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Reports


Inspection carried out on 27 to 28 June, and 5 July 2017

During a routine inspection

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