During our visit to Fulwood Hall Hospital we spoke with several patients, who all provided us with positive comments about the support they received. People told us they were able to make decisions about their planned care and treatment and that their needs were being met by a kind and caring staff team. They were very complimentary about the meals available and the quality of service provided.

Comments received included:

"I am very happy with all my treatment. I am very lucky to be here."

"The staff are very kind and the food is excellent."

"They have kept me up to date and always let me know what's happening."

During our inspection we looked at standards relating to consent and care and welfare. We also assessed recruitment practices adopted by the hospital and how the service was being monitored. We did not identify any concerns in any of the outcome areas we reviewed.

During our visit to this location we spoke with seven people using the service, who were all very complimentary about the staff team and the facilities available to them at the hospital.

Comments received from these people included:

"The staff are lovely. They really are marvelous and do such a smashing job."

"I have no compliaints at all, not a single one. I would choose to come to this hospital every time."

"I have been here before and I wouldn't want to go anywhere else. It is magnificent."

Fulwood Hall Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital/service has 29 inpatient and twelve day case beds. Facilities include three main operating theatres with laminar flow; an endoscopy/ minor operations unit; X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, outpatients and diagnostic imaging services. We inspected surgery, outpatients and diagnostic imaging services.

We inspected this service using our next phase inspection methodology. We carried out the inspection with an unannounced visit to the hospital on 14 and 15 August 2018.

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 service level.

Services we rate

Our rating of this hospital stayed the same. We rated it as good overall. We found practice was good in relation to care in surgery, outpatients and diagnostic imaging services:

• The provider 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.
• The hospital provided mandatory training for all staff and completion rates were high; this was up to date at the time of inspection.
• Staff were aware of hospital safeguarding procedures and followed these correctly.

• Staff were aware of the types of incident which could occur and reported these if they occurred. There was a good culture of incident reporting and learning was shared following this.
• Staff followed evidence-based care pathways for specific conditions; policies and procedures were developed on national guidance.
• Seven-day services were available in case of emergencies and for responding to concerns.
• Staff worked well together in multidisciplinary team approach to meet patients’ needs.
• The service responded well to different patient needs and had well established systems for supporting patients living with dementia or a learning disability.
• Leaders were visible and there was an open and positive culture amongst staff. The hospital had developed a clear vision and strategy in engagement with staff.
• There was a clear governance system in place and this had been reviewed and strengthened since our last inspection.
• The hospital engaged well with patients, staff, the public and local organisations to plan and manage services appropriately, and collaborated with partner organisations effectively.

However

• Surgical safety and other theatre checklists were not always being carried out in accordance with recognised best practice guidelines. The service did not always control infection risk well and we saw equipment and environmental defects which could present an infection control risk.
• Managers did not always ensure staff received annual appraisals. Appraisal rates in outpatients were poor and had been low in surgery.
• Pain scoring tools were used routinely in the physiotherapy department but not used consistently in the outpatient departments to manage patients’ pain levels.

We found areas of outstanding practice in surgery, outpatient and diagnostic care, including

• Development of a working group for supporting patients who had autism.
• A focus on safety culture, with implementation of a ‘Speak up for Safety’ initiative and provision of human factors training for all staff.
• Opportunities for staff development, and access to learning support funding for this, through Ramsay Healthcare.

We found areas of practice that require improvement in surgery and diagnostic imaging services, for

• Improving practice in World Health Organisation (WHO) checklists.
• Maintaining robust systems for cleaning radiology equipment used in theatres.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices that affected surgery and diagnostic imaging services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North West)