4 and 5 December 2018
During a routine inspection
Pinehill Hospital is operated by Ramsay Health Care UK. Originally it was a large house, but has had numerous extensions. The hospital has 37 beds; this includes 25 inpatient beds over two floors and a 12-bedded day ward. Facilities include three operating theatres with individual anaesthetic rooms and a recovery area. There is one minor theatre used for endoscopies and local anaesthetic procedures. Other facilities include general x-ray, ultrasound, two outpatient treatment rooms and a physiotherapy gymnasium.
The hospital provides surgery, endoscopy, outpatients and diagnostic imaging. Services for children and young people were ceased in September 2018.
The hospital provides an inpatient and outpatient service for various specialties to both private and NHS patients. This includes, but is not limited to, orthopaedics, gynaecology, general surgery, diagnostic imaging and urology.
We inspected this service using our comprehensive inspection methodology. We carried out an unannounced (staff did not know that we were coming) inspection on 4 to 5 December 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 report.
Services we rate
Our rating of this hospital/service improved. We rated it as good overall.
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Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had completed safeguarding adult and children’s training.
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The hospital managed patient safety incidents well. All staff recognised incidents and reported them appropriately. Managers investigated incidents thoroughly and shared lessons learned with teams throughout the hospital. When things went wrong, staff apologised and gave patients honest information and suitable support. There was good awareness of Duty of Candour and this was applied appropriately. There was a culture of openness and honesty at all levels.
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Staff generally kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
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Services in the hospital provided care and treatment based on national guidance and evidence of its effectiveness.
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Staff gave patients enough food and drink to meet their needs and improve their health. The service made adjustments for patients’ religious, cultural and other preferences.
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The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
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The service had enough medical and allied health professional staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment all the time.
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Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed hospital policy and procedures when a patient could not give consent. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
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There was good multidisciplinary working across the hospital. Staff in different teams worked together to benefit patients. Doctors, nurses and other healthcare professionals, supported each other to provide good care.
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Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients were treated with dignity, respect and kindness during all interactions with staff.
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Staff provided emotional support to patients to minimise their distress.
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Staff involved patients and those close to them in decisions about their care and treatment. They were communicated with and received information in a way that they could understand.
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Hospital services were planned and developed to meet the needs of the local population for both private and NHS patients.
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The service had suitable premises and equipment. Hospital premises were clean, well maintained, and suitable equipped. There was an equipment replacement programme to ensure that all large items of equipment were replaced when they became outdated.
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The hospital took account of patients’ individual needs. Reasonable adjustments were made for patients who had additional or complex needs.
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People could access services when they needed it. Waiting times from referral to treatment for surgical procedures, and arrangements to treat and discharge patients, were in line with good practice. There was an emphasis on the importance of flexibility, choice and continuity of care across the hospital. Services were delivered at times that were suitable for patients through the provision of out of hours services, and the use of additional clinics and appointments to meet areas of high demand.
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The hospital treated concerns and complaints seriously. Managers investigated them thoroughly and made responses within agreed timescales. There was an appropriate escalation process for complaints when patients were not satisfied with the outcome of a complaints investigation. Lessons were learned from complaints and were shared widely with all staff.
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Managers at all levels in the hospital had the right skills and abilities to run services and provide high-quality sustainable care. There were named and experienced heads of department for each area. Each service lead was passionate about the service they led and worked well with the team of staff in their department.
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The hospital had a vision for what it wanted to achieve and workable plans to turn it into action. The hospital set a five-year strategy and vision from 2018 to 2021. All staff we spoke with were aware of the vision for the hospital, and understood their role in achieving it.
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Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
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The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.
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The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.
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Information needed to deliver effective care and treatment was available to relevant staff in a timely and accessible way.
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The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
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The service was committed to improving services by learning from when things went well or wrong, promoting training and innovation.
We found the following areas for improvement:
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There were inconsistencies with the completion of risk assessments post-operatively which were necessary to maintain patient safety. Not all risk assessments were reviewed post-operatively.
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We were not assured that staffing levels were always safe at night when a second ward area was opened. During the night when there were additional wards opened, safe staffing levels were not always achieved.
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Carpet was present in consultation and treatment rooms and the general waiting area in outpatients and physiotherapy, which could be an infection control risk. However, a plan was in place to remove all carpet in clinical areas in the future.
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In the diagnostic imaging service, we did not find processes in place for the management of medicines that were stored within the service. There was no stock rotation and replacement process and no pharmacy support to ensure safe management of medicines in the service.
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Although outcomes were generally monitored, we did not always see action plans in place when a service did not achieve the hospital’s standards. This meant that we could not be assured there were processes in place to address any shortfalls in compliance.
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The diagnostic imaging service did not have systems in place to routinely obtain feedback from patients in order to improve the service.
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The diagnostic imaging service did not have processes in place to monitor turnaround figures (wait times from procedure to reporting). We were not assured that they could demonstrate they were meeting their targets.
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Not all staff were aware of their service’s performance as this information in some services was not routinely shared with staff.
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Not all equipment was within date for safety testing. Electrical safety testing had expired on some equipment meaning that we could not be assured that it was safe for use.
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Although the premises and environments were kept clean, we saw that hand hygiene was not always maintained by all staff.
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Training compliance for some staff was below the hospital target.
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 notice(s) that affected the surgery core service. Details are at the end of the report.