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We are carrying out checks at Fulwood Hall Hospital. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Good

Updated 6 December 2018

Fulwood Hall Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital/service has 29 inpatient and twelve day case beds. Facilities include three main operating theatres with laminar flow; an endoscopy/ minor operations unit; X-ray, outpatient and diagnostic facilities.

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

We inspected this service using our next phase inspection methodology. We carried out the inspection with an unannounced visit to the hospital on 14 and 15 August 2018.

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 service level.

Services we rate

Our rating of this hospital stayed the same. We rated it as good overall. We found practice was good in relation to care in surgery, outpatients and diagnostic imaging services:

  • The provider 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.
  • The hospital provided mandatory training for all staff and completion rates were high; this was up to date at the time of inspection.
  • Staff were aware of hospital safeguarding procedures and followed these correctly.

  • Staff were aware of the types of incident which could occur and reported these if they occurred. There was a good culture of incident reporting and learning was shared following this.
  • Staff followed evidence-based care pathways for specific conditions; policies and procedures were developed on national guidance.
  • Seven-day services were available in case of emergencies and for responding to concerns.
  • Staff worked well together in multidisciplinary team approach to meet patients’ needs.
  • The service responded well to different patient needs and had well established systems for supporting patients living with dementia or a learning disability.
  • Leaders were visible and there was an open and positive culture amongst staff. The hospital had developed a clear vision and strategy in engagement with staff.
  • There was a clear governance system in place and this had been reviewed and strengthened since our last inspection.
  • The hospital engaged well with patients, staff, the public and local organisations to plan and manage services appropriately, and collaborated with partner organisations effectively.

However

  • Surgical safety and other theatre checklists were not always being carried out in accordance with recognised best practice guidelines. The service did not always control infection risk well and we saw equipment and environmental defects which could present an infection control risk.
  • Managers did not always ensure staff received annual appraisals. Appraisal rates in outpatients were poor and had been low in surgery.
  • Pain scoring tools were used routinely in the physiotherapy department but not used consistently in the outpatient departments to manage patients’ pain levels.

We found areas of outstanding practice in surgery, outpatient and diagnostic care, including

  • Development of a working group for supporting patients who had autism.
  • A focus on safety culture, with implementation of a ‘Speak up for Safety’ initiative and provision of human factors training for all staff.
  • Opportunities for staff development, and access to learning support funding for this, through Ramsay Healthcare.

We found areas of practice that require improvement in surgery and diagnostic imaging services, for

  • Improving practice in World Health Organisation (WHO) checklists.
  • Maintaining robust systems for cleaning radiology equipment used in theatres.

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 two requirement notices that affected surgery and diagnostic imaging services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North West)

Inspection areas

Safe

Requires improvement

Updated 6 December 2018

We rated safe as requires improvement because:

  • Surgical safety checklists were not always being carried out in accordance with recognised best practice guidelines to ensure the safety of the patient during surgery.
  • The service did not always control infection risk well. Staff did not always keep equipment clean and we saw some equipment in outpatient and theatre departments was dirty. We saw that there were some defects with the environment in theatres that could present an infection control risk.
  • Intra-operative temperatures were not being routinely recorded and this was not in line with recognised guidelines
  • Medicines used for certain diagnostic imaging procedures were not always securely stored.

However

  • The hospital provided mandatory training for all staff and completion rates were high; this was up to date at the time of inspection.
  • Safeguarding training was completed and staff were aware of hospital procedures and followed these correctly.
  • Staff were aware of the types of incident which could occur and reported these if they occurred. Learning from incident investigations was shared with staff.
  • The service used safety monitoring results well. The hospital screened for Methicillin Resistant Staphylococcus Aureus (MRSA) and staff followed procedures for dispensing and administration of medicines.
  • There were high levels of compliance in cleanliness and hand hygiene audits; ward areas were visibly clean and storage rooms were well ordered.
  • Staff in diagnostic imaging services completed radiation risk assessments and followed safety protocols, in accordance with Ionising Radiation Medical Exposure Regulations (IRMER). Local safety standards for invasive procedures (LocSSIPS)were in place for certain diagnostic imaging investigations.
  • There were appropriate procedures and pathways in place to recognise and manage the deteriorating patient and to ensure they were transferred to the NHS hospital in a timely way, if required.
  • The hospital had enough staff with the right qualifications, skills, training and experience to provide safe care for patients.
  • There was a strong focus on safety following recent incidents and staff were aware of emergency procedures at the hospital.
  • The resident medical officer was available 24 hours a day, seven days a week, for response to any patient emergencies or concerns.

Effective

Good

Updated 6 December 2018

We rated effective as good because:

  • Care was based on national guidance and staff followed a number of care pathways for specific conditions. Policies and procedures were developed using an evidence-based approach.
  • Diagnostic imaging services routinely used diagnostic reference levels and completed observational audits as part of their practice. The service followed robust systems for checking patients’ previous exposure to radiation.
  • Pain management was good for surgical patients and patients were supported after discharge with follow-up calls within 48 hours.
  • A multidisciplinary approach was evident across the different hospital departments and staff worked well together when providing care for patients
  • Staff were aware of the needs of patients who lacked capacity and followed procedures appropriately in managing different patient needs.

However

  • The service did not always make sure staff were competent for their roles. Completion of annual appraisals was low in outpatient areas and had been poor in surgery.
  • Physiotherapy routinely used pain scoring tools but there was limited use of pain scoring tools in the outpatient department, despite these being available.

Caring

Good

Updated 6 December 2018

We rated caring as good because:

  • Staff were kind and showed compassion when caring for patients, with good communication skills.
  • Staff respected patients’ dignity and took time to engage with and understand patients’ individual circumstances.
  • Services endeavoured to improve patient experience where they could and feedback indicated high satisfaction levels.
  • Patients we spoke with were very appreciative about their care and treatment.
  • Patients felt involved in their treatment and were provided with emotional support where they felt anxious or upset.

Responsive

Good

Updated 6 December 2018

We rated responsive as good because:

  • The service took account of patients’ individual needs, and supported these appropriately where they had been identified.
  • People could access the service in a timely way. Waiting times from assessment to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
  • X-ray and other diagnostic imaging services could provide same day appointments for patients attending outpatient clinics and additional clinics could be arranged in response to increased demand.
  • The hospital received low numbers of complaints but investigated these when they occurred and learned lessons from the results.
  • Chaperones were available for patients who wished to have a chaperone during their appointment.
  • Patient feedback was consistently positive, with numerous thankyou letters and cards displayed in departments. Any negative responses were mostly concerned with parking facilities.

However

  • Patients did not routinely receive copies of clinic letters and were unaware they needed to request these, although there was a sign in the reception area to inform patients on how to request clinic letters.
  • The waiting area for diagnostic imaging services was limited and could become congested at times.

Well-led

Good

Updated 6 December 2018

We rated well-led as good because:

  • Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff we spoke with were involved in development of services at the hospital.
  • There was a clear governance system in place and this had been reviewed and strengthened since our last inspection.
  • There was a systematic approach to continually improving the quality of services and safeguarding high standards of care.
  • There were effective systems in place to identify risks, planning to eliminate or reduce them and coping with both he expected and unexpected.
  • The hospital collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. Managers had access to data to monitor performance and identify improvements.
  • The hospital engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 1 June 2017

Mandatory training rates for permanent staff within the departments were on target for full completion within the rolling twelve-month period.

The diagnostic imaging department was involved in multidisciplinary meetings with outpatient consultants to review imaging and reports.

Care and treatment was provided to patients who used the outpatient, physiotherapy and diagnostic imaging departments in a kind and compassionate way. This was reflected in the patient satisfaction survey.

As a response to a number of complaints in the diagnostic imaging department in 2015, the hospital had implemented an improvement plan. This included recruitment of a new departmental manager. There was a clear improvement in the feedback the department had recently received.

The hospital took part in the Ramsay Health Care UK customer service excellence awards scheme. Two staff in the physiotherapy department had received awards and a staff member in the outpatient department had two nominations. One staff member told us the award scheme meant that staff ‘feel appreciated’.

Outpatients

Good

Updated 6 December 2018

Outpatient services were available for consultants with practising privileges to refer patients.

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

We inspected but did not rate effective.

Diagnostic imaging

Good

Updated 6 December 2018

Diagnostic imaging services

were available to consultants with practising privileges who were authorised as

referrers

We rated this service as good

because it was caring, responsive and well-led, although it requires

improvement for being safe.

We inspected but did

not rate effective.

Surgery

Good

Updated 6 December 2018

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 caring, effective, responsive and well-led, although it requires improvement for being safe