Ashtead Hospital

Updated 21 May 2018

Ashtead Hospital is operated by Ramsay Health Care UK Operations Ltd and opened in 1984. It is a private hospital in Ashtead, Surrey. Accepting referrals from local GPs and consultants as well as the NHS, the hospital serves the local communities of Leatherhead, Ashtead, Epsom, Banstead, Oxshott, Cobham and Dorking, in addition to the wider community of Surrey and South West London.

The hospital carries out a variety of procedures including general and minimal access surgery (surgery completed with one or more small incisions instead of a large incision), gynaecology, urology, orthopaedics, dental, ear nose and throat and endoscopic procedures.

The registered manager has been in post since July 2016.

Ashtead Hospital took the decision in August 2016 not to have children and young people (CYP) as hospital inpatients. At the time of our inspection in December 2016, the outpatients department continued to see a small number of children and young people for blood tests and minor procedures under local anaesthetic.

During our inspection (report published in 2017), we reviewed three core services, which incorporated all the activity undertaken at the hospital. These were surgery, children and young people (CYP) and outpatients (including diagnostic imaging).

At the time, we rated the score for the hospital as ‘good’, although we found improvements were required in some areas to minimise risks and promote safety. Surgery was rated as ‘good’ in all domains and ‘good’ overall. Children and Young people services rated as ‘requires improvement’ in three domains and ‘requires improvement’ overall. Outpatients rated as ‘requires improvement’ in one domain and ‘good’ overall.

We told the hospital they must take the following actions to meet the regulations:

• Ensure all staff have undertaken mandatory training.
• Ensure governance strategies and processes are embedded throughout the hospital.
• Ensure patient records in outpatients and the children and young people’s services are complete and comply with Ramsay policy.

In addition, we told the hospital it should take the following actions to improve:

• Ensure that staff throughout the hospital have the required level of safeguarding including updates as required and that safeguarding systems are fully embedded.
• Address any continued risk of sharps injuries to patients and staff in the outpatients’ service.
• Ensure information about making complaints is available to patients in outpatient departments’ public areas.
• Ensure that necessary improvements are made when things go wrong and learning is taken from incidents occurring in the outpatient service.
• Ensure bin labels within the outpatient departments clearly identify the waste type(s) present within.
• Ensure all sinks in the outpatients’ service are compliant with the Health and Safety Executive regulations.
• Ensure a methodology for measuring and recording patient pain levels is used and embedded across the outpatient department.

The hospital rapidly responded with a comprehensive action plan and updated us on progress as they resolved the issues identified.

We scheduled a return visit to review the results of the plan and related initiatives the hospital had completed.

Updated 21 May 2018

Ashtead Hospital is operated by Ramsay Health Care UK Operations Ltd. The hospital has 29 ensuite patient rooms, a two bedded extended recovery area and 13 ambulatory care pods, of which four have ensuite WCs. Facilities include three laminar flow operating theatres (a system that circulates filtered air to reduce the risk of airborne contamination), an in-house Theatre Sterile Services Unit alongside the theatre suite, used to clean and sterilise all the hospital’s surgical instruments and their sister hospital’s instruments, and a five bedded recovery area. There is a dedicated Joint Advisory Group (JAG) accredited endoscopy unit with its own recovery area, 13 consulting rooms within the outpatient unit and seven designated treatment rooms within the physiotherapy department. The diagnostic imaging department includes X-ray, MRI and CT.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery, outpatients and services for children and young people. Medical care services are reported under the surgery section. Services for children and young people were limited to outpatients and represented 3% of the hospital’s total activity, with most aged 0 – 15 and a small proportion aged 16-17.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 – 14 December 2016.

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. Although some elements of the children and young people’s service required improvement, the overall standard of service provided throughout the hospital was largely good. Since the children and young people’s service represented only 3% of the hospital’s total activity, we have deviated from our usual aggregation of key question ratings to rate this service in a way that properly reflects our findings and is reflective of a proportionate judgment.

We found good practice in relation to surgery:

• Openness and transparency about safety was encouraged. Staff understood their responsibilities in relation to incident reporting. Staffing levels and skill mix were planned and reviewed to keep people safe at all times.

• Decision making about the care and treatment of a patient was clearly documented and record keeping was comprehensive.Staff planned and delivered patient care in line with current evidence-based guidance, standards, best practice and legislation and staff adhered to infection control policies and protocols.

• There was an effective system in place to ensure the monitoring, storage and availability of medicines.

We found good practice in relation to outpatient care:

• There were clearly defined systems, processes and standard operating procedures to provide safe care and respond in emergencies. Staff had a good understanding of how and when to report incidents and reflected that they understood the duty of candour and knew when to apply it.

• Staff worked collaboratively to share best practices and meet the patients’ needs. We saw multi-disciplinary working across departments and with other Ramsay Hospitals.

• The care provided to patients was consistently compassionate, with staff listening to patients’ concerns and responding in a way that reflected they understood and acknowledged the patient’s medical, personal and social needs.

• Services were planned and delivered to meet local needs with appointments available at a range of times to accommodate patient choice.

We found areas of practice that require improvement in services for children and young people:

• A new system of record keeping for children and young people meant that insufficient information was kept on file to provide a full record of the patient’s treatment.

• There was a lack of audits relating to children and young people attending the service which meant there was no effective way of monitoring patient clinical outcomes other than patient feedback.

We found areas of practice that required improvement in outpatients and diagnostic imaging:

• Patient records were not always complete and sometimes excluded consultant’s names, patient condition and treatment. In some cases, the consultant kept original copies of patient records.

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 Outpatients and the Children and Young people’s services. Details are at the end of the report.

Professor Edward Baker

Deputy Chief Inspector of Hospitals

Updated 6 July 2017

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

We rated this service as requires improvement because safe, effective, and leadership required improvement, although the service was rated as good for responsive. There was insufficient evidence to rate this service for caring.

Updated 6 July 2017

Outpatients and diagnostic imaging 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 it was caring and responsive, although it required improvement for safe.

Updated 6 July 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 this service as good because it was safe, effective, caring, responsive and well-led.