Rivers Hospital

Updated 25 March 2019

Rivers Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital opened in 1992. It is a private hospital in Sawbridgeworth, Hertfordshire. The hospital primarily serves the communities of the Hertfordshire. It also accepts patient referrals from outside this area.

The hospital had a registered manager, who had been in post since July 2018.

The hospital provides outpatient consultations to both adults and children. The outpatient department comprises 17 consulting rooms together with three treatment rooms which are used for minor procedures. The hospital offers imaging and physiotherapy services in addition to a pharmacy department providing services for both inpatients and outpatients

All wards and departments are situated on the ground floor of the hospital. The operating facilities include five theatres and an endoscopy suite. All of the theatres have laminar flow.

There are 248 consultants working under practising privileges; and two anaesthetists employed by the hospital. There were 46.7 nursing and staff and 26.5 operating department and health care assistant staff across all departments. In addition, there were 68.7 health professionals, administrative and clerical and support staff who were shared across the hospital services and who were employed by the hospital.

All patients are admitted and treated under the direct care of a consultant and medical care is supported 24 hours a day by an onsite resident medical officer (RMO). Patients are cared for and supported by registered nurses, care assistants, allied health professionals such as physiotherapists and pharmacists who are employed by the hospital.

The hospital is managed by Ramsay Healthcare UK Operations Ltd; part of a network of over 30 hospitals and day surgery facilities and two neurological rehabilitation homes, across England. In addition, they own and run hospitals in Australia, Indonesia and France.

The hospital provides care for private patients who are ether paid for by their insurance companies or are self-funding. Patients funded by the NHS (approximately 60%), mostly through the NHS referral system can also be treated at Rivers Hospital.

The hospital undertakes a range of surgical procedures and treats adults and children. The hospital also offers cosmetic procedures such as dermal fillers and laser hair removal, ophthalmic treatments and cosmetic dentistry. We did not inspect these services.

The hospital was previously inspected in June and July 2016, when safe, caring and responsive were rated as good and effective and well led rated as requires improvement. The hospital had the overall rating of requires improvement.

Updated 25 March 2019

Rivers Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital has 49 beds. Facilities include five operating theatres and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people (CYP), and outpatients and diagnostic imaging. We inspected all core services.

We inspected this service using our comprehensive inspection methodology. We carried out the short notice inspection on the 17,18 and 19 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.

Services we rate

Our rating of this hospital improved. We rated Medicine, Surgery, Outpatients and Diagnostic Imaging as good and children and young people’s services as outstanding. The hospital was rated as Good overall.

• The hospital provided staff with appropriate training to enable them to complete their roles and responsibilities.
• The hospital premises were visibly clean and well maintained. Surgical, outpatient, diagnostic and children and young people services managed infection control risks well.
• Equipment was well maintained and replaced as necessary.
• There were systems in place to support staff to assess patients’ risks to ensure the safe provision of care and treatment.
• The service 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.
• Medicines were stored, prescribed and managed safely.
• Safety incidents were managed using an effective system. There were processes in place to ensure shared learning.
• Staff were able to identify potential harm to patients and understood how to protect them from abuse. Services knew how to escalate concerns.
• The hospital provided staff with policies, protocols and procedures which were based on national guidance.
• Staff ensured that patients were provided with adequate food and hydration, offering varied diets to meet nutritional or religious preferences.
• Staff competency was assured through monitoring and regular appraisals.
• Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Patients were supported to make decisions and were kept informed of treatment options. Staff treated patients with dignity and respect.
• Services were planned to meet the needs of the patients, with additional support available for patients who had additional needs.
• Services provided by the hospital were flexible to meet the needs of patients, enabling additional clinics, appointments or out of-hour services as able. Waiting times from treatment and arrangements to admit, treat and discharge patients were in line with good practice.
• Complaints were taken seriously, with concerns being investigated and responses made within agreed timescales. Staff shared learning from complaints and encouraged patients to identify areas for improvement.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality child-centred care.
• Managers and leaders were appropriately skilled and knowledgeable to manage teams and services. Leaders were accessible and respected by staff.
• Managers promoted a positive culture which supported and valued staff, creating a sense of common purpose based on shared values.
• There was a hospital vision and strategy which was developed in collaboration with the clinical team and reflected a focus on patients and staff.
• The service had processes in place to monitor performance and used these to encourage staff to provide high standards of clinical care and treatment.

We found areas of outstanding practice in children and young people services:

• Parents’ and children were extremely positive about the care and treatment they received. Feedback on the care, compassion and quality of the children and young people’s services were unanimous in their praise for “for all aspects of the children’s service”. Six parents and two children who had experienced the day surgery pathway rated the service as ten out of ten and said, the service ‘could not have been any better’.
• We were told nurses, consultants and support staff were always friendly and welcoming to children and their families and were skilled in communicating with children and young people which helped to minimise their distress. We saw examples where staff had gone the ‘extra mile’ to adapt the service in a safe but personalised way to better meet the needs of children and young people and their families.
• Staff involved children and their families at pre-assessment clinics where they were shown the type of equipment that would be used during their admission to hospital. For example, syringes, cannulas and blood pressure cuffs. Younger children had the equipment demonstrated on toys and were able to familiarise themselves with the equipment through play.
• Children and young people services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
• Feedback from children and parents rated children’s services as being between 95% and 100% for all aspects of care including, overall rating of care 100%, being looked after 100%, and the care by nurses, doctors and physiotherapists was rated between 94% and 100%.
• Areas used were dedicated solely for the use of children and had been adapted where possible to make them more appropriate for any age of child. For example, beds for children and young people had special bed linen and activities were provided to entertain and distract children of all ages.
• Children and young people had short waiting times prior to consultations or appointments.
• Children and young people’s (CYP) services were overseen by a lead paediatric nurse (LPN) and a named consultant paediatrician. Staff told us the LPN had raised the profile of children’s services and was recognised as being the clinical expert in the care of children and young people. Staff told us they were approachable and could be contacted for advice and support.
• Children’s services were incorporated into the hospital vision and strategic direction for the hospital which was recognised by staff and integrated across children’s services.
• The children and young people service actively engaged with children and their parents and families in feedback and development of children’s services.

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

• The service did not monitor outcomes for oncology patients.
• Some policies provided were not in date or reviewed in line with the recorded timeline.
• Competencies within oncology were not always evidenced. For example, there was no evidence to support that pharmacists had completed oncology specific competencies and the head of department had self-assessed their skills. 
• There were not always accessible handwashing sinks available in-patient rooms on the inpatient ward so staff could maintain good hand hygiene practices.
• Intravenous fluids were not always clearly prescribed or recorded.
• Some pain management audits were not always completed.
• A minority of patients did not always appear to have time between consent being completed and the date of operation.

Following this inspection, we told the provider that 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 (Central Region)

Updated 25 March 2019

Medical care services were a small proportion of the hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

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

Updated 25 March 2019

Children and young people’s services were a small proportion of the hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

We rated this service as outstanding because it was caring, responsive and well led. Safe and effective were good.

Updated 25 March 2019

Diagnostic services were a small proportion of the hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

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

Updated 25 March 2019

Outpatient services were a small proportion of the hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

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

Updated 25 March 2019

Surgery was the main activity of the hospital.

Staffing was managed jointly with medical care.

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