Oaklands Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last assessment we rated this key question good. At this assessment the rating has remained good.

The service had enough staff to care for people and keep them safe. Staff had training in key skills, understood how to protect people from abuse and managed safety incidents and medicines well. Premises and equipment were clean and well-maintained. Staff followed systems for the management of infection prevention and control.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People who used the service told us they felt safe and did not have any concerns. They knew how to raise any concerns with staff if they needed to do this.

Staff knew what incidents to report and how to report them. Staff we spoke with could access the provider's electronic incident reporting system and were encouraged to report incidents when these occurred.

Staff reviewed incidents to identify any learning, and we saw examples of shared learning from incidents that occurred locally and across other hospitals in the group. We reviewed five examples of how incidents were managed and found no errors or omissions in the reports. Lessons learned from safety incidents resulted in changes that improved care for others.

We saw that there were quarterly medical advisory committee meetings held where any deaths were discussed and any opportunities for learning identified. We were given a specific example of how one patient death had led to improvements in documentation and wider systems.

All senior leaders knew the process for the investigation of incidents and were able to fully articulate the incident reporting system. Incidents were investigated by senior staff with the appropriate level of training. Staff we spoke with understood their responsibilities regarding duty of candour legislation. The duty of candour is a regulatory duty that relates to openness and transparency with patients if their treatment causes or has the potential to cause harm or distress. The service had a duty of candour policy and staff followed this process for any incidents rated moderate harm and above.

Serious incidents were reported centrally to the corporate provider. The service had reported one Never Event in the past 12 months.

The service worked with people and healthcare partners to establish and maintain safe systems of care. Staff made sure there was continuity of care, including when people moved between different services.

People who used the service told us they had an initial consultation to assess their needs and preferences and to determine if they were eligible for surgery. They told us they had received information about their planned surgery which was clear and explained to them. They had opportunity to raise any questions if they needed.

The service had an inclusion criteria which identified any patients who would not be suitable to access treatment and care due to their having more complex health needs. Staff in the service followed relevant and up-to-date service policies and procedures for admission, discharge and transfer of people who used the service.

Staff understood the process for managing patients during an emergency. They told us they carried out routine observations during surgery and people whose health condition was deteriorating would be stabilised and transferred to the local NHS hospital if they required emergency treatment. Between November 2024 and the date of inspection there had been seven patient transfers to the local NHS hospital.

People told us they were monitored by staff when undergoing a procedure. They told us they received information about post-operative recovery and the aftercare service as part of the discharge process.

Staff liaised with external agencies where needed, including such as with people’s GP (General Practitioners)

Partner feedback was mostly positive about safety and continuity of care in the service and communication was good between clinical services and hospital managers

The views of people who used the service were sought through engagement such as feedback from patient groups and surveys. The service used the results to make changes and improvements to patient care and safety.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

People who use the service told us they had not experienced any instances of abuse or neglect at the service. They told us if they had any safeguarding concerns, they would raise them with the managers.

The service provided safeguarding training in accordance with current intercollegiate guidance. All staff were required to complete Safeguarding and Prevent counter- terrorism (Levels 12) training, with overall training compliance for all hospital staff at 94% completion. By staff group, the lowest level of compliance for this training was 75% for housekeeping staff, with training below target but averaging 85% completion for a further five of fifteen overall staff groups.

Of all eligible staff required to complete this 99% had completed level 3 adult safeguarding training, with reduced compliance at 90% completion for theatre and endoscopy staff.

Staff were aware of the provider’s safeguarding policy and understood how to make a safeguarding referral and who to inform if they had concerns. They knew how to access support from the hospital safeguarding lead. Staff told us that learning from any reported safeguarding incidents was shared as part of daily safety huddles. Managers reviewed safeguarding incidents and identified any immediate actions where needed.

Meeting minutes showed safeguarding incidents were routinely discussed at monthly performance meetings and provider-level safeguarding leads meetings.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people's needs that was safe, supportive and enabled people to do the things that mattered to them.

People who used the service told us staff assessed key risks around their procedure and discussed these with them before undergoing surgery.

People told us staff carried out routine observations before, during and after their procedure and kept them informed about any changes to their care or treatment.

Care records showed staff completed risk assessments for each person on admission to the clinic, such as for venous thromboembolism (VTE — blood clots) and infection history risks.

Staff understood how to identify and manage risks. They told us risks to people were discussed during initial consultations and risk assessments were carried out on the day of surgery to determine people were suitable for surgery. They told us they regularly reviewed risk assessments and discussed any changes with people and their relatives or carers. Staff told us new or emerging safety risks were discussed during daily safety huddles.

Staff were able to describe how they monitored people's care and treatment, including undertaking vital observations. They understood how to identify and manage people with suspected sepsis or those whose health condition deteriorated. Staff used the recognised national early warning score system (NEWS2) to manage patients whose condition was deteriorating.

We observed staff in theatre teams undertaking the `five steps to safer surgery' procedures, including the use of the World Health Organization (WHO) checklist. The theatre staff completed safety checks before, during and after surgery in line with WHO guidelines. Care records showed surgical safety checklists were completed correctly. The service audited compliance for completion of the WHO checklist and recent audit results we reviewed showed the service achieved scores which met the standards set by Ramsay healthcare and Oaklands clinical leadership team.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care. The location was suitable for all work undertaken. We saw leaders had plans to improve the hospital footprint and improve the environment for both staff and patients.

People who used the service told us the environment was safe; the design and condition of the rooms was good and met their needs. They said the premises were clean and felt the equipment was suitably maintained.

Staff told us the premises and equipment were suitable for providing safe care and treatment. They told us there were sufficient quantities of equipment and consumable items and they could easily access them when needed. The service provided evidence of staff training in the use of clinical equipment and non-clinical equipment.

Staff told us they carried out routine monthly stock checks to check they had sufficient stock and to check consumables and single use sterile items were within expiry dates.

Staff told us there was a clear process for reporting any faults relating to the equipment or the premises. They told us any reported issues were promptly addressed by the maintenance and facilities staff.

All the areas we inspected were well-maintained, free from clutter and suitable for providing safe care and treatment.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people's individual needs.

People who used the service told us there were enough staff in the service and they provided safe care and treatment. They spoke positively about the way staff communicated and interacted with them and told us staff were professional, friendly and responsive to their needs.

People told us they felt staff were suitably trained and competent in their roles and they did not have any concerns in relation to their competence and abilities when providing care and treatment.

Staff told us there were enough staff to provide safe care and treatment. They told us their workload was manageable following recent recruitment. Staff we spoke with felt they received good support from managers.

At the time of inspection, data provided by the service indicated the vacancy rate at Oaklands was 3% clinical and 3% overall, with four substantive roles and three bank roles also being progressed following recruitment. The service had an overall sickness absence rate of 4.1% during the year to date and reported a significant reduction in the use of bank and agency staff following recent recruitment of permanent staff.

The service had enough medical staff to keep patients safe. Surgical procedures were carried out by a team of consultant surgeons and anaesthetists who were mainly employed in substantive posts by other organisations (usually in the NHS). Consultants worked under practising privileges with Oaklands Hospital which were reviewed regularly.

We saw that staff were available throughout the day to respond to patients in a timely manner. We observed that staff delivered positive interactions with patients and worked efficiently together. During the assessment we saw from the staffing rota and our observation that staffing in theatre and on the ward was sufficient and safe, with flexibility to adjust daily staffing levels in response to the number of patients and their needs. Each theatre was staffed to fulfil the requirements of national guidance from the Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the association of perioperative practice (AfPP) guidelines for safer staffing with a Surgical First Assistant (SFA) available in each theatre shift.

Staff received and kept up to date with their mandatory training. The mandatory training was comprehensive and met the needs of people who use the service and staff. Compliance with mandatory training overall was slightly below the hospital's target of 95% completion. Data provided by the service indicated a whole hospital compliance whereby 90% of staff had completed their mandatory training.

Managers told us they monitored training compliance and informed staff when they needed to update their training. Data provided showed that 100% of all required staff had completed advanced life support (ALS) and 94% of required staff had completed immediate life support (ILS). Basic life support (BLS) training had been completed by 82% of all required staff. Compliance for training in medicines management for all theatre staff was 100% and 75% for all ward staff. The reduced compliance here reflected staff who were newly recruited staff and also those who were on long term absence.

All staff, including bank and agency staff, received a full induction tailored to their role before they started work and had regular clinical competency checks. Staff told us they received annual appraisals, and the service monitored this. The compliance with annual appraisals for all staff groups was 80%. The service recorded and monitored when doctors and consultants working under practicing privileges had completed appraisals with their own organisations (usually an NHS trust). All clinic staff, including the consultants, had completed annual appraisals within the past 12 months.

Human resources processes relating to staff were monitored during monthly governance meetings.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People who used the service told us the premises and equipment were visibly clean and tidy, and they did not have any concerns relating to the cleanliness of the environment and equipment.

People told us staff used gloves and aprons when providing care and treatment. They told us staff washed their hands before making contact.

Staff told us they had completed mandatory training in infection prevention and control (IPC) and could access the lead nurse for any advice or guidance where needed. Staff in the service had access to the provider’s current IPC policies.

Staff understood the processes for managing risks related to infection. They were able to describe how they cleaned and decontaminated equipment and understood if and when people required isolation how this should be carried out.

Staff told us managers undertook regular infection control and hand hygiene audits. The service carried out routine hand hygiene audits and these results indicated over the previous six months there was above 95% compliance with IPC protocols.

The IPC lead nurse attended routine meetings and provided reports for the hospital’s relevant committees. The IPC lead nurse also undertook audits and provided support and training for staff. We saw that the senior leaders had oversight of all infection prevention and control (IPC).

We saw that all areas of the hospital were clean and hygienic. The preoperative assessment area, ward and theatres were visibly clean and had suitable furnishings which were clean and well-maintained. There were appropriate systems for the management of clinical waste in theatres, with clearly labelled routes, trolleys and bins separately identified. All the staff we observed wore suitable personal protective equipment whilst delivering care. We observed staff following hand hygiene and 'bare below the elbow' guidance appropriately.

Cleaning schedules were in place with clearly defined roles and responsibilities for cleaning the environment and cleaning and decontaminating equipment. We saw examples of cleaning record sheets that were up to date and without error or omission. All staff clearly understood their roles with regards to IPC and the hospital had an identified lead nurse for infection prevention and control.

People who used the service were screened for infections such as Methicillin-resistant Staphylococcus Aureus (MRSA) and the service had isolation rooms to support the management of cross infection risks. There had been no cases of MRSA or Clostridium difficile (C. diff) infections at the hospital in the previous 12 months.

We saw examples of IPC information posters in all areas of the hospital. We noted that IPC featured within the service governance structure and was regularly reviewed.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People told us staff gave them clear information around medicines and their medicines were prescribed and administered appropriately, including take home medicines following their discharge from the hospital.

People told us they received medicines in a timely manner and did not have any concerns around the storage and handling of medicines.

Staff told us they received training in medicines management and had access to the

service’s medicines management policies and procedures. Training for medicines management was 100% for theatre staff and 75% for ward staff.

Medicines that required storage in fridges had been stored appropriately. Fridge and room temperatures were monitored daily to check the temperature was correct. Records were complete and correct where we reviewed these. We reviewed a sample of medicines and found these were reconciled correctly with stock records and were kept within their expiry dates.

We observed that medicines were stored securely within a cabinet in the theatre area, which had separate secure access.

The provider carried out routine medicines’ audits. The latest audit record completed for Controlled Drugs (CDs) showed high levels of compliance (97.8%). This reflected a programme of quality improvement to improve staff performance in the management of CDs.

All medicines administered by staff at the clinic and given to patients to take home following discharge were prescribed by medical staff.

The provider had effective systems to manage and respond to safety alerts and medicine recalls.