Nuffield Health Leeds Hospital

Nuffield Health Leeds Hospital is operated by Nuffield Health. The hospital has 88 beds and facilities include six operating theatres (two of which have laminar flow), a hybrid interventional suite, endoscopy and radiology services. The hospital provides surgery, critical care, children and young people and outpatients and diagnostic imaging services. We inspected each of these services.

We inspected this hospital using our comprehensive inspection methodology. We carried out the announced inspection 8 to10 February 2017, with an unannounced visit to the hospital on 22 February 2017.

We rated surgery and outpatients and diagnostic imaging as outstanding and services for children and young people and critical care as good. We rated the hospital as outstanding overall.

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 outstanding overall because:

• The leadership drove continuous improvement and motivated staff to improve the quality of care through professional development and innovation. Staff were proactively supported by management to acquire new skills and share best practice. Levels of staff satisfaction were high; they told us they felt well supported by management and were proud of the hospital, the positive culture and focus on quality improvement.

• Learning was based on thorough analysis and investigation of things that went wrong. The hospital utilised professional development resources to develop education programmes based on the outcome of investigations to improve patient safety related to diabetes management, catheterisation, medicines management and quality of documentation. Resulting changes were monitored through audit.

• The hospital maintained strong relationships with local healthcare partners and had active roles in areas such as antimicrobial stewardship, professional development and education. One outcome involved the development of the ‘catheter passport’ to improve the quality of catheter care after discharge from the hospital.

• The pre-assessment process included a full health assessment. During this assessment, staff were able to identify patients who were at risk of developing diabetes or cardiac conditions. We were told of patients diagnosed with conditions they were unaware of as an outcome of the health assessment. Patients were provided with an overall health report to discuss with their GP if required.

• Feedback from patients, family and carers in all services was consistently positive and we saw evidence of care exceeding expectations. The Friends and Family survey found that 99% of patients would recommend the hospital to others. Feedback from parents was particularly positive about the quality of care given to children.

• Staff demonstrated a proactive approach to understanding the needs of different groups of people and delivering care in a way that met those needs. For example, the recovery nurse met children before anaesthetic to reduce anxiety when waking up after surgery. There were excellent facilities for patients living with dementia in the outpatients department and a designated room adapted for ease of use for patients living with dementia on the ward.

• New evidence-based techniques and technologies were used to support the delivery of high quality care. For example, the hospital was the first independent hospital to use the spinal navigation system for spinal surgery and the radiology department had introduced a new service, CT colonography, which used low dose radiation CT scanning to obtain an interior view of the large intestine. Staff had received specific training in order to provide these services.

We found areas of good practice in surgery, critical care, services for children and young people and outpatient and diagnostic imaging:

• There was a clear governance structure in place, with regular meetings held by all groups within the structure and effective reporting escalating to the hospital board and medical advisory committee.

• Risks were actively monitored through the hospital risk register at all levels of management and ways of reducing the risk investigated. Any changes in practice to reduce risk were monitored for compliance.

• There was proactive infection prevention leadership evidenced by improvement initiatives and a regular gap analysis against policy and procedures to monitor compliance. We saw there were actions in progress toalign withnational guidance for floor covering in clinical areas and clinical hand washing facilities where needed.

• The critical care team had developed a training programme on the management of a deteriorating patient; they provided this training to hospital ward staff and to staff at other Nuffield Health hospitals.

• There were clearly defined and embedded systems to keep people safe and safeguarded from abuse. Complaints were low in number and well managed.

• Staffing levels and skill mix were planned, implemented, and reviewed to keep people safe at all times. Staff shortages were responded to quickly.

• Consultant anaesthetists were responsible for their patients’ care for 24 hours post-surgery. Outside of this timeframe, should there be a need for anaesthesia care, the patient would be transferred to the critical care unit and an intensivist identified to take over the patient’s care.

• There was coordinated multidisciplinary working with all relevant staff involved in assessing, planning and delivering people’s care and treatment. High quality performance and care were encouraged and acknowledged and staff were engaged in monitoring and improving outcomes for patients.

• Services were planned to ensure the needs of children and young people were met. Dedicated paediatric operating sessions were established and children and young people were not seen in clinic without appropriately trained staff being available. There were no waiting times for admission and treatment children and young people.

We found areas of practice that require improvement overall:

• Consultant documentation in the patient’s record was not always timely, legible or clearly signed.

• Following a change in corporate training policy, paediatric resuscitation training levels for relevant staff were below target.

• Carpets were present in clinical areas; plans were in place for a refurbishment programme to remove these. Nuffield Health Leeds Hospital was built prior to the issue of the Department of Health guidelineson flooring in clinical areas where spillages may occur (Health Building Note 00-09: Infection control in the built environment, 2013).

• The hospital had established an informal agreement with the local NHS trust to accept patients to support their critical care needs. However, a formalised patient transfer arrangement was not in place.

We found areas of practice that require improvement in Critical Care

• The hospital did not participate in relevant national benchmarking databases to evidence patient outcomes in critical care or cardiac surgery.

• Audits of the critical care outreach service did not clearly identify the effectiveness of the service.

We found areas of practice that require improvement in services for children and young people:

• The hospital did not participate in relevant national benchmarking databases to evidence patient outcomes in paediatric surgery.

• Clinical hand washing facilities could be improved; plans were in place to install additional hand basins.

• We saw no evidence of Gillick competency assessments or of young people signing consent forms.

We found areas of practice that require improvement in the outpatient service:

• Not all cleaning chemicals were stored safely and securely.

• Not all staff were aware of how to manage the hearing loop.

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. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)