You are here

The Berkshire Independent Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 28 March 2017

The Berkshire Independent Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital has 43 inpatient and day-case beds. Facilities included three operating theatres, a two-bed level two care unit, and outpatient, x-ray and diagnostic facilities.

The Berkshire Independent Hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected services for surgery, medicine and outpatients / diagnostic imaging. The hospital had provided services for children and young people; however this service had been suspended pending review. The service was small and there was insufficient evidence to rate.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 5 and 6 December 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 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 core service.

Services we rate

We rated this hospital as good overall.

The senior management team, supported by the Heads of Departments, had a clear knowledge of how services were being provided and were quick to address any risks that were identified. They accepted the responsibility and ownership of the quality of care and treatment within the hospital and staff had a similar sense of pride in the hospital.

Care delivered was planned and delivered in a way that promoted safety and ensured that peoples’ individual needs were met. We saw patients had their individual risks identified, monitored and managed and that the quality of service was regularly monitored.

The general manager was in charge of the hospital, and all employed staff were line managed by the senior management team; matron, finance manager and operations manager. There were three senior managers that reported directly to the general manager: these were the operations manager, matron and finance manager. Heads of clinical departments reported to matron, including pharmacy manager, outpatients, diagnostic imaging and physiotherapy manager, ward manager, theatre manager and endoscopy manager.

The Medical Advisory Committee (MAC) met four times a year and included representation from all specialities offered at the hospital. It was attended by the general manager and the matron. Issues were discussed and action taken in response to any concerns or risks reported. Minutes of MAC meetings were distributed to all consultants at the hospital.

There were robust governance systems that were understood by staff, these were used to monitor the service and drive service improvement. We did not identify any concerns that the senior management team or local managers were not already aware of and already addressing.

We saw a strong safety culture with policies and systems in place to allow staff to challenge practice where they identified risk or potential harm. There was an admission criteria, pre-assessment processes and consultants could only carry out procedures that they were undertaking frequently in the NHS. This ensured that the hospital was able to meet the patients’ needs safely.

There was a positive culture among staff, many of whom had worked at the hospital for many years. These experienced staff offered stability and continuity to the benefit of newly appointed staff, which brought a fresh energy and encouraged development and new ways of working. The consultants with practising privileges held substantive jobs at the local NHS trusts and were used to working collaboratively.

We found good communication locally and from Ramsey corporate division, with updates provided to staff to ensure practice was in line with NICE guidance and risks were identified from medicines and medical device alerts.

We found good practice in relation to outpatient care:

  • The service managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and meet their needs.

  • Staff ensured patients were given sufficient information in a way they could understand. Patients were involved as partners in care and their decisions were respected.

  • There was a good understanding amongst staff at all levels about safeguarding arrangements and the Mental Capacity Act 2005.

  • Patients were seen in a timely manner. Appointments were offered at times that suited patients. Consultations and treatment were provided within the target referral to treatment times. Patients were seen promptly and delays were not common.

We found areas of good practice in surgery:

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

  • The theatre team provided a safe surgical environment by insisting that all theatre users adhered to national and local theatre best practice guidance. The WHO Five Steps to Safer Surgery checks were used routinely, with all staff present and participating fully.

  • Incident reporting was encouraged and staff were supported to raise concerns. There was an embedded culture of learning from incidents that spread across the whole hospital.

  • There were robust governance arrangements for surgical services at the hospital.Any anomalies in practice, trends in incidents or complaints were picked up and addressed swiftly. Lessons learned were disseminated across the organisation.

  • There were appropriate transfer arrangements in the event of a sudden and unexpected deterioration of a patient. Deteriorating patients were identified and transferred to a local NHS hospital in a timely manner; there was good communication with the receiving hospital.

  • Patients were positive about the level of care they received from all staff from the beginning of their contact with the hospital to the end.

We found areas of good practice in medicine:

  • Patients were very positive about their experiences at the hospital. They felt supported and involved in their care and treatment.

  • The arrangements for medicines management were good with multidisciplinary input from the pharmacy team.

  • Areas we visited were clean, tidy and fit for purpose. The environment was pleasant and comfortable. Audit results demonstrated that infection prevention and control measures such as hand hygiene and cleaning were fully implemented.

  • The use of the NEWS system for identifying patients at risk of deterioration was embedded and used correctly. Staff followed the hospital’s escalation processes and transfer policy.

Professor Edward Baker

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 28 March 2017

We rated safe as good because:

  • The hospital had an open culture and incidents and near misses were reported. There was evidence that incidents were investigated and learning from them was shared.

  • There was an embedded safety culture across the hospital.

  • Although staff were given time to complete their mandatory training, compliance with this was below the hospitals’ target.

  • Sufficient staff had undergone training in adult and children’s safeguarding.There were designated leads for safeguarding.Staff knew what to do if they had a safeguarding concern.

  • The hospital was clean, and staff adhered to policies to prevent the spread of infection. Standards were subject to check through an audit process.

  • In the diagnostic imaging department there were appropriate recorded safety checks of equipment in line with legislation. Radiation incidents were reported. There was sufficient equipment across the wards and theatre to provide safe treatment, this included equipment for resuscitation that was checked daily.

  • Medicines were managed correctly and securely across all departments. The pharmacy department worked with other departments to ensure the safety of medicines.

  • Patients’ records were maintained securely, but were available to staff that needed to use them.

  • There were appropriate risk assessments carried out for patients admitted to the hospital. There were robust processes for the escalation of a deteriorating patient and a policy to transfer out to NHS care if required.

  • There were sufficient numbers of suitably qualified nursing staff to support patients. There was a registered medical officer at the hospital across 24 hours.

Effective

Good

Updated 28 March 2017

We rated effective as good because:

  • Care and treatment was provided in line with legislation and evidence based guidance.

  • Surgical patients were given nutrition and hydration in line with best practice. Patients were not starved for prolonged periods without intervention.

  • Patients were given pain relief if they required it. The effectiveness of pain relief was checked and escalated if insufficient. Staff asked and recorded pain scores.

  • Patient outcomes were recorded and were good. The service was benchmarked against other hospitals.

  • Staff had appropriate skills, experience and training to deliver safe care and treatment.

  • Departments and different clinical roles across the hospital worked together to provide a patient centred service.

  • Staff had access to information they needed to provide safe and effective care.

  • Staff were aware of the impact of the Mental Capacity Act 2005, especially in regard to gaining consent to treatment from adults and children.

Caring

Good

Updated 28 March 2017

We rated caring as good because:

  • Patients reported that they felt safe and well cared for.

  • Staff treated patients with dignity, respect and compassion across all services.

  • Patients were supported emotionally with their care and treatment.

  • Patients were involved in all decisions about their care and treatment and were involved as partners.

Responsive

Good

Updated 28 March 2017

We rated responsive as good because:

  • Services were organised to meet the needs of the population that the hospital served.

  • Information could be given to patients in a way they could understand.

  • The individual needs of patients were assessed and care plans devised that reflected their preferences.

  • Patients could access services in a timely way. Appointments were available at times that suited them. If patients needed to return to the hospital after a complication this would be swiftly arranged.

  • There was a robust complaints process. Complaints were investigated and patients given appropriate communication. Learning from patient complaints was shared across the hospital through a variety of means.

Well-led

Good

Updated 28 March 2017

We rated well-led as good because:

  • The hospital had a set of values and statement of vision that was alive for the staff. Delivering a quality service that would be recommended was important to the staff.

  • There was a robust governance structure at the hospital, where incidents, complaints and risk were discussed, monitored and mitigated.

  • There was a programme of audit and measures in place to test the quality of services across the hospital.

  • The hospital leadership team were visible and accessible to staff and supported an open culture of quality and improvement. Staff were involved in developments within the hospital and felt they could contribute to the hospital’s vision.

Checks on specific services

Medical care (including older people’s care)

Good

Updated 28 March 2017

Medical care services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

There were a small number of medical patients that used the service at The Berkshire Independent Hospital. There was an infusion service that treated a small number of regular patients each month on a day case basis.

We have also reported endoscopy services under medicine.

We rated this service as good because;

  • Areas we visited were clean, tidy and fit for purpose. The environment was pleasant and comfortable for patients.
  • There was an embedded culture of incident reporting. Investigations were robust and there was evidence that learning was shared both within the hospital and across the organisation.
  • The endoscopy suite had Joint Advisory Group (JAG) accreditation incorporating the endoscopy global rating scale, which is a quality improvement and assessment tool for endoscopy services.
  • Medical services had an appropriate level of competent staff. The RMO was well supported by consultant physicians.
  • Patient feedback about the quality of care was consistently good.
  • Managers were visible, approachable and effective.
  • Referral to treatment targets were consistently met with patients being given appointments and receiving treatment in a timely way.

Outpatients and diagnostic imaging

Good

Updated 28 March 2017

Outpatient and diagnostic imaging services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated outpatients and diagnostic imaging as good because:

  • The hospital had systems and processes in place to protect patients from harm.

  • Infection prevention and control practices were good, and staff followed hospital policies.

  • The care environment was visibly clean, well presented and fit for purpose.

  • Medicines were managed and stored correctly; administration was in line with good practice and relevant legislation.

  • Patient care records were accurate and stored securely in line with the Data Protection Act 1998.

  • The hospital had a comprehensive audit programme in place to monitor services and identify areas for improvement.

  • The outpatient and diagnostic imaging services had sufficient numbers of appropriately trained competent staff to provide a safe service.

  • We observed that staff interactions with patients were kind, caring, and considerate and respected their dignity. Patients told us they were put at ease when having their investigation.

  • The hospital was responsive to the needs of the population it served. Appointments could be accessed in a timely manner and at a variety of times throughout the day.

  • Managers were visible, approachable and effective.

Surgery

Good

Updated 28 March 2017

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.

Staffing for surgery was managed jointly with medical care.

We rated surgery as good because;

  • Patients received safe, effective and appropriate care, treatment and support that met their individual needs and protected their rights.
  • The care delivered was planned and delivered in a way that promoted safety and ensured that people’s individual needs were met. We saw patients had individual risks identified, monitored and managed, and that the quality of service was regularly monitored.
  • The clinical environments we visited and other communal areas in the hospital were clean and fit for purpose. Hospital-acquired infections were monitored and reported rates were of an acceptable range for the size of hospital.
  • Outcomes for patients were good, and the department followed relevant national guidelines.
  • Complaints were investigated and handled in line with a standard policy. We saw the hospital used patient complaints and feedback for service improvement. The hospital encouraged feedback from its patients and their relatives.

  • We saw that the World Health Organisation (WHO) five steps to safer surgery checklist was used correctly and its use was embedded in practice.
  • Surgical equipment was available and working correctly in theatres.
  • The theatres were well managed and managers had the trust and support of their staff, and also had good working relationships with senior staff at the hospital.
  • The morning huddle meeting was an effective way to plan for the day ahead and learn from the previous day’s events.
  • Staffing levels in theatres were appropriate.
  • There was an open culture for reporting and learning from incidents.
  • The hospital had clear policies and protocols for cleaning and infection prevention and control that staff adhered to.

  • Patients were positive about the care they received from all hospital staff.

However,

  • Although staff were given time to complete their mandatory training, compliance with this was below the hospitals’ target.