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The rating for ‘Services for children and young people’ shown on this page does not reflect our latest judgement of services at Pinehill Hospital. These services are no longer provided at Pinehill Hospital.

The ‘Requires Improvement’ rating refers to the previous inspection in 2016

Reports


Inspection carried out on 4 and 5 December 2018

During a routine inspection

Pinehill Hospital is operated by Ramsay Health Care UK. Originally it was a large house, but has had numerous extensions. The hospital has 37 beds; this includes 25 inpatient beds over two floors and a 12-bedded day ward. Facilities include three operating theatres with individual anaesthetic rooms and a recovery area. There is one minor theatre used for endoscopies and local anaesthetic procedures. Other facilities include general x-ray, ultrasound, two outpatient treatment rooms and a physiotherapy gymnasium.

The hospital provides surgery, endoscopy, outpatients and diagnostic imaging. Services for children and young people were ceased in September 2018.

The hospital provides an inpatient and outpatient service for various specialties to both private and NHS patients. This includes, but is not limited to, orthopaedics, gynaecology, general surgery, diagnostic imaging and urology.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced (staff did not know that we were coming) inspection on 4 to 5 December 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 report.

Services we rate

Our rating of this hospital/service improved. We rated it as good overall.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had completed safeguarding adult and children’s training.

  • The hospital managed patient safety incidents well. All staff recognised incidents and reported them appropriately. Managers investigated incidents thoroughly and shared lessons learned with teams throughout the hospital. When things went wrong, staff apologised and gave patients honest information and suitable support. There was good awareness of Duty of Candour and this was applied appropriately. There was a culture of openness and honesty at all levels.

  • Staff generally kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

  • Services in the hospital provided care and treatment based on national guidance and evidence of its effectiveness.

  • Staff gave patients enough food and drink to meet their needs and improve their health. The service made adjustments for patients’ religious, cultural and other preferences.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

  • The service had enough medical and allied health professional staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment all the time.

  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed hospital policy and procedures when a patient could not give consent. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

  • There was good multidisciplinary working across the hospital. Staff in different teams worked together to benefit patients. Doctors, nurses and other healthcare professionals, supported each other to provide good care.

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients were treated with dignity, respect and kindness during all interactions with staff.

  • Staff provided emotional support to patients to minimise their distress.

  • Staff involved patients and those close to them in decisions about their care and treatment. They were communicated with and received information in a way that they could understand.

  • Hospital services were planned and developed to meet the needs of the local population for both private and NHS patients.

  • The service had suitable premises and equipment. Hospital premises were clean, well maintained, and suitable equipped. There was an equipment replacement programme to ensure that all large items of equipment were replaced when they became outdated.

  • The hospital took account of patients’ individual needs. Reasonable adjustments were made for patients who had additional or complex needs.

  • People could access services when they needed it. Waiting times from referral to treatment for surgical procedures, and arrangements to treat and discharge patients, were in line with good practice. There was an emphasis on the importance of flexibility, choice and continuity of care across the hospital. Services were delivered at times that were suitable for patients through the provision of out of hours services, and the use of additional clinics and appointments to meet areas of high demand.

  • The hospital treated concerns and complaints seriously. Managers investigated them thoroughly and made responses within agreed timescales. There was an appropriate escalation process for complaints when patients were not satisfied with the outcome of a complaints investigation. Lessons were learned from complaints and were shared widely with all staff.

  • Managers at all levels in the hospital had the right skills and abilities to run services and provide high-quality sustainable care. There were named and experienced heads of department for each area. Each service lead was passionate about the service they led and worked well with the team of staff in their department.

  • The hospital had a vision for what it wanted to achieve and workable plans to turn it into action. The hospital set a five-year strategy and vision from 2018 to 2021. All staff we spoke with were aware of the vision for the hospital, and understood their role in achieving it.

  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.

  • The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

  • Information needed to deliver effective care and treatment was available to relevant staff in a timely and accessible way.

  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

  • The service was committed to improving services by learning from when things went well or wrong, promoting training and innovation.

We found the following areas for improvement:

  • There were inconsistencies with the completion of risk assessments post-operatively which were necessary to maintain patient safety. Not all risk assessments were reviewed post-operatively.

  • We were not assured that staffing levels were always safe at night when a second ward area was opened. During the night when there were additional wards opened, safe staffing levels were not always achieved.

  • Carpet was present in consultation and treatment rooms and the general waiting area in outpatients and physiotherapy, which could be an infection control risk. However, a plan was in place to remove all carpet in clinical areas in the future.

  • In the diagnostic imaging service, we did not find processes in place for the management of medicines that were stored within the service. There was no stock rotation and replacement process and no pharmacy support to ensure safe management of medicines in the service.

  • Although outcomes were generally monitored, we did not always see action plans in place when a service did not achieve the hospital’s standards. This meant that we could not be assured there were processes in place to address any shortfalls in compliance.

  • The diagnostic imaging service did not have systems in place to routinely obtain feedback from patients in order to improve the service.

  • The diagnostic imaging service did not have processes in place to monitor turnaround figures (wait times from procedure to reporting). We were not assured that they could demonstrate they were meeting their targets.

  • Not all staff were aware of their service’s performance as this information in some services was not routinely shared with staff.

  • Not all equipment was within date for safety testing. Electrical safety testing had expired on some equipment meaning that we could not be assured that it was safe for use.

  • Although the premises and environments were kept clean, we saw that hand hygiene was not always maintained by all staff.

  • Training compliance for some staff was below the hospital target.

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 notice(s) that affected the surgery core service. Details are at the end of the report.

Amanda Stanford

Acting Deputy Chief Inspector of Hospitals (Central)

Inspection carried out on 19, 20 and 27 October 2016

During a routine inspection

Pinehill Hospital is operated by Ramsay Health Care UK Operations Ltd. The hospital has 37 beds. Facilities include three operating theatres, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery and outpatients for adults, children and young people, and diagnostic imaging. We inspected surgery, outpatients and imaging and services for children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 and 20 October 2016, along with an unannounced visit to the hospital on 27 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 services provided by this hospital were outpatients and surgery for adults. Children and young people’s services were a small proportion of hospital activity. 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, the main core service.

See the surgery section for main findings.

Services we rate

Safety, effective and well-led required improvement. We found caring and responsive was good. This led to a rating of requires improvement overall.

Main findings:

  • Mandatory and safeguarding training rates were below those expected by the organisation.
  • There was a high number of serious incidents and surgical site infections compared to other independent hospitals of the same type.
  • There were insufficient controls in place to ensure all equipment was cleaned regularly and to prevent the misuse of medicines and prescription forms. The hospital had taken action to address our concerns following our inspection.
  • Compliance with staff appraisals on the ward was low; however, staff had been booked for their appraisals at the time of inspection.
  • The risk register did not have clear action plans identified against each risk or review dates. Therefore, it was unclear to see if they were on-going or old risks. However, the ward and theatres individual risk registers were clear and up to date.
  • Staff turnover was higher than the average for independent hospitals. This had been recognised by the hospital and had plans in place.
  • There was only one employed registered nurse (child branch) supplemented by bank and agency staff. Children were sometimes not under the direct supervision of a suitably qualified member of staff. There was no registered nurse (child branch) on duty in recovery or in outpatients when children and young people attended for appointments.
  • There was not a separate children’s recovery area, which meant children recovered from surgery alongside adult patients. However, children were separated from adults by a curtain.
  • The outpatient department did not have a paediatric resuscitation trolley.
  • Not all staff involved in caring for children had safeguarding children’s level 3 training.
  • Children and young people’s preoperative medical questionnaires were not always completed or reviewed by a registered nurse.
  • Not all clinical policies referenced the most up to date national guidance available.
  • There was no audit schedule for children and young people to assess patient outcomes.
  • There was no strategy to fulfil the vision for expanding the paediatric service.
  • Risks we identified on inspection were not on the risk register. Risk registers lacked detail and did not include actions taken to mitigate risks or what assurances the hospital had in place to minimise risks identified. No paediatric specific risk register was in place and the hospital wide risk register did not have any paediatric risks listed.

However:

  • There were systems to keep patients safe, including the reporting and investigation of incidents. Learning from incidents was cascaded to all staff.
  • Staffing levels were sufficient to meet the needs of patients and we observed effective multidisciplinary team working by competent staff.
  • Staff were proud of the hospital and the care they provided. We observed positive interactions between staff and patients. All patients spoke highly of the care they had received.
  • Patients had access to care and treatment in a timely way. The hospital was exceeding the national referral to treatment times for NHS patients.
  • Patient care and treatment was delivered in line with national guidance.
  • Leadership was strong, supportive and visible. Staff felt confident to report concerns to senior managers.
  • Staffing levels were sufficient to meet the needs of patients and we observed effective multidisciplinary team working by competent staff.

We found some practice that required improvement in relation to outpatient care:

  • Mandatory and safeguarding training rates were below those expected by the organisation.

And some good practice:

  • Patients had access to care and treatment in a timely way. The hospital was exceeding the national referral to treatment times.

  • Patient care and treatment was delivered in line with national guidance.

  • Leadership was strong, supportive and visible. Staff felt confident to report concerns to senior management.

We found areas of good practice in surgery:

  • In surgery, staff worked especially hard to make the patient experience as pleasant as possible. Staff recognised and responded to the holistic needs of their patients from the first referral before admission to checks on their wellbeing after they were discharged from the hospital.

And some areas for improvement:

  • Compliance for staff appraisals on the ward was low; however, staff had been booked for an appraisal at the time of inspection.

  • The corporate risk register did not have clear action plans identified against each risk or review dates. Therefore, it was unclear to see if they were on-going or old risks. However, the ward and theatres individual risk registers were clear and up to date.

We found areas of practice that required improvement in services for children and young people:

  • Services did not meet the needs of their young patients fully because many facilities were shared inappropriately with adults, resulting in a lack of privacy and dignity for young patients.

  • There was insufficient numbers of staff with the right qualifications

  • There was a lack of oversight with regards to risk management and security.

And some good practice:

  • Pain was managed well, with child friendly pain scores in use.

  • Staff provided compassionate care to patients and their parents or carers.

Following this inspection, we told the provider that it must take some actions to comply with the regulations because they had been breached 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 3 requirement notices that affected children and young people’s service. Details are at the end of the report.

Edward Baker

Deputy Chief Inspector of Hospitals

Inspection carried out on 13 December 2013

During a routine inspection

People were given information that helped them to make decisions that influenced their care and treatment. They told us that the care they received met their needs and their dignity and privacy was respected. One person said, "I can�t fault it here. I have been in a few hospitals over the years and this is definitely the nicest.�

People told us that they found the hospital to be clean. They said that staff practiced good infection control procedures such as hand washing and wearing of disposable aprons and gloves. We found that there were robust systems in place to reduce the risk and spread of infection.

There were procedures in place to ensure that staff were well trained and supported to enable them to do their job to the best of their abilities. Staff told us that they received good induction and training to enable them to carry out their roles effectively.

Complaints were well managed. The provider listened to any comments and used them to improve the service.

Inspection carried out on 30 January 2013

During a routine inspection

People told us that they had discussed the treatment choices available to them before being admitted to the hospital. One person told us, "The information is easy to understand. Some of it is in pictures. There is a page for everything." We saw a range of leaflets published by the provider that were available in the day surgery unit for people to pick up.

All of the people we spoke with told us that they were very happy with the care and treatment that they had received. One person told us, "They are magnificent. They're faultless and do everything they possibly can to make you comfortable." One person described the food provided as, "Smashing. Better than some restaurants."

We looked at the care and treatment plans for six people who had been treated at the hospital. Each plan was personalised for the individual and contained risk assessments that were reviewed on a daily basis throughout the person's stay.

Appropriate checks were undertaken before staff began work. A person only started work after a full Criminal Records Bureau (CRB) check had been received and they had demonstrated that they were legally entitled to work in the United Kingdom.

We saw that there were appropriate quality assurance processes in place.

Inspection carried out on 23 January and 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Reports under our old system of regulation (including those from before CQC was created)