Ashtead Hospital

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