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Provider: Ramsay Health Care UK Operations Limited

Inspection Summary


Overall summary & rating

Updated 10 October 2019

Mount Stuart is operated by Ramsay Healthcare UK Operations Limited. The hospital has 26 single rooms, of which 23 are currently in use for patients. There are also 15 ambulatory care spaces for patients coming for a day procedure. Facilities include: three main operating theatres with laminar flow systems (laminar flow theatres aim to reduce the number of infective organisms in the theatre air by generating a continuous flow of bacteria free air), one day-case theatre and a recovery area.

Surgery, outpatient and diagnostic services are provided at the hospital. Day case and inpatient surgery specialities included general surgery, major and minor orthopaedic surgery, ophthalmology, ear nose and throat surgery, gynaecology, urology, dermatology, endoscopy and cosmetic surgery.

Outpatient and diagnostic services are delivered in consulting rooms and include orthopaedics, general surgery, gynaecology and obstetrics, cosmetic surgery, ear nose and throat, urology, oral and maxillofacial, ophthalmology, gastroenterology, dermatology, and facial surgery.

Diagnostic imaging services include plain X-ray, ultrasound, and fluoroscopy. Magnetic resonance imaging (MRI) and computed tomography (CT) are provided from a mobile unit. There is a private physiotherapy service for outpatient and inpatient services. Non-surgical cosmetic treatments are delivered by the cosmetic suite. However, these treatments are not in scope for CQC to regulate. The main service provided by this hospital was surgery.

Mount Stuart provides surgery, medical care, outpatients and diagnostic imaging services to adults over the age of 18 years. We inspected this service using our focused inspection methodology to follow up on concerns we had about the service. We carried out the unannounced visit to Mount Stuart on 8 August 2019. For this inspection, we inspected surgery, concentrating on the theatre department only. We did not inspect all key questions or all elements of key questions, but focused on elements of safe, responsive and well led. We did not inspect any elements of effective or caring. For this reason, we did not re-rate this service. The ratings from our previous inspection remain unchanged.

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.

Services we rate

Our rating of this hospital stayed the same. We did not change the rating for this service as this was a focused inspection to follow up on concerns.

We found good practice in relation to surgery:

  • Staff recognised patients at risk and took appropriate action. Staff identified and quickly acted upon patients who deteriorated. Safety checklists were undertaken in theatres to minimise risks to patients.

  • Although the service relied heavily on bank and agency staff to cover vacant shifts, it mostly used staff familiar with the service to maintain continuity of care and treatment for patients. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.

  • Most staff felt respected and valued by the service.

  • Feedback from patients for surgery was positive both through the friends and family test and the provider’s own survey.

However, we found areas of practice that require improvement in surgery:

  • Theatres had challenges in recruiting enough staff with the right qualifications, skills, training and experience. However, this was improving with new staff due to start work following our inspection.

  • Some training for emergency scenarios had not been completed.

  • Checks on the difficult airway trolley were not always being completed in line with the provider’s policy.

  • One policy had not been developed to meet local procedures.

  • Not all incidents were investigated in a timely manner. One serious incident that required an in-depth investigation had not yet been completed for over six months.

  • A number of staff were not aware of the provider’s values and vision.

  • No staff meetings had been held in the theatres’ department since November 2018.

  • Not all staff felt the senior management were visible in the service and they were listened to.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected surgery. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals, London and the South

Inspection areas

Safe

Updated 10 October 2019

We did not rate safe. We did not inspect all areas related to this key question. We found:

  • The service had enough staff to care for patients and keep them safe. Bank and agency staff were used to fill vacant shifts. Recruitment of staff was ongoing with new staff having been appointed and were due to start work shortly.

  • Staff assessed risks to patients and acted on them.

However, we also found the following issues that the service provider needs to improve:

  • The service relied heavily on agency and bank staff to fill gaps in the rotas for theatres. However, they tried to use the same staff for consistency of service.

  • Safety checks on the difficult airway trolley were not always in line with the provider’s policy.

  • Some emergency scenarios had not been practiced, and a local policy and procedure had not been produced in relation to major blood haemorrhage.

  • Not all incidents were investigated in a timely manner.

Effective

Updated 10 October 2019

Caring

Updated 10 October 2019

Responsive

Updated 10 October 2019

We did not rate responsive. We did not inspect all areas related to this key question. However, we found:

  • Patients could access the service when they needed it and did not have to wait too long for treatment.

  • There were limited operations cancelled at the provider’s request.

Well-led

Updated 10 October 2019

We did not rate well led. We did not inspect all areas related to this key question. We found:

  • Leaders had the integrity, skills and ability to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable around the service for patients.

  • Most staff felt respected, supported and valued. The service and staff focused on the needs of the patients receiving care. There was an open culture where patients, their families and staff could raise concerns without fear. Most, although not all, staff felt listened to. However, this had improved since our last inspection.

However, we also found the following issues that the service provider needs to improve:

  • Not all staff understood the vision and values of the service.

  • Some staff still felt the senior managers were not visible in the service.

  • Staff in theatres had not had a staff meeting since November 2018.