We spoke with a range of managers, clinical and other staff during our inspection. We also spoke with patients using the hospital and their relatives about their experience. We checked patients’ care records to help us understand their care and treatment. We also checked other records, such as meeting minutes and safety logs, to check how the hospital was run.

We found that consent for procedures was obtained and recorded. A patient told us, “On the day of my surgery, I met with the consultant again and he explained clearly all the risks and possible complications again and we both signed a consent form.” A nurse said, “All our patients are very informed. We gain verbal consent for nursing care and ensure patients understand all interventions.”

Patients’ care was organised using clinical pathways that reflected relevant research and guidance. We saw that care was delivered in a way that reflected the pathways, including a pre-procedure assessment and post-procedure medical reviews. A patient told us, “I’m looked after really well. They’re all really caring and keep checking on you to make sure you’re OK and don’t need anything. I’m really happy.”

Government guidance relating to infection prevention and control was followed and we found patients were cared for in a clean and hygienic environment. There were systems to ensure cleaning standards were maintained and that equipment was appropriately decontaminated.

We found there were systems in place to manage medicines and to reduce risks associated with their use. These systems covered the supply, storage, prescription, administration and disposal of medicines.

We checked the use and maintenance of equipment focussing on that used in operating theatres. We found there were arrangements that ensured that staff were trained in the use of equipment. We also found that equipment was checked and maintained to ensure it was ready for use and fit for purpose.

We found the hospital had a robust governance structure that provided a ‘board to ward’ system of quality assurance Patients were asked for their views and these were acted upon to improve the service. There were systems in place to analyse complaints and critical incidents and to manage risk.

People told us that they were aware of the treatment they were having and that they had given their informed consent to this. One person told us that, “Everything has been explained to me and the doctor has been very helpful”. This showed us that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

The individual care pathways seen had been completed appropriately and individual risk assessments were updated as necessary. This meant that people experienced care, treatment and support that met their needs and protected their rights.

People told us that they felt safe in this service and that if they had any concerns these would be promptly addressed by staff. This showed us that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The records seen showed us that 80% of clinical staff were up to date with their mandatory training. This meant that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We noted that monthly integrated clinical governance meetings were held and that actions had been taken to address any variations in the care provided to people. This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We carried out a comprehensive inspection of Nuffield Health Brighton Hospital on the 11, 12 and 22 July 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of medical care (including older people’s care), surgery, services for children and young people, outpatients and diagnostic imaging as these incorporated the activity undertaken by the provider, Nuffield Health, at this location.

We did not inspect the magnetic resonance imaging (MRI) or computerised tomography (CT) scanning services, or ophthalmology outpatient services as these are provided and managed by another registered provider.

We rated the hospital overall as good, and rated the core services of  surgery, outpatient and diagnostic services and medicine as good. Although we inspected the children's and young peoples service we did not have enough evidence to give this a rating.  This was because at the time of the inspection the hospital treated low numbers of children. 

Are services safe at this hospital?

We found services were safe at this hospital. This was because:

• There were systems for the reporting and investigation of safety incidents that were well understood by staff.

• Staff could demonstrate their understanding of the duty of candour and provide examples of its implementation.

• Patients were assessed prior to admission to ensure that hospital could safely meet their needs. There were arrangements to transfer patients whose care needs exceeded what the hospital could safely provide, and saw that staff used these processes when patients’ conditions required this.

• There was suitable medical cover at all times from a resident medical officer and on-call consultants and noted arrangements for consultants to provide cover for absent colleagues.

• There were sufficient numbers of nursing and support staff to meet patients’ needs.

• There were efficient and effective methods for the handover of care between clinical staff.

• However, medicines management did not always reflect best practice. We identified some concerns in the maintenance  of controlled drug registers and the storage and management of medical gases.

• There was no provision for the reporting of emergency imaging out of hours.

Are services effective at this hospital?

• There were arrangements to review guidance from national bodies such as the National Institute for Health and Care Excellence (NICE) and that care was delivered in line with best practice.

• There was a system for reviewing policies and these were discussed at the medical advisory committee (MAC) and other governance forums at the hospital.

• Care was continually monitored to ensure quality and adherence to national guidelines to improve patient outcomes and the hospital participated in relevant national audits and benchmarking activities.

• Patient outcomes were good when benchmarked against national standards. There were no concerns regarding rates of unplanned admission, return to theatre or transfer to another hospital.

• Patient’s received adequate pain control. They were provided with sufficient food and drink to meet their individual needs although some patients had complained about the quality of food offered.

• There were systems to grant and review practicing privileges to consultants that ensured they were qualified and competent, and of good character. There were systems to ensure that staff registered with professional bodies retained current registration, including through revalidation.

• Consent procedures followed national guidance and staff acted within the Mental Capacity Act 2005 when patients lacked capacity to make decisions for themselves.

Are services caring at this hospital?

• Patients were treated with dignity and respect and their privacy was maintained. Patients who share their views said they were treated well, with compassion, and that their expectations were met or exceeded.

• Results of the NHS friends and family test and other patients satisfaction surveys demonstrated that patients would recommend the hospital to others.

• There were arrangements to ensure patients with complex needs such as those undergoing gender reassignment surgery or chemotherapy had access to appropriate psychological support.

Are services responsive at this hospital?

• Services were planned to meet the needs of patients. We saw some flexibility in the organisation of services that allowed patients convenient access to care and treatment.

• We saw examples of systems to support patients living with dementia and learning difficulties. The environment was appropriate for patients with physical disabilities and was accessible.

• The hospital was exceeding national referral to treatment time standards and waiting lists were minimal.

• There was a robust complaints procedure, which was well publicised and understood by staff. Complaints were investigated, actions taken to resolve issues and there was learning evident from the content of complaints.

• There were arrangements that enabled staff to meet the need of people from diverse ethnic backgrounds. While there were facilities to enable translation, staff did not always follow best practice in this area.

Are services well led at this hospital?

• Nuffield Health has a clear, corporate statement of vision and values which staff at this hospital knew and understood.

• There were clearly defined and visible local leadership roles and managers provided visible leadership and motivation to their teams. Staff spoke well of the management team and of each other. The provider was responsible for ensuring that those in director level roles fulfilled the fit and proper person test

• There were arrangements to engage patients through invitations to a patients’ forum. Nuffield Health had arrangements for collecting patients views and the hospital’s performance was benchmarked against peers

• We noted the management team actively sort out novel ways of working that improved standards of safety and quality. The leadership team also developed new services to meet the needs of patients in the local community and beyond.

• There were governance systems, overseen by Nuffield Health to monitor quality and safety of services. However, these systems had not been effective for ensuring management of medicines met legal requirements. We noted that some corporate policies had passed their review dates and were in the process of being revised.

Our key findings were as follows:

• There were adequate systems to keep people safe and to learn from incidents.

• The hospital environment was visibly clean and well maintained and there were sufficient measures to prevent the spread of infection.

• There were adequate numbers of suitably qualified, skilled and experienced staff (including doctors and nurses) to meet patients’ needs. There were arrangements to ensure staff had and maintained the skills required to do their jobs.

• There were arrangements to ensure people received adequate pain relief and adequate food and drink that met their needs and preferences.

• Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked against national audits and other independent hospitals we hold data for.

• Robust arrangements for obtaining consent ensured legal requirements and national guidance were met.

• The individual needs of patients were met including those in vulnerable circumstances such as those with a learning disability or dementia.

• Patients could access care when they needed it.

• Patients were treated with compassion and their privacy and dignity were maintained.

• The hospital was managed by a team who had the confidence of their teams. Staff felt motivated by the management team.

• Governance systems were not always effective in identifying where services were not meeting legal requirements, or at monitoring the quality and safety of services for children and young people.

We saw several areas of outstanding practice including:

• The hospital worked with the local university to offer a joint Resident Medical Officer (RMO) post. Five RMOs covered the hospital over the 24 hour period and also undertook teaching anatomy and practical subjects to students at the local university. This was an innovative and practical way to attract skilled RMOs to the post and was working well.

• The hospital was a centre of excellence for transgender surgery performing over 300 procedures each year attracting patients from all over the UK and internationally. Feedback received from the gender reassignment service (GRS) was continually positive about the way the staff treated people. Patients thought that staff went the “extra mile” and the care they received exceeded their expectations. Within the GRS there was a proactive approach to understanding the needs of this patient group, which included people who are in vulnerable circumstances or who had complex needs and care was delivered in a way that met patients’ needs and promoted equality.

• The hospital had a strong ophthalmology pathway and was a leading independent provider of ophthalmology services in the area. The hospital offered innovative ophthalmic surgery with successful outcomes.

• The hospital had taken steps to become “greener” in its operation and had reduced its carbon footprint by the use of solar panels and light-emitting diode (LED) lights

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

The provider should:

• Ensure there is a planned preventative maintenance plan for medical gas regulators and that there are suitable safe storage facilities for larger cylinders not required for the medical gas manifolds.

• Consider keeping individual laser registers for each laser in a hard copy format.

• Review access in the pharmacy dispensary where there was lack of confidentiality and disability access to the dispensary hatch.

• Review the prescription tracking system to minimise the possibility of mis-use.

• Ensure that controlled drugs records are managed in line with legal requirements.

• Make adequate arrangements to report on emergency medical imaging out of hours.

• Take action to address patient feedback on the quality of food.

• Review maintenance and refurbishment plans to ensure the clinical environment meets national guidance.

• Ensure regular risk assessment of oncology patients for venous thrombo-embolism.

• Make arrangements for the transfer out of acutely unwell oncology patients

• Consider how best practice in the interpreting services could be achieved.

Professor Sir Mike Richards

Chief Inspector of Hospitals