Nuffield Health Hereford Hospital

Nuffield Health Hereford Hospital is operated by Nuffield Health. The hospital has 23 beds including a three bedded day care unit and a ward for 20 inpatients. Facilities include two operating theatres and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery and outpatients and diagnostic imaging. We inspected surgery and outpatients and diagnostic imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 7 to 8 November 2016, along with an unannounced visit to the hospital on 21 November 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.

Services we rate

We rated this hospital as good overall.

• Patient safety was monitored and incidents were investigated to assist learning and improve care. Staff had awareness of the importance of the duty of candour regulation.

• Patients’ with complex needs, such as a learning disability or mental health condition, were identified at pre-assessment. Appropriate arrangements were made to meet individual patient needs, such as increased staff levels, or the use of a dedicated room for patients living with dementia to use. The hospital also had a dedicated room for patients living with dementia to use.

• Operation cancellation rates were low and patients had been offered another appointment within 28 days of their original appointment date.

• Patients had their needs assessed, and care was planned and delivered in line with evidence-based guidance, standards and best practice.

• Staff complied with use of personal protection equipment and handwashing to prevent cross infection.

• There were systems in place to ensure that staff were competent to provide effective care, including 100% staff annual appraisal rate.

• Hospital staff had completed their mandatory training (94%, which exceeded the target of 90%).

• Medical staff working with practising privileges at the hospital had their agreements reviewed every two years.

• There were effective arrangements for the discharge of patients. Discharge planning began during the pre-operative assessment process.

We found the following areas of good practice in surgery:

• Staff complied with use of personal protection equipment, handwashing and the rate of surgical site infections were low.

• Patient’s records included risk assessments and were completed appropriately and stored securely.

• Early warning scoring was used and a checklist to ensure that patients were well enough to return to the ward from recovery following surgery.

• Processes and service level agreements were in place to transfer patients to an alternative acute hospital if their condition deteriorated. This included critical care if required.

• Patients felt that they were part of the decision making process regarding their treatment plan. We saw that staff provided an unhurried approach and treated patients with respect.

• Patients whose operations were cancelled were offered another appointment within 28 days of the cancelled procedure.

• There were processes and procedures in place for staff to manage patients’ pain and ensure that patients’ nutrition and hydration needs were met.

• The hospital performed better than the national standard of patients being treated within 18 weeks from referral for nine months out of 12 (July 2015 to June 2016).

• Appropriate arrangements were made to meet individual patient needs, such as increased staff levels, or the use of a dedicated room for patients living with dementia to use.

We found the following areas of good practice in outpatients and diagnostic imaging services:

• Patient safety was monitored and incidents were investigated to assist learning and improve care.

• Staff were aware of their responsibilities surrounding consent and staff understood their responsibilities under the Mental Capacity Act 2005.

• Patients had short waiting times in departments prior to consultations or appointments.

• Patients’ with complex needs, such as a learning disability or mental health condition, were identified at pre-assessment.

• Patients had their needs assessed, care planned and delivered in line with evidence-based guidance, standards and best practice.

• Policies and procedures reflected current guidelines and adherence was monitored with a schedule of local audits.

We found areas of outstanding practice in surgery and outpatients and diagnostic imaging services:

• Patients told us how staff treated them with kindness and dignity and consistently went the extra mile to meet their needs. Patients were truly respected and valued as individuals and were empowered as partners in their care.

• Staff worked in partnership with patients and showed determination and creativity to overcome obstacles to delivering care. For example, the matron and the team worked closely with a patient with anxiety issues to empower them to attend and undergo surgery.

• The imaging department worked closely with patients and their families. An example of this had enabled a patient to undergo treatment in their local area, instead of travelling to another provider, 150 miles away.

We found areas of practice that required improvement in surgery:

• While we found there were arrangements in place to safeguard people from abuse that reflected relevant legislation and local requirements, we were not assured that staff were trained to the appropriate level for their role in order to protect children associated with the adults they were caring for, from abuse.

• Not all required staff (68%) had completed immediate life support training. However, they were compliant with Nuffield Health group cardiopulmonary resuscitation policy regarding provision of advanced life support trained staff at the hospital and all trained inpatient nurses had completed the immediate life support course.

• There were issues regarding medicine management including preparation in advance of cases and documenting stock checks. Actions were taken by the provider and this practice was not seen during our unannounced inspection.

• The use and documentation of the World Health Organisation safer surgery checklist was inconsistent. However, during our unannounced inspection, this had been addressed and an action plan was in progress.

• The flooring and clinical hand wash sink provision on the ward was not in line with health building guidance.

• We found areas of practice that required improvement in outpatients and diagnostic imaging:

• There was not a lead anaesthetist identified for the pre-assessment service.

• The recommended thresholds (relative to the reference levels) at which excessive radiation doses should be reported were not clearly displayed in the diagnostic imaging department. This was addressed during our inspection.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve.

Ted Baker

Deputy Chief Inspector of Hospitals