Archived: Tees Valley Treatment Centre

Tees Valley Treatment Centre (TVTC) is operated by Ramsay Health Care UK Operations. We carried out an announced, comprehensive inspection of the hospital on 17th and 18th January 2017, along with an unannounced visit on 30th January 2017, as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of surgical and outpatients services, as these incorporated the activity undertaken by the provider at this location.

The hospital/service used a shared building in the centre of Middlesbrough and provided services to patients across north and south Tees and surrounding areas. It was a modern facility for day case surgical, diagnostic procedures, and outpatient services. The centre was commissioned locally to provide elective orthopaedic, general surgery, endoscopy, plastics, urology, gynaecology, and oral surgery services. From October 2015 to September 2016, the service reported 6,958 day case attendances. The endoscopy service was accredited by the Joint Advisory Group (JAG) for Gastrointestinal Endoscopy in February 2014, recognising standards and quality in endoscopy services. The outpatient department hosted specialities such as gastroenterology, general surgery, orthopaedic surgery, and plastic surgery. From October 2015 to September 2016 the hospital outpatient department recorded 19,730 total outpatient attendances. Of these, 8,918 were new appointments and 10,812 were follow-up appointments.

The hospital did not have overnight beds and did not admit emergency patients. It did not provide services for children and young people between the age of 0 and 18 years. TVTC had contract agreements for radiology, pathology, histopathology, blood transfusion, critical care and non-critical transfer, physiotherapy, and sterile services. The hospital was open from 7:30am to 8pm Monday to Friday, with additional capacity for Saturday working. Facilities included a pre-assessment area, two operating theatres, and an eight bedded recovery area (made up of two stage one recovery bays and six stage two recovery bays). There were three private outpatient clinic rooms. Of the surgical and outpatient activity delivered, 98% was NHS-funded with the remainder being funded via medical insurance or self-pay.

There were 13 nurses, eight health care assistants and three operating department practitioners, with 18 support and administrative staff. The hospital employed three doctors, and 43 consultants worked with practising privileges at this hospital. The senior leadership team comprised the general manager, matron and finance manager. The hospital was supported by experts in the Ramsay Health Care UK group and externally from local NHS providers.

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. Prior to inspection we reviewed a range of performance information about the hospital. We spoke with 33 members of staff; we reviewed 17 healthcare records and spoke with 14 patients. 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 in surgery – for example, management arrangements – also apply to outpatients, we do not repeat the information but cross-refer to the surgery core service section

Overall we rated TVTC as good. We rated it good for being safe, effective, caring, responsive, and well-led in surgical and outpatient services because:

• All patients we spoke with told us they were treated courteously and respectfully and their privacy was maintained. There was a strong, visible patient-centred culture within the organisation and embraced by all staff. Staff considered holistic, quality patient care paramount to service delivery. Staff recognised the totality of patient need and there were examples where staff had gone the extra mile to meet this. Feedback from patients using the service was consistently positive and collected in a number of approaches.

• The leadership, governance, and culture within the service were very good. There was a consistency in the vision, strategy, and culture of the organisation which was embraced by all staff. Governance arrangements were reviewed, adaptable to change, and reflected best practice. Managers were focused on delivering quality care and improving patient outcomes. Managers acknowledged the importance of their teams and recognised the value of their input into service provision. Managers were visible, approachable, available at all times, and were open and honest. Staff were proud to work for the organisation and morale was valued. The security of funding to build a new hospital had ignited a new energy and positivity throughout the service. The leaders of the organisation listened to staff and actively supported staff creativity and staff initiatives.

• There were robust incident reporting systems in place and we saw incidents were fully investigated and lessons learnt were shared with staff. Staff reported incidents confidently and there was a good track record on safety related issues.

• Infection prevention and control practices were good, and departments were clean and well-equipped. Record keeping, in particular for risk assessments and safety checks, was very good. Local policy for medicines management followed recognised guidelines.

• Staffing levels were planned and monitored to keep patients safe at all times. Staffing levels across departments were good. There were good processes in place to monitor signs of deteriorating health and respond to medical emergencies. Overall, mandatory training figures were good and attendance was well-managed. Staff had an awareness of safeguarding procedures and where to refer for additional support and guidance.

• Patient care and treatment was planned and delivered in line with current evidence-based guidance, standards, and best-practice recommendations. Outcomes for patients were good. Patients confirmed pain relief and nutritional standards met their needs. The service had maintained Joint Advisory Group (JAG) in Gastrointestinal Endoscopy accreditation since 2014.

• Staff received annual appraisals, were supported with revalidation, and worked together proactively to ensure best care and treatment was delivered to patients. Consent to care and treatment processes were good and patients were able to make informed decisions.

• TVTC planned and developed services to meet the needs of the local people which included flexibility and choice. Care and treatment was coordinated with other allied medical services. Referral to treatment times were consistently good. The service made reasonable adjustments to support vulnerable patient groups. Managers proactively monitored flow (waiting times, delays and cancellations) and kept patients informed accordingly. Service complaints were low and staff responded to these in a timely manner.

There were no breaches of regulations. However there were areas where the provider should make some improvements. These were:

• The hospital met the ethos of duty of candour in terms of apologising to patients and providing an explanation but did not strictly meet the group policy requirements or the full legal process, specifically in terms of meeting 10 day timescales to respond in writing to patients.

• The provider should continue with audit and improvement work to improve staff compliance and consistency of completion of National Early Warning Score (NEWS).

• The provider should develop the local and corporate risk register to ensure all clinical and local risks to service are captured fully.

• The provider should continue to monitor the attendance of theatre staff at mandatory training to ensure the action plan is fulfilled and compliance is met for 2016/2017.

Ellen Armistead

Deputy Chief Inspector of Hospitals