We spoke with five patients, six nursing and care staff and human resources (HR). Patients told us they were highly satisfied with the care they received. One patient said "the care I couldn't ask for better care nurse wise. Everyone's brilliant." Another told us "very good on the whole. The nurses are very efficient." This was verified by people's comments on the NHS choices website (rated five stars) and provider patient survey information.

Patients told us they were involved in their treatment plans and encouraged to ask questions. They said staff asked their permission and informed consent was sought before the commencement of treatment and care. Staff explained the actions they

would take if people with impaired mental capacity were unable to consent to care or treatment.

We found the provider had procedures to ensure other healthcare professionals involved in patient's care were kept fully informed of the outcome of the treatment.

The provider had systems to ensure new staff were suitably qualified, skilled and experienced to undertake their roles.

During our inspection we spoke with four people who were receiving treatment at the hospital or were attending an outpatient's appointment. We also spoke with three relatives. People told us that staff were polite and courteous at all times and respected their privacy. They said that they had been given a lot of information about their treatment and felt able to ask questions if they needed additional information.

They all said that they had received a high standard of care and treatment. One person told us the staff were, "tip top, excellent, wonderful.” Another said it had, "restored my faith in doctors. Been fantastic, I can't praise them enough." The records that we looked at confirmed that people were involved in the decision making and planning of their treatment and they had signed consent to their treatment.

There were effective systems in place to reduce the risk and spread of infection. We spoke with two people who were in-patients at the hospital, they told us they had had no problem with cleanliness of their room and that it was cleaned every day.

Patients and staff considered there were sufficient professional, support services and administration staff on duty at the time of our visit to meet the needs of people who use the services. One patient said “there are stacks on duty.”

The hospital had an effective quality assurance system in place to ensure that the service was audited, with action taken to address any issues that were identified.

People told us they had the opportunity to discuss their operation and recovery with their consultant at the first appointment, during their stay and before they returned home.

People were very pleased with their treatment and plans for aftercare. People's home circumstances were assessed to make sure they could go home safely and recover well.

The hospital had clear safeguarding policies and procedures for reporting allegations or observations of abuse of adults and children.

The lead registered nurse made sure that all members of staff understood and worked to the company's infection control policy and procedure. Systems were in place to screen and monitor healthcare associated infections.

Members of staff were available when people needed them. Staff were suitably qualified and had access to a range of relevant training according to the work they did.

The hospital made sure that people could comment on the service they received. All complaints were taken seriously and thoroughly investigated. People were told the outcome of their complaint and what had been changed as a result.

New Hall Hospital is operated by Ramsay Healthcare UK. The hospital has 33 beds which consist of single en-suite rooms, along with two and four bedded bays. They also have eight pods (small single-occupancy rooms) used by patients having day case procedures. The service was due to open an ambulatory care unit for patients undergoing minor procedures. At the time of our inspection this was near completion and due to open within the next few months.

Facilities include four operating theatres including a dedicated spinal theatre, and outpatient and diagnostic facilities including a CT and MRI scanner. Chemotherapy services are provided to a small number of patients and they provide a physiotherapy service.

The hospital mainly provides surgical services, and outpatients and diagnostic imaging for adult patients. They do not treat children.

The hospital was inspected in August 2016 and they received a rating of good. We carried out a focused inspection of the surgical services on the 10 and 11 April 2018 in response to some concerns arising from intelligence received and the routine monitoring of services. We looked at only two key questions. Are services safe? Are they well led? We did not inspect outpatient and diagnostic services.

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.

Services we rate

We found the following areas of good practice:

• There was a strong, supportive and enthusiastic leadership team at the hospital which was focused on maintaining a safe facility, with good quality outcomes.
• The hospital was well-equipped and had the necessary facilities to provide a wide range of treatments in a way that met the varying needs of patients. Facilities were specifically designed to manage in-patient, day case and minor procedures safely and efficiently.
• There were opportunities for training and career development within the organisation and staff were given encouragement to learn.
• The hospital had effective systems and controls to minimise the risk of infections. The working environment was visibly clean. We saw good microbial stewardship and regular audits ensured infection control standards were maintained.
• Medicines were managed safely and securely and audited regularly to ensure policies and procedures were being followed. Information about medicine was provided to patients on discharge to ensure they used the medicine effectively and understood any side effects.
• Pathways were used effectively to ensure patients at risk were managed appropriately and safely. Medical attention was available when it was needed. Protocols for managing unexpected complications or emergencies were available and arrangements were made to transfer patients if necessary.
• Incidents were investigated and there was a strong learning culture which ensured the hospital learned from adverse events and made improvements to ensure they did not happen again.
• There was a clear vision and strategy for the hospital which was ambitious, linked to the needs of the local population and focused on quality and sustainability.
• The hospital had a respectful and enthusiastic working environment and staff in all roles had a compassionate and patient-focused approach to their work. There were healthy positive relationships between staff and managers where ideas were encouraged and people were not afraid to challenge.
• Governance arrangements at the hospital were effective and risks were well-managed. There was a committee structure which provided good oversight. Committees linked up to provide a strong framework where finances, clinical performance and quality outcomes could be monitored and improved.
• The hospital collaborated with a wide network of stakeholders, including local trusts, commissioners, clinical networks and the local authority. This ensured their practices were up to date and in line with contractual requirements and best practice.

We found the following areas of practice that require improvement:

• Some staff were not up to date with their mandatory training, in particular safeguarding level 2, data protection and emergency management of patients.
• Intra-operative temperature monitoring for patients undergoing surgery was not in line with national best practice guidance.
• Carpets were used in the patient rooms which made it difficult to keep floors clean.
• Staff morale in radiology was lower than rest of the staff group and some staff said they felt overwhelmed with work due to staff shortages.
• Some staff wore long-sleeved jackets in clinical areas which presented a risk of cross contamination.
• We were not assured that risks relating to areas overseen centrally by the provider’s corporate group were being actively managed.
• There was a lack of storage space which meant the working environment was cluttered in theatres and in the administrative areas.
• Tourniquets used in upper-arm surgery were not used in accordance with manufacturer’s guidance. This presented a risk of tourniquet-related complications.
• The dispensing of medicines when the pharmacy was closed was not in line with the organisational medicines policy and we were not assured that practices around take-home medicines were compliant with best practice.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Standford

Deputy Chief Inspector of Hospitals (South), on behalf of the Chief inspector of Hospitals