During our inspection we spoke with nine people who used the service and three people’s relatives. Everyone we spoke with told us that they thought the service was excellent. One person said, “I find that they are all friendly and professional.” Another person told us, “I wouldn’t have thought that it could be any better. I find it a really wonderful service.”

We found that people who used the service understood the care and treatment choices available to them.

We reviewed ten sets of care records and found that the care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

We saw that medicines were prescribed, stored and administered safely. When we talked with people who used the service and with staff, we found that there were enough skilled, experienced and qualified staff to meet people’s needs. One member of staff told us, “Staffing is good here. We try our best to get it right because we don’t want to put patients at risk.”

Patients told us they were well informed about any procedures they were going to have before they gave consent to them. We saw consent forms were signed by the patient and consultant. One patient told us, “I was given time to think about whether I wanted it done or not before I signed the form.”

All the patients we spoke with told us they were very well looked after. One patient told us, “You won’t find any problem here, it’s wonderful.” Care records we looked at were comprehensive and complete. We saw good communication between staff and patients.

There were robust systems in place in both the operating theatres and other departments in the centre to ensure patients were protected against infection. A patient told us staff were always using the alcohol hand gel available and washing their hands.

We looked at personnel files for staff and saw the documentation required in order to keep patients safe. However these files were not always organised well.

The organisation had systems in place to monitor the risks of unsafe care. Patients were routinely asked about their opinions of the service.

During our visit we looked at the patient care in the service and spoke with six patients, three relatives and members of the nursing and medical staff. The centre did not offer overnight stay; treatment was on a day-care basis.

One patient told us “I can’t fault this place, it’s lovely.” Another said “You’re not just a number here.”

The patients we spoke with were all complimentary of the staff and how they were treated before and during admission. One patient said “I didn’t feel hurried at all by anyone.”

A relative told us she had known people who had used the service previously and they had all praised it. She said that “They (the staff) have time for patients and relatives. They are very caring and all seem very nice. I’ve never heard anything bad about it.”

All the patients we spoke with told us they felt very safe in the service. When we asked what they would do if they didn’t, they told us they would tell one of the nurses. All of them said they felt confident the staff would do something about it.

One of the patients we spoke with said they felt the staff knew “exactly what they are doing, that’s why I asked to come here” and “they’re obviously well trained.”

All patients we spoke with except one, told us they had been given a “We value your opinion” leaflet when they left the centre with a self addressed envelope to send it back. They said they had been encouraged to fill it in.

Boston West Hospital is an independent health care, purpose built day case hospital which provides services for assessment, diagnosis and treatment of common medical conditions. The hospital is part of the Ramsay Health Care provider group.

The hospital’s senior management team consisted of a registered manager, matron and medical director who provided professional leadership for all staff.  The chair of the hospital’s local Medical Advisory Committee (MAC) was a member of the provider’s regional MAC.

We inspected the hospital on 28 and 29 April 2015 on an announced visit. On 14 May 2015 we carried out an unannounced inspection of the hospital.

We inspected surgery and outpatients and diagnostic imaging at Boston West Hospital. Our inspection was part of our ongoing programme of comprehensive Independent Health Care inspections.

The overall rating for the hospital was good. We found Surgery services were good in all of the five domains we inspected; Safe, Effective, Caring, Responsive and Well-led. Outpatients and Diagnostic Imaging services were good in the four domains we inspected; Safe, Caring, Responsive and Well-led.

Are services safe at this hospital?

We found a robust incident reporting system in place at this hospital. Staff knew how to report incidents and were encouraged to do so by their managers. Staff monitored patients before, during and after their procedures and surgery to minimise risks to individual patients. Nursing and surgical staffing were managed effectively to deliver appropriate care to patients.

Are services effective at this hospital?

Evidence based assessment, care and treatment was delivered to patients following national guidance by appropriately qualified and competent staff. Clinical staff maintained professional registrations as required. We found clinical staff had completed mandatory training and had all received annual appraisals. The hospital had an audit programme in place for 2014/15 which included audits of medical records, controlled drugs and medicines management and infection prevention and control. Medical records audit in January 2015 showed 98% compliance. Audits in controlled drugs and medicines management showed 100% compliance in December 2014 and October 2014 respectively. A hand hygiene audit in December 2014 showed 94% compliance.

Are services caring at this hospital?

The care we observed in the hospital was very good. Staff were very attentive and compassionate, with patients being involved at every stage of their treatment. Staff were very proud of the care they delivered and spoke about patients with utmost respect. Patient satisfaction was high with recent data showing that over 90% of outpatients and patients undergoing surgery would recommend the hospital to their family and friends as a place to receive treatment and care.

Are services responsive at this hospital?

We saw the care delivered was very responsive to patients’ needs. The hospital had measures in place to support patient’s differing needs, such as access to interpreters via a telephone interpretation service. The hospital had trained two members of staff to work as dementia champions so they could advise other staff on how best to support people living with dementia. Between October 2014 and February 2015, 100% of patients were seen within the 18 week referral to treatment target. In 2014 the hospital received 10 complaints. We found complaints were taken seriously, with processes in place to learn from them and share this learning with staff.

Are services well-led at this hospital?

The hospital had a robust governance and risk management system in place. Morale was good with staff talking positively about the organisation and their local management team. Engagement at all levels was good with staff feeling listened to and supported. Feedback from patients was encouraged and when feedback rates had dropped, initiatives were put in place to increase it.

Our key findings were as follows:

•  All clinical areas were clean. The hospital had reported no incidence of MRSA, clostridium difficile (C.diff.) or methicillin-sensitive staphylococcus aureus (MSSA) in the reporting period between January to December 2014.
• Best practice infection prevention and control practices were being followed.
• Nursing staffing was managed effectively to ensure patients received safe care with access to consultants obtained in a timely manner. Staffing levels were reviewed daily to enable team leaders in the clinical areas to flex their staffing, according to patient requirements. The hospital had not used any agency staff for the twelve months prior to our visit.
• The provider employed 1.6 whole time equivalent (WTE) consultants in the hospital; an anaesthetist and a surgeon. At least one of the employed consultants was present throughout the hospital’s operating hours. A consultant anaesthetist was present in the hospital for both operating lists each day. This meant they could respond quickly in an emergency and reduce any risk to patients.
• The hospital had not reported any patient deaths between January 2014 and December 2014.  There had been no transfer of care to a nearby trust for patients between January 2014 and December 2014.
• Staff followed guidance on fasting prior to surgery which was based on best practice. For healthy patients requiring a general anaesthetic this allowed them to eat up to six hours prior to surgery and to drink water up to two hours before.
• The hospital provided only day surgery, therefore meals were not provided. A selection of hot drinks and biscuits were available to patients once they had recovered from their procedure and prior to discharge.

We saw several areas of outstanding practice including:

• 100% of staff had completed all mandatory training and appraisals in 2014/15.
• The hospital had been awarded accreditation by the Joint Advisory Group (JAG) on gastrointestinal endoscopy and was the first independent hospital to achieve this.
• The hospital operated a 24 hour telephone helpline run by hospital staff, available to all patients post procedure or operation.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the hospital should:

• The provider should ensure specialist personal protective equipment (PPE) in radiology, including lead aprons, is checked regularly.
• The provider should ensure requests to repair equipment are made, recorded and completed using standard processes and procedures.

Professor Sir Mike Richards

Chief Inspector of Hospitals