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Inspection Summary


Overall summary & rating

Good

Updated 26 July 2018

New Hall Hospital is operated by Ramsay Healthcare UK. The hospital has 33 beds which consist of single en-suite rooms, along with two and four bedded bays. They also have eight pods (small single-occupancy rooms) used by patients having day case procedures. The service was due to open an ambulatory care unit for patients undergoing minor procedures. At the time of our inspection this was near completion and due to open within the next few months.

Facilities include four operating theatres including a dedicated spinal theatre, and outpatient and diagnostic facilities including a CT and MRI scanner. Chemotherapy services are provided to a small number of patients and they provide a physiotherapy service.

The hospital mainly provides surgical services, and outpatients and diagnostic imaging for adult patients. They do not treat children.

The hospital was inspected in August 2016 and they received a rating of good. We carried out a focused inspection of the surgical services on the 10 and 11 April 2018 in response to some concerns arising from intelligence received and the routine monitoring of services. We looked at only two key questions. Are services safe? Are they well led? We did not inspect outpatient and diagnostic services.

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.

Services we rate

We found the following areas of good practice:

  • There was a strong, supportive and enthusiastic leadership team at the hospital which was focused on maintaining a safe facility, with good quality outcomes.
  • The hospital was well-equipped and had the necessary facilities to provide a wide range of treatments in a way that met the varying needs of patients. Facilities were specifically designed to manage in-patient, day case and minor procedures safely and efficiently.
  • There were opportunities for training and career development within the organisation and staff were given encouragement to learn.
  • The hospital had effective systems and controls to minimise the risk of infections. The working environment was visibly clean. We saw good microbial stewardship and regular audits ensured infection control standards were maintained.
  • Medicines were managed safely and securely and audited regularly to ensure policies and procedures were being followed. Information about medicine was provided to patients on discharge to ensure they used the medicine effectively and understood any side effects.
  • Pathways were used effectively to ensure patients at risk were managed appropriately and safely. Medical attention was available when it was needed. Protocols for managing unexpected complications or emergencies were available and arrangements were made to transfer patients if necessary.
  • Incidents were investigated and there was a strong learning culture which ensured the hospital learned from adverse events and made improvements to ensure they did not happen again.
  • There was a clear vision and strategy for the hospital which was ambitious, linked to the needs of the local population and focused on quality and sustainability.
  • The hospital had a respectful and enthusiastic working environment and staff in all roles had a compassionate and patient-focused approach to their work. There were healthy positive relationships between staff and managers where ideas were encouraged and people were not afraid to challenge.
  • Governance arrangements at the hospital were effective and risks were well-managed. There was a committee structure which provided good oversight. Committees linked up to provide a strong framework where finances, clinical performance and quality outcomes could be monitored and improved.
  • The hospital collaborated with a wide network of stakeholders, including local trusts, commissioners, clinical networks and the local authority. This ensured their practices were up to date and in line with contractual requirements and best practice.

We found the following areas of practice that require improvement:

  • Some staff were not up to date with their mandatory training, in particular safeguarding level 2, data protection and emergency management of patients.
  • Intra-operative temperature monitoring for patients undergoing surgery was not in line with national best practice guidance.
  • Carpets were used in the patient rooms which made it difficult to keep floors clean.
  • Staff morale in radiology was lower than rest of the staff group and some staff said they felt overwhelmed with work due to staff shortages.
  • Some staff wore long-sleeved jackets in clinical areas which presented a risk of cross contamination.
  • We were not assured that risks relating to areas overseen centrally by the provider’s corporate group were being actively managed.
  • There was a lack of storage space which meant the working environment was cluttered in theatres and in the administrative areas.
  • Tourniquets used in upper-arm surgery were not used in accordance with manufacturer’s guidance. This presented a risk of tourniquet-related complications.
  • The dispensing of medicines when the pharmacy was closed was not in line with the organisational medicines policy and we were not assured that practices around take-home medicines were compliant with best practice.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Standford

Deputy Chief Inspector of Hospitals (South), on behalf of the Chief inspector of Hospitals

Inspection areas

Safe

Good

Updated 26 July 2018

We rated safe as good because:

  • The hospital was well-equipped and had the necessary facilities to provide a wide range of treatments in a way that met the varying needs of the patients. Facilities were specifically designed to manage in-patient, day case and minor procedures safely and efficiently.
  • There were opportunities for training and career development within the organisation through the Ramsay Academy. Staff were given encouragement and opportunities to learn.
  • The hospital had effective systems and controls to minimise the risk of infections. We saw good infection control practices, good microbial stewardship and regular audits ensured that high standards were maintained.
  • Medicines were managed safely and securely and audited regularly to ensure that policies and procedures were being followed.
  • Patients were provided with helpful information about their surgery and medicine to ensure that they understood how to manage their wound, what side effects to expect and know when they should seek help.
  • Pathways were used effectively to ensure patients at risk were managed appropriately and safely. Medical attention was available when it was needed, protocols for managing unexpected complications or emergencies were available, and arrangements could be made to transfer patients if necessary.
  • Incidents were investigated and there was a strong learning culture which ensured the hospital learned from adverse events and made improvements to ensure that they did not happen again.

However, we also found the following issues that the service provider needs to improve:

  • Some staff were not up to date with mandatory training and compliance was particularly low for Safeguarding level 2, Data Protection and Emergency Management of Patients.
  • Patients did not have their intra-operative temperatures monitored during surgery in line with national best practice guidance. This is needed to prevent hypothermia and related surgical complications such as infection.
  • Carpets were used in some patient rooms which made it more difficult to keep floors clean. This is not in line with best practice guidance.
  • Some staff were not compliant with the uniform policy and were not bare below the elbow in clinical areas. Long-sleeved jackets were worn in the clinical area. This presented a risk of cross-contamination.
  • There was insufficient storage in theatres and in some administration areas which led to a cluttered and unsafe working environment.
  • Staff did not use six-use tourniquets in accordance with manufacturer’s instructions and did not record the time in which the tourniquet had been applied. This increased the risk of tourniquet injuries.
  • Medicine reconciliation checks at the weekend did not always happen within the 24 hour standard set by the organisation.
  • The dispensing of medicines by nurses when the pharmacy was closed was not in line with the organisational medicines policy.

  • We were not assured that practices around take-home medicines were compliant with best practice.

Effective

Good

Updated 26 July 2018

Caring

Good

Updated 26 July 2018

Responsive

Good

Updated 26 July 2018

Well-led

Good

Updated 26 July 2018

We rated well-led as good because:

  • There was a strong, supportive and enthusiastic leadership team at the hospital, focused on maintaining a safe facility with good quality outcomes.
  • There was a clear vision and strategy for the hospital which was ambitious, linked to the needs of the local population and focused on quality and sustainability.
  • The hospital was a respectful and enthusiastic working environment and staff in all roles had a compassionate and patient-focused approach to their work. There were healthy positive relationships between staff and managers where ideas were encouraged and people were not afraid to challenge.
  • Governance arrangements at the hospital were effective and risks were well-managed. There was a committee structure which provided good oversight. They linked up to provide a strong framework where finances, clinical performance and quality outcomes could be monitored and improved.
  • The hospital collaborated with a wide network of stakeholders, including local trusts, commissioners, clinical networks and the local authority. This ensured their practices were up to date and in line with contractual requirements and best practice.

However, we also found the following issues that the service provider needs to improve:

  • There was a risk on the risk register belonging to the corporate team but there was no record of any steps taken to control or mitigate the risk.
  • Morale was low in the radiology team and staff felt overwhelmed due to staff shortages.
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 9 February 2017

  • Incidents were reported and acted upon and risk was managed. Feedback and learning was shared with staff.

  • Treatment and care were effective, and delivered in line with best practice and recognised national guidance.

  • Patients were at the centre of the service and the priority for all staff. Feedback from people who had used the service was positive. Patients spoke very highly of the staff and the care and support they were given.

  • Patients received care from dedicated, caring staff who were skilled in working with and communicating with patients and their families.

  • Services were designed and delivered to meet patient’s needs.

  • There were clear lines of accountability and lines of management in place. The management team were described as approachable. The culture of the service drove improvement and the delivery of high quality care.

  • There were clear systems in place for managing governance and measuring quality.

Surgery

Good

Updated 26 July 2018