Fulwood Hall Hospital

Updated 6 December 2018

Fulwood Hall Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital opened in 1986. It is a private hospital in Preston, Lancashire. The hospital primarily serves the communities of Preston and Lancashire. It also accepts patient referrals from outside this area.

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

Fulwood Hall Hospital provided a range of surgical procedures and outpatient services for patients aged 18 and over, including orthopaedic surgery; neurosurgery; general surgery; ear, nose and throat; gastroenterology, gynaecology; neurology; ophthalmology; vascular surgery; colorectal surgery; and urology.

The hospital also offers a range of diagnostic imaging, including plain X-rays; dental X-rays; fluoroscopy imaging; arthrography; general ultrasound scanning and ultrasound guided injections; urodynamic testing and barium swallow investigations.

The hospital also offers cosmetic procedures such as dermal fillers and laser hair removal, ophthalmic treatments and cosmetic dentistry. We did not inspect and do not regulate these services.

Updated 6 December 2018

Fulwood Hall Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital/service has 29 inpatient and twelve day case beds. Facilities include three main operating theatres with laminar flow; an endoscopy/ minor operations unit; X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, outpatients and diagnostic imaging services. We inspected surgery, outpatients and diagnostic imaging services.

We inspected this service using our next phase inspection methodology. We carried out the inspection with an unannounced visit to the hospital on 14 and 15 August 2018.

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 service level.

Services we rate

Our rating of this hospital stayed the same. We rated it as good overall. We found practice was good in relation to care in surgery, outpatients and diagnostic imaging services:

• The provider managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
• The hospital provided mandatory training for all staff and completion rates were high; this was up to date at the time of inspection.
• Staff were aware of hospital safeguarding procedures and followed these correctly.
• Staff were aware of the types of incident which could occur and reported these if they occurred. There was a good culture of incident reporting and learning was shared following this.
• Staff followed evidence-based care pathways for specific conditions; policies and procedures were developed on national guidance.
• Seven-day services were available in case of emergencies and for responding to concerns.
• Staff worked well together in multidisciplinary team approach to meet patients’ needs.
• The service responded well to different patient needs and had well established systems for supporting patients living with dementia or a learning disability.
• Leaders were visible and there was an open and positive culture amongst staff. The hospital had developed a clear vision and strategy in engagement with staff.
• There was a clear governance system in place and this had been reviewed and strengthened since our last inspection.
• The hospital engaged well with patients, staff, the public and local organisations to plan and manage services appropriately, and collaborated with partner organisations effectively.

However

• Surgical safety and other theatre checklists were not always being carried out in accordance with recognised best practice guidelines. The service did not always control infection risk well and we saw equipment and environmental defects which could present an infection control risk.
• Managers did not always ensure staff received annual appraisals. Appraisal rates in outpatients were poor and had been low in surgery.
• Pain scoring tools were used routinely in the physiotherapy department but not used consistently in the outpatient departments to manage patients’ pain levels.

We found areas of outstanding practice in surgery, outpatient and diagnostic care, including

• Development of a working group for supporting patients who had autism.
• A focus on safety culture, with implementation of a ‘Speak up for Safety’ initiative and provision of human factors training for all staff.
• Opportunities for staff development, and access to learning support funding for this, through Ramsay Healthcare.

We found areas of practice that require improvement in surgery and diagnostic imaging services, for

• Improving practice in World Health Organisation (WHO) checklists.
• Maintaining robust systems for cleaning radiology equipment used in theatres.

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 two requirement notices that affected surgery and diagnostic imaging services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North West)

Updated 6 December 2018

Diagnostic imaging services were available to consultants with practising privileges who were authorised as referrers

We rated this service as good because it was caring, responsive and well-led, although it requires improvement for being safe.

We inspected but did not rate effective.

Updated 6 December 2018

Outpatient services were available for consultants with practising privileges to refer patients.

We rated this service as good because it was safe, caring, responsive and well-led.

We inspected but did not rate effective.

Updated 6 December 2018

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 caring, effective, responsive and well-led, although it requires improvement for being safe