Nuffield Health Chichester Hospital is an independent hospital which is part of Nuffield Health, a not for profit organisation. The hospital has six consulting rooms, 19 in-patient and 11 day-case beds and two laminar flow theatres. There is also an endoscopy suite and a dedicated gynaecology suite. It is situated in Chichester, West Sussex in a residential area.

The hospital provided a range of surgical services to private and NHS-funded patients from the local community. NHS patients accounted for an average of 40% of all patients.

We previously visited this hospital in July 2016 as part of our national programme to inspect and rate all independent healthcare providers. We inspected two core services at the hospital, which incorporated all the activity undertaken. These were surgery and outpatients, including diagnostic imaging.

Whilst we rated both core services and the hospital as ‘good’ overall, we found improvements were required to minimise risks and promote safety. We told the hospital it must:

• Ensure infection control policies and standard operating procedures (SOP) are adhered to within theatres.

• Ensure adequate availability of staff handwashing facilities in line with the Department of Health’s Health Building Note 00-09.

• Ensure the sinks in patient rooms are compliant with the Department of Health’s Health Building Note 00-09: Infection control in the built environment.

• Ensure compliance of record keeping in theatres relating to Misuse of Drugs Regulations 2001 and Safer Management of Controlled Drugs: a guide to good practice in secondary care (England).

• Standardise and improve compliance with the ‘five steps to safer surgery’ (WHO) checklist.

• Ensure that there is proper assurance of the safety, calibration, security and servicing of any privately owned clinical equipment brought into the hospital.

• Ensure patients’ privacy and dignity is maintained at all times in theatre.

The hospital was in breach of three regulatory requirements:

• Regulation 12 HSCA (RA) Regulations 2014 Cleanliness and infection control.

• Regulation 17 HSCA (RA) Regulations 2014 Good governance.

• Regulation 10 HSCA (RA) Regulations 2014 Dignity and respect.

We told the hospital that it must give us an action plan showing how it would bring services into line with the regulations. The hospital provided a comprehensive report on the actions it planned to take and updated us on progress, as the issues were resolved.

The purpose of the inspection on the 29th June 2017 was to see if the hospital had made the necessary changes outlined in the action plan provided. During this follow up inspection we focused on the action plan and the areas of concern which included some aspects of the surgery core service. We did not inspect any parts of the outpatient and diagnostic imaging core service.

We cannot re-rate these services due the time elapsed since the comprehensive inspection, therefore the rating for safe for surgery remains requires improvement. However, during this inspection we were assured that the hospital had met all the required improvements, recommendations and were no longer in breach of regulations.

The hospital had significantly improved and had taken action to comply fully with regulations and we found:

• The hospital had an internal quality audit review following our inspection and showed us evidence of changes as a result of this.

• The hospital had introduced a Standard Operating Procedure (SOP) for compliance with the uniform policy in theatres.

• A new infection prevention co-ordinator had been employed and infection prevention link nurses worked in each department.

• We saw evidence of plans to undertake refurbishments install handwashing facilities on wards to ensure adequate handwashing facilities for use by staff.

• Staff training in Aseptic Non Touch Technique (ANTT) had been implemented and 90% of staff had undertaken the training.

• Consultants were no longer bringing privately owned clinical equipment on site.

However:

• We saw an improvement in the controlled drug registers; however, at the time of inspection these were not always correctly completed.

We will continue to monitor the performance of this service and inspect it again, as part of our ongoing programme.

Professor Edward Baker

Chief Inspector of Hospitals

People we spoke with on the day of inspection told us that they "could not fault the service" the staff were described as “excellent”. People we spoke with felt that they had adequate information to make decisions about their care and treatment. They told us that they understood the risks associated with the options available. Our review of records evidenced that care was personalised and that people were supported by the hospital to make informed choices. One person said, “I had good explanation and advice from my consultant and even better from the anaesthetist when I gave my consent.”

Records that we looked at showed people’s needs were assessed and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The care records were clear and made it easy to follow all aspects of the patient pathway from consultation through to discharge. They were signed at each stage by the nursing or medical staff responsible to show that proper procedures had been followed.

Proper infection prevention and control measures meant that the risk of people contracting infections were reduced.

Staff of all grades were appropriately recruited. Where agency staff were used, the provider had a formal agreement in place that included details of how people were recruited.

People told us that they received good care at the Nuffield Health Chichester Hospital. They said that the nursing staff were kind, knowledgeable and attentive and that they got all the help they needed to make a speedy recovery.

We were told that pain was well managed and that staff encouraged patients to move around as soon as possible after their operation to prevent complications.

When we looked at records we saw that care had been provided following a surgical pathway specific to the type of surgery each person was having. All the essential safety measures were in place and staff were following the correct peri-operative procedures.

The provider had sound governance systems for managing the risks associated with healthcare and to monitor the quality of care and treatment being provided at the hospital.

Patients and visitors that we spoke with were all very positive about the care and treatment they received at the hospital.

One couple that we spoke with asked each other how they would score it overall. One of the partners said “We have been very well looked after; I would say maybe 9 out of 10, what do you think?” The reply was “I think, maybe, a little higher.”

Overall, we rated surgical services at Nuffield Health Hospital Chichester as good. This was because:

• The hospital had a good track record on safety. The hospital had one serious injury, no patient deaths or never events between April 2015 and March 2016.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents. The hospital fully investigated incidents and shared learning from them to help prevent recurrences.
• The hospital had effective systems to assess and respond to patient risk. This included a comprehensive use of the modified early warning system (MEWS) track and trigger flow charts to identify deteriorating patients and respond appropriately.
• The hospital participated in relevant local and national audits and contributed to national data to monitor performance such as the National Joint Registry (NJR).
• We found there were arrangements to ensure that staff were competent and confident to look after patients. Mechanisms were in place to support staff and promote their positive wellbeing. Staff were supported to maintain and further develop their professional skills and experience, and were passionate about working at the hospital.
• Staffing levels and skill mix were planned, implemented and reviewed to keep patients’ safe at all times. Any staff shortages were responded to quickly and adequately.
• Staff encouraged patients and their relatives or supporters to be partners in their care. Patients told us staff had time to answer questions and that they made sue that they had been understood.
• It was easy for people to complain or raise a concern and they were treated compassionately when they did so. We saw evidence the service learnt from complaints and made improvements to working practices where appropriate.
• Waiting times, delays and cancellations were minimal and the service managed these appropriately.
• The leadership team was knowledgeable about quality issues and priorities, and understood what the challenges were and took action to address them.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The endoscopy suite was working toward Joint Advisory Group (JAG) on gastrointestinal (GI) endoscopy accreditation incorporating the endoscopy global rating scale, which is a quality improvement and assessment tool for the GI endoscopy service.
• The endoscopic services demonstrated compliance with British Society of Gastroenterology (BSG) guidelines

However;

• We saw examples of poor compliance with infection control policies within theatres. Infection control procedures were not given sufficient priority at all times. There was concern that theatre staff did not understand the risks associated with these issues.
• We saw poor completion of the World Health Organisation (WHO) Surgical Safety checklist in theatres.
• We saw instances where theatre practice was below expected levels.
• Relatives were used to interpret for patients during the consent process rather than an official interpreter.