Archived: Clifton Park Hospital

Updated 12 June 2015

Clifton Park Hospital is operated by Ramsay Health Care UK Operations Limited. It opened in 2006 as a purpose built hospital originally contracted to deliver NHS activity for a five year period. The hospital secured a further three year standard acute contract (SAC) in 2010 to deliver orthopaedic services. In December 2014 the hospital was awarded the contract to provide NHS services for the next five years with options to extend a further two years.

Clifton Park comprised 24 inpatient beds, day case facilities, x-ray, theatres, outpatient and diagnostic facilities. The theatre department has a seven bay day care facility, two laminar flow operating theatres, a four bay stage1 recovery, one point of care testing facility and a Theatre Sterile Services unit (TSSU) department. There was also a small physiotherapy gym and a restaurant providing food for patients, staff and visitors. The hospital provided a wide range of elective orthopaedic surgical procedures covering the sub specialities of hands, knees, hips, shoulders, feet and ankles. Referrals were received primarily for NHS patients although there were some self-funding / insured patients (approximately 3%). There was an MRI mobile scanner which visited the hospital every two to three weeks.

Clifton Park primarily serves the communities of York and North Yorkshire and accepts patient referrals outside of this catchment area.

There were no special reviews or investigations of the hospital by the CQC at any time during 2013/14. The hospital has been inspected three times, and the most recent inspection took place in October 2013 which showed the hospital was meeting all standards of quality and safety it was inspected against.

For this inspection, the team inspected the following two core services at Clifton Park hospital:

• Surgery
• Outpatient and diagnostic imaging

Updated 12 June 2015

The Clifton Park Hospital is operated by Ramsay Health Care UK Operations Limited. It primarily serves the communities of York and North Yorkshire and accepts patient referrals outside of the catchment area. The hospital has two theatres and 24 beds configured into one ward which is used for day cases and inpatients. It provides elective orthopaedic surgery and care for adults including diagnostic services, outpatient facilities and physiotherapy. The hospital does not treat children or young people under the age of 18 years. Referrals were received primarily for NHS patients, treated under standard NHS contract, although there were some self-funding patients.

There were over 20 clinical staff (both nursing and physiotherapists) who were employed by the hospital and 34 consultants working at the hospital under a secondment agreement with York Teaching Hospitals Foundation Trust. There were a small number of these consultants who undertook private practice under practicing privileges. The senior leadership team comprised of a general manager, an operations manager, a matron and a finance manager. The hospital was supported by other professionals within the Ramsay Health Care UK.

We inspected the hospital on the 27 and 28 January 2015 and undertook an unannounced inspection on 10 February 2015. We inspected this hospital as part of our second wave independent hospital inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

Overall the care and treatment patients received at Clifton Park Hospital was good for the safe, effective, caring, responsive and required improvement in the well led domain.

Our key findings were as follows:

Medical and nurse staffing levels were adequate on the ward, theatres, outpatients and diagnostic services. Staffing establishments and skill mix were reviewed regularly and levels increased to meet patient needs where required.

Arrangements were in place to manage and monitor the prevention and control of infection. We found that all areas we visited were visibly clean. There were no hospital acquired infections reported from October 2013 to September 2014.

Some patients fasted pre-operatively for longer periods than necessary before their surgery. This had been identified by the hospital and an interim measure had been put in place to address this. Interim measures had improved the situation regarding prolonged fasting. Patients gave positive feedback about the choice and quality of food they received.

There was sufficient equipment to ensure staff could carry out their duties. Processes were in place for monitoring and maintaining equipment.

The majority of records we viewed across both core services were well maintained and documents were completed to a good standard including completion of patient risk assessments, however there were gaps in some records.

Staff understood their responsibilities to raise concerns and record patient safety incidents and near misses. There was evidence of a culture of learning and service improvement.

Overall the hospital responded to the Central Alert System (CAS). However we noted it had not fully implemented the National Patient Safety Agency alert “Emergency support in surgical units: Dealing with haemorrhage” Reference number 1025, dated10 September 2007. Clifton Park Hospital had not assured itself that blood products could be transported in a timely manner should an emergency arise.

Medicine management arrangements were in place. Medicines were stored securely and staff were competent to administer medicines.

There were systems for the effective management of employed staff which included an annual appraisal, however, not all staff had received an appraisal.

The monitoring system to ensure the consultants’ safety to practice within the hospital was not robust at the time of the inspection. For a significant number of the doctors information regarding: DBS checks; appraisal information from the employing organisation and; professional indemnity insurance arrangements, was out of date or had not been provided to the hospital and therefore the consultants’ safety to practice within the hospital was not assured. When this issue was raised with the hospital management team the employing trust was contacted immediately to provide this assurance. Information provided by the hospital on the 10 February 2015 indicated that the figures for appraisal and indemnity insurance had improved.

The hospital undertook a programme of clinical audits. These covered a range of areas including infection prevention and control, medicines management and nutrition and were acted upon.

There was no secure access to the theatre suite to prevent patients or other people inappropriately accessing this area

Leaders were aware of their responsibilities to promote patient and staff safety and wellbeing. Leaders were visible and there was a culture which encouraged candour, openness and honesty.

Governance arrangements enabled the effective identification and monitoring of clinical risks and action was taken to improve performance. Progress on achieving improvements was reported and measured through the relevant committees with oversight and scrutiny from the provider’s quality governance committees with ultimate responsibility resting with the Ramsay Health Care UK chief executive and board. It could be seen through the results from the audit programme that where a need for improvement had been identified this was actioned and subsequent audit demonstrated the progress made.

In addition to the above, we saw areas of good practice:

Patient information leaflets within outpatients were of a very high standard and had recently been developed and improved by members of the outpatient team. The radiology manager told us that the information tools developed were to be showcased within the Ramsay hospital group.

The radiology manager had been recognised by the Head of Diagnostics for Ramsay Health Care UK for her audit work regarding use of “C arm” equipment and had been asked to present her work to the Ramsay Radiology group.

The governance structures enabled national learning from other hospitals within Ramsay Health Care UK.

Patients were positive about their care and experiences. They felt involved in the decisions about their care and treatment and records were completed sensitively.

However, there were some limited areas of poor practice where the provider needed to make improvements:

Action the hospital MUST take to improve

1. The provider must take action to ensure that the appropriate checks and records are in place and recorded for the doctors working at the hospital including Disclosure and Barring Service DBS checks, indemnity insurance and appraisals.
2. The provider must take action to ensure that there is an effective system in place for the timely delivery of blood products from the local provider should an emergency arise and that emergency transport procedures are tested on a regular basis.
3. The provider must improve the security of access to the theatre suite to prevent patients or other people inappropriately accessing this area.

Action the hospital SHOULD take to improve

1. The provider should ensure that the timings of theatre lists were agreed in advance to avoid patients unnecessarily fasting for an excessive number of hours.
2. The provider should ensure that all staff received an appraisal each year.
3. The provider should ensure that all medical records are fully completed and signed.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 12 June 2015

Patients were happy with the care they received and found the service to be caring and compassionate.

The positive themes from patient feedback were: caring staff attitude, being listened to and being treated with dignity and respect, cleanliness, the environment and feeling safe. There were also positive comments relating to food.

Staff were well trained, provided with good support and worked within nationally agreed guidance to ensure that patients received appropriate care and treatment for their conditions. Patients were protected from the risk of avoidable harm by adherence to policies and procedures and by competent use of clinical risk assessments which ensured care needs were managed appropriately.

Staff listened to and engaged with patients to actively seek their opinions. Services were delivered in a way which responded to patients’ needs and ensured the departments worked effectively and efficiently.

The monitoring system to ensure the consultants’ safety to practice within the hospital was not robust at the time of the inspection. We found that for a significant number of doctors, the information regarding DBS checks, appraisal information from the employing organisation and professional indemnity insurance arrangements was out of date or had not been provided to the hospital and therefore the consultants’ safety to practice within the hospital was not assured.

Updated 12 June 2015

Incidents were reported and dealt with appropriately and themes and outcomes were disseminated to staff. Patient areas were clean and we saw staff wash their hands and use hand gel between patients.

The hospital had not fully implemented the National Patient Safety Agency alert "Emergency support in surgical units: dealing with haemorrhage". The hospital had not fully assured itself that blood products would be transported in a timely manner should an emergency arise. 

Staffing establishments and skill mix were reviewed regularly and levels increased to meet patient needs where required. Effective medicine management arrangements were in place and effectively followed. Nursing staff were knowledgeable about what actions they would take if they had any safeguarding concerns.

There were processes for implementing and monitoring the use of evidence-based guidelines and standards to meet patients’ care needs. Nursing, medical and other healthcare professionals were caring and patients were positive about their care and experiences. Patients were risk assessed appropriately and effective pain relief arrangements were in place. Staff were able to recognise and respond to warning signs of rapid deterioration of a patient’s health.

Service planning, delivery to meet the needs of people and access and flow arrangements were in place.

There were very few complaints arising from patient experiences in surgical services. There were two negative comments relating to the abrupt manner of a particular doctor who did not introduce themselves. prior to marking the operation site. Information about the hospital’s complaints procedure was available for patients and their relatives. The service reviewed and acted on information about the quality of care that it received from complaints.

Staff were aware of the hospital’s vision and there were arrangements for monitoring the service at a local level. The hospital had only recently recruited to its full leadership team.

The monitoring system to ensure the consultants’ safety to practice within the hospital was not robust at the time of the inspection. At the inspection we found that for a significant number of doctors, the information regarding DBS checks, appraisal information from the employing organisation and professional indemnity insurance arrangements was out of date or had not been provided to the hospital and therefore the consultants’ safety to practice within the hospital was not assured. This had not been identified as a risk on the hospital risk register.