Duchy Hospital is an independent hospital operated by Ramsay Health Care. We carried out a comprehensive inspection as part of our national programme to inspect and rate all independent hospitals. We carried out the announced part of the inspection on 11 and 12 October 2016, along with an unannounced visit to the hospital on 14 October 2016.
The hospital provided surgery, and outpatients and diagnostic imaging service to NHS patients and privately funded patients, including self-funded and medical insured. At the time of the inspection, the hospital did not provide care and treatment to patients under the age of eighteen. The surgical specialties treated were orthopaedics, spinal, urology, gynaecology, ophthalmology, oral & maxillo-facial, general surgery, gastroenterology, ENT, dermatology, cosmetic & plastic surgery. Medical specialties included cardiology, respiratory and neurology. The hospital also had an in-house physiotherapy department, X-ray & diagnostic unit and an outpatient department.
The hospital had 31 beds with 26 en-suite rooms and 12 day case beds. Facilities included three operating theatres and a day case theatre/endoscopy room, a cardiac catheter laboratory, and X-ray, outpatient and diagnostic facilities with 11 consulting rooms and two treatment rooms.
We rated the service overall as requires improvement. We rated surgery as requires improvement, and outpatients and diagnostic imaging as good. This was because we had concerns about aspects of safety at the hospital in both the surgical services, and outpatients and diagnostics services, and in the effectiveness and leadership of surgical services. We found the management of incidents, patient records, the deteriorating patient, some consent processes, resuscitation equipment, and governance processes required improvement. However, we found the service provided outstanding 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.
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.
The hospital also had a cardiac catheter laboratory where coronary angiography investigations are carried out for patients with suspected coronary heart disease. The diagnostic imaging manager was responsible for the imaging equipment in the laboratory. Therefore information about activity in the laboratory is included in the outpatients and diagnostic imaging section.
Services we rate
We rated this hospital as requires improvement overall.
We found areas of practice that require improvement in surgery services and outpatient and diagnostic imaging:
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Resuscitation equipment and storage arrangements were not safely managed.
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The management and storage of records was not effective. Records of procedures such as invasive procedures in outpatients and the administration of intravenous fluids in surgery, were not well documented.
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The safeguarding lead for the hospital was not level 3 safeguarding trained.
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Consent processes did not always follow guidelines or hospital policy.
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Governance arrangements, audit and risk management processes to monitor quality and safety within the hospital were not always effectively implemented or actions monitored.
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There was a lack of a coordinated response team for responding to medical emergencies.
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Patient leaflets and information were not available in other formats such as other languages, pictorial or braille or in large print.
In surgery:
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The management of incidents and investigations did not consistently follow the incident reporting and being open policies.
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Duty of candour was not fully implemented and did not follow hospital policy.
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The provision of cover by an anaesthetist in the 24 hours following patients’ treatment was not clear.
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Mandatory training and appraisal levels were not achieved.
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The management of the deteriorating patient was poorly understood by staff, and issues where identified during audits and investigations, were not addressed.
In outpatients and Diagnostic Imaging:
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Medical records generated by staff holding practising privileges were not always available to staff (or other providers) who may be required to provide care or treatment to the patient
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It was not clear to the staff we spoke with, who the laser protection supervisor was.
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The National Safety Standards for Invasive Procedures were not yet implemented in the main outpatients department.
However,
We found outstanding practice in relation to patient care in outpatient and diagnostic imaging:
We found good practice in relation to surgical services and outpatient and diagnostic imaging:
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The service always had enough staff to meet patients care needs and worked effectively within hospital teams, the local acute trust and ongoing services.
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Pain was managed effectively to ensure patients remained comfortable.
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Patients were well cared for and services were planned and delivered in a way that met the needs of the local population. Waiting times were minimised where possible.
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Staff spoke highly of the leadership in the organisation who were visible and approachable.
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 twelve requirement notice(s) that affected surgery and outpatient and diagnostic imaging services. Details are at the end of the report.
Name of signatory
Ted Baker Deputy Chief Inspector of Hospitals