We saw people’s privacy and dignity were respected. One person told us, “I am pleased I came here. They have explained the treatment options to me and I am satisfied I have all the facts. It has been very reassuring.”

We found people's needs were assessed and treatment was planned in line with their needs. There were arrangements in place to deal with foreseeable emergencies. One person said, “I feel better than I expected. It is not like a hospital. I have the recovery area to myself and the staff have been very attentive.”

There were appropriate arrangements for the maintenance and checking of equipment and this protected people who used this service.

We found staff had sufficient training and supervision to equip them with the skills to be able to deliver effective care and treatment to the people treated at this centre.

People's medical records and other records relevant to the management of the service

were accurate and fit for purpose. All records were held securely.

We spoke to one person who had used the service on three occasions and they told us the procedures had been thoroughly explained each time and they had been asked for their consent. They told us, “I was very happy with the treatment and was reassured by the staff. They kept me informed at each stage of the process and sent information to my own doctor. I am very satisfied with the service.”

Before people received any treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was delivered in a way that ensured people’s safety and welfare.

People who used the service were protected from the risk of infection because the provider had followed appropriate guidance.

There were effective recruitment and selection processes in place.

The provider had a system in place to assess and monitor the quality of the service people received.

Cobalt Hospital is part of Ramsay Health Care UK Operations Limited. It is a purpose built 6 bedded day case facility with no overnight beds. It also has an outpatient department. The hospital provides elective day care services in minor general surgery, minor orthopaedics, endoscopy and plastic surgery to the local populations of Newcastle Upon Tyne, North Tyneside and surrounding areas. Private services commenced at Cobalt Hospital in 2006, this involves primarily cosmetic surgery services (facial, breast, body contouring and non- surgical treatments).

The hospital does not provide any services for children and young people aged between 0 and 18 years. The hospital does not admit emergency patients. Cobalt Hospital contracts services for diagnostic imaging, pathology, histopathology, pharmacy services, blood transfusion, critical care and non- critical transfer, occupational health, and physiotherapy. These services did not form part of this inspection report.

There are 43 staff, 3 employed doctors and 15 consultants working at this hospital. The senior leadership team comprises of the General Manager, Matron and Finance Manager. The hospital is supported by experts within the Ramsey Health Care Group and externally from local NHS providers.

We inspected the hospital from 29 to 30 June 2016 and undertook an unannounced inspection on 8 July 2016. We inspected this hospital as part of our independent healthcare inspection programme.

Overall, we rated Cobalt Hospital as good. We rated it good for being safe, effective, caring, responsive and well led in surgical services and out patients.

Are services safe at this hospital

We rated safe as good because:

• Staff were knowledgeable about the reporting process for incidents using the electronic hospital incident reporting system. Staff were encouraged to report all incidents and felt that the senior management team demonstrated effective management of all incidents. Lessons were learned across the organisation.
• Policies and procedures were in place for transfer and escalation of patients to local NHS hospitals when necessary. The hospital had links to local NHS trusts and was part of the local critical care network.
• The hospital had appropriate service level agreements and associated quality monitoring in place for services which were outsourced. These included diagnostic imaging, pathology, histopathology, pharmacy services, blood transfusion, critical care and non- critical transfer, occupational health, and physiotherapy.
• Safeguarding procedures were well managed and staff were aware of the safeguarding policies and principles within the hospital. The matron was the designated hospital lead for safeguarding adults and children. This individual was trained to level 3 in safeguarding children and vulnerable adults.
• The duty of candour is a legal duty on healthcare providers that sets out specific requirements on the principle of being open with patients when things go wrong. All staff had a good understanding of this duty and we observed the duty of candour being implemented in relation to a serious incident. Ramsay Health Care UK had provided training for senior staff and prioritised the principles of duty of candour in its overall strategy.

• Nurse staffing was adequate to meet the needs of patients. Actual staffing was in line with planned during our inspection. Nurse to patient ratios were observed as good, with 1:5 or less. A flexible approach was taken to ensuring any changes were made to facilitate adequate staffing levels and competence in the hospital. Many staff were able to work across more than one area. There was no use of agency nursing staff at Cobalt hospital in 2015 and up to May 2016.
• Three medical staff were solely employed by Cobalt Hospital and covered the day case service from Monday to Thursday 08.30am to 08.00pm with Friday and Saturday 08.30am to 05.30pm.They also covered any on call enquiries from patients if required. We observed good teamwork and communication between the team. One member of the team was an anaesthetist which supported skilled cover in emergencies.
• Consultants were employed under the Ramsay Health Care UK practising Privileges policy. There was 15 consultant staff with practising privileges. The senior manager held the required information for every consultant in line with their practising Privileges policy. The hospital had information accessible to all staff which outlined consultant cover and cross cover arrangements.

Are services effective at this hospital

We rated effective as good because:

• There were processes in place for implementing and monitoring the use of evidence-based guidelines and standards to meet patients’ care needs.
• Surgical services participated in national clinical audits and reviews to improve patient outcomes.
• All policies and local procedures were agreed and signed off through the clinical governance committee and medical advisory committee (MAC).
• Cobalt hospital contributed to the private healthcare information network (PHIN) as part of benchmarking its practice.
• Between January 2015 and December 2015 there were 4 cases of unplanned transfer of an inpatient to another hospital. All cases of unplanned transfer of an inpatient to another hospital were discussed at the clinical governance committee and the MAC. These were also reported through to the organisation’s clinical governance meetings.
• Practising privileges arrangements and agreements as well as revalidation were robust and effective.
• All staff had received an annual appraisal.
• Consent to treatment was appropriately obtained.
• Staff had completed some training with regard to the Mental Capacity Act and Deprivation of Liberty Safeguards.

Are services caring at this hospital

We rated caring as good because:

• Senior managers and staff involved and treated patients with compassion, kindness, dignity and respect.
• The results of the Friends and Family test demonstrated that 100% of all patients at Cobalt Hospital were ‘extremely likely’ or ‘likely’ to recommend the service to family and friends.
• Ramsay Health Care UK reported patient experience in monthly reports. In May 2016 results for Cobalt Hospital were very good. The comments complimented all levels of staff as individuals and where improvements could be made apologies were made to patients and actions were documented.

• Appropriate emotional support was provided to patients. There was access to psychological support for men and women undergoing cosmetic surgery.
• There was access to specialist advice and support when required.

Are services responsive at this hospital

We rated responsive as good because:

• The hospital was meeting overall referral to treatment indicators (RTTs).
• The service was responsive to the needs of patients.
• There were robust procedures for safe transfer of patients to acute hospitals if required. These were understood by staff.
• Patients admitted to Cobalt hospital were assessed for admission suitability by their consultants. Risk classification was in line with local and national guidelines. Patients who were assessed as not meeting low risk day case surgery criteria were referred back to their GP or consultant for review. There were no incidents of exceptions to this practice. The hospital had a strict admission criteria and policy.
• There was a service level agreement in place for the transfer and admission of patients to local hospitals in the event of patients becoming unwell. Staff we spoke with were familiar with arrangements however there was low incidence of inter hospital transfers. (Four in 2015).
• There were very few formal complaints. The hospital had a robust complaints procedure. The senior management team review all complaints. All complaints are reported at the senior management team/heads of department meetings. Actions in terms of themes and trends are discussed at the clinical governance committee and MAC.
• There was learning from complaints and examples of this were provided during the inspection.

Are services well-led at this hospital/service

We rated well-led as good because:

• The hospital has an experienced and stable senior leadership team. There was strong local leadership of the service from the General Manager and Matron. Managers were approachable, available and visible within the hospital.
• There was good staff morale and they felt supported at ward and department level. There were low rates of sickness absence within the hospital for all grades of staff. There were no staff vacancies at the time of the inspection.
• There were robust arrangements in place between the senior management team and the MAC to monitor, agree and review practising privileges.
• There was a comprehensive committee and meeting structure to ensure governance, risk and quality management was effective. These committees included senior management team and heads of department, clinical governance committee, health and safety committee and the MAC. Meetings were held monthly at both hospital and organisational levels and minutes of these meetings confirmed monitoring of risk, quality and governance.
• Fit and proper person requirements were being met at this hospital, with all required checks being in place for the relevant senior staff.
• There were examples of innovation and improvement.
• A corporate Workforce Race Equality Standard (WRES) report and action plan against the 9 relevant indicators was in place for 2016. There were monitoring arrangements in place both at corporate and local level through the appropriate committee structures. The hospital also reported against these 9 WRES indicators to NHS England.

Our key findings were as follows:

• Medical and nurse staffing levels were adequate on the day case unit, theatres and outpatients services. Staffing establishments and skill mix were reviewed regularly and levels increased to meet patient needs where required.
• Arrangements were in place to manage and monitor the prevention and control of infection with dedicated personnel to support staff and ensure policies and procedures were implemented. We found that all areas we visited were visibly clean.
• There were no hospital acquired infections during 2015.
• There were no unexpected patient deaths during 2015.
• Processes were in place to ensure patients nutrition and hydration was effectively managed prior to and following surgery.
• There was sufficient equipment to ensure staff could carry out their duties. Processes were in place for monitoring and maintaining equipment.
• Staff understood their responsibilities to raise concerns and record patient safety incidents and near misses. There was evidence of a culture of learning and service improvement.
• Medicine management arrangements were in place. Medicines were stored securely and staff was competent to administer medicines.
• There were systems for the effective management of staff which included an annual appraisal. All doctors were appropriately vetted to ensure they had the skills to undertake surgical procedures.
• The hospital undertook a programme of local clinical audits depending on risk assessments. These covered a range of areas including infection prevention and control and medicines management.
• Senior and departmental leadership at the hospital was good. Leaders were aware of their responsibilities to promote patient and staff safety and wellbeing. Leaders were visible and there was a culture which encouraged candour, openness and honesty.

We saw several areas of outstanding practice including:

• An aesthetic day surgery study and audit and been performed and presented to the British Association of Aesthetic Plastic Surgeons (BAAPS) capturing practice and patient outcomes from 2010 to 2014. There were 455 procedures included in analysis; overall results were very positive with low complication rates and positive patient satisfaction.
• Patients undergoing endoscopy procedures were offered a deep sedation service, which was a dedicated list with an anaesthetist for those patients who were not able to tolerate lighter sedation methods.
• A nurse led out of hours on call service for patients to contact the team after discharge if they needed advice or support.

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

In addition the provider should:

• Ensure that the policy for the use of preferred agency providers to cover nurse staffing is followed at all times.

Professor Sir Mike Richards

Chief Inspector of Hospitals