Standard Health Ltd provides this service at Nuffield Health Wessex Hospital (host hospital) which has 46 beds for inpatients and day cases. We carried out a comprehensive inspection on the 4 November 2016, as part of our national programme to inspect and rate all independent hospitals. We inspected the core service of surgery as this is the main activity carried out at this location by the provider Standard Healthcare Ltd. We rated the core service as good overall.

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 how the provider understood and complied with the Mental Capacity Act 2005.

The service provided by Standard Healthcare at this location was Orthopaedic surgery. Services were provided under a service level agreement with the host hospital. Some of these included:

• Theatres.

• Pharmacy

• Staffing including nursing and others.

• Medical cover such as Resident Medical officer (RMO) provision.

• Infection control.

• Physiotherapy.

• Radiology and imaging

• Catering and laundry services.

• Clinical Waste disposal services.

• All equipment inn theatres and wards and their maintenance.

We rated this service as good overall because:

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

• Medicines were managed safely and patients had access to their medicines including pain control as needed.

• There were enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.

• The areas we inspected were clean and well maintained and there were processes which staff followed to control and prevent the spread of infection.

• There was adequate equipment and this included those for bariatric patients. The operating theatre had a laminar flow system

• Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked.

• Patients could access care when they needed it and they were treated with compassion and their privacy and dignity was maintained at all times.

• People were supported and received adequate food and fluids and choices were offered that meet their needs.

• All staff demonstrated a good understanding of the duty of candour and their responsibility in safeguarding people from abuse.

• There was effective multidisciplinary working for the benefits of patients which patients confirmed to us.

• There was a robust admission procedure which staff followed and this reduced the risk of inappropriate admissions.

We found areas that required improvements

• The provider was not involved and did not attend governance or medical advisory committee (MAC) meetings. The governance process was not robust as minutes of MAC were not shared in order to promote learning.

Following this inspection, we told the provider 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.

Name of approver

Deputy Chief Inspector of Hospitals: Professor Ted Baker

During this inspection we found that people’s views and experiences were taken into account and their privacy, dignity and independence were respected. Patients had been involved in discussions and decisions about their proposed treatment. We met a person who was due to have surgery on the day of the inspection and they told us “He even checked today if I still felt I wanted to go ahead with the operation”. They said they felt “looked after” and told us “everything was explained to me”. We looked at the records of five people who had undergone a surgical procedure under the care of Standard Health Ltd at the Nuffield Health Wessex Hospital. We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider confirmed that whilst major operations he undertook were carried out at the Nuffield Health Wessex Hospital (Nuffield), pre and post-operative consultations with patients were carried out at another location in Wimborne. The provider told us he used the Nuffield as he knew the ward and theatre staff provided good patient care. He said if there were any issues he liaised with the matron. The provider said he worked in line with the policies at the Nuffield and that he employed his own anaesthetist.