterborough and the surrounding area. The hospital no longer offers care to children.
The hospital is registered to provide the regulated activities of:
The hospital has had a registered manager in post since 1 October 2010.
We inspected surgery services in response to the eight serious incidents and two never events reported by the provider between January 2017 and September 2017. We focused our inspection on surgery services and the domains “safe” and “well led”.
We previously inspected this service in December 2016 and issued the provider with one requirement notice along with some actions the provider should take in order to improve services. The requirement notice related to services for children and young people in surgery.
We agreed an action plan with the provider as a result of the requirement notice from the previous inspection (December 2016). The provider had completed three out of four actions and the remaining action was ongoing. We were satisfied with the progress the provider had made against the action plan.
Updated
10 November 2017
Fitzwilliam Hospital is operated by Ramsay Health Care UK. The hospital has 45 beds. Facilities include a two-bedded high care unit (HCU), three main theatres with laminar flow, a purpose built ambulatory care unit and a day case unit. The hospital provides surgery, outpatients and diagnostic imaging for adults.
We carried out a responsive inspection of surgery services in response to the number of serious incidents in gynaecological surgery reported by the provider between January 2017 and September 2017. We announced the inspection to the provider on the 6 September 2017 and carried out the inspection on the 13 September 2017and inspected the key question of safe in surgery only.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
Services we rate
We rated surgery as good for safe and good for Well led.
We found good practice in relation to surgery:
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Staff understood their responsibility to raise incidents and concerns and the hospital had documented procedures for incident investigation and sharing of learning.
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Staff mandatory training and e-learning compliance was above hospital target (85%).
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The hospital was 100% compliant with intermediate life support (ILS) training.
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Staff knew their responsibility to safeguard vulnerable adults. Safeguarding training compliance was above the hospital target.
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The hospital had processes in place to manage risks to people. Risks were assessed, monitored and managed appropriately.
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Staffing levels and skill mix were appropriate and reflected patient acuity.
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The hospital had a clear governance structure in place with appropriate arrangements for communication. The hospital had committees such as clinical governance, senior management, and heads of department, which all fed into the medical advisory committee (MAC) and hospital management team.
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The theatre department and the ward had dedicated managers who reported to the hospital matron.
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Theatre and ward staff told us they felt valued and well supported by their manager. All the staff we spoke with told us that they were able to raise concerns openly and both managers had an open door policy.
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Staff knew the hospital vision was to be the number one provider of health care in the local area, and to offer high quality, safe, patient centred care.
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The hospital had a variety of mechanisms to gain feedback from patients by means of the friends and family test, monitoring social media comments, the online patient survey and through complaints and complements received.
We found areas of practice that require improvement in surgery:
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Two of the eight duty of candour letters the hospital had sent to patients who suffered serious incidents (SIs) were not accurate. One suggested “patient anatomy” to be the cause and the second did not detail why two procedures had been carried out when one would have sufficed.
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Theatre staff we spoke with said they were not as well informed around previous incidents and their investigation outcomes despite incidents being a standard agenda item at weekly meetings.
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In theatre three anaesthetic room nursing staff recorded the room temperature to be 27°C. We reviewed room temperature records for theatre three anaesthetic areas. Theatre staff had recorded the temperature above 26 degrees on seven days in July, 13 days in August and 15 days in September. This is above recommended limits for storing medications and may impact on medicine efficacy
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The hospital did not keep records of conversations between the hospital general manager, the medical director (MD) and the MD at the local NHS provider regarding concerns around behaviour and performance of consultants.
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.
Heidi Smoult
Deputy Chief Inspector of Hospitals
Outpatients and diagnostic imaging
Updated
8 February 2017
The outpatient department at Fitzwilliam Hospital had 16 consultation rooms and three treatment rooms providing patient clinics, a health screening service, and a private general practitioner (GP) service. There were a range of speciality services available including: gastroenterology, cardiology, gynaecology, breast, and general surgery amongst others.
There was a minor procedures room, ear nose and throat suite and a physiotherapy suite. The diagnostic imaging department offered magnetic resonance imaging (MRI), computerised tomography (CT), ultrasound, fluoroscopy, mammography, and general x-rays.
The hospital provided consultation and treatment for aged 16 and 17 years of age and adults. The outpatient department operated between 8am and 8.30pm Monday to Friday, and on a Saturday from 8am to 4pm.
Between July 2015 and June 2016, 77,046 patients attended the outpatient department, 1,144 were children up to 17 years of age, and 75,902 were adults. Sixty-three percent of the total attendances were NHS funded patients, and 37% either self-funded or funded from other sources, for example, private insurance claims. The service ceased providing outpatients to children under the age of 16 from June 2016.
The hospital had an onsite pharmacist and patients could access this service during outpatient clinic hours. Staff had access to a Resident Medical Officer (RMO) 24 hours a day, seven days a week for support and guidance on medication and the management of patients who may become unwell during treatment.
Updated
10 November 2017
We inspected surgery services in response to the number of serious incidents the reported by the provider in relation to gynaecological surgery between January 2017 and September 2017. We focused our inspection on surgery services and the domains “safe” and “well led.”
Staff understood their responsibility to raise incidents and concerns and the hospital had documented procedures for incident investigation and sharing of learning.
The hospital complied with duty of candour regulations in a timely way.
Staff mandatory training and e-learning compliance was above the hospital target (85%).
The hospital was 100% compliant with intermediate life support (ILS) training
Staff knew their responsibility to safeguard vulnerable adults. Safeguarding training compliance was above hospital target.
The hospital had processes in place to manage risks to people. Risks were assessed, monitored and managed appropriately.
Staffing levels and skill mix were appropriate and reflected patient acuity.
The hospital had a clear governance structure in place with appropriate arrangements for communication.
The hospital had committees such as clinical governance, senior management, and heads of department, which all fed into the medical advisory committee (MAC) and hospital management team.
The theatre department and the ward had dedicated managers who reported to the hospital matron.
Theatre and ward staff told us they felt valued and well supported by their manager. All the staff we spoke with told us that they were able to raise concerns openly and both managers had an open door policy.
Staff knew the hospital vision was to be the number one provider of health care in the local area, and to offer high quality, safe, patient centred care.
The hospital had a variety of mechanisms to gain feedback from patients by means of the friends and family test, monitoring of twitter and Facebook comments, the online patient survey and through complaints and complements received.
However,
Two of the eight duty of candour letters sent to patients were not accurate, one stating patient anatomy as a cause and the second not describing why two procedures had been performed when one should have sufficed.
Theatre staff we spoke with said they were not as well informed around previous incidents and their investigation outcomes despite incidents being a standard agenda item at weekly meetings.
In theatre three anaesthetic room nursing staff recorded the room temperature to be 27°C. We reviewed room temperature records for theatre three anaesthetic areas. Theatre staff had recorded the temperature above 26 degrees on seven days in July, 13 days in August and 15 days in September. This is above recommended limits for storing medications and may impact on medicine efficacy
The hospital did not keep records of conversations between the hospital general manager, the medical director (MD) and the MD at the consultant’s substantive NHS provider regarding concerns around behaviour and performance of consultants outside of the annual appraisal process.