Nuffield Health York Hospital

Updated 14 June 2017

Nuffield Health York Hospital is operated by Nuffield Health. The hospital opened on its current site in December 2004. It is a private hospital in the city of York and primarily serves the communities of York and the surrounding area. It also accepts patient referrals from outside this area.

The hospital provides a range of surgical, outpatient and diagnostic imaging services to NHS and other funded (insured and self-pay) patients and works predominantly with consultants from the local NHS hospital.

The hospital director is the registered manager and controlled drugs accountable officer and has been in post since November 2009.

Outpatient services include dermatology, rheumatology, orthopaedics, urology, cosmetic surgery and cardiology. The outpatient department consists of 12 consulting rooms. The hospital provides an outpatient physiotherapy service in a dedicated department and has four treatment rooms and a gymnasium. The hospital also provides a range of diagnostic imaging services including X-ray, mammography, fluoroscopy, bone mineral density scanning and ultrasound. The service had a fixed site MRI scanner and a mobile CT scanner.

Inpatient and day case surgical services include endoscopy, orthopaedic, ophthalmology, gynaecology, urology, spinal, vascular, ear, nose and throat and cosmetic surgery. The hospital has one ward and a surgical unit for day cases. 

The hospital provides consultation-only outpatient services for children 15 years and below and full services to 16 and 17 year olds in accordance with policy as part of their adult services.

The hospital is registered to provide the following regulated activities:

• Diagnostic and screening procedures
• Family planning
• Surgical procedures
• Treatment of disease, disorder, or injury.

The inspection did not include the family planning service.

Updated 14 June 2017

Nuffield Health York Hospital is operated by Nuffield Health. The hospital has 40 beds and facilities include three operating theatres (two of which have laminar flow), a surgical unit for ambulatory care, radiology, outpatient and diagnostic facilities. The hospital provides surgery and outpatients with diagnostic imaging services and we inspected both of these services.

We inspected this hospital using our comprehensive inspection methodology. We carried out the announced part of the inspection on the 6th and 7th September 2016 with an unannounced visit to the hospital on 13th September 2016.

We rated both core services and the hospital as good 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 good overall because:

• There were systems and processes in place to promote practices that protected patients from the risk of harm. Openness and transparency about safety were encouraged. When something went wrong, people received an explanation, and a sincere and timely apology.
• There were sufficient and appropriately qualified and experienced staff working in all departments to meet the needs of patients. We saw that equipment in all areas was well maintained and kept clean to minimise the risk of infection. Staff were able to respond to signs of a deteriorating patient and medical emergencies.
• Patient feedback demonstrated that staff strived to make the patient experience as positive as possible. Staff recognised and responded to the individual needs of their patients throughout the patient journey.
• The hospital had systems in place to provide care and treatment in line with national guidance. There was effective multi-disciplinary working and good communication between teams within the hospital and with external healthcare partners.
• There was a stable leadership team who were highly regarded by staff. Staff felt proud to work within the hospital and were very positive about the culture and the quality of teamwork.
• There was a clear governance structure and a comprehensive reporting framework in place that provided timely information to the hospital board, medical advisory committee and to the corporate team.

We found areas of practice that required improvement in both surgery and outpatients services.

• We did not identify a clear mechanism to share learning from unplanned transfers and patient safety incidents with the Resident Medical; Officer. This was acted upon at the time of inspection and at the unannounced inspection, communication systems had been improved.

In surgery:

• None of the ten surgical case notes reviewed for consultant entries recorded daily consultant visits as per the requirements of practising privileges. Two sets of notes had documentation about the consultant’s visit from the nurse in charge of the patient’s care.
• Two patients receiving oxygen did not have oxygen prescribed on the medication record. This was raised at the time of inspection and immediately actioned.

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)

Updated 14 June 2017

We rated this service as good because it was safe, caring, responsive and well-led. We did not rate effective as we are currently not confident that we are collecting sufficient evidence to rate effectiveness for Outpatients & Diagnostic Imaging.

The service had reported no never events or serious incidents and no incidents had been reported to the CQC in accordance with the Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R). Staff were encouraged to raise concerns and report incidents. We saw evidence of lessons learnt from safety incidents and changes to clinical practice.

Medications including contrast media used in radiology were stored securely in appropriately locked rooms and fridges. There was an effective process in place for monitoring the use of prescription charts.

Policies and procedures were accessible to staff and had been developed and referenced to the National Institute for Health and Care Excellence (NICE) and national guidance.

All staff had completed an appraisal and they described being supported in undertaking further learning to develop their skills and knowledge.

All patients spoke positively about the care and treatment they had received and we observed staff acting in a compassionate manner. Patients were treated with dignity and respect. Patients were given appropriate information and support about their care or treatment.

The service was responsive to patients’ needs. Access and flow in the Outpatient department (OPD) and radiology departments was well managed. Patients could be seen quickly for urgent appointments if required and patients told us their appointments were on time. Patient records were available for appointments and the department had timely access to test results.

People using the service could raise concerns and complaints were investigated and responded to in a timely manner.

Updated 14 June 2017

Surgery was the main activity of the hospital.

Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

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

The service had reported no never events or serious injuries. Learning was cascaded via the governance committees and received at staff team meetings.

Internal patient satisfaction surveys indicated 96% satisfaction for cleanliness and the service had a low rate of hospital acquired infection.

The hospital target for mandatory training completion was 100% compliance; training data we reviewed showed a compliance rate of 95% at the beginning of September 2016.

Integrated care records covered the entire patient pathway from pre-operative assessment to discharge and included comprehensive care plans for identified care needs.

We reviewed 25 sets of medical and nursing care records whilst on site and records were legible, complete and contemporaneous.

Staffing was reviewed on a daily basis for the forthcoming shifts and adjusted according to clinical need and theatre activity. A weekly capacity meeting was held each Thursday morning to review the following week’s activity and staffing levels.

The hospital had an out-of-hours rota for anaesthetists to provide 24-hour cover for patients post-operatively and there was a service level agreement (SLA) for emergency transfer arrangements with the local NHS trust.

The rate of unplanned transfers of care from this hospital to a nearby NHS trust, unplanned readmissions and unplanned returns to theatre was similar to or better when compared to independent hospital performance data held by CQC.

Staff told us they had been supported with personal development through attending degree-based training programmes, national vocational qualifications and care certificate programmes.

During the inspection, we observed warm, open and positive interactions between staff and patients. All patients we spoke with were happy with the care they received and we received universally positive written feedback from patients during the inspection.

The hospital achieved the overall referral to treatment indicators of 90% of NHS patients admitted for treatment from a waiting list within 18 weeks for the reporting period. It also achieved better than the indicator of 92% of incomplete admitted patients beginning treatment within 18 weeks of referral in the reporting period.

A dementia “champion” provided additional support and training for staff on the inpatient ward. Patient- led assessments of the care environment (PLACE) scoring for the hospital showed dementia assessment as scoring 85%, which was better than the England average of 81%.

Inpatients had access to physiotherapy sessions several times a day, which allowed for quicker mobility and shorter stays in hospital.

In the last 12 months, the hospital cancelled 28 procedures. All patients received another appointment within the next 28 days.

The inpatient ward and theatres had regular staff meetings. We noted good attendance and discussion of key items such as the risk register, audit outcomes, complaints, incidents and infection control.

However:

We did not identify a clear mechanism to share learning from unplanned transfers and patient safety incidents with the RMO. This was acted upon at the time of inspection and at the unannounced inspection, communication systems had been improved.

None of the ten surgical case notes reviewed for consultant entries recorded daily consultant visits as per the requirements of practising privileges. Two sets of notes had documentation about the consultant’s visit from the nurse in charge of the patient’s care.

We saw that checks were made to ensure patients had adhered to fasting times before surgery went ahead; however, at the time of the inspection, the hospital did not undertake audits of actual fasting times and whether these met the expected standard.

Two patients receiving oxygen did not have oxygen prescribed on the medication record.

We noted that patient specific directives (PSD) for bowel preparation did not always evidence that the patient had been assessed by the prescriber before it was supplied.