You are here

Inspection Summary


Overall summary & rating

Good

Updated 5 September 2017

One Ashford Hospital is operated by One Ashford Healthcare Limited. The hospital has 20 inpatient beds and a further 10 day surgery beds. The hospital has three operating theatres, two of which have laminar flow (a system that circulates filtered air to reduce the risk of airborne contamination). The third theatre is used for the provision of endoscopy services. Facilities also include a physiotherapy gym, X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, services for children and young people, and outpatients and diagnostic imaging. We inspected and rated surgery and outpatients and diagnostic imaging. The hospital introduced services for children and young people in April 2017. The hospital only carried out surgical procedures on children aged three years and over, and saw all ages of children in the outpatients department. This meant the hospital did not treat any children or young people under the age of 18 during the inspection reporting period (April 2016 to March 2017). Therefore, we did not report on services for children and young people as a separate core service. However, we reviewed the provision for children and young people during our inspection and reported on this within the surgery and outpatients and diagnostic imaging core service reports.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 27 and 28 June 2017, along with an unannounced visit to the hospital on 5 July 2017.

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.

Services we rate

We rated this hospital as good overall.

  • The hospital had a positive incident reporting culture, which encouraged staff to report incidents and raise concerns. Staff were able to give examples of lessons learned from incidents.

  • The hospital had reliable systems to prevent and protect people from healthcare-associated infections. All areas we visited were visibly clean, tidy and uncluttered. Regular audits, such as hand hygiene audits, provided assurances around infection prevention and control practices.

  • The hospital took a pro-active approach to monitoring for surgical site infections (SSIs). With patient consent, the hospital contacted patients’ GPs 30 days after surgery to help detect SSIs.

  • In the diagnostic imaging department, we observed good compliance with the Ionising Radiation (Medical Exposure) Regulations 2000 and the Ionising Radiation Regulations 1999 throughout our visit.

  • Services had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.

  • Patients received care and treatment in line with evidence-based guidance. This included guidelines and publications from the National Institute for Health and Care Excellence (NICE), the World Health Organisation (WHO) and the Department of Health.

  • The hospital had effective systems for the granting and renewing of practicing privileges. This ensured patients received care and treatment from competent medical staff who worked to the hospital’s values.

  • The hospital monitored and met patients’ nutrition, hydration and pain relief needs.

  • We saw effective multi-disciplinary working between all professions and grades of staff. The hospital had a multi disciplinary complex case review team which reviewed more complex surgical cases. This ensured effective planning of the patient’s surgical, post-operative and post-discharge care.

  • The hospital participated in national audits to benchmark patient outcomes following surgery against other hospitals. These included the National Joint Registry (NJR), Public Health England (PHE) Infection Rate audits, and Patient Reported Outcome Measures (PROMS).

  • The hospital also collected internal data to measure their performance. This included re-admission rates and unplanned transfers. The physiotherapy department used recognised outcome measures such as range of movement, pain scores and quality of life measures to establish the effectiveness of treatment.

  • Staff in all departments treated patients with kindness and compassion, and involved patients in decisions about their care. Staff protected the privacy and dignity of patients throughout the hospital.

  • In outpatients and diagnostic imaging, patients could access care and treatment promptly at a time that suited them. This included evenings and Saturdays. Outpatients we spoke with told us they had their first appointment within days of referral.

  • The hospital was responsive to patients’ individual needs. This included patients living with dementia and learning disabilities.

  • The hospital took complaints seriously. We saw evidence of learning from complaints and changes to practice to help services improve.

  • Hospital staff helped create the hospital’s values. Staff were subsequently engaged with the vision and values, and incorporated the values into their day-to-day work.

  • The hospital had an effective governance structure that proactively reviewed performance, identified areas of risk, and took action to mitigate risks and drive improvement.

However:

  • On the resuscitation trolley in the theatre recovery area, we found one drug was in the wrong drawer and another medicine was missing from the trolley, despite being available elsewhere in the recovery area. We raised this issue immediately, and staff re-stocked the trolley with the correct medication straight away. During our unannounced visit a week later, we reviewed all of the resuscitation bags in the hospital and found they were in order. This meant the hospital took prompt action to keep patients safe.

  • We saw staff wearing uncovered theatre scrubs outside of the theatre department. This meant theatre scrubs could be contaminated while outside theatres.

  • Despite being within its review date, the hospital consent policy did not reflect that the hospital treated children and young people. It stated, “One Healthcare hospitals do not treat children under 18 years of age”. This was incorrect as the hospital began treating children in April 2017. However, we reviewed three patient consent forms for children and young people, which showed staff had obtained consent appropriately in line with the appropriate legislation and guidance.

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

Professor Edward Baker

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 5 September 2017

We rated safe as good because:

  • The hospital had a positive track record on safety, with no never events or serious incidents in the reporting period (April 2016 – March 2017).

  • Patients were protected from risk of abuse and avoidable harm. Staff could confidently escalate risks that might affect patient safety and we saw effective systems for reporting, investigating and learning from incidents, which included duty of candour if applicable.

  • There were sufficient numbers of staff with the necessary skills, experience and qualifications to meet patients’ needs. They were supported by a programme of mandatory training in key safety areas.

  • There were reliable systems to prevent and protect patients from healthcare-associated infections. All areas we visited were visibly clean, tidy and uncluttered. Regular audits, such as hand hygiene audits, provided assurances around infection prevention and control practices.

  • The hospital had effective systems to assess and respond to patient risk. This included risk of falls and venous thromboembolism (VTE), as well as risks associated with surgical procedures or radiation.

Effective

Good

Updated 5 September 2017

We rated effective as good because:

  • The hospital planned and delivered patient care in line with national guidance and best practice standards. Ongoing audits ensured these standards were maintained.

  • The hospital had effective systems for the granting and renewing of practising privileges. This ensured patients received care and treatment from competent medical staff who worked to the hospital’s values.

  • The hospital monitored and met patients’ nutrition, hydration and pain relief needs.

  • We saw effective multi-disciplinary working between all professions and grades of staff.

  • Consent forms for children and young people were completed appropriately in line with national legislation and provided clear guidance on completion for staff.

However:

  • Documentation for one mental capacity assessment we reviewed was not completed correctly. After we raised the issue, staff raised an incident on the electronic incident reporting system. Staff told us the issue was being reviewed and was on the agenda for the next Medical Advisory Committee (MAC) meeting.

Caring

Good

Updated 5 September 2017

We rated caring as good because:

  • Throughout our inspection, we saw that staff treated patients with kindness and compassion. Staff protected the privacy and dignity of patients at all times, for example, by screening them behind curtains and closing clinic room doors.

  • Patients spoke positively about the care they received from staff. During our inspection, we saw thank you cards, letters and comment cards from patients who were grateful for the care and treatment they had received.

  • Patients were involved in decisions about their care. We saw that staff allowed patients sufficient time to ask any questions they had, and to discuss any anxieties or fears.

Responsive

Good

Updated 5 September 2017

We rated responsive as good because:

  • Patients could access care and treatment in a timely way and at a convenient time. This included outpatient appointments in the evenings and on Saturdays.

  • The hospital took pride in working with a local medical charity to provide private care to certain patients who had been waiting for treatment and might not otherwise be able to access private medical care.

  • The hospital had systems, staff training and an appropriate environment to meet patients’ individual needs. This included patients living with dementia and learning disabilities. Staff gave examples of responding to patients’ individual needs, for example, by allowing the mother of a patient with learning disabilities stay overnight and helping the patient rearrange their room to lower their anxiety.

  • The hospital took complaints seriously. We saw evidence of learning from complaints and changes to practice to help services improve. In many cases, staff were able to resolve informal complaints straight away and avoid escalation to a formal complaint.

  • The environment provided was appropriate and patient centred, with comfortable and sufficient seating, toilet and refreshment facilities. Free car parking and internet connectivity (Wi-Fi) enhanced facilities for patients and their families.

Well-led

Good

Updated 5 September 2017

We rated well-led as good because:

  • Hospital staff helped create the hospital’s values. Staff were subsequently engaged with the vision and values, and incorporated the values into their day-to-day work. The senior management team took action to address any behaviour that was inconsistent with the hospital values, regardless of the grade of staff.

  • The hospital had an effective governance structure that proactively reviewed performance, identified areas of risk, and took action to mitigate risks and drive improvement.

  • There were assurance systems to monitor compliance and performance. The hospital’s monthly quality and safety data included indicators covering safety thermometer variables, readmission rates, patient satisfaction data and departmental key performance indicators.

  • The hospital culture was positive and staff felt well-supported by their line managers. The senior management team had an “open door approach” and engaged with staff at regular staff focus groups.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 5 September 2017

We rated this service as good because it was safe,

caring, responsive to people’s needs and

well-led. We inspected, but did not rate, this service for the effective domain.

  • The service had an effective incident reporting culture, and effective systems to protect patients from avoidable harm or abuse.

  • We observed compliance with the Ionising Radiation (Medical Exposure) Regulations 2000 and the Ionising Radiation Regulations 1999 throughout our visit.

  • Patients received care and treatment that reflected best practice guidance from competent staff.

  • Staff treated patients with kindness and compassion, and involved patients in decisions about their care.

  • Patients could access care and treatment promptly at a time that suited them. This included appointments in the evenings and on Saturdays.

  • We saw good examples of local leadership in the nursing, imaging and physiotherapy teams.

  • Staff were engaged with the hospital’s vision and values. They told us they enjoyed coming to work and were passionate about the care they gave to patients. This was consistent with the low staff sickness and turnover rates in the outpatient and imaging departments.

Surgery

Good

Updated 5 September 2017

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 because it was safe,

effective, caring, responsive to people’s needs and

well-led.

  • The service had an effective incident reporting culture, and effective systems to protect patients from avoidable harm or abuse.

  • There were reliable systems to prevent and protect patients from healthcare-associated infections.

  • Patients received care and treatment that reflected best practice guidance from competent staff.

  • Staff treated patients with kindness and compassion, and involved patients in decisions about their care.

  • The service had processes to meet patients’ individual needs, including those living with dementia or learning disabilities

  • Staff were engaged with the hospital’s vision and values.

  • There was strong leadership in developing and managing the hospital and its culture in its first year.

  • However, on the resuscitation trolley in the theatre recovery area, we found one drug was in the wrong drawer and another medicine was missing from the trolley, despite being available elsewhere n the recovery area. We raised this issue immediately, and staff re-stocked the trolley with the correct medication straight away. During our unannounced visit a week later, we reviewed all of the resuscitation bags in the hospital and found they were in order. This meant the hospital took prompt action to keep patients safe.