Cobham Day Surgery

Updated 9 December 2016

Cobham Day Surgery is operated by Epsomedical Limited. It is a private day surgery and outpatient unit in Cobham, Surrey, although 99% of the work undertaken is on behalf of the NHS. The unit primarily serves the communities of Cobham and Epsom but it also accepts patient referrals from outside this area. The service opened in 2005 when Epsomedical Limited was invited by the NHS to set up an additional day surgery unit.

The service is provided to adults over 18 years since May 2016 when Epsomedical Limited no longer accepted referrals for under 18’s following review of the service provided and after consultation with the local Clinical Commissioning Group.

The hospital has had a registered manager in post since September 2013, and has a designated Controlled Dugs Accountable Officer who was the medical director. The unit has been registered for the following regulated activities since January 2011:

• Diagnostic and screening procedures

• Surgical procedures

• Treatment of disease, disorder, or injury

There were no special reviews or investigations of the hospital ongoing by the CQC at any time during the 12 months before this inspection. Prior to this inspection, we had not inspected and rated this service using our new methodology. We last inspected the service in July 2013 and we did not identify any problems at this time.

Updated 9 December 2016

We carried out a comprehensive inspection of Cobham Day Surgery on the 13 and 14 September 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of surgery and outpatients and diagnostic imaging as these incorporated the activity undertaken by the provider, Epsomedical Limited, at this location.

We rated the core service surgery as requiring improvement and outpatients and diagnostic services as good, with the hospital overall rated as good. Our concerns were that aspects of medicines management were not robust in surgery, some equipment was not consistently checked to ensure its safety and processes to ensure fit and proper persons were employed at board level did not meet the relevant regulations. Although some elements of the service required improvement, the overall standard of service provided outweighed those concerns. We have deviated from our usual aggregation of key question ratings to rate this service in a way that properly reflects our findings and avoids unfairness.

Are services safe at this unit?

We found improvements were required to minimise risks and promote safety as the management of medicines and equipment was not always robust.

However, we also found there were systems to report and investigate safety incidents and to learn from these. Risks to patients were understood and actions taken to mitigate them. The unit employed sufficient numbers of staff with the necessary skill, qualifications and experience to meet patients’ needs.

Are services effective at this unit?

Care was planned and delivered in accordance with current guidance, best practice and legislation. There was a programme of audit to ensure good practice was maintained and patients experienced good outcomes. Patients’ pain was well controlled.

Are services caring at this hospital?

Patients were treated with kindness and respect. Patients gave positive feedback and said they were treated with compassion and dignity.

Are services responsive at this hospital?

Services were planned to meet the needs of patients and give them a choice as to where they received their care and treatment. Patients referred to the unit were consistently seen and treated promptly within nationally set timescales. There were arrangements to ensure that the individual needs of patients were assessed and met. Complaints were appropriately investigated in a timely way.

Are services responsive at this hospital?

There were insufficient processes to ensure board members fulfilled the “fit and proper person” requirements. However, leaders were visible and were valued by staff and there was a clear vision of what the service aimed to achieve currently and in the future. Information technology was used innovatively to improve the efficient running of the service.

Our key findings were as follows:

• There were adequate systems to keep people safe and to learn from critical incidents.

• The hospital environment was visibly clean and well maintained and there were measures to prevent the spread of infection.

• There were adequate numbers of suitably qualified, skilled and experienced staff (including doctors and nurses) to meet patients’ needs and there were arrangements to ensure staff had the competency to do their jobs.

• There were arrangements to ensure that patients had access to suitable refreshments, including drinks, and were not starved pre-operatively longer than was necessary.

• Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked.

• Arrangements for obtaining consent ensured legal requirements and national guidance were met, including where patients lacked capacity to make their own decisions.

• Patients could access care in a timely way without undue delay.

• The privacy and dignity of patients was upheld.

• The hospital management team were visible and were supported by the staff and there was appropriate management of quality and governance.

We noted the following examples of outstanding practice:

• The provider had direct access to electronic information held by community services, including GPs. This meant that unit staff could access up-to-date information about patients.

• Epsomedical Limited had invested in bespoke, integrated IT systems to ensure efficient management of staff, finances, other resources, clinical activity and governance.

• Specific procedures were separated by gender, with females undergoing the procedure on one day and males another day to ensure compliance with the Department of Health's same-sex accommodation guidance.

There were also areas of where the provider needs to make improvements.

Importantly, the provider must:

• Introduce systems to ensure the checking and availability of anaesthetic equipment.

• Introduce a robust system for the reconciliation, storage and monitoring of medicines.

• Introduce processes to ensure compliance with the ‘fit and proper person’ requirement.

In addition the provider should:

• Consider how to raise awareness of the complaints procedure for both staff and patients

• Review processes on assessing pain to ensure they meet best practice

• Take action to be assured all cleaning schedules are implemented and monitored.

• Improve awareness of the ‘duty of candour’ obligation amongst the management team.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 9 December 2016

• The unit had systems and processes in place to keep patients free from harm. Staff were aware of how to report incidents which were then investigated, infection prevention and control practice met national guidelines and the management of medicines was appropriate.

• Care was delivered in line with national guidance and the unit had a comprehensive audit programme in place to monitor services and identify areas for improvement.

• There were sufficient numbers of appropriately trained and competent staff to provide their services.

• Patients were treated in a kind, caring and considerate manner and staff respected their privacy and dignity.

• Appointments could be accessed in a timely manner at a variety of times throughout the day; waiting times met national targets

• Managers were visible, approachable and effective. There were robust systems and processes in place in relation to governance and quality assurance.

Updated 9 December 2016

• Systems to store, monitor and ensure the availability of medicines were not robust.

• Equipment was not consistently checked or maintained to ensure it was ready for use and some items of emergency equipment were not readily available.

• There were insufficient processes to ensure that board members fulfilled the “fit and proper person” requirements and there was limited understanding by some senior leaders of the duty of candor regulations.

• There was some limited awareness of complaints procedures for both staff and patients.

• However, we also found staff understood and fulfilled their responsibilities to raise concerns and report incidents and these were appropriately investigated and learning shared. There were effective systems to assess and respond to patient risks and infection prevention and control practices were in line with national guidelines.

• There were sufficient numbers of staff with the necessary skill, qualifications and experience to meet patients’ needs.

• Care was planned in accordance with current evidence-based guidance, standards, best practice and legislation. The unit monitored this to ensure consistency of practice and patients experienced good outcomes.

• Patients were treated with kindness and courtesy and their privacy and dignity promoted. There were arrangements to respond to individual needs.

• Leaders were visible and were valued by staff. There was a clear vision which was shared through the service. There was innovative use of new technology to run the service.