During our inspection we spoke with 20 patients and looked at the medical and nursing records for 24 patients. We spoke with the Matron, three heads of department, an anaesthetist, an orthopaedic surgeon and five members of the nursing staff.

Before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Patients told us they had been fully consulted about their treatment options, including any possible risks. One patient said, "I came in for a pre-assessment check, spoke to the nurse and consultant and was given lots of information to take away and look at”. Another said, "I needed my operation quickly so didn’t visit beforehand. I’ve had the doctors and nurses explaining everything to me and signed some forms to say I agreed to have the operation”.

Patients we spoke with were highly complimentary about the care and treatment they had received. One patient told us, "All the staff are fantastic and the surgeon and anaesthetist are top class, they are amazing”. During our visit we saw a patient's care while they were in the operating theatre. We found that the centre had robust systems in place to ensure patients were safe during their operation.

We observed that nursing staff were responsive to patient’s needs. For example, we observed that patients were asked about their levels of pain and offered pain relief. One patient told us “when I told people I was having this operation they said you will be in terrible pain, but I haven’t been, I regularly get tablets and if I buzz they come immediately”.

We found that patients were protected against the risks associated with medicines because the provider had safe and effective arrangements in place for the management of medicines.

Staff told us they felt well supported in their roles. Patients told us that staff were knowledgeable and knew what to do for them. We saw evidence that the provider had provided opportunities for staff to gain knowledge in particular medical conditions and obtain further relevant qualifications. We found that the provider had worked continuously to maintain and improve high standards of care by creating an environment where clinical excellence could do well.

During our inspection we looked at the provider’s quality assurance and risk management systems. We found that the provider had an effective system in place to regularly assess and monitor the quality of the service that patients received.

We found the medical and nursing records to be comprehensive. Assessments were detailed and accurate. The World Health Organisation checklist for surgery was present for all the files we looked at. This is seen as an area of good practice. All the monitoring charts were up to date and completed appropriately. The work undertaken for being able to treat young people was very comprehensive. Further evidence of this was seen in a letter from the commissioners confirming the service could go ahead.

We spoke to four people who had used the service. They told us “It is very good here, everything is lovely”. “It’s excellent here, all the staff are very friendly and they are all willing to help”. “I have not had to wait for anything. Its very good, they could not have done any more”.

All four people also told us that they would use the treatment centre again if they needed too. They also agreed that there was nothing that could be improved from their point of view.

Horton Treatment Centre, operated by Ramsay Health Care UK, is an independent hospital based in Banbury. The hospital is located on the site of an NHS acute trust. The hospital has 40 registered beds, across 28 single or double rooms. Facilities include three operating theatres, a purpose built ambulatory care unit, physiotherapy, and outpatient and diagnostic facilities including a radiography department.

The hospital provides elective (planned) orthopaedic and spinal surgery, outpatients and diagnostic imaging. We inspected all of these services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 December 2016, along with an unannounced visit to the hospital on 19 December 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.

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

Services we rate

We rated this hospital as good overall.

• Staff knew the process for reporting and investigating incidents using the hospitals reporting system. They received feedback from reported incidents and felt supported by managers when considering lessons learned.
• Staffing levels and skill mix were planned and reviewed to keep people safe at all times. Although the service used agency staff, wherever possible regular bank and agency staff were employed who were inducted and familiar with the service procedures. Medical staff practicing privileges were monitored to ensure doctors were suitable and safe to work in the service.
• Patient’s care and treatment was planned and delivered in line with evidence-based guidelines.
• Feedback from patients about their care and treatment were mostly positive. We observed patients were treated with kindness, compassion and dignity throughout our visit. We saw patient information leaflets explaining procedures and after care arrangements.

We found good practice in surgery:

• Staff completed comprehensive patient risk assessments from the initial pre-assessment clinic through to discharge. Care was provided in-line with national best practice guidelines and outcomes for patients were better than average. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.
• Patients had assessments of their needs and access to different methods of pain relief. Staff monitored and responded to patients’ pain levels appropriately.
• The hospital treated 100% of NHS patients within 18 weeks of their referral from July 2015 to June 2016.

We found good practice in relation to outpatient and diagnostic services:

• There were efficient systems to keep patients safe and to allow staff to learn and improve from incidents.
• There was effective multi-disciplinary working with informative handovers, good record keeping and communication.
• The service was planned and delivered to meet people’s individual needs.
• The leadership, governance and culture promoted the delivery of high quality person-centred care.

We found areas of practice that require improvement in surgery:

• We were not assured that the World Health Organisation (WHO) five steps to safer surgery checklist was completed consistently with patients undergoing local anaesthetic procedures. This increased the potential risk of a patient safety incident occurring.
• In the theatre, the scrub area that facilitated two theatres was open to the main corridor. Staff were not aware this was not ideal as infection control standards could be compromised.

We found areas of practice that require improvement in outpatient and diagnostic services:

• Nursing staff had been applying plaster of Paris casts without formal competencies in place. There was no assurance that staff were competent to undertake this task.
• There was no evidence of an audit trail on the use of prescription pads.
• We were not assured that mandatory training completed elsewhere had been checked to ensure it covered the required elements.

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. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals