Duchy Hospital

Updated 2 August 2022

The main service provided by this hospital was surgery for a mixture of NHS and privately funded patients. 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 service.

The hospital has 30 beds, 29 beds were available for use at time of inspection with 26 ensuite rooms and 12-day case beds. Facilities include, physiotherapy department, three operating theatres, a day case theatre, endoscopy room, a cardiac catheter laboratory, x ray, outpatient and diagnostic facilities with 11 consulting rooms and two treatment rooms.

During the year from 1st April 2021 to 31st March 2022, 5,112 patients received treatment of which, 2,285 were NHS patients (45%). Of the overall total, 3,392 (66%) were treated as day cases.

The hospital had no never events over the past year, but had reported seven serious incidents.

Between February 2021 and February 2022, the hospital reported it carried out the following number of procedures;

Nine ear, nose and throat procedures, 161 general surgery procedures , 12 Gastroenterology , 44 Gynecology , 128 Ophthalmology, eight Oral and Maxilla Facial , 157 Plastic Surgery , 46 Spinal, 496 Orthopedic, 83 Urology, 21 Vascular, 67 Cardiology.

Updated 2 August 2022

We carried out this unannounced comprehensive inspection on 10 and 11 May 2022.

Ramsay Duchy Hospital is an independent hospital that provides, care to patients in the South West of England.

The hospital has a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered person. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service is registered to provide the following regulated activities:

• Diagnostic and screening procedures.
• Family planning services.
• Surgical procedures.
• Treatment of disease, disorder or injury.

The hospital was last inspected 11, 12 and 14 October 2016 and was rated as requires improvement overall with requires improvement in Safe and Well Led. We rated all key questions for diagnostic and imaging services apart from effective as defined within our methodology.

Our previous rating included a joint rating of outpatients and diagnostic and imaging screening services, we have rated them independently as part of this inspection.

We inspected and rated the following services during this inspection:

• Surgery
• Outpatients
• Diagnostic imaging and screening procedures.

Surgery services include:

Trauma and Orthopaedic surgery, Cosmetic/Plastic Surgery, General Surgery, Ophthalmology, Gynaecology, Urology, Gastroenterology, Colorectal, Cardiology, Bariatric, ENT, Dermatology

Our rating of the location improved. We rated it as good overall because:

Surgery has been rated as good overall.

Diagnostics and screening procedures have been rated as good overall.

Outpatients has been rated as good overall.

Updated 2 August 2022

We rated all key questions for diagnostic and imaging services apart from effective as defined within our methodology.

Our previous rating included a joint rating of outpatients and diagnostic and imaging screening services, we have rated them independently as part of this inspection.

We did not inspect the cardiac catheter labs during this inspection as this fell within the surgery core service and was not part of this inspection.

Our rating of diagnostic imaging and screening procedures improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service. However, not all staff were up to date with mandatory training.
• Staff provided good care to patients and monitored their pain. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for a diagnostic procedure.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 2 August 2022

The outpatient’s department had a total number of 42,747 appointment visits during the period May 2021 to April 2022 of which 13,816 were NHS appointments. The service treated adults and did not treat children. The service carried out a range of consultant led outpatient services which included dermatology, cosmetic surgery, gynaecology, orthopaedics, ophthalmology and general surgery.

This was the first inspection of outpatients as a stand alone service. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Services were available six days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and waiting times for treatment were reasonable.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service was behind in its cubicle curtain changing schedule and some curtains had not been changed within a six month period.
• The service had a significant amount of ophthalmic equipment stored in one consulting room which was a health and safety trip hazard issue for patients, staff and visitors using the room. This was mitigated by staff escorting patients in and out of the room.
• Access to keys for medicines was not limited to authorised personnel.
• The temperature of medicines stored in fridges were monitored by staff. However, it was not escalated when deviations in the fridge temperatures occurred. This may have caused some of the medicines to be ineffective.
• The service could not identify the number of cancelled outpatients appointments as any changes to appointments on the system such as the patient requesting another date was recorded as a cancellation. This made it difficult to check the number of cancellations that were as a result of the service’s own shortfalls.
• Staff were not aware of the requirement to have a sign on the door indicating when laser treatment was occurring in the ophthalmology room.

Updated 2 August 2022

The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated effective, caring, responsive and well led as good. Safe was rated as required improvement.

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Staff did not secure medicines properly. The staff reported the environment occasionally exceeding the manufacturers recommended temperatures for the storage of medicines. Records for temperature and medicines were not always complete.
• Infection control was not always effectively managed with damaged equipment and potentially hazardous articles left in clean areas. Some areas appeared cluttered.
• A staff member was observed inserting a cannula while not using the correct aseptic technique. A soiled ruck sack was found in a clinical area.