Somerset Surgical Services

Updated 28 March 2017

Somerset Surgical Services is an independent provider of health services located at Weston General Hospital, Weston-super-Mare, Somerset. The service employs an operations manager and an administration team. Consultant surgeons and anaesthetists are engaged on a self-employed basis. The service carries out elective (that is non-emergency) surgery for NHS patients commissioned by the Bristol, North Somerset, South Gloucestershire and, more recently, Somerset Clinical Commissioning Groups. Somerset Clinical Commissioning Group  became an associate of the contract in April 2016. It provides a range of procedures, which includes orthopaedic, simple spinal surgery, Maxillo-facial, hand and wrist surgery, ophthalmology and non-complex plastic surgery.

Somerset Surgical Services provides two core services:

• Surgery
• Outpatients and diagnostic imaging

It is registered for the following regulated activities:

• Diagnostic and screening procedures
• Surgical procedures
• Treatment of disease disorder or injury

To provide these services, Somerset Surgical Services has an agreement with Weston Area Health NHS Trust (the host NHS trust) to have access to their facilities and nursing and operating theatre staff at Weston General Hospital. There is an agreed framework for Somerset Surgical Services to provide outpatient clinics and surgery for some procedures not currently offered by Weston Area Health NHS Trust. To accommodate this, pre-admission assessment, day case, and inpatient nursing care is provided by Weston General Hospital’s staff under a service-level agreement between the organisations. The additional work delivered by Somerset Surgical Services is built into planning within the NHS staff and hospital’s service provision.

Somerset Surgical Services was established in 2012 and has developed what it provides to local residents in response to changes and recognised gaps within Weston Area Health NHS Trust’s services. Somerset Surgical Services also offers some patients the opportunity of waiting-list-transfers from other NHS trusts to Weston General Hospital. Patients being cared for by Somerset Surgical Services are provided with all the support services given to any other NHS patients treated at Weston General Hospital. This includes nursing care, medical review, physiotherapy, pharmacy and, if required, out of hour’s emergency care.

From its establishment in 2012, Somerset Surgical Services’ activities have increased year upon year. There were 731 new referrals in 2013 with 260 follow-ups, 255 day-case patients and no inpatient stays. During the twelve-month period between April 2015 and March 2016, the service undertook 2,047 first time appointments in outpatients. The service completed 1,380 surgical procedures; of these 26 were as inpatients. The surgery completed for this period was broken down as follows:

Maxillofacial 4%

Ophthalmology 34%

Oral 9%

Orthopaedic 21%

Plastic 24%

Spinal 8%

Somerset Surgical Services consisted of three company directors, commercial, operations, administrative managers, and five clerical and administrative staff. At the time of our inspection, the organisation employed 22 consultant surgeons, anaesthetists and dentists practising under a private contact. Since our first inspection and prior to our return, a nursing sister had been employed by the organisation to work closely with staff at Somerset Surgical Services and the host NHS trust, Weston Area Health NHS Trust.

Updated 28 March 2017

Somerset Surgical Services is an independent provider of health services located at Weston General Hospital, Weston-super-Mare, Somerset. It engages consultant surgeons and anaesthetists on a self employed basis, to carry out elective (that is non-emergency) surgery for NHS patients which are otherwise not provided at Weston General Hospital. To provide this service, Somerset Surgical Services has an agreement with Weston Area Health NHS Trust to use their facilities and nursing staff at Weston General Hospital.

We carried out an announced inspection visit to this service on 12 and 13 July and 8 of December 2016. This was part of our programme of inspection of independent health providers. Overall, we rated this service as good.

Are services safe

• Incidents involving patients of Somerset Surgical Services were reported and dealt with effectively. There was a good culture of reviewing incidents at a senior level.
• Somerset Surgical Services were provided with access to the audit data of Weston General Hospital to determine that infection control practices, medicines’ management, and equipment and facilities were safe.
• Staff were knowledgeable about the duty of candour legislation, and their responsibilities around this.
• Staff were up-to-date with their mandatory training.
• Staff were knowledgeable about safeguarding and their responsibilities to vulnerable people.

Are services effective

• Relevant and current evidence-based guidance, standards and legislation were identified and used to develop how services, care and treatment were delivered.
• Feedback from patients was positive and all recommended the service.

Are services caring

• We received positive feedback about staff and services from all of the patients we spoke with. We heard patients were treated with respect and shown kindness by nursing staff and consultants when they visited outpatient clinics.
• Patients told us the administrative staff working for Somerset Surgical Services were friendly, patient and helpful.

Are services responsive

• Somerset Surgical Services worked in collaboration with local clinical commissioning groups and Weston Area Health NHS Trust to develop services to meet local people’s needs.
• The service focused its developments on specialty areas that were not delivered by Weston Area Health NHS Trust. These services were delivered to enable local people to have their treatment at Weston rather than need to travel out of the area.
• People had timely access to initial assessment and diagnosis. Somerset Surgical Services’ waiting times for referral to treatment (RTT) were consistently below the NHS England target of 18 weeks.

Are services well-led

• Somerset Surgical Services provided safe care and treatment. It gained the appropriate assurances that services delivered for their patients by Weston General Hospital (the NHS hospital that provided the facilities and nursing staff) were safe.
• Somerset Surgical Services’ stated vision was “to provide first class patient care, quickly and safely as possible.” This had been successfully delivered by the clinical and the administration staff team, and through the management of the service.
• The service, in conjunction with its two sister organisations located in other parts of the UK, had a vision and strategy to develop the services it provided. It planned to work in cooperation with NHS trusts and commissioning bodies to provide surgical procedures that were complimentary to those provided by the hospitals they were located in and working with.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 28 March 2017

• There were systems for recording incidents and a clear process for learning from concerns. There was a good integrated approach with the host NHS trust for the sharing information and learning.
• Staff were knowledgeable about safeguarding and their responsibilities to vulnerable people.
• There was a service level agreement with the host trust, Weston Area Health NHS Trust, for the provision of diagnostic or imaging a patient required.
• Staff employed by Somerset Surgical Services were suitably trained and qualified for their roles.
• There was good multidisciplinary working between Somerset Surgical Service staff and the medical staff who undertook patient consultations.
• We received positive feedback about staff and services from all the patients we spoke with. We heard that patients were treated with respect and shown kindness by nursing staff and consultants when they visited outpatient clinics.
• Somerset Surgical Services worked in collaboration with local clinical commissioning groups and Weston Area Health NHS Trust. The service focused its developments on specialty areas that were not delivered by the trust.
• People had timely access to initial assessment and diagnosis and waiting times for referral to treatment were consistently below the NHS England target of 18 weeks
• Clear information was provided to patients about how to make a complaint or raise a concern. Somerset Surgical Services gained the appropriate assurances that services delivered for their patients by the host NHS trust were safe.

Updated 28 March 2017

• Incidents were reported and dealt with effectively and there was a good culture of discussing incidents at a senior level.
• Staff were aware of their responsibilities to safeguard vulnerable people.
• Staff were appropriately qualified and trained for their roles. They had regular reviews of their competence.
• Relevant and current evidence-based guidance, standards and legislation were used to develop how services, care and treatment were delivered.
• There was a multidisciplinary approach to patient care and close links between Somerset Surgical Services and the host NHS trust, Weston Area Health NHS Trust.
• Feedback from patients was positive and all those we spoke with recommended the service.
• Services were planned and provided to meet the needs of the local population who otherwise would have to travel out of the area for the procedures undertaken by the organisation.
• Patients were treated in a timely way and the surgery services were delivered well within the national 18-week target.
• People were enabled to complain or raise concerns that were listened to and acted upon.
• There was a good culture among staff at the service with strong and committed leadership.