Orthopaedics and Spine Specialist Hospital

The Orthopaedics and Spine Specialist Hospital is a purpose built facility which opened in 2004, and operates as part of the NHS choice scheme where patients, referred for specialist treatment can choose where to have their treatment. The hospital has 20 beds. Facilities include one operating theatre (laminar airflow system) and outpatient and diagnostic facilities.

The hospital provides surgery and outpatients and diagnostic imaging. We inspected surgery 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 Wednesday 14 September 2016, along with an unannounced visit to the hospital on Monday 19 September 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.

We found good practice in Surgery:

• 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.
• From April 2015 to March 2016, the service reported no never events, no clinical incidents and no non-clinical incidents. Staff knew what constituted an incident and how to report incidents.
• Theatre staff used the World Health Organisation safer surgery checklist. This is a safety checklist used to reduce the number of complications and deaths from surgery. An audit of 20% of randomly selected patient records from April 2016 to June 2016 showed that the safer surgery checklist was documented in all of the records.
• From April 2015 to March 2016, the service reported no incidents of venous thromboembolism (VTE) or pulmonary embolism and no unplanned returns to theatre or unplanned readmissions within 28 days of surgery.
• Staff worked with patients and their loved ones to make plans for discharge before surgery took place. This meant that patients were not delayed in going home after surgery.
• Medications were stored securely in all clinical areas. Staff consistently completed stock checks for controlled drugs and completed daily safety checks for emergency equipment.
• Staff completed patient records accurately. All patient records we saw contained appropriate risk assessments and management plans.
• Patients were satisfied with the service. All four patients we spoke to said that staff were caring and responsive to their needs. Results from the NHS friends and family test showed positive results; from October 2015 to March 2016, the service consistently scored 100%.
• There were few complaints about the service. The service reported three complaints in the last year. We saw evidence that managers responded to complaints appropriately and shared learning from complaints with staff.
• Leaders of the service were visible and approachable. Staff reported a good culture and working environment.

We found areas of outstanding practice in surgery:

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

We found areas of practice that required improvement in Surgery:

• We found some gaps in reporting to national databases. Data on Patient Reported Outcome Measures (PROMs) was reported but outcomes were not available. Senior staff told us this was because the service did not have full access to the reporting data base and that the number of questionnaires submitted to the system was too small to be interpreted statistically.
• Some policies seen on inspection appeared to be out of date, for example, the medicines management policy was dated 2009.However, following the inspection period the provider submitted evidence that the policies had been reviewed regularly and were in date. 
• Staff did not use the National Early Warning Scoring system(NEWS) to monitor patients’ observations. This meant that there was no standardised system for assessing and responding to patient deterioration. However the hospital had systems in place to ensure patients were monitored.

We found good practice in outpatients and diagnostic imaging:

• The service did not report any clinical or non-clinical incidents for the period April 2015 to March 2016.
• Equipment used for outpatient appointments was in date of servicing and provision was in place for repairs.
• Medical records were well structured and recorded the patients’ pathways through the service from referral to discharge.
• Ninety-two percent of staff were compliant with safeguarding training and all staff were compliant with their mandatory training.
• The hospital reduced the risk of patient deterioration by setting an admission criteria that excluded medically complex and unstable patients, which was checked in the consultation stage of care.
• Policies were underpinned by regulation and national guidance.
• Patients told us that staff were compassionate and kind, and feedback about the service was consistently good. Patients felt involved and informed about their care.
• Missed appointments were well managed and we saw an improvement in the rate of missed appointments from 2015 to 2016.

We found areas of practice that required improvement in outpatients and diagnostic imaging:

• The pregnancy status of women of child bearing age was not always checked.
• Staff were not trained in, and therefore did not have up to date knowledge, of the Mental Capacity Act or Deprivation of Liberty Safeguards.
• There was a hospital risk register, however most of the risks were generic, rather than specific risks for the hospital.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals