Optimised Care Limited

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive - this means we looked for evidence that the provider met people's needs. This is the first assessment for this service. We rated this key question good, which meant people's needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in need.

The service monitored patient-centred care through the patient survey. In the previous 12 months patients rated the service highly, with an average satisfaction rate of 95%.

Referring NHS trusts were responsible for long-term care plans. However, Optimised Care staff created care and treatment plans for use during each patient’s stay in the hospital. This included a review of physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. Staff were trained to act on needs relating to the Equality Act and could explain action they would take in a range of scenarios.

Staff made reasonable adjustments to the service to enable patients with diverse needs to access care.

Staff acknowledged each patient’s social history and needs as part of their approach to person-centred care. We saw the theatre team discussed this during pre-operative briefings to give each member of the team an understanding of why the patient was undergoing surgery and the results they were hoping for. The ward team used this information during post-operative care to support recovery. For example, we observed a patient discussing their hobbies and usual exercise with a nurse, who explored how they could safely return to such activities after surgery.

Staff understood the diverse health and care needs of people. Care was joined-up, flexible, and supported choice and continuity.

Staff ensured continuity of care between services. Under most NHS contracts, Optimised Care was responsible for the inpatient aspect of surgical pathways. This included pre-operative admission, surgery, and recovery. A physiotherapist and radiographer provided post-operative care under some treatment pathways. The level of care was predetermined by the referring NHS trust.

The service provided all aspects of care for patients who paid privately for treatment.

Staff adapted the service to meet the needs of patients with complex needs or vulnerabilities. They worked with each person and their loved ones to make sure arrangements in the hospital made them comfortable and reduced any barriers to care.

Staff contacted patients after discharge as part of the follow-up and continuity of care process. These stages were determined by the type of surgery the patient had and the contract with the NHS service.

Nurses undertook additional training to support patients with post-operative care, such as removing surgical packs after ear, nose, and throat procedures.

The provider offered different types of surgery each day, some of which had additional staff, such as radiographers for X-ray and a physiotherapist for post-operative rehabilitation. Managers and team leaders held a daily briefing before the start of service to plan the day and review how they would meet the needs of patients with complex conditions and make sure the various aspects of care were seamless. They focused on the integration and continuity of care by making sure each part of the care pathway was in place and staff knew how to implement contingency plans in the event of a problem or delay.

Physiotherapists provided post-operative care for patients referred to the service from 3 different NHS trusts. They followed specific care pathways established by the trusts, including follow-up reviews and outpatient referrals to each patient’s local services. The team audited demand on the service, which varied widely from 20 to 60 patients per month. The senior physiotherapist planned care and capacity to meet demand, including flexible working.

Staff provided appropriate, accurate, and up-to-date information in formats tailored to individual needs.

Staff worked with patients to make information accessible in line with their individual needs, in line with the national Accessible Information Standard. This included making reasonable adjustments for disabled people, interpreting and translation for people who did not speak English as a first language and for deaf people who used British Sign Language. Staff supported patients who had difficulty with reading, writing or using digital services.

Patients knew how to access their health and care records and decide which personal information can be shared with other people, including their family and GP.

Staff made sure NHS patients understood Optimised Care Limited was responsible for the surgical aspect of their treatment. Information included which organisation had referred them for treatment and explained the differences in responsibilities between each organisation. Staff provided information to patients in a way that ensured good standards of access. For example, printed information could be provided in large print or other languages and staff offered patients the option of secure digital information.

The service delivered care and treatment as a subcontractor for another CQC-registered provider. This took place under a service level agreement that meant Optimised Care Limited was responsible for surgery and patient safety. The team made it clear to patients which organisation was responsible for their care at each stage of treatment.

Physiotherapists provided a structured post-operative programme with patients. This included a practical exercise and movement demonstration on the ward and was followed by telephone follow-ups at 1, 3, and 6 weeks post-operatively. The senior physiotherapist audited this standard and reported 100% compliance in the previous 12 months.

Each referring NHS trust had a different standard for follow-up care. The clinical team understand the requirements of each and made sure post-operative referrals, including for community physiotherapy, met the contractual requirements.

Good information governance processes were in place to protect people’s data and make sure this was shared appropriately with other organisations involved in delivering care. All staff, including those subcontracted to the service, completed General Data Protection Regulation training.

The provider made it easy for people to share feedback and ideas or raise complaints about their care while they were in the hospital. However, recent changes to the website meant the complaints policy and guidance was not easily accessible.

During our site visits we saw the complaints procedure was displayed in appropriate areas, including in each patient’s bedroom. Information about how to make a complaint was also included in each patient's printed discharge information pack.

The service involved patients in complaints investigations to help achieve a good resolution. Where this involved an NHS patient, staff involved the referring service. For example, a patient reported a concern regarding a potential wrong-site treatment. The team confirmed the procedure had been correct according to pre-operative notes from the trust and they reviewed the case together. The outcome identified improvements needed in how the trust communicated with patients. Staff in this service took enhanced steps to make sure patients understood the specifics of their planned treatment.

Feedback from patients was consistently good. A recent patient said, “Everything was excellent. Highly recommended.” Another patient said, “Nothing was too much bother.”

In the previous 12 months the service received 21 formal complaints, reflecting 2% of all patient contact, and 7 informal concerns. Of the total, 43% related to same-day surgery cancellations caused by the interference of another service on the safe operation of care. The provider handled this through legal channels and implemented business continuity plans and risk assessments to keep people safe. Other complaints referred to 4 themes around experiences of care.

The provider recently updated their website and did not include details of how to make a complaint. We raised this with the provider. While they added an e-mail address for complaints, they did not update the terms and conditions of treatment or add the complaints policy.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The team delivered pre-operative care based on each NHS contract. In some cases, patients travelled several hours for treatment and the provider arranged hotel accommodation and transport. This service arranged pre-operative processes such as consent and blood tests to balance the referrer’s requirements with patient needs.

In the previous 12 months the service cancelled an average of 5% of procedures on the day due to the patient being unsuitable for treatment. In each case staff worked with the patient and the referring trust to identify a solution and rebooking.

The service benchmarked length of stay, referral to treatment times, and readmission rates against national data for hip and knee replacement surgery. In the previous 12 months, the service performed better than expected in all measures, reflecting a focus on improving access and streamlining safe care practices with the use of the latest standards of practice.

The service offered flexible appointments, including virtual appointments for preoperative discussions, and weekend surgical slots.

Staff worked with a referring trust to schedule procedures that avoided religious periods that could impact patients’ diets and ability to prepare and recover. For example, the team noted a series of patients who did not attend booked appointments. Staff contacted the referring trust and found people had not attended due to a religious period that impacted their daily routine. In response, the service mapped festivals and holidays with surgical schedules.

All bedrooms on the ward with single occupancy and en-suite. Patients chose whether to have their door fully closed for privacy, or ajar so they could see staff and the ward area. All areas of the building were accessible step-free, including from the car park.

Staff and leaders proactively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response.

Staff used a telephone translation service to support patients who did not speak English. We observed this in practice during our inspection and saw good coordination between the theatre team and the ward team to provide seamless care. Staff maintained communication with the translator while the patient was transferred from the ward to theatre and made sure they had time to ask questions and time to clarify information. Staff used a specific risk assessment to treat patients when communication was through a translator. On one day of our inspection, 4 patients required use of translation services and staff maintained consistent, coordinated care.

The physiotherapy team worked with patients after surgery to make sure they could mobilise safely using standard equipment and to build their confidence when transferring, such as from bed to a chair. The team tailored rehabilitation to each patient’s home circumstances. For example, where patients lived in a multi-storey home, physiotherapists provided mobility training on stairs. Staff educated patients about car transfers and reinforced precautions to prevent complications.

The service provided care for private and NHS patients. Staff provided care equitably regardless of how it was financed.

The service had reduced length of stay in line with new approaches to surgery and recovery. In the previous 12 months, the service achieved a length of stay significantly lower than the national average for hip and knee replacement patients.

Staff considered each patient’s physical, mental, emotional, and social needs under the Equality Act. All staff completed cultural awareness training. The provider monitored data about ethnicity provided by referring NHS trusts to make sure patients felt respected and understood.

Staff supported patients to plan for recovery.

Post-operative rehabilitation took place for up to 6 weeks and staff empowered patients to build healthy lives that made the most of their surgical procedures. Staff worked together to support patients with flexible appointments and joint working with the referring NHS trust.

All surgery was planned to improve people’s independence, physical abilities, and quality of life. Staff worked together to help them achieve their goals. For example, the physiotherapy team prepared specific post-operative rehabilitation and exercise plans to help patients work towards their long-term plans.