Mount Stuart Hospital

Updated 10 October 2019

Mount Stuart Hospital is an independent hospital which is part of the Ramsay Healthcare UK Operations Limited. The hospital is in Torquay and opened in 1984. It treats NHS patients and privately funded adult patients, who are either self-funded or medically insured. The hospital has three outreach clinics which are for consultation only. These are staffed by surgeons with practicing privileges.

The registered manager for Mount Stuart Hospital is the hospital director, who has been in post since December 2009. The accountable officer for controlled drugs is the head of clinical services (matron).

Updated 10 October 2019

Mount Stuart Hospital is operated by Ramsay Health Care.

This inspection was a follow-up to our 2016 inspection and we only looked at areas previously found to need action.

We carried out a comprehensive announced inspection of Mount Stuart Hospital on 6 and 7 September 2016, and an unannounced inspection on 15 September 2016. We found that safety, effectiveness and well-led had areas for improvement and breaches were found under four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. An extensive action plan was provided by the service to meet those areas and it is recognised that significant improvements have been made.

We inspected surgery and outpatients under the domains of safe, effective and well-led. We did not inspect any elements of caring or responsive.

Surgery, and outpatient and diagnostic services are provided at the hospital. Day case and inpatient surgery specialities included general surgery, major and minor orthopaedic surgery, ophthalmology, ear nose and throat surgery, gynaecology, urology, dermatology, endoscopy and cosmetic surgery.

The hospital has 26 single room inpatient beds of which 23 are currently in use and 12 ambulatory care spaces. There are three main operating theatres each with air flow systems suitable for their use, one day case theatre, and a recovery area.

Outpatient and diagnostic services are delivered in consulting rooms and include orthopaedics, general surgery, gynaecology and obstetrics, cosmetic surgery, ear nose and throat, urology, oral and maxilla, ophthalmology, gastroenterology, dermatology, and facial surgery.

Diagnostic imaging services include plain x-ray, ultrasound, and fluoroscopy, magnetic resonance imaging (MRI) and computed tomography (CT) is provided from a mobile unit. There was a private physiotherapy service for outpatient and inpatient services. Non-surgical cosmetic treatments are delivered by the cosmetic suit.

We inspected this service using our inspection methodology. We carried out an unannounced visit to the hospital on the 25 and 26 June 2018.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We rated this hospital/service as good overall.

• Staff were suitably skilled to meet the needs of the patients. Mandatory training was provided for all staff and monitored to ensure all staff remained suitably skilled and updated. Staffing was planned and managed to ensure sufficient staff were available. Staff were appraised to ensure they had the skills, knowledge and experience to deliver effective care.
• Systems were followed to ensure cleanliness of the departments and promote infection control. The arrangements for managing waste in the hospital environment kept people safe. The systems and processes to manage the environment and equipment kept patients safe.
• Patients were suitably assessed and systems were provided to respond to risks to ensure patient safety. Risk assessments were completed to measure and manage patient risks. The safeguarding systems and processes ensured patient safety.
• Care and treatment was provided using best practice standards and evidence based guidance. Management of medicines was safe. The nutritional needs of patients were reviewed, assessed, monitored and met and patients’ pain was assessed and managed to ensure patients were comfortable.
• The outcomes of patients’ care and treatment were collected and monitored to measure the quality of the service provided. Incidents were recorded and reviewed to provide learning and prevent reoccurrence.
• Staff worked well between departments and with external services. Patient records were well maintained and stored securely.
• Consent was appropriately sought for each aspect of care and treatment.
• We saw leadership of each department was well organised and proactive. The senior staff had developed a local vision to complement the corporate vision and strategy.
• There were clear governance processes to monitor the service provided. Risks and audits were used to prompt remedial action and change practices to improve the service.

However, we also found the following issues the service provider needs to improve:

• The lack of permanent theatre staff impacted on procedures being undertaken. The fragility of theatre staffing had a direct impact on patients as procedures sometimes had to be cancelled.
• Cosmetic surgery practice was not monitored to ensure practice was in line with the Professional Standards for Cosmetic Practice – Cosmetics Surgical Practice Working Party, Royal College of Surgeons (RCS) Professional Standards.
• The matron had the responsibility to decide which incidents had an investigation. This response was not formalised to ensure a standardised approach was taken.
• There continued to be no assurance to confirm the photographs taken by consultants on their own cameras were held securely and images were deleted from the device or memory card immediately after they had been printed or sent to the patient.
• On call arrangements were not well organised to ensure patient safety and clear decision making processes
• The risk register recorded risks and action which were not all addressed in a timely manner.
• The staff survey results for 2018 showed that some areas of senior and corporate management scored poorly.

Following this inspection, we told the provider it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)

Updated 8 October 2018

The outpatients and diagnostic services worked with the surgical services to provide pre assessment and diagnostic review. Physiotherapy services also provided post-operative support.

We rated this service as good for safe and well-led. We do not rate effective for outpatient services. We did not inspect caring or responsive.

Updated 8 October 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 for safe, effective, and requires improvement for well-led. We did not inspect caring or responsive.