The Berkshire Independent Hospital

The Berkshire Independent Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital has 43 inpatient and day-case beds. Facilities included three operating theatres, a two-bed level two care unit, and outpatient, x-ray and diagnostic facilities.

The Berkshire Independent Hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected services for surgery, medicine and outpatients / diagnostic imaging. The hospital had provided services for children and young people; however this service had been suspended pending review. The service was small and there was insufficient evidence to rate.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 5 and 6 December 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 good overall.

The senior management team, supported by the Heads of Departments, had a clear knowledge of how services were being provided and were quick to address any risks that were identified. They accepted the responsibility and ownership of the quality of care and treatment within the hospital and staff had a similar sense of pride in the hospital.

Care delivered was planned and delivered in a way that promoted safety and ensured that peoples’ individual needs were met. We saw patients had their individual risks identified, monitored and managed and that the quality of service was regularly monitored.

The general manager was in charge of the hospital, and all employed staff were line managed by the senior management team; matron, finance manager and operations manager. There were three senior managers that reported directly to the general manager: these were the operations manager, matron and finance manager. Heads of clinical departments reported to matron, including pharmacy manager, outpatients, diagnostic imaging and physiotherapy manager, ward manager, theatre manager and endoscopy manager.

The Medical Advisory Committee (MAC) met four times a year and included representation from all specialities offered at the hospital. It was attended by the general manager and the matron. Issues were discussed and action taken in response to any concerns or risks reported. Minutes of MAC meetings were distributed to all consultants at the hospital.

There were robust governance systems that were understood by staff, these were used to monitor the service and drive service improvement. We did not identify any concerns that the senior management team or local managers were not already aware of and already addressing.

We saw a strong safety culture with policies and systems in place to allow staff to challenge practice where they identified risk or potential harm. There was an admission criteria, pre-assessment processes and consultants could only carry out procedures that they were undertaking frequently in the NHS. This ensured that the hospital was able to meet the patients’ needs safely.

There was a positive culture among staff, many of whom had worked at the hospital for many years. These experienced staff offered stability and continuity to the benefit of newly appointed staff, which brought a fresh energy and encouraged development and new ways of working. The consultants with practising privileges held substantive jobs at the local NHS trusts and were used to working collaboratively.

We found good communication locally and from Ramsey corporate division, with updates provided to staff to ensure practice was in line with NICE guidance and risks were identified from medicines and medical device alerts.

We found good practice in relation to outpatient care:

• The service managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and meet their needs.

• Staff ensured patients were given sufficient information in a way they could understand. Patients were involved as partners in care and their decisions were respected.

• There was a good understanding amongst staff at all levels about safeguarding arrangements and the Mental Capacity Act 2005.

• Patients were seen in a timely manner. Appointments were offered at times that suited patients. Consultations and treatment were provided within the target referral to treatment times. Patients were seen promptly and delays were not common.

We found areas of good practice in surgery:

• In surgery, staff worked hard to make the patient experience as pleasant as possible. Staff recognised and responded to the needs of patients from referral before admission to checks on their wellbeing after discharge.

• The theatre team provided a safe surgical environment by insisting that all theatre users adhered to national and local theatre best practice guidance. The WHO Five Steps to Safer Surgery checks were used routinely, with all staff present and participating fully.

• Incident reporting was encouraged and staff were supported to raise concerns. There was an embedded culture of learning from incidents that spread across the whole hospital.

• There were robust governance arrangements for surgical services at the hospital.Any anomalies in practice, trends in incidents or complaints were picked up and addressed swiftly. Lessons learned were disseminated across the organisation.

• There were appropriate transfer arrangements in the event of a sudden and unexpected deterioration of a patient. Deteriorating patients were identified and transferred to a local NHS hospital in a timely manner; there was good communication with the receiving hospital.

• Patients were positive about the level of care they received from all staff from the beginning of their contact with the hospital to the end.

We found areas of good practice in medicine:

• Patients were very positive about their experiences at the hospital. They felt supported and involved in their care and treatment.

• The arrangements for medicines management were good with multidisciplinary input from the pharmacy team.

• Areas we visited were clean, tidy and fit for purpose. The environment was pleasant and comfortable. Audit results demonstrated that infection prevention and control measures such as hand hygiene and cleaning were fully implemented.

• The use of the NEWS system for identifying patients at risk of deterioration was embedded and used correctly. Staff followed the hospital’s escalation processes and transfer policy.

Professor Edward Baker

Deputy Chief Inspector of Hospitals