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Inspection Summary


Overall summary & rating

Good

Updated 3 February 2017

Blakelands Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital provides surgery, and outpatients and diagnostic imaging. We inspected these services. The hospital has two theatres, one that is used for surgical procedures including orthopaedic, general and ophthalmology (eye) surgical procedures. The second theatre is used for endoscopy procedures. There are recovery stage one and recovery stage two areas. The recovery stage one area has four trolley spaces, and the stage two area has four chairs. Other facilities include general x-ray, ultrasound, five outpatient treatment rooms and a reception area.

The hospital provided services to adult patients (over 18 years old).

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 5 October 2016 along with an unannounced visit to the hospital on 14 October 2016.

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 good overall.

  • There was a positive incident reporting culture, with good evidence of learning from incidents.

  • Staff understood their roles and responsibilities to safeguard adults from abuse.

  • Nurse staffing levels were appropriate for the service. Medical staff practicing privileges were monitored to ensure doctors were suitable and safe to work in the service.

  • Medicines were checked, monitored and managed appropriately.

  • Staff were kind, respectful and always introduced themselves.

  • The June 2016 patient survey showed that 96% of patients would recommend the hospital to their friends and family.

  • The management team were visible and approachable.

  • Patient’s care and treatment was planned and delivered in line with evidence-based guidelines.

We found areas of good practice in surgery:

  • There were incident reporting processes in place.

  • There were robust infection prevention and equipment maintenance procedures in place.

  • The hospital achieved 100% of NHS patients treated within 18 weeks of referral from July 2015 to June 2016.

  • Pre-operative fasting information sent to patients was aligned to the recommendations of the Royal College of Anaesthetists.

  • The average length of patient stay was reported to be less than four hours (September 2016).

  • Patients with cancelled operations were offered another appointment within 28 days of the cancelled procedure.

We found good practice in relation to outpatient and diagnostic services:

  • There were incident reporting processes in place.

  • The hospital had no patients waiting six weeks or longer from referral for non-obstetric ultrasound.

  • Staff mandatory training rates were 100%.

  • Patient notes were stored securely.

We found areas of practice that require improvement in surgery:

  • The risk register was not always used as a tool to manage risk actively at a departmental level and we identified risks that were not included in the risk register.

  • We found that not all surgical site infections that were reported had an associated root cause analysis report. Therefore, we could not be assured that the organisation was investigating and learning from all reported surgical site infections.

  • We were not assured that the World Health Organisation five steps to safer surgery checklist was completed consistently in line with the three stages. This increased the potential risk of a patient safety incident occurring.

  • There was not a service level agreement in place for patients requiring transfer if they became critically ill.

We found areas of practice that require improvement in outpatient and diagnostic services:

  • Audits were not always followed up with appropriate actions to ensure the service improved.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected surgery and outpatient and diagnostic services. Details are at the end of the report.

Ted Baker

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 3 February 2017

We rated safe as good because:

  • There were robust infection prevention procedures in place.

  • There were systems in place for staff to complete mandatory training in a range of subjects. Compliance ranged from 84% to 100%.

  • Medicines were checked, monitored and managed appropriately.

  • Patient notes were stored securely. There were care pathway documents that were used to record the patients’ journey through their care and treatment.

  • Staff understood their roles and responsibilities to safeguard adults from abuse. However, not all staff were up-to-date with safeguarding training.

  • Nurse staffing levels were appropriate for the service. Medical staff practising privileges were monitored to ensure doctors were suitable and safe to work in the service.

  • Staff completed emergency scenario training.

  • The national early warning score (NEWS) was used to identify deteriorating patients.

  • Equipment was appropriately maintained and fit for purpose.

  • We were not assured that the World Health Organisation five steps to safer surgery checklist was completed consistently in line with the three stages. This increased the risk of a patient safety incident occurring.

  • There were incident reporting processes in place. However, not all surgical site infections that were reported had an associated root cause analysis report. Therefore, we could not be assured that the organisation was investigating and learning from all reported surgical site infections.

  • The hospital had a service level agreement (SLA) in place with a nearby NHS trust. This was for patients needing to be transferred for overnight care and observation. However, this SLA did not cover transfer for critical care.

Effective

Good

Updated 3 February 2017

We rated effective as good because:

  • Patient’s care and treatment was planned and delivered in line with evidence-based guidelines.

  • Patient pain levels were well managed and monitored.

  • There was a 68% appraisal rate for staff for 2016.

  • Staff demonstrated a good knowledge and understanding of obtaining consent, Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

  • Pre-operative fasting information sent to patients was aligned to the recommendations of the Royal College of Anaesthetists.

  • We observed that the team worked well together. It was a small facility and this assisted with maintaining good multidisciplinary working.

  • Staff had access to the information they needed to deliver effective care and treatment.

Caring

Good

Updated 3 February 2017

We rated caring as good because:

  • Staff were kind, respectful and always introduced themselves.

  • The June 2016 patient survey showed that 96% of patients would recommend the hospital to their friends and family.

  • Patients felt listened to by staff and able to ask questions about their care and treatment.

Responsive

Good

Updated 3 February 2017

We rated responsive as good because:

  • The hospital achieved 100% of NHS patients treated within 18 weeks of referral from July 2015 to June 2016.

  • The hospital had no patients waiting six weeks or longer from referral for non-obstetric ultrasound.

  • Staff adjusted their care and treatment to meet the individual needs of patients.

  • There was a robust complaints procedure and staff had feedback about complaints received.

  • The average length of patient stay was reported to be less than four hours (September 2016).

  • All cancelled patients procedures were offered another appointment within 28 days of the cancelled procedure.

Well-led

Requires improvement

Updated 3 February 2017

We rated well-led as requires improvement because:

  • The risk register was not always used as a tool to manage risk actively at a departmental level and we identified risks that were not included in the risk register.

  • We found that not all surgical site infections that were reported had an associated root cause analysis report. Therefore, we could not be assured that the organisation was investigating and learning from all reported surgical site infections.

  • Audits were not always followed up with appropriate actions to ensure the service improved.

  • There was a clinical strategy for the hospital for 2016 to 2019. Understanding of the strategy was clear at a senior level. However, this was less clear at a departmental level.

  • Staff we spoke with were able to summarise the hospital values and discussed the ‘Ramsay way’, which was a corporate set of values.

  • The management team were visible and approachable.

  • Staff felt that they worked within a good team and that they all worked well together.

  • There was a patient focus group to improve services.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 3 February 2017

We rated outpatient and diagnostic services as good overall.

  • There were incident reporting processes in place.

  • Staff understood their roles and responsibilities to safeguard adults from abuse.

  • The hospital had no patients waiting six weeks or longer from referral for non-obstetric ultrasound.

  • Staff mandatory training rates were 100%.

  • Patient notes were stored securely.

  • Nurse staffing levels were appropriate for the service. Medical staff practicing privileges were monitored to ensure doctors were suitable and safe to work in the service.

  • Staff were kind, respectful and always introduced themselves.

  • Patient’s care and treatment was planned and delivered in line with evidence-based guidelines.

However:

  • Audits were not always followed up with appropriate actions to ensure the service improved.

  • Staff were not all aware of the strategy and vision of the hospital.

  • Staff were not aware of the acceptable temperature limits for the safe and appropriate storage of medicines.

Surgery

Good

Updated 3 February 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 surgery service as good overall. We rated the service as good for safe, effective, caring and responsive to people’s needs. We rated it requires improvement for being well-led.

  • There were systems and processes in place to protect patients from avoidable harm including incident reporting, medicines management, infection prevention and control and staff mandatory training.

  • Staffing levels were appropriate and staff understood their responsibilities regarding safeguarding, consent, Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

  • Patient’s care and treatment was planned and delivered in line with evidence-based guidelines. For example, the pre-operative fasting information sent to patients was aligned to the recommendations of the Royal College of Anaesthetists.

  • The team worked well together and patients told us they felt listened to by staff and able to ask questions about their care and treatment.

  • Access to treatment was good, with 100% of NHS patients treated within 18 weeks of referral from July 2015 to June 2016. Due to day case surgery, the average length of patient stay was reported to be less than four hours (September 2016).

  • The senior management team were visible and approachable.

However,

  • We found that not all surgical site infections that were reported had an associated root cause analysis report. Therefore, we could not be assured that the organisation was investigating and learning from all reported surgical site infections.

  • The hospital had a service level agreement (SLA) in place with a local NHS trust. This was for patients needing to be transferred for overnight care and observation. However, this SLA did not cover transfer for critical care.

  • There was an audit programme in place. However, areas of weakness were not always followed up with appropriate actions to ensure the service improved.

  • The risk register was not always used as a tool to manage risk actively at a departmental level and we identified risks that were not included in the risk register.