The Yorkshire Clinic

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question as good. At this assessment the rating has changed to outstanding. This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 93 (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 4. The evidence showed an exceptional standard. The service had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

The service set out its first clinical three-year strategy with a vision to be ‘The Leading Healthcare provider where Clinical Excellence, Safety, Care and Quality are at the heart of everything they do, whilst growing business and profitability’. The service also laid out clear plans to be a Ramsay flagship hospital. Within the service strategy we saw key objectives, which were modelled using the CQC domains. Each domain was structured to ensure the delivery of high-quality care, whilst addressing the local health care needs of the population it served. The service outlined expansion and development plans whilst acknowledging the increasing complexity of conditions and comorbidities, overall population growth and addressing workforce shortages within the health care system. The Yorkshire Clinic’s three-year business plan outlined ambitions to increase complexity reflective of local healthcare needs based with priority given to specific areas based on statistical growth. These include orthopaedics, ophthalmology, general surgery, cardiology, neurosurgery and GP surgery. We saw clear project plans in place to achieve strategic success. These had been developed with collaboration of colleagues and health care partners. Plans included but was not limited to, the expansion of diagnostic capabilities. We reviewed some of the new technology being fitted at the time of inspection. Enhancing pharmacy services to support the local community, introduce spinal surgery, provide increased outpatient physiotherapy services through off site modelling, increased theatre operating sessions, provide three-day ophthalmology sessions and increase orthopaedic complexity and robotic provision.

All staff we spoke with outlined a positive culture of continuous learning and improvement. The service philosophy of ‘People caring for People’ was placed at the centre of everything and staff were able to articulate how this philosophy translated through every aspect of their role.

Service strategy was clearly communicated to all staff and we saw visual display boards which set out both clinical and business objectives. These were aligned to CQC quality statements and domains. Each department had further developed their own strategy which was aligned fully to the vision of the organisation. We saw clear measurable objectives and all staff we spoke with were able to articulate them.

The service had also implemented people resource groups. These were focused strategic groups, looking at key areas of priority in which to further develop. These included disability and neurodiversity, wellbeing, pride and the armed forces. We saw clear plans in which to improve and support the wellbeing of colleagues and local communities alike with learning opportunities, improved employee rewards and general recognition.

The service had a clearly defined patient experience strategy, which aimed to identify what the process of receiving care felt like for the patients. This formed part of a key element of quality for the service and was aligned to The NHS patient experience framework. The service understood the critical elements of the framework which included respect of patient centred values, preferences and expressed needs, coordination and integration of care across the health care system, information communication and education on clinical status, progress and prognosis, physical comfort of the patient including pian management, emotional support and alleviation of fear and anxiety, welcoming of family and friends involvement, transition and continuity of care and access to care with attention paid to patient waiting times.

As part of a three year approach a culture roadmap had been developed and laid out in three key stages. These were resetting foundations (2025), Building and Empowering Environment (2026) and Fostering Growth and Long-Term Sustainability (2027). Success in achieving expectations within the roadmap was measured through participation rates, engagement levels and track progress through four main KPIs: Engagement, Wellbeing, Inclusivity and Burnout. At the time of inspection phase one of the culture roadmap was underway. The purpose of this phase was to establish a unified and cohesive culture by clearly defining the organisations values, expected behaviours and governance structures to ensure robust foundations for future cultural initiatives and improvements. We saw within quarter one of the year the service were able to demonstrate they had achieved their plans, through increased participation in ‘The People and Culture Forums’ and positive feedback from colleagues. We reviewed this feedback and saw the service demonstrated clear commitments to positively promoting an honest, curious innovative culture. The service had relaunched the People and Culture forum and established a clear mission and governance structure, supported leaders with personal development in influencing, project management and communication, provided regular updates to colleagues through colleague forums and provided business update calls. We further reviewed plans for 2025 roll out which included one voice survey roll out, enhanced psychological safety and the creation and implementation of a listening model.

We reviewed meeting minutes which showed the organisations strategy aligned to the departments objectives and expected behaviours. We saw murals along staff corridors demonstrating how the service met its business and clinical objectives and how these mapped alongside the providers three-year plans. The mural not only provided a visual aid but showed clearly the expectations and road mapping plans that all staff were able to review.

We scored the service as 4. The evidence showed an exceptional standard. The service had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

The provider had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

The Yorkshire Clinic was led by a dedicated, enthusiastic, transparent and compassionate management team, who fully displayed the provider values. The ethos of the service was based on empowerment, compassion, dignity, respect, responsibility and passion. Every person, relative, staff member and professional we spoke with confirmed this to be the case. Leaders told us ‘Ramsay Cares’ was embedded throughout the organisation and was placed at the centre of everything that they did. The philosophy of ‘people caring for people’ based on three key pillars: healthier people, stronger communities and a thriving planet.

All staff we spoke with told us leaders across the service were highly visible and took time to recognise each individual’s strengths and needs across the organisation. Some staff told us about personal support they had received during difficult times from both immediate and senior leaders. We observed genuine professional and caring communication between teams during our inspection and a visible respect for each other. It was evident that senior leaders took a ‘hands on’ approach to their role. Several staff told us that matrons always attended crash calls for example and attend to patient alarm calls, to ensure staff were fully supported each day.

We reviewed communication records between staff, which demonstrated empathy and compassion. Leaders displayed a genuine caring approach as managers and ensured staff had a voice through forums, daily walkarounds, open events and and bespoke surveys.

Staff told us leaders promoted an open culture without fear of retribution or blame and this was evident in the records we reviewed.

Nursing excellence was displayed through embedded understanding of evidence-based practice and excellent fundamental care standards. This was further supported by the introduction of the back to bedside programme, which reviewed and refined current nursing practice. Staff told us they were provided with both the time, training and support in equal amounts to deliver exceptional care. Leaders fully understood and empowered staff to achieve their best through the use of benchmarking. For example, the ‘Essence of Care 2010.

Several of the senior leaders and managers we spoke with, had worked at The Yorkshire Clinic for more than ten years or more. Many of these staff had commenced in junior roles and were supported by the organisation to develop and obtain professional qualifications. There was a real drive to develop and support staff to reach their full potential.

We heard about training provided to team leaders and heads of departments to support effective leadership. Team leaders and heads of department we spoke to told us they felt supported to progress in their roles. We heard examples of staff who had progressed within the organisation and leaders spoke with pride and ‘growing our own’ workforce. We saw teams were working through their own goals with their heads of departments.

Staff were supported with flexible working arrangements and staff rotas were managed around people’s other interests and activities. Leaders recognised work life balance and staff told us they were supported with time off to attend personal events, religious ceremonies or pursuit of hobbies.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

All staff we spoke to told us they were aware of the Freedom to Speak Up guardians (FTSU) and they would know how to raise concerns through this formal route. We also heard there were several Freedom to Speak Up Guardians across the service should staff wish to speak up outside of their immediate service.

All staff we spoke to felt that they would be able to raise concerns either through the FTSU process or directly with managers and senior leaders.

We saw there was a clear process in place for receiving and reviewing concerns raised regarding the Freedom to Speak Up route. There was a monthly call with the national FTSU lead and regional monthly meetings for review of themes and trends. The FTSU guardian at local level had designated time for the role. There was regular training provided for those carrying out FTSU roles.

We also saw the provider had introduced Speaking Up For Safety which provided an opportunity for staff to raise safety concerns. The most recent report showed there were no concerns reported in the last twelve months.

We saw openness and transparency in sharing themes with appropriate processes in place to ensure that sensitivity and confidentiality was maintained.

The service reported no Freedom to Speak Up concerns in the last six months.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service clearly defined its commitment to ensuring workforce equality, diversity and inclusion by “preventing discrimination and promoting equality of opportunity where the rights and dignity of all employees are respected and where employment decisions are free from discrimination, prejudice, intimidation and all forms of harassment”.

The service had developed a clear vision which was “To have a compassionate inclusive culture at all levels of Ramsay Health. This Valuing the differences in people’s skills and experiences to help us deliver people driven services within inspiring environments, embracing all the benefits of diversity. This vision formed part of the providers Strategy for People plan which set our clear areas of strategic focus. Four ‘People Resource Groups’ (PRG) had been created to specifically acknowledge and support colleagues with disabilities or neurodiversity. This included the application by the service to obtain and achieve ‘Disability Confidence employer schemes levels 1 & 2. A wellbeing PRG was also in place at the time of assessment which promoted and supported the wellbeing of colleagues. This included but was not limited to improving support from the mental health first aiders, prioritising work life balance for all staff and aligning staff benefits against the organisation's wellbeing goals. The providers Diversity Working Group and the Diversity and Inclusion Committee were an integral part of these groups.

All Ramsay Health employees were set standards of behaviour collaboratively, to reduce barriers and to promote Ramsay Health equal opportunities, diversity and inclusion aims and objectives.

Leaders within the service told us diversity at work means having respect for individuals and treating employees with dignity, courtesy, fairness and consideration, welcoming and accepting differences and aiming to meet people's needs.

We reviewed the providers equal opportunities and recruitment policies and saw clearly defined expectations and processes in order to support this ethos.

Leaders spoke with passion about ‘The Ramsay Way’ in which leaders displayed a culture of behaviours and competencies which recognised that the practice of inclusive leadership is critical to create the reality of an inclusive culture. These behaviours were incorporated into every aspect of the staff support structures. For example, induction through to clinical supervision.

The staff engagement survey ‘The One Voice Employee Engagement Survey’ was an annual initiative designed to gather feedback from employees across all services. This survey, alongside feedback from the staff engagement group ensured the views of staff were actively collated as part of a fluid process of reflection and continual development of good working practices. Leaders told us this ensures all Ramsay Health stakeholders were treated with dignity and respect and no individual will be treated detrimentally on the grounds of their protected characteristics.

We reviewed the results of the last staff engagement survey and saw the survey included questions relating to staff feeling included at work. We saw 68% of staff said they did but fed back that they wanted to feel recognised for the work that they did and be able to share opinions without fear or hesitation. We reviewed the survey action plan and saw clear points of action including target dates for completion. Leaders of the organisation outlined clear ‘You said, we will’ actions as a result of this feedback. These included but were not limited to training managers to create psychological safe spaces, where all voices are welcomes, recognise and reward staff who constructively challenge ideas or offer new perspectives, create team building days and continue to use anonymous tool in leadership forums to gather honest feedback. We also saw the service undertook bespoke surveys to gain specific feedback for particular issues. For example, improving the staff dining area.

The provider took allegations made against and Ramsay Health employee in relation to equality and diversity seriously and were addressed under the Dignity at Work policy (HPP–250) which may lead to disciplinary action under the Staff Discipline policy (HPP–230).

All staff we spoke with were aware of the providers policies and these were upheld through effective supervision. All staff received equality, diversity and inclusion training an at the time of inspection we saw the compliance score for completion of this training was 98%.

We scored the service as 4. The evidence showed an exceptional standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The provider had developed a robust Integrated Governance Accountability Structure, which sat alongside Clinical subcommittees. We saw three overarching senior leadership teams which were the Information Governance Forum, Health and Safety Committee and the Senior Leadership Teams. The Medical Advisory Committee, Integrated Governance and Clinical Governance Committee all reported directly to these three senior teams. Departmental meetings then flowed from this tier, with heads of departments reporting into the clinical subcommittees. These clinical subcommittees represented all clinical and professional groups, and the patient voice was fed directly into the patient experience committee.

We saw the service held Resuscitation and Critical Care Committee meetings in which serious incidents involving the transfer out of patients to local NHS trusts were discussed. This supported further clinical review as part of a wider MDT with learning points outlined from each review and further discussed where appropriate as part of the mortality and morbidity review. All aspects of clinical care in relation to resuscitation and critical care were discussed. For example, medications and national updates. This team also linked into the National Resuscitation Committee to ensure learning across the network was shared.

The senior leadership team including heads of departments had clear responsibilities, and defined roles within the structure. Medical Advisory Committee (MAC) minutes also showed extensive representation of all consultant specialities, with clear roles and responsibilities defined. Incidents, clinical outcome data, risk, safety flash updates, national guidance, complaints and concerns and policy review were discussed as standardised agenda items. We saw presentations were given to the MAC by the Clinical Governance team and also included patient feedback and achievements across the service.

The provider outlined the frequency of these meetings, which were all completed and minuted as scheduled and had agreed agendas to ensure all aspects of effective clinical and operational governance was upheld.

Staff spoke of a highly visible and capable leadership who understood operational challenges and expectations. Opportunities for training were embedded for every role and staff were supported to develop through individual training plans and focused appraisals. Education and development was a pillar stone within the service and The Yorkshire Clinic’s Clinical Strategy outlined a clear vision to build a knowledgeable workforce which recognised the needs of the current patient population but also that of the future. This included the creation and introduction of roles such as the clinical nurse specialists and Professional Nurse Advocates. The service had also joined the Florence Nightingale Foundation to support advancing nursing practice across the hospital.

Centrally the Ramsay academy ensured all staff received timely mandatory training.

Service and department leads ensured compliance for completion of appraisals was high. We saw this was 98% at the time of inspection. Appraisals were aligned to the providers values and vision and staff were actively supported to develop beyond their existing roles as part of clear succession planning. All staff we spoke with told us they received comprehensive appraisal sessions but were able to request support and line manager discussed as part of an ongoing process of peer support. Leaders told us and we saw managers fostered an inclusive and positive culture of continuous learning to drive improvement for patients whilst living ‘The Ramsay Values’.

Key members of staff were expected to attend a hospital wide daily huddle at 09.30 every morning. The huddle aimed to improve communication to ensure key messages reached all teams, discuss any emerging or concerning issues quickly, enhance team co-ordination to ensure all teams across the hospital are working cohesively. Boost morale and engagement by building a platform of recognition. Provide a process for continual feedback and enhance patient care through the exchange of information across the clinical teams.

We reviewed minutes of Clinical Governance meetings and saw they were comprehensive and well represented by all stakeholders. For example, we reviewed the most recent Clinical Governance Committee meeting minutes and saw colleagues included but were not limited to theatre, pharmacy, minor ops, decontamination, diagnostic imaging and blood transfusions all represented.

Multi – disciplinary teams also sat alongside clinical sub committees. These were hip and knee arthroscopy, upper limb arthroscopy, bariatric and complex patients.

We saw teams working together seamlessly to provide the highest standards of care through comprehensive assessment, dedicated pathway referral, robust risk assessing and continual review. We saw cohesive sharing of information from professional staff demonstrating high standards of communication.

We observed two elective theatres lists and saw strong leadership by professional staff with clear direction and adherence to the theatre protocols, for example sign in and time out checks.

The service ensured safety remained a fundamental priority for everyone by implementing the patient safety incident response framework (PSIRF) and further adopting the NHS Patient Safety Strategy recommendations and standards. This included introducing patient safety specialists to provide leadership and oversight support for the safe delivery of the strategy.

The Yorkshire Clinic also revived and strengthened the ‘Speaking up for Safety’ initiative with the introduction of safety leads. The service also provided ‘Close the loop’ reports so staff can find out what happened as a result of incident reporting.

The service also used the four ‘Principles of Medicines Optimisation’ to drive quality and safety in medicines optimisation. This team focused on implementing and embedding the revised NatSSIPs2, provided extended medicines support to patients from the point of admission through to ward and discharge.

Following the introduction of Martha's Rule across NHS hospitals, The Yorkshire Clinic reflected the principles of Martha’s Rule, by ensuring patients and families have a clear and supported route to escalate concerns about a patient’s condition. These practices were embedded within the clinical governance and staff training frameworks to promote safety, responsiveness, and transparency. All staff we spoke with were aware of the principles. To further embed Martha’s Rule, The Yorkshire Clinic planned to use the resources/toolkit provided by the Department of Health and Social Care, to support clear communication with staff and patients and ensure alignment with national standards, particularly around recognising patient deterioration.

We reviewed the service risk register and saw this accurately reflected the current risks both clinically and operationally. Risks were regularly reviewed and risks were known to all senior staff we spoke with. Risks were a standardised agenda item at both executive and local committee level meetings and the decision to escalate risk to the actual risk register was made the Clinical Governance Committee. We saw comprehensive discussion of all risk upon review of the minutes.

We saw a comprehensive audit programme using ‘Tendable’. Ramsay centrally issue the service with a programme, with clear expectations that any audits achieving less than 90% must be repeated. Staff were also in addition able to request specific audits to satisfy selves that things are working or improving.

Leaders ensured outcomes for patients were continually improved through targeted work in areas such as acute kidney injury and hyponatremia. We saw as a result of this extraordinary review; a bespoke integrated care pathway had been designed and included but was not limited to enhanced assessments for patients deemed to be a greater risk.

Outcomes were further enhanced through the introduction of unrestricted fluids prior to surgery and temperature management of the patient to reduce infection risk and promote recovery.

Corporately a Mortality and Morbidity Group had been established, with each hospital within Ramsay able to learn and share from each other. We saw as a result of these meetings that case presentations were developed and shared as a deep dive into the events that led to the death, key learning points but also areas of good practice that we identified. We reviewed one of these cases and saw it was presented by The Head of Clinical Services to clinical and including the Medical Advisory Commitee (MAC) and local commissioning colleagues. We saw actions taken included but were not limited to the compulsory attendance of Resident Medical Officers at safety huddles, all ward physiotherapists to complete Immediate Life Support Training and NEWS2 training. All deaths were referred to the Medical Examiner and we reviewed a standard operating procedure which supported this. The provider also updated a mortality and morbidity tracker which included coroners' outcomes and further actions to be taken where required.

We saw a genuine desire to promote excellence through the inspection whilst ensuring patients remain at the heart of everything. For example, the introduction of the nutrition and hydration health care assistants to ensure optimum intake, based on individual assessment, the completion of the patient diaries, updated at every point of the patient journey, patient forums to drive change and provide effective feedback, ward customer care standards and recognising the importance of family and carer involvement. Continual review of service policy against national best practice whilst considering the latest innovation was embedded throughout.

We saw clear succession planning with staff actively and openly supported through management training to further develop their skills and prepare them for the next step in their career.

Creativity was embraced and staff told us they were never refused if approaching senior leaders for either bespoke funding or equipment The new electronic care planning system allowed the management to continually audit care outcomes and review these promptly. The service took a ‘whole team’ approach to ensuring high standards were upheld. Reviews for people took a fully holistic approach, involving staff from each department across the service. For example, a member of the maintenance team explained how they were involved in these regular reviews. They told us, “We do full bedroom assessments every month, to ensure the environment is safe, and meets the planned care. We are all involved in the full review. We have really good support from all colleagues.”

The service had developed a digital capability road map as part of an overarching digital strategy for the Clinic. We saw process and plans for ‘Transition to Electronic System’, looking at the current Maxims EPR system providing an automated system in relation to NEWS2 escalation.

The Strategy also provides other key digital capabilities that will be introduced within Ramsay UK Hospitals to support enhance patient care and safety.

We scored the service as 4. The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

We did not gather feedback from people regarding partnerships and communities. However, we heard about opportunities available to people that were viewed by partners as positive experiences.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

We saw positive relationships between the service and commissioning colleagues and we saw proactive sharing of information. For example, the service produced an annual safeguarding report which was sent to the Integrated Care Board. Feedback was provided to ensure safety was shared between partners.

Leaders recognised and demonstrated positive proactive partnership working and told us about local links with, GP services, district nurses and community-based specialist teams. The Yorkshire Clinic’s clinical strategy clearly identified local community needs and also outlined future trajectories to meet the next generations requirements. The service understood the growing numbers of patients requiring care and support in areas such as diagnostic and orthopaedics. We also reviewed expansion plans in ophthalmology, oncology, cardiology, neurosurgery, general surgery and GP services and we saw how these services were prioritised in order to meet the local needs.

We saw evidence of bespoke pathway development in areas such as hip and knee enhanced care and the creation of outpatient physiotherapy services, to address the needs of the local communities.

The service had also developed blood services and antimicrobial stewardship with external providers to enhance patient safety and in addition, had also developed a service level agreement with a local haematology service to provide immediate and ongoing advice regarding the prevention of VTE, surgical bridging and thrombosis.

The service planned to expand the current pharmacy services, in order to support local community need.

The MRI/ CT team developed a community project to raise awareness of possible symptoms and their corresponding diagnosis and advise of the options available to patients from ethnic minorities. Aims of the service included full engagement with the local community to promote health and wellbeing with a focus on the role of diagnostic services.

Raise awareness of common signs and symptoms specifically related to musculoskeletal cases, for example, hips, knees and lower back etc. Discuss diagnostic capabilities so the local community is aware of the available options and direct patients about where to go for further advice i.e. GP or specialist consultant.

We received feedback from the local Critical Care Network and the Integrated Care Board (ICB). The service worked with local networks participating in peer reviews that supported service development in areas identified, for example through a critical care network peer review process. We reviewed details and actions identified from reviews. We also heard that there was active engagement in forums such as transfer forums that had led to improvement such as revision of guidelines.

We also saw effective partnership work with both immediate health care partners also those outsides of the immediate teams. For example, education sessions with local schools and work with veterans in and around the local area.

The Yorkshire Clinic had also launched a Local Community Project to better engage with and support underserved populations, particularly ethnic minority groups within the area. Recognising barriers such as language, health literacy, and limited awareness of available services, this initiative seeks to raise understanding around common health symptoms, the importance of early medical intervention, and access to both NHS and private care pathways. Led by the Head of Clinical Services and supported by clinical teams, the project focused on musculoskeletal health, promoting awareness of diagnostic services and encouraging early engagement with healthcare providers. By connecting directly with local communities, The Yorkshire Clinic promoted health and wellbeing but also gained valuable insights into how services could be better tailored to reflect patient demographics. This initiative supports more inclusive, accessible care and fostered a positive relationship between the clinic and the diverse communities it serves.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

All staff within the service spoke with pride regarding their contributions to innovative and creative practice. Leaders told us staff were encouraged to have a curious mind set and were supported to have the courage to innovate by providing multiple avenues in which to discuss and design ideas.

The philosophy of the service of ‘People Caring for People’ was at the heart of everything and the concept of ‘Ramsay Cares’ was their approach to sustainability.

Senior leaders told us the hospital will be the flagship hospital for the UK and we saw a number of achievements which supported this goal. The service was awarded the Aseptic Non-Touch Technique gold accreditation award from The Association for Safe Aseptic Practice in 2024. This award was in place until 2027.

The service had also completed the ‘Getting it Right First Time’ (GIRFT) national programme which was a national programme designed to improve the quality of care with the NHS by reducing unnecessary variations within the service. GIRFT identifies changes that will improve care and patient outcomes.

The service was awarded JAG accreditation within endoscopy services.

We saw a number of digital innovations across the service as a whole. This included but was not limited to the installation of Trauma CAD software which provides a comprehensive set of told for orthopaedic planning, Connection of all cardiology echo machines to allow remote viewing of all scans from any consulting room. Updated RADAR incident reporting systems to enhance risk management and overall compliance. Installed TOMO 3D mammography screening to improve breast cancer detection by creating three dimensional images.

We saw innovation and optimisation of arthroscopy patients by undertaking a trial of 54 patients and through monitoring oxford knee score outcomes areas for improvement and development were identified. The evidence base for knee replacement rehabilitation was reviewed, factors that contribute to poorer outcomes identified and strategies to optimise outcomes were developed.

The service followed The National Standards of Cleanliness 2021, which ensures that each functional area had a dedicated cleaning folder and within the folder there is a frequency sheet and signature sheet, depending on the functional risk of each clinical area will be dependent on the function risk. This dictates bespoke cleaning frequency for specific areas and the levels of auditing and monitoring. A cleaning matric further supports this process and identified who is specifically responsible for which area.

The service also used the ‘Essence of Care 2010’ processes of benchmarking aspects of care in a structured approach to share and compare practices. This enables healthcare professionals to identify best practice and standards of excellence.

The service had developed clear customer care standards which ensured staff working within each team or department were working to a consistently high standard. Key points for the team, sat within these standards.

We saw clear priorities aligned to each department to drive improvement and maximise the patient experience. We saw plans to further develop medicines optimisation and improve discharge support. We also saw the creation of speciality nurses and the adherence of bedside handovers. We saw clear expectations at every service level. For example, all medicines reconciliation to be completed within 24hrs and fluid intake sip to send for all surgical patients.

All wards adhered to the customer care standards which provided detailed narrative as to how patients should receive care and treatment at every stage of their journey.

We saw the completion of ward 2 refurbishment with 20 new bedrooms and a gym at the end of the ward.

We saw within the service three-year clinical strategy, phased plans to introduce the following:

• Move to digital pre-assessment
• Work through a clear development plan of renovation and expansion work to meet patient need.
• Look at how to become net zero, have a green team, looking at how to reduce plastics, waste management and then how to give back to community.

Safety remained a clear priority and saw the introduction of the Patient safety learning response team who meet twice weekly and identifies trends proactively.

The service introduced the "red hat" worn by the list safety officers following an initiative introduced by the Yorkshire Clinic to enhance safety protocols. This was then rolled out across all Ramsay Hospitals in the UK. Their responsibilities include: 1.Oversight of Safety Protocols: LSOs ensure that all safety procedures, including those outlined in the National Safety Standards for Invasive Procedures (NatSSIPs), are followed. 2.Team Coordination: They acted as a central point of coordination within the procedural team, ensuring that all members are aligned on safety expectations and that any concerns are addressed promptly. 3.Training and Competency: LSOs undergo specific training and are assessed on their understanding and application of safety protocols. Practical workshops and individual assessments are used to maintain high standards

The service carried out thematic reviews swiftly, to mitigate future incidents and improve best practice. We reviewed a recent thematic review regarding medication administration which saw changes to practice and enhanced training.

We saw clear learning from incidents, which was then rolled out across the Ramsay network nationally. For example, hyponatraemia and a risk assessment launched as a result of review of cases. The service took extraordinary steps to carry out thematic reviews to explore, identify and mitigate possible future risks.

As part of the global vision The Yorkshire Clinic sets out plans to increase recycling and reduce waste, reduce unnecessary use of single use items, provide greener theatres and establish a green team.