Oaklands Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we did not rate this key question due to differences in our inspection methodology. As such, this is the first rated assessment for this service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The service adopted a holistic approach to assessing patients’ needs and provided care that followed best practice and national guidelines. Regular audits and benchmarking underscored a commitment to evidence-based practice. Multidisciplinary team (MDT) meetings effectively prioritised patient outcomes and worked together to encourage patients in their ongoing recovery. The service provided care that followed best practice and national guidance and had processes in place to identify and manage risks.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Initial consultations and documentation were comprehensive, covering medical, psychological, emotional, and social needs providing personalised care planning.

Staff considered protected characteristics such as disability, neurodivergence, and cultural needs. Patients were provided with a contact number if they had queries or concerns after appointments and patients we spoke with said they felt able to ask questions or raise concerns with staff.

Clear referral and booking criteria were in place, and triage systems helped allocate the right consultant and intervention pathway. Private fee-paying patients had the opportunity to choose their consultant when booking.

During the assessment, we reviewed 5 care plans in the outpatient department (OPD). Care plans were personalised and holistic. Staff updated care plans on a regular basis. We saw evidence that risk assessments were completed and care plans were put in place to ensure patients received the right level of care including the malnutrition universal screening tool (MUST) and venous thromboembolism (VTE) risk assessment. Assessments reliably identified patients with dementia, learning disabilities or autism.

The hospital had a policy on mental capacity and deprivation of liberty safeguards (DoLS); however, staff we spoke to were not always knowledgeable about these. Staff we spoke to said this was due to the nature of the service and there had been no instances of a DoLS application having been needed in the last 12 months prior to our assessment.

Patients received follow up phone calls 24 hours after their procedures and were offered further outpatient appointments or referrals to other services, such as physiotherapy, depending on their needs.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff took part in clinical audit, benchmarking and quality improvement initiatives. We saw evidence that clinical pathways aligned with National Institute for Health and Care Excellence (NICE) guidance.

The service had corporate group policies in place that followed nationally recognised recommendations such as the National Institute for Health and Care Excellence (NICE) guidance. The policies we reviewed were easy for staff to access, up to date and referenced national guidance. Staff told us how they accessed relevant policies and procedures via the Intranet for reference and were given regular updates if and when guidance was reviewed or practice changed. The majority of staff worked across clinics on a rota basis and told us they received all updates.

As well as doctors and nurses within the OPD, patients had access to physiotherapy and pharmacists. We saw evidence that referrals to these services were timely and appointments for private fee-paying patients were booked within 24 to 72 hours. Patients we spoke with said their nutrition and hydration needs were met. Patients we spoke to said outpatient staff helped them prepare for their procedure and their post-operative appointments supported their recovery. The physiotherapy service was in the process of developing a range of group sessions for patients to allow cohorts of patients to be seen together where appropriate.

The service regularly monitored corporate policies and procedures at monthly head of department meetings. Leaders reported that all policies were up to date, and the policies we checked were within their review timeframes.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff communicated effectively within multidisciplinary teams. This was supported by shared care planning, clinical supervision, and other methods including meetings, emails and documentation. We saw evidence that staff worked well together as a team. Consultants and nurses worked with other teams such as physiotherapy services to plan and deliver treatment pathways.

Staff told us that there were good lines of communication from management and within the OPD.

Staff communicated well with each other to respond promptly to people's needs. Each morning, the heads of each department attended a senior leadership huddle meeting. Managers told us that they would use this meeting to escalate any last minute staffing issues

During our assessment we attended a multidisciplinary meeting and observed good teamworking and best practice. Discharge and onward referral planning was discussed, taking patients individual needs, circumstances and expected outcomes into consideration.

Consultant surgeons and anaesthetists had clinical responsibility for patients receiving care and treatment. The hospital had a medical advisory committee (MAC) with quarterly meetings to review and discuss any issues.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported people to reflect on their own health goals and recovery journeys as part of treatment planning.

We saw evidence of health promotion and advice in public facing areas, such as stopping smoking and advice about the menopause. Patients were also given advice on how they could be involved in monitoring their own health and wellbeing to maximise their independence and comfort.

Patients were asked about smoking and alcohol consumption as part of their pre-operative assessment. All identified smokers and patients who were deemed to be at risk of alcohol related complications were given advice leaflets.

Patients were offered health advice specific to their needs and we saw staff explain to patients how their rehabilitation could help the recovery process. One staff member said, ‘it’s great to be a part of people’s recovery and see the improvements they make, it really does change peoples’ lives…’.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Within the OPD, local audits were developed to address areas of non-compliance in the national audit programme and for any other local areas of concern. Examples included pre-operative assessments, patient consent and medical records.

Staff regularly reviewed patient progress and adapted support accordingly, and nurses completed follow up calls with patients.

Physiotherapy staff told us they reviewed patients' records on their initial presentation before treatment. They also asked patients to assess their initial perception of their current abilities prior to surgery and compared this to their patient outcome forms at the end of their treatment. Staff told us patients were often pleased with the progress they had made.

The department participated in hospital wide and department specific audits. Departmental audits included surgical safety checklist for minor operations. Managers shared and made sure staff understood information from audits. We saw that managers included audit results in team meeting agendas.

Managers monitored waiting times and made sure most patients could access services when needed and received treatment within agreed timeframes and national targets. Patient appointments were booked by the administrative team, who assessed patients’ individual needs and scheduled an appointment with adequate time.

Performance reported outcomes measures (PROMs) data was reported at hospital level.

Patients we spoke with told us that staff contacted them after treatment to check on their comfort and progress, and that their recovery was reviewed at follow‑up outpatient appointments.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Patients gave informed consent prior to treatment; we saw this was documented in patient records. Records of consent that were reviewed were thorough and included details of the risks associated with the procedure. We saw evidence that the outpatient department (OPD) was 100% compliant with consent governance and achieved 97% compliance with the consent process.

However, the audit identified a gap in practice. In 7 out of 10 records where patients required an X-ray, there was no documented evidence within the consent that the risks associated with radiation exposure had been discussed or that a radiation information leaflet had been provided.

Staff told us consent was gained before any sharing of patient information, both internally and with other care services. We saw evidence that staff clearly recorded consent in the patients’ records.

Staff understood how to assess whether a patient had the capacity to make decisions about their care and when this was appropriate. Where patients did not understand information given or asked about care and treatment, or they demonstrated reduced capacity to consent, staff carried out a capacity assessment. Where relevant, best interests’ decisions were clearly recorded within patient care records and staff gave examples of meetings they had been involved in.