Claremont Hospital

Updated 8 August 2017

Claremont Hospital is operated by Aspen Healthcare Ltd. The hospital opened in 2002 and became part of the Aspen Healthcare Group in 2012. It is a private hospital in Sheffield, Yorkshire. The hospital primarily serves the communities of Sheffield and surrounding areas. It also accepts patient referrals from outside this area.

The hospital has had a nominated individual in post since January 2013.

The hospital has had a registered manager in post since June 2012.

The hospital has had a Controlled Drugs and Accountable Officer (CD AO) since July 2012.

Surgical services at the Claremont Hospital provide day and overnight facilities for adults and young people between the ages of sixteen and eighteen.

The hospital provides elective treatments for different specialities such as orthopaedic and spinal surgery, general surgery, urology, ophthalmology, ENT, vascular, gynaecology, cosmetics and plastics, oral and maxilla facial and dermatology. Facilities at the Claremont Hospital include one inpatient ward with 30 registered beds with six day case beds and an additional day case area with six beds. Whilst most rooms are ensuite, some do not have ensuite facilities. The hospital had three laminar flow theatres that were open from 7.30am until 9.30pm, Monday to Friday and from 8.30am until 5.30pm on Saturday.

Updated 8 August 2017

Claremont Hospital is operated by Aspen Healthcare Limited. Claremont Hospital has 42 beds, three laminar flow theatres, 13 consulting rooms, a static MRI and CT scanner, and plain and digital X-ray. 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 20 to 21 February 2017 with an unannounced visit to the hospital on 3 March 2017.

We rated the hospital as outstanding overall, with surgery rated as outstanding and outpatients and diagnostics rated as good.

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 services provided by this hospital were surgery, outpatients and diagnostics. 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.

We rated this hospital as outstanding overall because:

• We saw excellent leadership from managers who were passionate about patient care and staff welfare. They were visible to all levels of staff and patients.

• There were robust governance structures and reporting mechanisms in place where performance and the quality of the service was reviewed and changes made. Actions were monitored through audit processes and reported to leadership and governance committees.

• We saw a service wide vision and strategy that was embedded across the organisation.

• Patient care was at the heart of the service and the priority for staff. We saw several areas of outstanding caring practice.

• Staff were trained in a nationally recognised accreditation programme in customer care. Following this staff completed a Values Partners programme which is a workshop to explore values and behaviours between staff and towards patients and aims to create a positive working culture.

• The hospital took part in a recognised comprehensive observational study process to consider the approach by staff to the general care of patients, the level of patient/visitor engagement, and the environmental factors within patient reception areas. We saw an example of one survey in July 2016 and there had been an overall high score of 97%.

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

• The hospital environment was visibly clean 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’ need.

• There were arrangements to ensure staff had and maintained the skills required to do their jobs.

• There were arrangements to ensure people received adequate food and drink that met their needs and preferences.

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

• Robust arrangements for obtaining consent ensured legal requirements and national guidance were met.

• The individual needs of patients were met including those in vulnerable circumstances, such as those with a learning disability or dementia.

• Patients could access care when they needed it.

However:

• We observed some environmental concerns in theatre areas. There was a refurbishment plan in place.

• Surgical safety checklists were not completed consistently.

• Not all checks had been completed in theatre for controlled drugs, drug fridges and warming cabinets. Some cleaning checks in the theatre areas had not always been completed daily.

• Not all eligible staff had received an appropriate level of safeguarding training to allow them to recognise any issues of concern.

• Mandatory training figures did not reach Aspen Healthcare Ltd targets.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ted Baker

Chief Inspector of Hospitals

Updated 8 August 2017

We rated this service as good. Safe, responsive and well-led were rated as good. Caring was rated as outstanding. 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 one incident 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 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.

Staff knew how to report incidents and there was good evidence of sharing and learning from incidents.

All areas were clean, organised, and well equipped. Staff complied with ‘arms bare below the elbows’ policy, correct handwashing technique, and use of hand gels.

Staff we spoke who were aware of their roles and responsibilities in relation to safeguarding. They were able to identify different types of abuse and were aware of how to escalate concerns.

Staffing levels were good with no vacancies in the outpatients and physiotherapy departments. One vacancy in the radiology department was in process of being filled.

The culture across the hospital was replicated in outpatients and diagnostic services. Patients told us they were treated with kindness, dignity, and respect. We observed staff interacting with patients and their families in a respectful and considerate manner. Reception staff were welcoming and friendly and patients told us they were courteous.

All patients we spoke with said they felt informed about their care and treatment. They said staff had time to explain things fully and to answer any questions they had.

Nursing staff could provide emotional support to patients receiving bad news and psychiatric support was available for patients receiving cosmetic, bariatric or breast cancer treatment.

Referral to treatment time (RTT) for patients on incomplete pathways waiting 18 weeks or less at this hospital, was consistently 95% or higher.

Patients were seen promptly and able to access appointments at a date and time to suit them. Outpatient clinic cancellations were low.

Staff in outpatient and diagnostic imaging services met the individual needs of patients. Waiting areas had been improved for patients with dementia and telephone and face to face interpretation services were available for patients whose first language was not English.

Patients were made aware of how to complain and staff dealt with patient concerns immediately to prevent them escalating. The outcome of formal complaints was shared with staff at team meetings, which included feedback and learning.

Staff spoke highly of both local and senior leaders. They said they were accessible and approachable. There was a positive culture with good staff morale. Staff felt able to raise concerns and said they felt listened to and valued.

Risks were managed well and there was a clear mechanism for escalating risks when necessary.

Outpatients and radiology departments were continually seeking to improve services for patients.

Updated 8 August 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 outstanding overall. We rated caring and well-led as outstanding. We rated safe, effective and responsive as good.

The service had reported no never events and two serious injuries between October 2015 and September 2016. There had been one never event, involving wrong site surgery, that had been reported in January 2017 prior to our inspection. We saw that this was being investigated and an action plan developed.

Learning was cascaded via the governance committees and received at staff team meetings.

Internal patient satisfaction surveys indicated 98% satisfaction for cleanliness and the service had a low rate of hospital acquired infection.

The hospital training performance for the surgical services showed mandatory training completion results were predominantly above the hospital target of 85%.

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

We saw excellent individualised care which was delivered by highly motivated staff.

The surgery service at the hospital had a good overall safety performance and patients were protected from harm.

We found good processes for reporting and escalating incidents and good sharing of learning from incidents.

There was a good understanding of the duty of candour regulation and major incident policies amongst clinical staff.

There were good patient outcomes across surgical specialties and care was delivered in line with relevant national guidelines.

The hospital performed well in national clinical audits.

Staffing needs were based on acuity of patients and reviewed daily to ensure safe staffing.

Patients had effective and timely pain relief.

Staff felt supported with training opportunities to fulfil their role

There was effective multidisciplinary team (MDT) working between doctors, nurses and allied health professionals and local NHS hospitals.

Staff across the surgery service were caring and professional and patients were treated with dignity. Staff often went ‘the extra mile’ to ensure that patient needs were met and patients were comfortable and informed about their treatment and care.

Patients that we spoke to consistently highly praised staff of all levels, in particular their caring attitude.

Patient flow from admissions, through theatres and onto to surgery wards was smooth and bed availability was managed effectively.

We saw leadership from staff who were passionate about patient care and staff welfare. They were visible to all levels of staff and patients.

There were comprehensive and robust governance and risk management processes in place.

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.