Nuffield Health Brentwood Hospital

Updated 14 June 2017

Brentwood Hospital is operated by Nuffield Health. The hospital/service opened in 1970. It is a private hospital in Brentwood, Essex. The hospital primarily serves the communities of Brentwood,Billericay,Basildon and Romford. It also accepts patient referrals from outside this area.

The hospital had a registered manager in post since January 2016.

The hospital also offers cosmetic procedures such as dermal fillers and, ophthalmic treatments. We did not inspect these services.

Updated 14 June 2017

Brentwood Hospital is operated by Nuffield Health. The hospital/service has 42 beds. Facilities include four operating theatres (three laminar flow and one state of the art digital), one endoscopy theatre, 16 consulting rooms, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, services for children and young people, and outpatients and diagnostic imaging. We inspected all three services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 February 2017, along with an unannounced visit to the hospital on 10 March 2017.

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.

The main service provided by this hospital was surgery. Where our findings on surgery for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

Services we rate

We rated this hospital as Good overall.

• There was evidence of incident reporting, a good level of understanding of duty of candour amongst staff and actions and learning from incidents were discussed at the service’s Quality and Safety Committee meetings and Heads of Department meetings, and staff gave examples of where learning had occurred.
• For the period October 2015 – September 2016, 100 per cent of patients were risk assessed for venous thromboembolism (VTE) and there were no cases of hospital-acquired VTE.
• The pharmacy lead had recently ran a teaching session for nursing staff within the service to ensure good practice in medicines management. We were given examples of learning from these sessions such as clearer labelling of medications.
• Staff knew how to report a safeguarding concern and who the safeguarding lead for the hospital was. The safeguarding lead ran training days each month. Training included ‘Prevent’ training to help staff identify individuals at risk of radicalisation and female genital mutilation (FGM) awareness.
• mandatory training records which showed a current compliance rate of 97% overall for the whole hospital
• We observed the World Health Organization (WHO) ‘Five Steps to Safer Surgery’ checklist being undertaken, alongside record completion, both of which were completed appropriately.
• Staffing levels were assessed on a daily basis using the ‘professional judgement’ model and Nuffield Health at provider level was assessing the most appropriate acuity tool to use at the time of our inspection
• The resident medical officer (RMO) attended each nurse handover which took place three times a day, between shifts, to ensure they were informed about patient conditions and progress.
• Policies were updated in line with national guidance and best practice and shared at provider level.
• The hospital responded to audits to improve patient outcome. For example the implementation of education and training to improve post operative analgesia prescribed before discharge from recovery, which increased from 60% compliance in September 2016 to 100% compliance in February 2017.
• The hospital could access nutritionists from the community where more specialist advice or input was required.
• PROMs results from November 2016 for NHS-funded patients receiving a primary knee replacement showed the service was within the estimated range of the England average. 
• PROMs results from November 2016 for NHS-funded patients receiving a primary hip replacement showed the service was within the estimated range of the England average.
• Funding had been agreed to improve the environment of the endoscopy department.
• The service was compliant with referral to treatment (RTT) times for NHS patients admitted within 18 weeks of referral, with over 90% of patients admitted within this timeframe between October 2015 and September 2016.
• The service had a structured process in place for the medical advisory committee (MAC) and Practising privileges were routinely discussed as part of the MAC.
• The hospital had a risk register which was detailed with updates, progressions dates and actions to mitigate risks.
• Service leads displayed strong leadership and management and there was a drive to promote a positive, open and transparent culture.
• The service had recently refurbished their theatres department, including a development of a new digital theatre of which staff were proud of.

We saw several areas of outstanding practice including:

• We saw evidence of the application of “Human Factors” approach, when the hospital investigated incidents. For example we reviewed one investigation which considered the training and competency of staff as well as custom and practice, as part of the review process. 
• There was evidence of innovative work to improve and engage all staff in infection prevention and control, such as running lab experiments with staff to show the difference in bacteria levels with good hand hygiene practice, and an anti-microbial awareness week.
• In January 2017 “Think Like a Customer” (TLC), was rolled out across the hospital and was part of the Nuffield organisations aspiration to become “one Nuffield” , with an aim to improving patient experience. There was a monthly newsletter published which included results from quality indicators, complaints and net promoter score, and also reviewed feedback from patients to improve the overall patient experience.
• The hospital had a clear strategy to improve services for children and young people with evidence of progress completed in the last twelve months and with a clear progression for future developments.
• The Senior Management Team ran a number of staff engagement strategies in the hospital to improve patient experience, to engage staff and to consistently review the leadership of the service. These included the “have you say make a difference” monthly meetings, and the annual “leadership MOT” review.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 14 June 2017

Children and young people’s services were a small proportion of hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

We rated this service as good because:

• Staff completed safeguarding risk assessments and followed guidance to protect service users from harm.
• There were systems and tools in place to recognise and manage the deteriorating child or young person.
• The hospital maintained systems to keep children and young people safe in line with national guidance.
• The care and treatment for children and young people was planned and delivered using evidence based guidance and standards.
• Children and young people received care from the multidisciplinary team who worked together to achieve the best outcomes.
• Care was patient centred and individual to each child or young person’s needs.
• The emotional support for children was recognised in the care provided with distraction techniques observed during the inspection 
• All children were placed first on the theatre list as a priority to minimise waiting time for children.
• All admissions for children and young people were pre assessed by the consultant and the lead nurse.
• The hospital had a clear strategy to improve services for children and young people with evidence of progress completed in the last twelve months and with a clear progression for future developments.
• Staff confirmed their concerns raised were acted upon and an example was given regarding the adult focused rooms which now feature child friendly wall stickers.
• The hospital maintained systems and processes to promote staff and user engagement.

Updated 14 June 2017

Outpatient and diagnostic imaging services were a small proportion of hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

We rated this service as good because:

• Incidents were reported and investigated appropriately and staff could give examples of learning from incidents.
• 100% of staff had received an appraisal and completed mandatory training.
• The imaging department had implemented a pause and check process before every patient examination to ensure the delivering of safe and effective patient care as part of clinical imaging services using ionising radiation.
• There was good multidisciplinary team working and good communication between staff at all levels.
• Staff interactions with patients and visitors were friendly and respectful. Care was given with compassion and dignity.
• Patients could choose appointment times to suit their needs. The diagnostic imaging department provided a walk in x-ray service so that patients could have their x-ray in conjunction with their appointment.
• Complaints and concerns were investigated appropriately and there was evidence of learning from complaints and concerns in order to improve services.
• There was strong leadership from the service managers. Staff spoke highly of their managers. Managers promoted a positive team culture that created a “lovely place to work”. Managers worked hard to make the department an effective and safe place for patients, visitors and staff.

Updated 14 June 2017

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

We rated surgery as good overall because:

• Incidents were reported and investigated appropriately and staff could give examples of learning from incidents.
• There was evidence of innovative work to improve and engage all staff in infection prevention and control, such as running lab experiments with staff to show the difference in bacteria levels with good hand hygiene practice, and an anti-microbial awareness week.
• The pharmacy lead had recently run a teaching session for nursing staff within the service to ensure good practice in medicines management. We were given examples of learning from this session such as clearer labelling.
• Both nursing and medical staffing levels were appropriate to meet patient need.
• Policies were updated in line with national guidance and best practice and staff were aware of any updates or new policies and procedures.
• The ward ran teaching sessions for nursing staff every Tuesday on different topics to maintain and develop staff competencies.
• There was effective multidisciplinary team working to maximise patient outcomes, with good communication between staff at all levels.
• Staff displayed compassionate care and patients and families were involved in their own care.
• Services were planned and delivered to meet individual patient needs, including assessment of medical, social, psychological and physical needs.
• Complaints and concerns were investigated appropriately and there was evidence of learning from complaints and concerns in order to improve services.
• Service leads displayed strong leadership and management and there was a drive to promote a positive, open and transparent culture. Staff described the culture as “supportive” and “like family”.