The Yorkshire Clinic

On this page

• 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

Effective – this means 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 rated this key question as good. At this assessment the rating has changed to outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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.

Patients were able to self-refer or access services through the National Health Service (NHS) electronic referral choose and book portal. At the time of inspection NHS work accounted for 82% of all activity.

All patients were required to complete a health screening questionnaire, which was reviewed before submission for consultant review. This included assessment for suitability of procedure including medical risks and initial consent. We saw information obtained from patients General Practitioners (GP) to ensure all known risks were identified prior to admission. We reviewed a comprehensive suite of documents completed for each patient, depending on their procedure and risks associated with this procedure. Staff told us that patients with specific risks or complex health conditions would be further discussed as part of a multidisciplinary meeting to ensure suitability for surgery. We observed this as part of the morning staff briefings.

The provider shared an inclusion / exclusion criterion at the time of inspection. This outlined the adult general anaesthetic / spinal guidance for the service. It was used to determine which patients were suitable for surgery and to avoid last minute cancellations.

The document had been reviewed regularly, to ensure compliance with national guidance and best practice.

The service had also developed clear processes for the management of patients with specific health needs. This included the management of patients at risk of acute kidney injury and specific management of venous thromboembolism, of which the service was an exemplar within the Ramsay hospitals. Where a deep vein thrombosis or pulmonary embolism was suspected patients were escalated immediately. If either was confirmed and the patient's clinical condition was stable, treatment plans were implemented within the clinic. Should a patient be assessed as requiring a higher level of care of monitoring, the patients were transferred to a local NHS hospital. Patients requiring thrombolysis or surgical intervention were referred to tertiary vascular centres.

The service further developed processes by carrying out specific reviews to improve patient outcomes in this area. We saw the Head of Clinical Services presented findings following a bespoke twelve-month period of patient review. We saw changes made to pre-assessment documents to ensure swift identification of patients and a reviewed integrated care pathway. A staff knowledge bank was also developed to supplement staff clinical skills.

We also saw a lead nurse had been appointed to oversee blood transfusion services. We reviewed the latest Blood Safety and Quality Regulations (BSQR) audit dated November 2023 and saw the service achieved 100% compliance.

The service did not have an Intensive care unit or high dependency unit; however, leaders of the organisation recognised the need for higher levels of care for patients presenting with complex or multiple health issues. The Yorkshire Clinic previously had HDU facilities, however this facility no longer exists. Staff however had been retained by the service and as such, a team of highly skilled and trained staff are used to provide outreach services.

Theatre staff identified the need for the outreach service to enhance the care available to patients whose health was deteriorating. Theatre staff with advanced life support training offer support to ward staff by assisting and advising about care of the deteriorating patient. Any patients of concern discussed in the early morning CRASH meeting or those triggering on the NEWS chart as concerning are discussed. At any point of the day further review and discussion takes place.

Theatres at The Yorkshire Clinic run six days per week. The CRASH medical team meet at 08.30 each morning to assign roles and discuss patients of concern.

Theatre staff with ALS (Advanced Life Support) training, offer support to ward staff by assisting and advising about the care of any deteriorating patient, any patients of concern. Morning’s meetings were held to discuss those patients triggering on NEWS charts as high risk and further discussed again at a 09:30hrs huddle or at other times of the day, to ensure each patient is given optimal care, which may negate the need for patients to be transferred out to neighbouring NHS hospitals. We reviewed the records of two patients who had been transferred out and saw swift clinical decision making and comprehensive assessment and consultant review. Records were completed thoroughly and detailed clear decision making by all clinicians involved.

The service carried out local audits, which they used to benchmark themselves against other Ramsay hospitals. We reviewed the last audit collection for 2024 and saw the service scored 100% regarding cleanliness, 99% for food quality, 100% for privacy and dignity, 97% for dementia support and 97% for disability support.

Patient Led Assessment of the Care Environment is the national system for assessing the quality of the patient environment and aims to help organisations understand how well they are meeting the needs of their patients, identifying where improvements can be made. The service carried out a PLACE audit in November 2024 with 4 patients and 1 independent validator from the Integrated Care Board (ICB). The service received excellent feedback throughout the audit and scored above the national benchmark in all areas.

We scored the service as 4. The evidence showed an exceptional standard. The service always 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. They worked to develop evidence-based good practice and standards.

All staff we spoke with were able to describe clearly evidence-based practice and the improvements to the care and treatment patients received as a result of this. Policies were managed centrally through Ramsay Corporate services and all staff were able to access policies electronically.

We reviewed six clinical policies and three staff and recruitment related policies during our assessment and found that they all reflected current National Institute for Health and Care Excellence (NICE) guidance. We reviewed a further six policies following inspection submitted by the service and saw all had been fully ratified, version controlled and made specific reference to appropriate practice. For example, ‘Perioperative care in adults' NICE guidance (NG89).

The service held monthly training and development meetings to ensure all staff were following the most up to date guidance and national advice across all clinical areas.

Training was developed for the year ahead with the training lead and deputy matron to ensure it continually met with national standards and evidence-based practice. The Ramsay academy monitored compliance in conjunction with department leads.

We saw extensive examples of the use of NICE guidance and evidence-based literature to develop pathways to support people on an individual basis. These pathways supported consistent pre-operative optimisation of health and well-being, early mobilisation of patients and enhanced recovery plans. Pathways developed by the service demonstrated clinical excellence through effective use of evidence-based practice. Pathways focussed on reducing known risks of complications in theatre and minimising these risks as far as possible prior to surgery. For example, the anaemia pathway for patients identified as having iron deficiency before operation.

Through development of the pathways, we saw that a range of MDT’s had been set up for specific areas of clinical care, for example hand and wrist MDT’s. By underpinning these MDT’s with evidence based literature and NICE guidance the team were able to routinely capture and talk through all complex cases. Adherence to guidance was clearly referenced within terms of reference for each MDT.

Mentors and buddies were also allocated to new staff to ensure completion of clinical competencies were completed, which were aligned to NICE guidance and other evidence-based practice.

The service had introduced two Professional Nurse Advocates at The Yorkshire Clinic

The primary focus of the PNA role was to deliver restorative clinical supervision which allows individuals to reflect on personal and professional evidence-based practice in a safe, non-judgmental, confidential setting. This was intended to be a two-way process with no set agenda, allowing time to think, to explore feelings and emotions and ultimately to determine how these feelings and emotions can impact practice either in a beneficial or detrimental way.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

All staff consistently had access to the information they needed to appropriately assess, plan and deliver peoples’ care. Staff teams were committed to working collaboratively and had found efficient ways to deliver joined up care to people using services. We observed several staffing briefings in which all members of the multi-disciplinary team were represented. Each department held a briefing at the start of each shift. We attended the inpatient morning briefing in which every patient was reviewed and surgical priorities were established for each day. We saw staff engage fully with these processes and liaise with each other to ensure patients journey and surgical experience was maximised. For example, ensuring patients pre surgical scans and blood tests were completed.

Physiotherapists ensured care was delivered in a way that met actual patient need, through provision of identifying needs at a pre-assessment appointment and follow up care post-surgery. The physiotherapy team produced weekly assessment reports, which were shared with all members of the multi-disciplinary team involved in the patients care.

Clinical information was shared between clinical staff using the Situation, Background, Assessment and Recommendation (SBAR) tool. This structured communication tool was used to improve the clarify and effectiveness of communication between healthcare professionals.

The service had found innovative ways to ensure care was planned taking into account peoples individual needs and expected outcomes. For example, the service had developed bespoke MDT’s for hand and wrist services, upper limb, hip and knee arthroplasty and arthroplasty complex cases. We saw the use of standardised handover templates and ward daily huddle and ward round templates. These documents had been developed as part of the service’s ward communication strategy to support patient safety. This demonstrated a genuine drive to ensure the holistic and comprehensive assessment of patients and to promote safety throughout the patients’ journey. All staff told us meetings were well attended and followed the standardised agendas.

Patients receiving care during our inspection told us they had positive experiences of staff working together as a team to provide their care. All patients we spoke with described seamless communication between colleagues and a flow of clear information provision commencing from pre-assessment to discharge.

Staff told us their teams worked effectively together to meet the needs of people and had further developed services with colleagues such as the enhanced pharmacy support team, outreach and resuscitation team. We also saw evidence of joined up working with external organisations through service level agreements, for example, infection, prevention and control and venous thromboembolism prevention.

The pre-assessment team provided patients with patient diaries and encouraged patients and their families to keep a note of personal journeys at each step, to enable effective communication across all services. An additional ‘This is Me’ care plan was completed to support patients with a cognitive impairment or dementia.

We reviewed incidents where there had been transfers out of the service. We saw these transitions had been managed well. We also saw that learning had been shared with health care partners outside of the service to mitigate possible further incidents or events. This included nationally shared learning.

The service had developed ‘Close the Loop’ reports to ensure all staff understood learning throughout the service. We also saw routine national learning shared throughout the Ramsay network.

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.

The service ensured patients were fully prepared for joint replacement surgery through physiotherapy, which was included in the weeks prior to surgery. The physiotherapy team completed pre-assessments which included assessment of the patient’s home environment and any physical aids that were required or were likely to be required. The assessment also covered what to expect on the ward and how patients would be supported throughout their stay including likely length of stay and managing expectations. Patients were also supported with information video’s, information leaflets and QR codes. For example, arthroscopy wound care information and medicines derived from animals’ information.

Patients were supported by enhanced recovery, for example, out of bed the same day following joint replacements and pre-surgical physio to develop patients’ core strength enabled this. All patients we spoke with told us they were out of bed the same day.

We spoke with physiotherapists who told us they had been actively engaged in developing a bespoke orthopaedic pathway which included recent evidence of positive impact the introduction of additional post operative physio classes made, to patient outcomes.

Physiotherapy staff undertook patient preoperative assessments which focus on the patient as a whole with the aim of understanding patients' health status to ensure patients are at ‘optimum health’. These assessments included but were not limited to health M.O.T’s, weight loss advice, alcohol consumption advice, looking after your heart, looking after your liver and mental health and wellbeing. Staff also told us about the benefits of assessing patients prior to surgery, to enable equipment to be ordered if needed for use at home.

Patients were provided with wound check-up letters and physio information prior to discharge, to enable discussion and understanding before patients were discharged home.

A ward gym had been developed to support both individual patients and groups with regular pre and post op exercise programmes.

A hearing loop was provided within the hospital to assist all patients with communication difficulties.

Staff understood the importance of providing information to patients at every point of their journey. All patients we spoke with told us they had received clear information from staff and felt they had been given access to visual and video guidance.

We scored the service as 4. The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

We reviewed the providers clinical audit programme and saw a comprehensive suite of monthly and yearly audits were in place, which were all collated within a dashboard showing overall compliance. We reviewed the most recent dashboard and saw 478 audits had been completed across the year averaging a score of 95%. Audits included but were not limited to records, patient journey, VTE and hand hygiene.

We reviewed the providers most recent VTE audit and saw the service scored 99% compliance in January 2025. We also reviewed the most recent medical records audit dated March 2025, which scored 100%.

The provider also collated a patient experience dashboard which looked at the patient’s experience of various aspects of the service. For example, patients feeling involved in decision making showed a 96% compliance, providing enough privacy when discussing private conditions / treatment scored 98%, dignity and respect scored 99%, patients told about medication side effects scored 90%, patients told who to contact after leaving hospital if worried scored 99%.

Patients were also asked to score the service in regard to meals, cleanliness, confidence in staff, communication, information and kindness care and compassion. We reviewed the latest scores and saw all scores which was scored out of ten were between 9.5/10 and 9.7/10. A separate score was also collated in regard to the patient’s experience of the consultants. We reviewed the latest score dated April 2025 and saw scores ranged between 91% and 99%. Questions included but were not limited to delivering appropriate care, information provided in a way that was easy to understand and having sufficient time during consultations.

The provider submitted data to the Private Healthcare Information Network (PHIN). We reviewed the latest published data, which showed the hospital was performing as expected for all submitted quality measures. These included revision rates, readmission and 90-day mortality indicators. The service also collated PHIN patient experience data. We saw all scores ranged between 9 to 9.9 out of a maximum of ten. For example, overall patient satisfaction 9.6%.

The service had introduced ‘sip to send’ which enables patients to continue to drink water right up to the point of being taken to theatre. Sip to send fluid management ensures patients are fully hydrated prior to surgery, which in turn enables faster recovery post procedure. The service adopted this new research, which evidences good patient outcomes when patients have unrestricted drinking.

The service identified a number of patients developing post-operative hyponatremia which required them to be transferred out to NHS facilities. Following a detailed review of each case involving consultants and staff and examining available research and guidelines a risk identification tool was developed to aid the early detection at pre-assessment. This assessment alongside staff training resulted in zero patients developing acute symptoms post-surgery and patient's transfers are no longer required.

All data was benchmarked against other Ramsay hospitals and staff had access to these dashboards, which were continually updated.

The Yorkshire Clinic was the first and only Ramsay hospital to have achieved 100% in the Blood Safety and Quality Regulations (BSQR) audit. This involved assessing various aspects including storage, traceability and reporting of adverse reactions. These audits are deemed to be crucial for patient safety.

The service was also Joint Advisory Group (JAG) Accredited. The aim of the JAG accreditation standards is to define ‘a high-quality, safe and appropriate endoscopy service, delivered by a highly trained, highly supported and highly-motivated workforce’.

The process of accreditation ensures high quality care is provided to endoscopy patients.

The Yorkshire Clinic JAG re-accreditation audit was completed in December 2023 with an immediate on the day pass and no actions.

The Patient Safety Incident Response Framework (PSIRF) sets out the systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. The Yorkshire Clinic had developed a Standard Operating Policy (SOP) which described how the service will implement the NHS England Patient Safety Incident Response Framework (PSIRF) and Ramsay Patient Safety Incident Response Plan (PSIRP). In addition, the service appointed a local patient safety investigation review group (PSIRG) and patient Safety Team.

The service had also introduced a patient support service that exemplifies inclusive care by proactively identifying and supporting individuals with additional needs throughout their entire healthcare journey—from their initial appointment through to admission and discharge. This service ensured that any specific requirements are recognised early, documented clearly, and consistently communicated across all departments.

In addition, the service had developed ward customer care standards which ensured each ward or department provided care, treatment and services in a consistent and high-quality manner. We reviewed the standards and saw staff were prompted with key statements which was followed by quality elements for each standard. This ensured staff provided care consistently and to a high standard at all times.

The service reported two deaths within the last twelve months, which were also submitted as notifications as appropriate by the service. We saw both deaths were investigated and were included within the mortality and morbidity processes. We saw the service also developed a mortality tracker in which outcomes of investigations, including actions and findings were collated and shared across the Ramsay network as part of national learning. Lessons learnt were detailed and also comprehensive. For example, we saw six learning actions to further improve existing processes. We saw these actions had been embedded at the time of assessment.

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.

Staff we spoke with understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before surgery following the consent policy. Records we reviewed show clear recording of consent for all procedures including non-surgical care and treatments. Patients told us that consent was fully explained and reconfirmed at each aspect of the patients’ journey.

We saw the provider had developed their consent forms further, to ensure extra procedures such as photographs and blood transfusions were also included within the formal recorded consent processes. Where patients were requiring x-ray, there was evidence of consent that the risks of receiving radiation had been discussed and/or a radiation leaflet had been provided. All documents developed had also been approved by the Medical Advisory Committee (MAC).

Consent was also audited by the service. We reviewed the most recent audit dated April 2025 and saw the service achieved 98% compliance. The audit included but was not limited to, the correct use of consent forms, timely stage 1 consent had been achieved and overall document completion standards.