Nuffield Health Leicester Hospital

Updated 26 October 2023

We carried out this unannounced focused inspection within the surgical service. We checked the quality of the services in response to an incident that occurred at the hospital in March 2023. We looked at certain areas, such as infection control, mandatory training, risk assessments, culture and governance to ensure the service provided was safe, effective and well-led.

During this inspection we inspected the surgical service using our focused inspection methodology. We did not cover all key lines of enquiry; however, we have re-rated some key questions based on the findings from our inspection. Overall, we rated safe and effective as good and well-led as requires improvement in the surgical service. We did not rate the caring or responsive domains. This means that overall, the service remains as good.

Updated 26 October 2023

Nuffield Health Leicester Hospital provides a range of private treatments and services. They had specialists in orthopaedic, general surgery, ear nose and throat, cosmetic surgery, paediatric surgery, women’s health, physiotherapy and sport injuries. The hospital saw both private, insured and NHS patients. We inspected the surgery core service for adults only.

Our rating of this location stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff managed medicines well. The service managed safety incidents well and mostly learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available 7 days a week.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all staff were correctly assessing patients using the National Early Warning Score 2 (NEWS2) scoring system.
• Not all staff were trained on safeguarding adults and children, however, they were close to the target set by the provider.
• Whilst there was a robust audit programme, not all audits were completed, and action plans were not always in place or actioned.
• Leaders did not always feedback information to their teams during meetings. Staff were not always aware of incidents, learning, risks and audits. This meant leaders could not ensure improvements were made.
• The risk register was brief and did not contain all the risks within the service.

Areas for improvement

Action the service SHOULD take to improve:

• The service should ensure that all staff are trained on NEWS2. (Regulation 12: Safe Care and Treatment).
• The service should ensure that all staff are aware of the Control of Substances Hazardous to Health Regulations (COSHH) and all items are stored appropriately. (Regulation 15: Premises and equipment).
• The service should ensure that all audits are completed in line with the hospital audit programme, and they have an associated action plan to increase compliance. (Regulation 17: Good Governance).
• The service should ensure they have embedded methods of feedback for staff to ensure that all staff are aware of learning, incidents, audits, and areas where improvements are needed. (Regulation 17: Good Governance).
• The service should ensure that all theatre staff complete the debrief following surgery as per policy. (Regulation 12: Safe care and treatment).
• The service should consider putting further detail into their meeting minutes to ensure that staff who could not attend were aware of the content of the meeting. (Regulation 17: Good Governance).
• The service should ensure that staff are aware of the risks contained on the risk register and the measures in place to reduce the risks. (Regulation 17: Good Governance).

Updated 14 March 2017

Children and young people’s services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring, responsive and well led.

• The hospital met the Royal College of Paediatrics and Child Health (RCPCH) standards for paediatric consultant presence. Nurse staffing met the Royal College of Nursing (2013) guidelines and shortfalls in trained nurse provision within children’s services were managed through escalation pathways.

• There was good access and flow within the children’s service. Children received evidenced based care and treatment and good multi-disciplinary working existed between the children’s services, external providers and the rest of the hospital.

• Monitoring records of resuscitation equipment showed that monitoring of this equipment had taken place daily.

• Staff were caring, compassionate and respectful. Children’s emotional and physical wellbeing was central to everything staff did.

• All staff worked hard to ensure children and young people felt included and were active partners in their care.

• Staff were positive about working in the service and there was a culture of flexibility and commitment.

• The service was well led and a clear leadership structure was in place. Governance processes had been reviewed, clinical risks monitored, and feedback from staff, parents and children and young people had resulted in changes to aspects within the service.

However we also found ;

• The security doors with access to the ward were unsecured.

Updated 14 March 2017

We rated this service as good because it was safe, effective, caring, responsive and well led.

• Learning from incidents was communicated throughout the hospital to support improvement in all areas.

• Patient records were stored securely and available for provision of care.

• Staffing levels were sufficient to perform care, although there was no leeway to cover sickness or increased demand in clinics.

• Staff appraisals were completed and training requirements met.

• Consent to care and treatment was obtained in line with legislation and guidance.

• Care from a range of services was co-ordinated. Staff worked collaboratively to understand and meet the range and complexity of people’s needs

• People were supported, treated with dignity and respect, and were involved in their care.

• Waiting times and cancellations were minimal.

• The service took complaints and concerns seriously, responded in a timely way and listened to service users.

However we found that;

• Staffing within the outpatients department left no leeway to cover sickness or an excessive demand for clinic.

• There were some gaps in the mandatory training due to staff sickness.

• Complaints leaflets were not visible in the outpatients and radiology area.

• Staff told us they would use family members to translate if required.

Updated 26 October 2023

We inspected the surgery core service for adults only. We rated Safe and Effective as Good and Well-led as Requires Improvement. This meant overall the ratings remained at Good.