Renacres Hospital

Updated 28 December 2016

Renacres independent hospital is part of Ramsay Health Care UK, who are the fourth biggest provider of independent health in the world. There are a number of Ramsay hospitals in the United Kingdom and three in the local area

The hospital has a ward area with 23 inpatient beds and an additional six mixed use beds for day cases or inpatients. We inspected the OPD and radiology services in the hospital but we didn’t inspect the mobile magnetic resonance imaging (MR) and computerised tomography (CT) scanning service because it was registered and provided by another provider. The inspection was part of our ongoing programme of comprehensive independent health care inspections.

The hospital has a rural location and is close to Southport which has an ageing population. Southport has a district general hospital. There is a low black minority ethnic (BME) population most of who are Eastern European who work in the service industry and agriculture. It is also close to Skelmersdale which is an area of deprivation. Skelmersdale has a walk in centre .There is also a low BME population in Skelmersdale.

The registered manager had only been in post for five weeks at the time of the inspection but the previous registered manager was present for the duration of the inspection. She has moved to another Ramsay hospital in the area.

Updated 28 December 2016

Renacres hospital is an independent hospital, based in a rural location near Southport and is part of Ramsay Health Care UK. Renacres hospital is registered to provide the following regulated activities:

• Diagnostic and screening procedures.

• Surgical procedures

• Family planning services

• Treatment of disease, disorder or injury.

Our key findings were as follows:

• Safety Thermometer information between June 2015 and June 2016 showed there were no pressure ulcers, falls with harm or catheter urinary tract infections reported by the hospital relating to surgical services.

• Systems were in place to protect people from healthcare associated infections. There had been no cases of MRSA or clostridium difficile at the hospital. There was a lead nurse for infection control that was given protected time in her job role. There were monthly infection prevention audits and hand washing audits

• Staffing levels were good at the hospital and sickness levels were low. Use of agency staff was low as there was a bank of existing staff that were happy to work additional hours. There was a corporate workforce policy, though senior managers felt that it needed to be strengthened to retain and recruit nursing staff. The Ramsay group was looking at international recruitment for nurses. However, skill mix was not always appropriately used at the hospital. In theatre some of the health care assistants had been trained as first scrub assistants but elsewhere in the hospital there were fewer opportunities. On the ward, trained nurses were cleaning equipment and in the OPD blood was taken by trained nurses. These tasks could be delegated to lower banded staff following appropriate training and competency assessment.

• Mandatory training levels were good; the hospital informed us that all eligible staff had completed their training. We were shown a completed training matrix for staff and signing in sheets for the face to face sessions.

• The (resident medical officer) RMO was available 24 hours a day seven days a week and had full access to the consultant surgeon and anaesthetists details. Nursing staff said that they worked well with the RMO but if they had concerns they would contact the consultants directly.

• There were robust systems in place to ensure that information was communicated with the patients GP.

• There was a clear patient exclusion criteria to identify patients who were not suitable for surgery at Renacres hospital.

• The hospital had a ‘management of patient complaints’ policy in place. The rate of complaints received was lower than other independent hospitals. No complaints progressed to the Ombudsman or to ISCAS (Independent Healthcare Sector Complaints Adjudication Service), or were received by CQC in this period.

• There was a corporate risk register. The current register recorded 10 risks; six of which related to financial risks. The remainder included a number of risks that were not relevant or of very low risk to Renacres hospital. The risk registers were an agenda item on the health and safety committee, which was not attended by the MAC chair; this meant that there was no clinical ownership of risk. Risks were reviewed annually. There were risk registers for clinical areas, some of these had review dates and actions and others did not. Risks were reviewed at the health and safety meetings and did not feed into the corporate risk register.

• There was a policy in place for the granting of admitting rights and/or practising privileges to health care professionals. Compliance with the policy was mandatory for all consultants, staff and accredited healthcare professionals and approval needed to be granted at a local and national level. Consultants could only practice at the hospital what they practiced in the NHS and the MAC chair would look at the number of procedures that had been carried out in the NHS and the training logs of the consultants, he would also look at local data available on the consultants e.g. complication rates and infection rates

• Consultants had to provide evidence of revalidation and indemnity insurance. If they did not, payments were withheld The MAC chair was about to start the appraisal training so that he could undertake consultant appraisals.

• Some of the consultants did not work in the NHS, including the MAC chair; he discussed the robust processes for revalidation and appraisals. Although the hospital were keen to recruit new consultants, the MAC chair said that he would be comfortable refusing a potential new consultant practising privileges if necessary.

• The MAC chair audited consultants practice and could benchmark this against other consultants in the Ramsay group and identify individual consultants who were outliers. He was proud of his service and the level of governance at the hospital.

• The hospital had a responding to concerns about a doctor’s practice policy in place. It set out the actions to be taken when concerns were raised about any GMC registered doctor in the hospital. The policy did not set out any details about informing other local healthcare providers about the concerns but the MAC chair said that he would always write to the medical director of the employing trust outlining his concerns if there were any issues about a doctor and he gave us a specific example where this had happened.

• Staff could be nominated for customer service excellence awards, these were for staff who had gone the extra mile in their work, we saw three nominations for staff working at Renacres.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 28 December 2016

People who used the services were protected from abuse and avoidable harm and staff were aware of the processes and reporting systems for recording incidents and safeguarding concerns. Staffing levels were sufficient to provide care in a safe way and staff appropriately responded to changing risks. Hygiene and infection control practices were followed. Patient records were held securely.

The care and treatment provided to people was evidence based and in line with relevant standards and legislation, including National Institute for Health and Care Excellence (NICE) and professional organisational guidelines.

Staff provided care and treatment to people who used the services in a caring and compassionate way and people were involved in decisions about their care. Translation services were available to people as necessary

The hospital planned the services to meet the needs of the local population. Waiting times for initial assessment, and treatment, following referral were low, and the services met the waiting time targets. Staff treated people as individuals, and made appropriate adjustments as necessary.

There was a robust governance framework and strong management and leadership within the hospital. A comprehensive audit programme and a risk register were in place.

There was good staff engagement within the services and staff felt supported by the management team.

Updated 28 December 2016

Patient safety at the hospital was monitored, incidents were reported and the learning from incidents was used to improve patient care. Staffing levels met the patients’ needs and there was good multi-disciplinary team working. Medicines were stored safely and the environment was clean and records were stored securely.

Patients received care and treatment according to national guidelines such as National Institute for Health and Clinical Excellence (NICE) and the Royal Colleges. Surgery services participated in national audits.

Patients spoke positively about their care and all patients were treated with privacy and dignity.

The hospital was meeting national targets for referral to treatment times and processes were in place to support vulnerable patients. Complaints were dealt with efficiently.

Governance structures were good and there was effective teamwork with visible leadership within the services. Staff were positive about the culture within the surgical services and the level of support they received from their managers.