31 March 2017
The McIndoe Centre is operated by Horder Healthcare since July 2015. It is a private hospital in East Grinstead, West Sussex. The hospital primarily serves the communities of the East Grinstead area. It also accepts patient referrals from outside this area.
The hospital has had a registered manager in post since April 2009.
The hospital also offers cosmetic procedures such as dermal fillers and laser hair removal, ophthalmic treatments and cosmetic dentistry. We did not inspect these services.
31 March 2017
The McIndoe Centre is operated by Horder Healthcare. The hospital has 19 beds. Facilities include three operating theatres, although one was decommissioned and under refurbishment at the time of inspection and outpatients. The hospital offers a wide range of surgical procedures, including, orthopaedics, general surgery and ophthalmology,
We inspected surgery and outpatient services.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17th and 18th October 2016 along with an unannounced visit to the hospital on 21st October 2016.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
The main service provided by this hospital was surgery .Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.
We rated this hospital as Good overall.
Horder Healthcare had a strategy in place. At the McIndoe Centre the strategy included the provision of a therapeutic location by carrying out a full refurbishment of the hospital, to provide an orthopaedic service along similar standards to that of the Horder Centre, the other location at which services are provided ) and to invest in the staff to provide appropriate training and development to support practice.
The Interim clinical services manager and executive lead were visible on the floor and used a variety of strategies to communicate the vision such as staff forums, weekly communications bulletins, staff meetings, and individual objective setting as part of appraisal process
Staff knew the vision for the hospital and plans to develop it. The refurbishment programme in theatres was underway and staff were aware of the introduction of the orthopaedic service.
All the staff we spoke with on the ward,in theatre and in outpatients told us they were encouraged to report incidents using the electronic reporting system. Lessons learnt from incidents were regularly communicated through handovers, staff meetings, weekly communications bulletin, and information being placed in the ward communications board.
The Medical Advisory Committee (MAC) meetings took place quarterly and practicing privileges, quality assurance and new national guidelines were discussed along with key points from the Governance meetings.
The hospital has one employed Resident Medical Officer (RMO) and an agency RMO covering alternate weeks They are onsite 24-hours day seven days a week, on a rotational basis. The RMO undertook regular ward rounds to make sure the patients were safe.
The ward manager completed duty rotas two weeks in advance and any change on the day was clearly documented. Staff worked flexible hours to cover the rota and shifts included day, night, and twilight. Staff told us that extra patients can be added to the ward list up until the last moment which meant the ward was not always staffed safely.
At the quarterly Clinical Governance meeting the Director of Clinical Services, senior Clinical Managers, the Medical Director, the Chairman of the MAC, the lead Consultant Anaesthetist, the Resident Medical Officer and, where appropriate, other staff members and healthcare professionals review complaints and any trends identified. A summary of the Clinical Governance report was shared with the Medical Advisory Committee. Clinical complaints were reviewed at the Clinical Focus Group.
We saw a strong safety culture with policies and systems in place, and we saw that staff reported incidents appropriately.
There were robust governance systems that were known and understood by staff and which were used to monitor the provision and to drive service improvements.
We observed the staff on the unit being very kind, caring, and compassionate towards their patients. All patients and relatives we spoke with told us staff always introduced themselves, were polite, and treated them nicely.
We found areas of practice that required improvement in surgery.
In anaesthetic room one we saw the anaesthetic machine had incomplete checks on at least three occasions. This was not in line with the guidance for daily pre use checks from the Association of the Anaesthetists of Great Britain and Ireland (AAGBI) which provides assurance that anaesthetic machines work safely. The anaesthetic machine in theatre one also showed missed checks.
Professor Edward Baker
Deputy Chief Inspector of Hospitals (London and the South East)
31 March 2017
We rated this service as good for all key questions.
The hospital had an incident report writing policy and staff used an electronic incident reporting system. Awareness of how to report and respond to incidents was included in staff induction. Staff had a good understanding of how to use the system. Staff told us feedback from incidents was discussed at departmental meetings. We saw minutes of meetings which confirmed this. Staff told us the hospital encouraged them to report incidents to help the whole organisation learn. Staff were able to give us examples of incidents that had been reported in the past.
We saw reported incidents were graded according to severity and investigated by the management team to establish the cause. These were then reported locally to departmental teams, the management board, the medical advisory committee (MAC) and other relevant organisations as required. The hospital had a robust audit programme throughout all clinical departments. Regular audits included patient health records, medicine management, hand hygiene and infection, prevention and control. We saw copies of these audits. Findings were reported to the departments and through to the management board meetings. Trends were identified and action plans created to improve the service to patients which was communicated back to the clinical departments for their action.
We saw relevant and current evidence based guidance, standards, best practice and legislation were identified and used to develop how services, care and treatment were delivered. For example, National Institute for Health and Care Excellence (NICE) guidelines.
Patients told us they loved the hospital and received great care. They felt listened to and received good explanations about their care. We saw staff treating patients in a kind and considerate manner. Patients and their relatives told us staff always treated them with dignity and respect.
The provider told us Horder healthcare depended entirely on patient choice for its income and therefore focused the hospital to be responsive to patients needs and ensure this was forefront of planning and delivering care.
The outpatient department was open from 8am Monday to Friday and could stay open as late as 9pm if required. The department was open on Saturday mornings 8am to 1pm. Patients told us they had been offered a choice of times and dates for their appointments.
The outpatient department provided a health screening service which provided an appropriate range of tests and examinations based on clinical need. We looked in six sets of patient’s records which indicated this was being completed. Reports went to patients and their GP if further investigations were required.
The overall responsibility for clinical governance and risk management lay with the director of clinical services who reported directly to the board of directors via a clinical governance subcommittee and the audit committee
31 March 2017
We rated this service as good because it was, effective, caring, responsive and well-led, although it requires improvement for being safe.
The McIndoe Centre incident reports for July 2015 to June 2016 consisted of 128 clinical incidents with 109 incidents occurring in surgery or inpatients. Fifty seven non clinical incidents were reported with only two incidents occurring in surgery. Incidents reported included cancellation of procedures, unplanned returns to theatre, extended length of stays and equipment not fit for purpose. All incidents were classed as low harm. We saw robust systems were in place to investigate incidents with the learning from each incident.
Theatre one scrub up area had sensor taps and appropriate cleaning solutions in place. Hand washing sinks were compliant to national standards.
The sterile services department had areas clearly designated with clean and sterile areas. All instruments were audited through the process with an internal system that tracked and enabled traceability of all instruments. There was also external monitoring of the system completed by the staff.
There was no evidence morbidity and mortality meetings take place. These meetings are peer reviews of complex patients or where there may have been concerns over the clinical care and lead to improved services.
Hand washing audits were carried out by the infection control and prevention (IPC) nurse on a regular basis in both the ward and theatre areas. However, at the time of the visit the IPC nurse post was vacant. No recent hand washing audits had been undertaken. Data we reviewed for July 2016 showed compliance with hand washing was 75% on the ward. Further work was needed to improve compliance and prevent cross contamination.