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HCA Healthcare UK at the Wilmslow Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 31 July 2019

HCA Healthcare UK operates six private hospitals and many diagnostic centres across the country, including The Wilmslow Hospital. HCA Healthcare UK also entered into a joint venture alongside NHS trusts. The Wilmslow Hospital is a private hospital in Cheshire, England, owned and operated by HCA Healthcare UK.

The hospital opened in May 2014, providing an outpatients, diagnostics and day case surgical facility for self-paying and NHS patients. The hospital also offers an outpatient service to children between the age of 0– 17 years old and surgery (including cosmetic surgery) to children aged 16-17 years old.

The ten most common procedures included arthroscopic rotator cuff repair greater than 2cm (as sole procedure), coracoid bone block transfer for recurrent instability of shoulder and multiple arthroscopic operations on the knee (including meniscectomy, chondroplasty, drilling or microfracture).

The hospital operates across three floors, offering patients a full range of treatments including orthopaedics, general surgery, urology and dermatology.

The hospital serves the communities in the local area, but also accepts patient referrals from across the country and overseas. The hospital has had a registered manager in post since 2014.

The location houses an outpatient suite, diagnostic imaging and theatre day case unit, two laminar flow operating theatres, nine recovery bays, a walk out room and 13 consulting rooms. Additionally, the hospital has a dedicated women’s health unit with ultrasound mammography diagnostic and full breast care service.

We inspected the outpatients and surgery provision at the hospital using our comprehensive inspection methodology. We carried out the announced part of the inspection on 3 December 2018 and 4 December 2018. We carried an unannounced inspection of diagnostic services on 27 February 2019 as it was not included in the initial inspection.

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 the 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.

We rated the hospital good overall; surgery and diagnostics were rated as good. Outpatients was rated as outstanding,

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Inspection areas

Safe

Good

Updated 31 July 2019

We rated safe as Good because:

  • There were comprehensive systems to keep people safe, including processes and systems to safeguard patients and carers from abuse.
  • The hospital had an exemplary record of staff mandatory training compliance which included safeguarding, infection control and information governance.
  • The hospital proactively monitored and managed safety by anticipating risks to patients using the services. This was embedded in practice and was recognised by staff as their responsibility. It ensured that the department had sufficient nursing and medical staff to ensure patient safety, and nursing staff had access to a resident medical officer during opening hours.
  • The hospital had high staffing levels and patients did not wait long to be seen by doctors or nurses. The services reported no unfilled shifts and all relevant staff had up to date training.
  • Staff discussed changes they had made to the services they offered to patients, after they had identified any risks. All incidents were appropriately documented and reviewed by a senior manager.
  • All areas we inspected were extremely clean and tidy. Staff were proficient in making sure the department was orderly and neat.
  • Theatre suites and anaesthetic rooms were very well equipped with advanced technology, monitoring systems and displays. Each theatre was equipped with laminar flow which safely filtered air away from the theatre.
  • Within the diagnostics department, contrast and emergency medicines were stored securely. 

  • The service had systems in place to manage emergency procedures.

Effective

Good

Updated 31 July 2019

We rated effective as Good because:

  • The service used evidence based processes and best practice which followed recognised protocols. They used technology to improve the service they provided.

  • The service had clear, well written standard operating protocols and policies.

  • Staff participated in audits and projects to improve quality and patient outcomes. We saw evidence of active participation in accreditation schemes to ensure recognition of excellence from creditable external bodies.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

  • We found continuing development of staff’s skills, competence and knowledge; managers proactively supported and encouraged staff to acquire new and transferable skills and share best practice through learning and development.

  • The service provided annual staff appraisals and had a compliance rate of 100% completion at the time of our inspection.

  • Staff understood their obligations regarding patient consent and the Mental Capacity Act.

Caring

Good

Updated 31 July 2019

We rated caring as Good because:

  • We observed patients were truly respected and valued as individuals. We observed excellent interactions between staff and patient during consultations.

  • Staff empowered patients who used the service by listening to their opinions and thoughts about their treatment plan. Staff took into consideration, the patient’s individual preferences when delivering care.

  • Staff were highly motivated to offer care that was kind and promoted patient dignity. They were fully committed to working with patients to make their experience at the hospital a positive one.

  • Feedback from patients who used the service was continually positive about the way staff treated them. Patient surveys demonstrated that 100% of patients recommended the service.

  • Patients and those close to them were actively involved in their care and treatment. Care was tailored to meet their needs following discussions with clinicians.

  • All patients we spoke with fed back that staff went the extra mile, and the care they had received exceeded their expectations.

  • Staff demonstrated a strong patient-centred culture, recognising the emotional and psychological needs of patients, relatives and carers.

Responsive

Good

Updated 31 July 2019

We rated responsive as Good because:

  • The department offered services tailored to meet the needs of individual patients. Services offered within the outpatient department delivered care accordingly to the needs of people using the service. This was to ensure flexibility and choice.

  • The facilities and premises across the outpatient’s department was sufficiently designed to meet the needs of patients.Patient waiting times were consistently low and the clinic could quickly adapt to the needs of individual patients to provide care in a way that suited them.

  • There were excellent patient pathways developed in collaboration with other services.

  • People could access the service when they needed it. Patients had direct access to a variety of specialist services on site and could be assessed the same day.

Well-led

Outstanding

Updated 31 July 2019

We rated well-led as Outstanding because:

  • The department was led by compassionate and effective leadership at all levels who demonstrated their high level of experience, capacity and capability to deliver excellent and sustainable care.

  • The vision and values of the hospital was well embedded across the service and staff were focused on achieving these.

  • The service had a clear quality framework with the focus on patient safety and quality care.

  • The culture and attitude among all staff was to offer high-quality patient‑centred care. We heard excellent examples of how learning had driven improvements in service.

  • The service had a well-established and effective governance structure. Governance arrangements were reviewed to ensure the practice reflected best practice. We saw systems in place to improve care outcomes.

  • Staff demonstrated commitment to best practice at all levels by identifying, monitoring, and understanding their risks. There were systems in place to ensure a consistent approach amongst staff to reduce risks. For example, daily, monthly, annual checks were in place and reviewed to make certain the service was safe.

  • There was strong team-working ethos and staff engaged well with each other to improve the quality of care and patient expectations. We heard of excellent examples of innovation to improve the provision of the outpatient’s department.

Checks on specific services

Diagnostic imaging

Good

Updated 31 July 2019

The diagnostic service included magnetic resonance imaging, mammography, ultrasound scans, x-ray and fluoroscopy mainly for self-paying patients.

We reviewed records and spoke with patients. We found that there was sufficient staff with the right skills. Equipment and environment checks were carried out.

Staff were caring and compassionate. There were no waiting lists and some clinics were one-stop services.

There were management processes in place with visible leadership.

Outpatients

Outstanding

Updated 31 July 2019

The service had processes and systems in place to keep patients safe. All staff were provided with mandatory and safeguarding training to ensure staff had the right knowledge to keep patients free from harm. The service reported all staff had completed this training.

All areas we inspected were cleaned to a high standard. Staff followed HCA Healthcare policy for waste management processes. Waste was appropriately labelled and segregated

Equipment was well maintained, we saw that service level agreements were in place to maintain equipment across all areas.

We found exceptional practices to improve practice through incident reporting, staff were encouraged to provide detailed descriptions of incidents so that leaders could implement action across the hospital to prevent other anticipated risks.

Records were completed appropriately and could only be viewed by staff who had access to the electronic system.

The service had staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Staffing levels and skill mix was planned and reviewed by the service lead twice daily to address any shortages. The resident medical officers (RMO) was available during opening hours.

Patient’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. This was monitored to ensure the consistency of care was in line with evidence-based guidance. The service regularly updated policies and procedures in line with new guidance.

Staff actively engaged in activities to monitor and improve quality of care and patient outcomes. Outcomes were routinely collected and monitored to ensure the service was delivering consistent care.

Regular audits had been completed and subsequent action plans were carried out. For example, the service participated in the corporate audit programme that demonstrated compliance and performance.

The service ensured staff were competent in their roles by providing induction programmes, appraisals and supervision. There was a strong focus on ensuring newly qualified staff were supported through competency based frameworks, shadowing senior staff and by attending comprehensive corporate and site inductions.

We found senior staff had an excellent ethos to supporting staff to upskill themselves through training days and development programmes. Staff were proactively encouraged to acquire new and transferable skills and share best practice.

The service was committed to working collaboratively so that patients received a seamless service. Staff coordinated person centred care so that patients could move between different services.

The service did not see any patients who were detained under the Mental Health Act 1983. However, staff understood the importance of complying to the Mental Health Act code of practice.

Patients were truly respected and valued individuals. They were empowered as partners in their care, staff took social and emotional and physical needs into consideration.

Staff cared for patients with compassion, treating them with dignity and respect. Feedback from patients who used the service and those close to them was continually positive about the way staff treated them. We observed jovial interactions between patients and staff, which showed the great rapport between them.

There was a strong visible person-centred culture, staff were passionate and motivated to deliver the best care possible. Patients we spoke with said they felt empowered to give their opinions and thoughts about their treatment plan and felt confident that staff took into consideration, their individual preferences when delivering care.

Patients, families and carers gave positive feedback about their care.

Patients thought that staff went the extra mile to support them and their expectations. Patient surveys demonstrated that 100% of patients recommended the service.

The department tailored their services to meet the needs of individuals, this meant care was delivered in a way that promoted flexibility, choice and continuity of care.

There were innovative approaches to providing holistic and person-centred care. We heard of positive examples where staff changed clinics to accommodate patient needs.

Patients could access services and appointments in a way and at a time that suited them. Appointments were made on an individual basis. Nursing and medical services were accessible at all times including out of hours if required.

The service had robust systems in place to ensure complaints were effectively dealt with. Staff spoke about improvements that had been made as a result of learning from reviews and complaints.

Leaders at all levels demonstrated the high level of experience, capacity and capability needed to deliver person-centred care. It was evident from discussions that leaders empowered staff to develop in their role.

The hospital’s strategy supported HCA’s vision and values, it underpinned the objectives and plans to extend the hospital’s facilities and services. We saw that the strategy was fully aligned with the wider health economy. This was achieved by collaborative working with internal and external stakeholders.

HCA’s values were firmly embedded in practice across the outpatient department.

We saw that leaders recognised and understood the challenges to quality and sustainably. Minutes from governance meetings showed that the leadership team had put actions in place to address them.

There was a systematic and integrated approach to monitoring and reviewing progress against the strategy. We found all staff in the outpatient’s department demonstrated commitment to best practice. They escalated risks appropriately which were reviewed and managed through the performance and risk management systems and processes.

Staff were extremely proud of the hospital and the colleagues they worked with; teams worked cohesively to support each other across all functions of the department.

All staff focused on improving the quality and sustainability of patient care, making sure their experience was excellent. They were fully engaged in improvement methodologies and strived to achieve a higher quality of care.

Surgery

Good

Updated 31 July 2019

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 overall.

The service had an exemplary record of mandatory training compliance for theatre staff. Overall compliance for the department was 95%.

Staff demonstrated excellent awareness of how to protect patients from abuse and the service worked well with other agencies to do so.

The service had a comprehensive safeguarding work plan to ensure staff had the resources to protect patients from harm.

The service had put in place extra safety measures to ensure any waste that may need to be tracked could be easily identified.

The service had systems in place to manage emergency procedures.

The service had a robust system for assessing patients at risk and staff completed and updated risk assessments for each patient.

The service had enough medical, nursing and operating department staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

The service had a robust medicines management policy developed in line with national standards and regulations.

The service had an excellent culture of incident reporting and staff were fully aware of the correct process and procedures. There was a strong emphasis on learning from incidents.

The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

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.

Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

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.

Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

The service had a robust process for consent which was checked thoroughly and reviewed throughout the patient’s pathway.

Staff consistently demonstrated professionalism and competence in their roles. Patients told us they were constantly reassured by the staff depth of knowledge and were extremely confident in the staff looking after them.

Staff provided emotional support to patients to minimise their distress. Patients told us they were naturally anxious before surgery and staff constantly checked to ensure emotional support was provided.

Staff involved patients and those close to them in decisions about their care and treatment. We observed consistency in staff consideration and their desire to ensure patients were kept safe.

There was a very high standard of patient pathways that included pre- and post-operative support for patients.

We observed staff acknowledging patients’ individual needs. We observed patient records of assessments where individual requirements were discussed.

The service did not have a waiting list as all surgery was elective and access to the service was flexible to meet patient’s needs.

Staff demonstrated a proactive approach to continuous learning from complaints and concerns.

There was a very well established, proactive senior management team

The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff, patients, and local community groups. Staff we spoke with were very clear on the service vision and strategic framework.

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

There was a very strong culture of staff feeling supported and confident to challenge practice.

The hospital had a highly established and effective governance structure. They systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.

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

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 when they went wrong, promoting training, research and innovation.