You are here

Inspection Summary


Overall summary & rating

Good

Updated 13 April 2017

The Yorkshire Clinic Hospital is part of the Ramsay Health Care UK Operations Limited. The hospital has 56 beds and 12 ambulatory bays. Facilities include five operating theatres, a four-bed level two care unit, an endoscopy unit, angiography suite, physiotherapy, pharmacy, central sterile services department (CSSD) and X-ray, outpatient and diagnostic facilities. The Lodge is a separate building but still part of the hospital, which has one theatre, consulting and treatment rooms and is the dedicated ophthalmology centre.

The Yorkshire Clinic provides surgery, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery, outpatients and diagnostics 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 18 to 20 October 2016, along with an unannounced visit to the hospital on 3 November 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 core services. See surgery section for main findings.

We rated this hospital as good overall.

We found good practice in relation to surgery, diagnostics and outpatient care and services for children and young people:

  • The service managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
  • Staff were encouraged to report incidents and we saw good sharing of learning following incidents. Staff were aware of the two never events and subsequent changes in practice.
  • Mandatory training compliance levels were high and we observed good practice in relation to infection prevention and control and medicines.
  • Documentation was good and patient care and treatment was evidence based. There were clear pathways of care and staff were able to recognise and respond to signs of deteriorating health.
  • Patients were involved in their care and treated with dignity and respect.
  • Service provision was focused around the needs of the people using the hospital.
  • The provider met national indicators for referral to treatment (RTT) waiting times.
  • Staff spoke positively about their leaders and managers.
  • The governance arrangements in place ensured that quality, performance and risks were managed.

We found some areas of outstanding practice, these were:

  • The pharmacy department had undergone external benchmarking of their aseptic department.
  • The new senior children’s nurse was building links to the local authority safeguarding children’s board and had attended a recent link meeting.
  • The senior registered sick children’s nurse had started weekly two hour information and advice safeguarding children ‘drop ins’. These had proved popular and provided a link between local and national developments and staff.

There were no breaches of regulations. However, there were areas where the provider should make some improvements, even though a regulation had not been breached, to help the service improve. These were:

  • The provider should consider making designated areas more child focused.
  • The provider should ensure that all staff receive an annual appraisal.
  • The provider should ensure best practice guidance is followed in relation to mental capacity assessment and best interest’s decisions.

Ellen Armistead

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 13 April 2017

We rated safe as good because:

  • Staff were encouraged to report incidents and we saw good sharing of learning following incidents. Staff were aware of the two never events and subsequent changes in practice.
  • We observed good infection prevention and control practice and there had been no reported cases of hospital acquired infections
  • Mandatory training compliance was high.
  • We found good practice in relation to medicines management.
  • Safeguarding policies were in place, staff were appropriately trained and aware of how and when to escalate concerns.
  • There were robust systems in place for assessing patient risk and regular emergency simulations were run. The process for transferring patients, when it was no longer safe to provide their care at the hospital, worked well.
  • Staffing was at planned levels and appropriate to meet the needs of patients in the different clinical areas.

However;

  • Although unauthorised access to theatre was being addressed, we could not be assured at the time of inspection that access to theatre was limited or monitored.
  • Within the physiotherapy outpatient department records were not always fully completed and we saw examples of care plans, risk assessment scores and allergy records not always being completed.
  • We identified from records in outpatients, early warning scores were not always recorded following minor procedures. Following the inspection we were provided with new documentation which addressed this.
  • We lacked assurance over staffs understanding and training on mental capacity and best interest decisions.
  • We identified concerns in how private prescriptions were managed. These were resolved by the service by the time of our unannounced inspection.

Effective

Good

Updated 13 April 2017

We rated effective as good because:

  • Care and treatment of patients was delivered in line with current best practice and guidance.
  • Pain levels were monitored and assessed; patients received pain relief in a timely manner.
  • There was evidence of participation in local and national audit and within the service and showed good performance against audit targets.
  • There was good support for new staff and training was comprehensive.
  • There were good examples of multidisciplinary working within the service and the wider hospital.
  • Informal clinical supervision took place via team and one to one meetings with staff.

However;

  • We were provided with several figures in relation to staff appraisals. Appraisal figures for theatre staff were 60%.

Caring

Good

Updated 13 April 2017

We rated caring as good because:

  • The majority of patients gave us positive feedback and told us that they received care that was compassionate and maintained their dignity.
  • Friends and family test data showed good response rates with 100% of respondents recommending the service.
  • Patients were involved in their care and treated with dignity and respect.
  • There was good support for patients undergoing bariatric surgery.

However;

  • Some patients told us that they felt that their dignity was not always maintained in the radiology waiting area.

Responsive

Good

Updated 13 April 2017

We rated responsive as good because:

  • Service provision was focused around the needs of the people using the hospital.
  • There was good patient flow through the hospital with proactive management of theatre lists and admission times.
  • Those patients who had operations cancelled for non-clinical reasons were all rebooked within 28 days.
  • The service was meeting referral to treatment indicators and imaging was reported within an appropriate timescale.
  • Training was provided and staff sought to deliver individualised care.
  • There was access to interpretation services available.
  • The service received a low number of complaints, with no particular trends or themes.

However;

  • There were no dedicated areas in the hospital for children. However the challenge in relation to this was acknowledged due to the level of paediatric activity.

Well-led

Good

Updated 13 April 2017

We rated well-led as good because:

  • Staff were aware of the wider hospital and corporate vision and strategy.
  • Staff spoke positively about their leaders and managers.
  • The governance arrangements in place ensured that quality, performance and risks were managed. This enabled information to be shared between senior management and clinical staff.
  • Staff representatives were able to engage with leaders via a monthly engagement forum.
  • A new patient focus group had been set up for the hospital that could drive improvements and change within the service.

However;

  • The arrangements and governance processes for children and young people’s services were new and needed embedding.
Checks on specific services

Services for children & young people

Good

Updated 13 April 2017

Children and young people’s 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 of the report.

We rated this service as good because it was safe, effective, responsive and well-led. We did not rate the caring domain.  

Outpatients and diagnostic imaging

Good

Updated 13 April 2017

We rated this service as good because it was it was safe, caring, responsive and well-led. We did not rate the effectiveness of the service.

Surgery

Good

Updated 13 April 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.

We rated this service as good because it was safe, effective, caring, responsive and well-led.

High dependency care services were a small proportion of hospital activity. The hospital has a four-bed high dependency unit providing level 2 care.

The main service was surgery. We have reported any findings specific to high dependency in the surgery section of the report.