Springfield Hospital

Springfield Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital has 64 overnight beds. Facilities include five operating theatres, a three-bed observational unit, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care and outpatients and diagnostic imaging services. We inspected surgery, medicine, children’s and young people’s services, and outpatient and diagnostic imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 04 October 2016 along with an unannounced visit to the hospital on 17 October 2016.

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 core service.

Services we rate

We rated this hospital as requires improvement overall.

We found areas of practice that require improvement in relation to outpatient services:

• Some patient’s medical records generated by doctors holding practice privileges were taken off the hospital site without copies being made. Referrals were not always assessed by a clinical practitioner and at times patients arrived for an appointment without staff expecting them. Departmental risk registers were not in place and the hospital-wide risk register did not reflect known risk. Staff had not received training in duty of candour.

We found areas of practice that require improvement in relation to surgery:

• Concerns were noted with infection control. Despite practice changes results of audits showed that compliance with hand hygiene and infection control had not improved significantly. The hospital had identified the upward trend in the rate of surgical site infections over the 12 months prior to our inspection.Staff only had access to the NHS patient records because the relevant consultants had taken away their privately funded patients records off site.

We found areas of practice that require improvement in services for children and young people:

• There were no local audits undertaken to demonstrate outcomes for the effectiveness of outpatients or children and young people’s services. Gillick competence was not being recorded in children’s records to demonstrate whether this had been considered as required or not. Oversight or information relating to children’s services had not been reported to the medical advisory committee. Risks identified during the inspections, specifically around monitoring of the service had not been identified as a risk by the service.

We found areas of practice that require improvement in medical care:

• There was no formal triage tool in place which staff on the ward could refer to if an oncology patient called the out of hours helpline feeling unwell. This system did not promote timely intervention for conditions such as sepsis, which require immediate medical assistance. Oversight or information relating to oncology service had not been reported to the medical advisory committee. Risks identified during the inspections, related to oncology had not been identified as a risk by the service.

However, we found the following areas of good practice:

• Patient feedback about receiving care or treatment at the service was positive in all services.

• Equipment used for safe care and treatment, such as resuscitation equipment, was regularly checked.

• Staffing levels in theatre, outpatients and on the ward were observed to be sufficient to meet the activity in the service.

• There was good local leadership in outpatients, medical care and children’s services.

• The service was responding to identified concerns and creating plans to address these.

• There was some good local innovation within services.

• Diagnostic imaging and physiotherapy appointments were coordinated to reduce the number of hospital outpatient appointments required where possible.

• The service made adjustments to meet the needs of patients with complex needs.

• Staff explained the child’s procedure in an age appropriate way using photographs and teddy bears when necessary.

• No children’s surgical procedures had been cancelled in the last 12 months.

• Cancellation rates for surgery were low.

• The service undertakes benchmarking though local audits on outcomes and PROMs, which are comparable across the Ramsay Health Care UK Operations Limited nationally.

• PROMs outcomes had seen an improvement in all areas except the Oxford knee score.

• The Endoscopy service had received accreditation form the Joint Advisory Group on Gastrointestinal Endoscopy (JAG).

• Practicing privileges were routinely reviewed by the hospital. There was RMO coverage 24 hours per day.

• The hospital had a local business continuity plan in place.

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.

Professor Ted Baker

Deputy Chief Inspector of Hospitals