Renacres Hospital

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