People who use the service understood the care and treatment choices available to them. People we spoke with told us that they were able to access information about CircleReading and their upcoming treatment very easily.

We observed call bells for people admitted were answered promptly and if additional or specialised help was needed, it was summoned. This meant people’s needs were constantly monitored and when they changed, treatment plans were altered.

People we spoke with also told us the location well-presented and clean. They told us they were confident that the cleaning staff were thorough and demonstrate high standards in their routines. All of the people we spoke with during the inspection told us they had no concerns about infection control and told us they had not experienced any post-operative infections.

The provider had established a number of committees to oversee the quality and safety of care that people who use the service received. We saw these included meetings held about health and safety, medicines management, radiation management and a critical care.

We spoke with four people admitted to the location, three people who had outpatient consultations and one visitor on the day of our visit. All of the people we spoke with were satisfied with the service provided and none had any concerns to raise with us.

The Circle Reading hospital is one of three hospitals provided by the Circle group in England. It is located on the outskirts of Reading, Berkshire. On-site facilities include inpatient beds, comprising 29 inpatient bedrooms (one bedroom is a double) and 20 day case ‘Pods’. The hospital has five operating theatres, three of which have laminar flow. There is an endoscopy suite within the theatre complex, as well as a suite of consulting and treatment rooms, and an imaging department offering x-ray, ultrasound and scans. The hospital also has a pharmacy on site.

The Circle Reading hospital provides a range of medical, surgical and diagnostic services to patients who pay for themselves, are insured, or are NHS funded patients. Services offered by the hospital include orthopaedics, spinal, general surgery, gynaecology, ENT, ophthalmology, endoscopy, physiotherapy and diagnostic imaging.

The Circle Reading hospital was selected for a comprehensive inspection as part of our routine inspection programme. The inspection was carried out using the Care Quality Commission’s new inspection methodology.

The announced inspection took place on 15 and 16 August 2016, followed by a routine unannounced visit on the 25 August 2016. This was an inspection of all core services provided at the hospital, surgery and outpatients/diagnostic imaging. The endoscopy service was inspected under the surgical core service.

Our key findings were as follows:

Are services safe at this hospital?

By safe, we mean that people are protected from abuse and avoidable harm.

• Patients were protected from the risk of abuse and avoidable harm across all inspected services.

• Staff reported incidents and openness about safety was actively encouraged.

• Incidents were monitored and reviewed and staff could demonstrate learning from these.

• Clinical areas were visibly clean and tidy.Hospital infection control and prevention policies were followed and these were regularly monitored, to reduce the risk of spread of infections.

• Staff received appropriate training to be able to safely undertake their roles, and were supported in keeping their skills up to date.Staff received regular appraisals and were supported to undertake further learning.

• Equipment was maintained and tested, in line with manufacturer’s guidance.There were appropriate checks and maintenance on the hospital building and plant.

• Medicines were stored securely.

• There was regular monitoring of patient records for accuracy and completeness.Patient records were stored securely and were available when needed.

• Staffing levels and skill mix were planned, implemented and reviewed to keep patients’ safe at all times. There was a resident medical officer in the hospital 24 hours a day seven days a week.

• When things went wrong patients were given a full apology.However, not all steps of the duty of candour legislation were always carried out.

Are services effective at this hospital?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

• There was a lack of evidence based care and use of national guidelines around the starving of surgical patients.Staff did not have access to national guidance around this to enable them to advocate for patients.

• Although staff demonstrated understanding of consent, and the implications of the Mental Capacity Act, they sometimes had limited understanding of the deprivation of liberty safeguards (DoLS).

• There was evidence of local and national audits, including clinical audits and other monitoring activities such as reviews of services.However, WHO checklist audits had not been completed in the radiology department.

• Information about patient’s care and treatment, and their outcomes, was routinely collected and monitored.

• Patient outcomes were in line with the national average, and there were a low number of patients that required to be transferred to other hospitals. There were low numbers of unplanned readmission of patients.

• The staff were competent to carry out their roles.Staff were given time to undertake training, and their competence was checked.

• The hospital submitted data to the National Joint Registry and information to NHS England surgical site infection surveillance.

• Practicing privileges were reviewed robustly and regularly: they were removed from consultants who did not provide suitable assurance of revalidation.

Are services caring at this hospital?

By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.

• Staff provided care that was compassionate and treated patients with dignity and respect at all times.Feedback we received from patients and those close to them was positive.

• Staff spoke about developing and promoting good relationships with patients and having the time to care for them to a high standard.

• Patients anxious about surgery were given time and information, and their individual needs and preferences were always taken into consideration. Patient’s family’s needs were also considered.

Are services responsive at this hospital?

By responsive, we mean that services are organised so they meet people’s needs.

• Services were planned and delivered in ways which met the needs of the local population. Patients told us that there was good access to appointments, and these were at times which suited their needs.

• Waiting times, delays, and cancellations were minimal and managed appropriately. Facilities and premises were suitable for the services being delivered.

• Patients were given written information to support them through the pre and post-operative period.However, these were not available for any patients whose first language was not English.

• Patients discharge was planned for as soon as they were admitted to hospital, and the length of stay was flexible if required.

• The hospital monitored patient waiting times; these showed that 90% of patients began treatment within 18 weeks of referral.

• The hospital had a robust system for learning from complaints and concerns. However, patient information on how to make a complaint was not readily available on the wards.

• There was openness and transparency in how complaints were dealt with.

Are services well led at this hospital?

By well-led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

• There was a supportive culture and staff felt empowered to raise concerns to keep patients safe.

• Visions and values of the hospital were devised in partnership with staff.Staff could talk about the values and ethos of the hospital and were proud to work there.

• The culture was open and staff felt that they had the ability to prevent harm to patients through the use of ‘Stop the Line’; this was a mechanism by which staff could stop a procedure for immediate review by a senior member of staff. Staff said they did not feel that there would be any repercussions for using this mechanism.

• There were robust systems in place for identifying and managing risk.Risks were recorded and mitigations put in place.

• Staff were encouraged to escalate concerns around patient safety using ‘Stop the Line’, we were given several examples of this in action.

Our key findings were as follows:

• The hospital was well led by managers that fostered an open culture among staff to report risks to patient safety.

• The hospital was clean and well maintained, staff followed infection control procedures and this was checked regularly.

• There were an appropriate number of suitably qualified staff to look after patients safely.

• Patients were given food and drinks when they wanted them, and as appropriate to their specific needs.

We saw several areas of outstanding practice including:

• Privacy and dignity arrangements for patients undergoing endoscopy were excellent offering them a ‘pod’ with ensuite facilities.

• There was a domiciliary food delivery service for patients that had undergone surgery.

However, there were also areas of where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that statutory notifications are always reported to the Care Quality Commission in a timely way.

• Ensure that the Duty of Candour process is fully completed after an incident involving patient harm.

In addition the provider should ensure:

• Resuscitation equipment for use with children should be removed from trolleys, as there is a risk of confusion about what equipment to use in an emergency.

• Checks of defibrillators should include a record of a shock test in case the equipment should fail to self-record this.

• Fluid balance charts for patients, especially those having intravenous fluids, should always be accurately completed.

• WHO checklist audits in the radiology department are completed.

• Staff are trained in Duty of Candour and the application of this duty is monitored.

• Patient leaflets are available in the imaging and diagnostic department.

• The space in the imaging and diagnostic department is reviewed for bed patients, and a standard operating procedure is in place.

Professor Sir Mike Richards

Chief Inspector of Hospitals