Archived: Southampton NHS Treatment Centre

Southampton NHS Treatment Centre opened in October 2008. NHS treatment centres are private-sector owned treatment centres contracted to treat NHS patients free at the point of use. In 2014, the treatment centre was acquired by Care UK Clinical Services Ltd, the largest independent provider of NHS services in England.

The Treatment Centre provided inpatient and day case elective surgery with associated outpatient and diagnostic clinics across nine specialties Orthopaedics, Oral Surgery, Gynaecology, General Surgery, ENT (ear, nose and throat), Urology, Eye Surgery, Endoscopy and Pain Management. It provided services to people living in Hampshire, Southampton and the Isle of Wight. It did not provide treatment to and care to children but did offer a service to young people aged 16 and over.

The Treatment Centre has a 19 bed inpatient ward and a 24 bed day patient ward. There are five theatres that operate Monday to Saturday. Minor, intermediate and major elective procedures are carried out across the nine specialties.

We carried out a comprehensive announced inspection of Southampton NHS Treatment Centre on 7 and 8 May 2015, and an unannounced inspection on 20 May 2015 as part of our second wave of independent healthcare inspections.

We inspected the following two core services:

• Surgery
• Outpatients department.
• The diagnostics service is supplied by another provider and was therefore not included in this inspection.

Our key findings were as follows:

Are services safe?

By safe, we mean that people are protected from abuse and avoidable harm.

• Patients were protected from the risk of abuse and avoidable harm. There were clear open and transparent processes for reporting and learning from incidents. Learning from incidents was shared locally. In surgery, learning was shared across the other treatment centres of the organisation.
• Wards and departments were visibly clean and infection prevention and control practices were followed. Post-operative infection rates were lower (better than) the national hospital average.
• Patients were risk assessed to ensure they were suitable for treatment at the centre and they were monitored appropriately during their stay.
• Equipment was appropriately maintained and tested.
• Medicines were stored securely and handled correctly.
• Staffing levels and the skill mix of staff in the surgical and outpatient areas were sufficient to meet the needs of patients and there was good access to medical support at all times. There was a low use of agency staff. On the surgical wards, where extended vacancy time was identified agency staff were employed for blocks of 3 months which supported continuity and safety of care. Staff worked flexibly as a team to cover additional sessions.
• Patient records were always available prior to a patient being seen.
• Staff undertook appropriate mandatory training for their role and were supported to keep this up-to-date.
• Staff received simulation training, to ensure they could appropriately respond if a patient became unwell or a major incident occurred, and staff were aware of processes to follow in an emergency.

Are services effective?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

• Within the surgical units, care was delivered that was evidence based and in line with nationally agreed policies and practice. In outpatients, there was limited evidence that clinical audits against national guidance or local policies were completed in all outpatient areas. There was some recording of patient reported outcomes.
• The Treatment Centre was performing in line with other providers who provided the same surgery.
• Patients’ pain needs were met and reviewed appropriately during a procedure or investigation.
• Services were available seven days a week, with surgery occurring six days a week. In the outpatients department, clinics were held mainly in the week, with some Saturday clinics. By working in multidisciplinary team clinics and one stop clinics, the treatment centre reduced the number of appointments patients needed.
• Staff received regular appraisals and supervision, and were encouraged and supported to participate in training and development.
• The consent process for patients was well structured, with written information provided prior to consent being given.

Are services caring?

By caring we mean that staff involve and treat patients with compassion, dignity and respect.

• Care was provided that was outstandingly kind and compassionate within the surgical ward and department. Patients were seen to be respected, and fully involved in the decisions about their care. They described holistic care provided not just by nursing and medical staff, but by staff of all grades and posts, across the work spectrum.
• In outpatients, patients and relatives commented positively about the care provided from all of the outpatient staff. People were treated courteously and respectfully.
• In outpatients, patients were kept up to date with and involved in discussing and planning their care and treatment. They were able to make informed decisions about the treatment they received. The treatment centre maintained patient’s privacy and dignity and actively sought patient feedback.

Are services responsive?

By responsive we mean that services are organised so they meet people’s needs.

• Surgical services were responsive to the needs of people: Patients were able to influence the choice of date for their surgery during outpatient consultations. Patient admissions for surgery were staggered throughout the day so patients did not experience long waits after being admitted prior to their procedure.
• Outpatient services were planned and delivered in a way which met the needs of the local population. Clinics were held on weekdays, with regular Saturday clinics as well. .
• The Treatment Centre was meeting national waiting times and patients had surgery within 18 weeks of referral.
• Services were flexible and staff adapted to meet patients specific needs, for example, endoscopy were considering a trial of late afternoon/ early evening appointments to meet people’s needs. They also ran single sex clinics to maintain patient’s privacy and dignity. At the time of booking outpatient visit, patients were offered a choice of time to suit their needs.
• There was information on specific procedures or conditions, but this information was only in English and not in other languages or formats, such as Braille. Interpretation services were available, but information on this was not clearly displayed in waiting areas. This meant that patients who had difficulties reading, or whose first language was not English, might have difficulties fully accessing information. This had the potential to hinder patients’ full understanding of their treatment and care.
• Patients were encouraged to provide feedback after their outpatient appointment by completing the Friends and Family test. Results were displayed in waiting areas, but did not include actions taken in response to patients making suggestions or raising concerns.
• There was an effective process for managing and learning from complaints from surgical patients, and complaints guides were seen in outpatient waiting areas. However, there were no comment cards on display for patients to access. They were called comment cards rather than complaints cards. It could sometimes be difficult for patients to access information on making a formal complaint.

Are services well-led?

By well-led, we mean that the leadership, management and governance of the organisation, assure the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

• In surgical areas, staff were aware of the vision and strategy to expand the service. One area had developed their own philosophy of care which was displayed for patients and visitors to view. They were generally positive about the leadership of the service. All surgical specialities had a clinical lead surgeon.
• Governance processes at department level, treatment centre level and corporate level allowed for monitoring of the service and learning from incidents, complaints and results of audits across surgical services.
• In outpatient areas, staff and managers had a vision for the future of their department and were aware of the risks and challenges faced by their department. There was an open and supportive culture where incidents and complaints were reported, lessons learned and practice changed at a local level.
• Staff in all outpatient areas stated they were well supported by their managers. They were visible and provided clear leadership. Staff and managers told us there was an open culture, and they felt empowered to express their opinions and felt they were listened to.
• All departments supported staff who wanted to be innovative and try new services and treatments. Patients were given opportunities to provide feedback about their experiences of the services provided, although this learning was not shared with patients.

We saw several areas of outstanding practice including:

• The outstandingly compassionate care delivered to patients within the surgical areas. This was delivered not just by nursing and medical staff but by a whole spectrum of individuals including housekeeping, portering and administrative staff.
• The number of outpatient one-stop clinics offered to patients, enabling consultation, investigation and treatment at the same appointment.
• The development opportunities for health care assistants in main outpatients. There were a number of different competencies they could complete to enable them to run or support clinics such as phlebotomy, minor operations and pre-assessment.

However, there were also some areas where the provider needs to make improvements.

The provider should ensure that

• Learning from incidents is shared more widely.
• All medical leads are engaged in the assurance processes being followed to reduce risks to patients. All medical leads in surgery are aware of the assurance processes followed by Care UK to ensure visiting surgeons have the necessary skills and competencies.
• Patient group directions for all departments are up to date.
• Audit systems in outpatients to monitor compliance with national guidelines improve.
• Written literature is available in different formats, such as large print or braille, and languages other than English, and information on how to access patient information is provided.
• Actions taken in response to patient’s comments and complaints should be displayed.
• All staff are made aware of the risk and hazard register records that relate to their ward/department areas.

Professor Sir Mike Richards     Chief Inspector of Hospitals