Archived: Bodmin Treatment Centre

Bodmin Treatment Centre is an independent treatment centre operated by Ramsay Health Care UK Operations Limited. We carried out a comprehensive inspection as part of our national programme to inspect and rate all independent hospitals. We carried out the announced inspection on 12 and 13 October 2016.

The treatment centre provides surgery and outpatients to NHS patients and privately funded patients, including self-funded and medical insured. The day surgery unit offers procedures in orthopaedic, general surgery, ears nose and throat (ENT), gynaecology, maxillofacial / oral, ophthalmic and urology. The day surgery unit has two theatres and one recovery area. The recovery area is located at the end of corridor close to both theatres and can accommodate up to five patients. The treatment centre does not operate on children only adults (18 and above) and has no overnight beds. The outpatient department has five consulting rooms and a minor procedure room.

We rated the service overall as requires improvement. We rated surgery and outpatients as requires improvement. This was because we had concerns about aspects of safety and leadership in surgery and outpatients services. We found the management of incidents and governance processes were inadequate. However, we found the service provided good care for its patients and those close to them, and services were planned and delivered in a way that met the needs of the local people.

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.

Services we rate

We rated this hospital as requires improvement overall.

We found areas of practice that require improvement in surgery services and outpatients:

• Not all incidents were being reported via the providers reporting system. Therefore, incidents were not properly investigated and actions taken to minimise any risks and analysis of trends to prevent reoccurrence were not in place.

• There was no guidance on quality standards for sepsis screening and management pertinent to Bodmin Treatment Centre.

• The procedure for emergency calls for collapsed patients was not specific enough and staff were not identified as to whom would attended.

• Staff did not have a clear understanding of risks, as there was no departmental or detailed local risk register to allow risks to be recorded, escalated and managed locally.

• A corporate audit programme was in place but actions to improve results and performance were not implemented effectively and rarely followed through.

• Governance arrangements did not always identify areas of concern or risk.

• Some senior management were not always visible and/or accessible to staff.

• There was formal engagement with staff but they felt unable to give their views on the service provided due to time constraints.

• Staff had not received specific training on caring for patients living with dementia.

In surgery:

• The endoscopy unit in theatre two did not meet the requirements for Joint Advisory Group (JAG) accreditation. JAG accreditation is the formal validation that an endoscopy service has demonstrated it delivers against a range of quality improvement and assessment measures. The unit was not validated because the recovery area did not meet the requirements for privacy. Plans had been submitted to address this and they were awaiting a response at the time of our inspection.

• Staff were not following all National Institute for Health and Care Excellence (NICE) guidance as required, especially relating to recording of patients temperature pre, during and post operations. There was no documented evidence to demonstrate if all staff were following NICE guidance.

In outpatients:

• Out of date medication found in the outpatient department.

• Medical equipment inside the resuscitation trolley on the outpatient department was outside its use by date.

• Infection and prevention controls were not adhered to by all staff.

• Guidance on the cleaning of specialist equipment was not always adhered to.

• Leak testing of nasopharyngeal endoscopes was not performed between each patient use, which was a requirement in line with guidance for decontamination, Health Technical Memorandum 01/06 part E testing.

• Staff were not always following medication management policy.

• Resuscitation procedures were not formalised and scenarios within the outpatient department were not practiced. There was no evidence that results from audits were being used to highlight areas for improvement within the department.

• There was a lack of communication between senior management and the outpatient department as incidents and learning outcomes were not always shared internally.

However,

We found outstanding practice in relation to patient care in surgery services:

• They exceeded the England average scores in the Patient Led assessments of care environment (PLACE).

• Patient Reported Outcome Measures (PROMs) data for groin hernia repairs also exceeded the England average.

We found good practice in relation to surgery services and outpatients:

• There were no hospital-acquired infections from July 2015 to June 2016.

• All staff that we spoke with understood the principles of duty of candour.

• Patient records were stored securely and completed in full.

• All staff were up to date with their mandatory training.

• All care and treatment was consultant led and delivered.

• The compliance rate for yearly staff appraisals was high.

• Staff had access to all information needed to meet the needs of patients during their treatment.

• Patients were treated with kindness, dignity and respect.

• The vast majority of comments from patients were very positive and they had good results from the NHS Friends and Family Test (NHS FFT).

• Patients were encouraged to be actively involved in the decision making process regarding their care and proposed operation/procedure.

• Information about their condition, treatment and operation/procedure was shared with the patient so they were aware of the benefits and any potential risks.

• Staff demonstrated good communication to patients.

• Information about the needs of the local population was used to inform how services were planned and delivered and they worked in partnership with the local commissioners.

• Complaints were reviewed and investigated in line with policy and shared at relevant committee meetings and lessons learnt disseminated.

• Staff were highly positive about their department manager and the some of the hospital management team.

• Senior local leadership within the hospital were visible, approachable and supportive.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices that affected surgery and outpatient services. Details are at the end of the report.

Name of signatory

Ted Baker

Deputy Chief Inspector of Hospitals