Nuffield Health Haywards Heath Hospital is operated by Nuffield Health. The hospital primarily

serves the communities of mid Sussex. It also accepted patient referrals from outside this area. The hospital had 27 beds. Facilities included three operating theatres, including one with laminar flow, a two-bedded area for closer post-operative observation, and outpatient and diagnostic facilities.

The hospital provided surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. The main service provided by this hospital is surgery.

We previously visited this hospital in November 2016 as part of our national programme to inspect and rate all independent healthcare providers. We inspected all core services at the hospital, which incorporated all the activity undertaken. We rated both surgery and outpatients and diagnostic imaging as ‘good’ overall.

Within the outpatient and diagnostic service we found a breach of regulation relating to the maintenance of patient records. This breach related to both adults and the children’s services within the outpatients department. If a service is in breach of regulations it means we cannot give a rating higher than requires improvement within that domain. For this reason the service had a 'required improvement' rating in safe for services for children and young people and outpatients and diagnostic imaging.

We told the hospital it must:

• Securely maintain an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided.

• Records must be kept secure at all times and only accessed, amended, or securely destroyed by authorised people.

The hospital was in breach of one regulation in relation to this:

Regulation 17 HSCA (RA) Regulations 2014 Good governance (17(2) (c)

We found an area of practice that required improvement in services for children and young people:

• Services did not meet the needs of their young patients fully because many facilities were shared inappropriately with adults, resulting in a lack of privacy and dignity for young patients, and there was a lack of resources available for this patient group.

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 our inspection on 17 October 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 highlighted in the previous report. We did not inspect any parts of the surgery core service, and focused on patient records in line with the breach of regulation and the provision for children’s services only.

We cannot re-rate these services due to the period of time that had elapsed since the comprehensive inspection, therefore the rating for safe for outpatients and diagnostic imaging 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 the regulations.

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

• Patients now have a full set of hospital records. These include outpatient activity

• Secure storage facilities were now in place for patients records, with a further area identified, and funding allocated to ensure a permanent more appropriate records store.

• All consultant documentation was duplicated and placed into the patients records. This included any had written clinic notes and GPs referral letters.

• Monthly Audits were undertaken to ensure compliance.

We also saw evidence that the hospital were stopping the children’s and young person’s service for children under 16, from October 2017 with current lists continuing until January 2017.

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

Amanda Stanford

Deputy Chief Inspector of Hospitals

We spoke with five patients to find out their opinions of the hospital. All were complimentary about the care and treatment provided by staff. One patient informed us, “I can’t say enough good things [about the hospital].” We also contacted a GP by email to find out his thoughts about the care and treatment of patients whom he referred to the hospital. He too was complimentary and wrote, “I have no criticisms of the care provided at the Nuffield Hospital because I have had nothing but good feedback from both my patients and friends who have used the Hospital.”

We found that patients’ needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Patients’ health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Patients were complimentary about the staff. They described staff as, “attentive,” “competent,” “professional” and “gentle.” We considered that there were effective recruitment and selection processes in place.

Patients raised no complaints or concerns about their care or treatment during our inspection. We found that patients who used the service, their representatives and staff were asked for their views about the care and treatment provided and their comments were acted on.

Patients’ personal records including medical records were accurate and fit for purpose.

In this report, the names of two registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time. A new interim hospital director had recently been appointed. He assisted us with our inspection, together with the matron of the hospital.

We spoke with people who told us that they received a very good level of service. They told us that members of staff ''really care" and that ''the food was great''.

Requests for assistance were responded to promptly and they were always provided with information and explanations to questions at every stage of their care.

We found that patients had the opportunity to have procedures explained to them, prior to signing consent to treatment.

Patients experienced effective, safe and appropriate care and treatment that met their needs.

Patients were protected from the risks of inadequate nutrition and dehydration.

The hospital had systems and processes in place to maintain equipment so that people were cared for safely.

There were suitably trained staff in all departments and there were staff available depending on the number of people receiving care.

There was a system in place to receive complaints, to investigate these and respond to the complaint in a timely manner.

Patients told us that they received courteous and professional advice before, during and after treatments. They said they were offered choices and given options at all stages of their care. When we asked people if they were given enough information to ensure that they were able to make considered decisions regarding their treatment they said they were.

Patients we spoke with said they received treatment and care from well trained, polite and knowledgeable staff in clean, comfortable and safe surroundings. We were told that the staff focus was on patient comfort and great care was taken to respect peoples’ privacy and dignity. During our visit we spoke with a range of patients including some who were attending pre-operative and post-operative appointments and others who were accommodated as in-patients.

We were told that patients were very happy with the service and care. One patient told us “the staff are very efficient here and nice and you couldn’t wish for anything better”. Another person remarked that she could not speak highly enough of the staff and said that they were so friendly with nothing being too much trouble.

Nuffield Health Haywards Heath Hospital is operated by Nuffield Health. The hospital has 27 beds. Facilities include three operating theatres, including one with laminar flow, a two-bedded area for closer post-operative observation, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected all four core services. Because of the low numbers of patients receiving medical care at this service, we have reported this under the surgery section.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 07 – 09 November 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.

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 core service.

We rated this hospital as good overall because:

• Staff confidently escalated any risks that could affect patient safety and we saw effective systems for reporting, investigating and learning from incidents.
• There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training for their roles. Completion rates for mandatory training including key topics such as safeguarding were better than the target set by the Nuffield Group.
• The hospital was visibly clean and there were appropriate systems to prevent and control healthcare associated infections. We saw that rooms were equipped with sufficient equipment and consumable items for their intended purpose. The waiting areas were spacious and well-appointed with amenities for refreshments and comfortable seating, including a variety of seat heights available to assist those recovering from surgery.
• Medicines were managed safely in accordance with legal requirements and checks on emergency resuscitation equipment were performed routinely.
• Staff responded compassionately when people needed help and support to meet their basic personal needs. Staff also respected people’s privacy and confidentiality at all times. Patients’ feedback through interviews and comment cards was positive.
• People were always made aware of waiting times and meals were offered to those delayed or in clinic over meal times. Any concerns or complaints were listened and responded to and feedback was used to improve the quality of care.
• We saw strong leadership at the location with an open and transparent culture. The hospital director used the Heads of Departments forum as a governance and performance management tool to maintain and improve the quality of the service. There was a clear vision and focused strategy to deliver good quality care.
• The governance framework ensured staff responsibilities were clear and that quality, performance and risks were all understood and managed. Services continuously sought to improve and develop novel approaches to enhancing care, such as exercise courses offered to the public.
• Staff were overwhelmingly positive about their experience of working at the hospital and showed commitment to achieving the provider's strategic aims and demonstrating their stated values. Staff told us they were supported by the hospital director and the new matron, both of whom were visible and approachable.
• We found evidence of multidisciplinary team (MDT) working across all of the areas we visited and we saw good collaborative working and communication amongst all staff in and outside the department. Staff frequently reported they worked well as a team and liked the “family” feel of the organisation.
• There were no delays in accessing surgical intervention once the patient was identified and had accessed the hospital’s booking systems. The hospital offered rapid access to diagnostic imaging and physiotherapy services, usually within a week. The hospital was above the 90% national referral to treatment (RTT) waiting time target for the majority of the year.

However, we found an area of practice that requires improvement in outpatients and children and young people’s services:

• During our inspection, we observed a number of outpatient records kept in a lockable filing cabinet in a utility room. We saw that these folders contained care notes for patients attending the clinic for dressings or other interventions. These records were stored separately from medical files we had previously viewed and were treatment notes held loosely in clear plastic wallets. Some had been labelled with a patient’s name and all were stored in an alphabetic filing system.
• Health and Social Care Act 2008 (Regulated Activities) Regulations 201417 (2) (c)states the provider must “maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided.”
• Keeping separate file notes in this manner did not meet the requirement of the regulation and because of this, our rating lowers to ‘requires improvement’ for safety. The way the records were kept added to the risk that papers could be separated or misfiled, which was an unsafe practice. We noted that this had occurred in a file our colleagues from the children’s team viewed. In addition, separating the medical records in this way made it harder for the consultant to monitor the results of treatments and the patient’s progress.

We found an area of practice that requires improvement in services for children and young people:

• Services did not meet the needs of their young patients fully because many facilities were shared inappropriately with adults, resulting in a lack of privacy and dignity for young patients, and there was a lack of resources available for this patient group.

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 one requirement notice that affected outpatients and children and young people’s services. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals