Oaks Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital has 57 bedrooms including three twin-bedded rooms all with en-suite facilities beds and an 11 bay ambulatory unit which caters for patients undergoing day surgery procedures and endoscopy.

Facilities include four operating theatres, outpatient and diagnostic facilities. Outpatient facilities include two fully equipped ophthalmology suites, fourteen consultant rooms and two minor treatment rooms.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. Services for children and young people were suspended and under review at the time of inspection. Oaks Hospital had treated two oncology patients between July 2015 and June 2016. We inspected surgery services and outpatients and diagnostic imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 December 2016 along with an unannounced visit to the hospital on 29 December 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.

Services we rate

We rated this hospital as good overall.

We found good practice in surgery:

• Staff knew how to report incidents using the electronic reporting database. Incidents were investigated and learning shared.

• Medicines and controlled drugs were stored and monitored appropriately.
• The hospital was visibly clean and tidy and equipment was maintained and serviced.
• The hospital used the World Health Organisation five steps to safer surgery checklist and we found through observation and review of records that this was followed correctly. Audit data provided by the hospital showed 100% compliance with five steps to safer surgery in February and May 2016.
• One-hundred per cent of staff had completed level two safeguarding training.
• There was a comprehensive audit programme in place to monitor compliance with best practice and hospital policies.
• The hospital had Joint Advisory Group (JAG) accreditation for endoscopy services.
• We observed staff interacting with patients in a kind and caring manner. Patients told us that staff were kind, compassionate and kept them informed about their care. Figures for the Friends and Family Test between May and August 2016 showed that 93% to 100% of patients who responded would recommend the service to friends and family.
• On average over 90% of NHS patients were admitted for treatment within 18 weeks of referral.
• The hospital cancelled only six operations during the reporting period and all were offered another appointment within 28 days.
• There was a robust complaints process and learning from complaints was shared with staff.
• There was a clear governance process in place with clear lines of communication between staff, heads of department, senior management team and the medical advisory committee (MAC).
• The general manager was respected by all staff and the MAC chair and all were positive about the impact they had had on the hospital.

We found areas of practice that required improvement in surgery:

• Immediate life support training rates were below the hospital target for both theatre and ward staff. Only two members of the recovery team plus the resident medical officer and matron had completed advanced life support training.
• There was no clearly defined escalation process for a deteriorating patient following chemotherapy. Oncology patient records held on site did not contain clearly defined drug protocols or a copy of the patient consent.
• We found that a number of consultants had not provided their up to date appraisal as per the hospital policy in order to maintain their practising privileges.
• The hospital did not specifically monitor fasting times so were unable to assess if patients were fasted for extended periods if their operation was delayed.
• Risk management processes were not fully embedded. The lack of consent forms and of triage and assessment of the deteriorating oncology patient had not been recognised as a risk.

We found good practice in outpatients and diagnostic imaging:

• There had been no never events or serious incidents within outpatient and diagnostic imaging services between July 2015 and June 2016. Incidents were fully investigated and lessons were learned and shared.

• Areas we visited were visibly clean and we saw good infection control techniques, which were in line with policy and national guidance. Equipment had up to date maintenance and recorded checks.
• All outpatients and diagnostic imaging staff had completed training in both adult and children’s safeguarding to level two and staff we spoke to understood the principles of safeguarding.
• Medicines and controlled drugs were stored and monitored appropriately.
• Policies were up-to-date, version controlled and referenced national guidance.
• Staff had completed training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguarding and the staff we spoke to were able to demonstrate an understanding of relevant guidance.
• Friends and Family Test results were high; between January and June 2016 an average of 98% of patients that responded would recommend the hospital to their family and friends. Patients provided consistently positive feedback about the care they had received and we observed positive interactions between patients and staff.
• The hospital met the target of 92% of NHS funded patients on incomplete pathways waiting 18 weeks or less from time of referral in the reporting period July 2015 to June 2016.
• Above 95% of NHS funded patients started non-admitted treatment within 18 weeks of referral in the same reporting period.
• The hospital had no patients waiting six weeks or longer from referral for the magnetic resonance imaging, computerised tomography or non-obstetric ultrasound diagnostic test.
• Complaints were handled in line with policy. We saw that lessons were learnt and shared. Improvements were made to the outpatient service as a result.
• Outpatients had good leadership. Staff described the senior team as approachable and supportive. There was a culture of openness and transparency.
• There was a clear governance structure. The hospital risk register contained risks which matched concerns identified by staff.

We found areas of practice that required improvement in outpatients and diagnostic imaging:

• Resuscitation equipment such as nasopharyngeal airways and intubation blades had open packaging. This was escalated and addressed immediately.
• Mandatory training figures were below the hospital target. However, the staff who were not up to date were bank (temporary) staff who had not recently worked at the hospital.

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.

Sir Mike Richards

Chief Inspector of Hospitals 

We spoke with five people who used the service. People told us they were very satisfied with the service. People said they had been given information and support from staff to help them understand the care they were consenting to, and to support their continuing health needs.

The service was safe as there were sufficient staff to provide care and treatment, arrangements were in place to deal with foreseeable emergencies and the service had systems to prevent and control the risk of infection. People’s safety was also promoted through effective recruitment of staff, clear systems of recording of care, and continuous monitoring of the quality of the service.

The service was responsive to people’s needs. People told us they had good information about who to contact if they needed help prior to admission or after discharge. There were systems to enable people to provide feedback on the care and treatment they received.

We spoke with two people who were receiving care and treatment in this service. They reported that they were aware of the treatment they were having and confirmed that they had been involved in discussions with their consultant surgeon and their consultant anaesthetist regarding their procedure. They confirmed that they had signed the relevant consent form for their surgical procedure. They also spoke highly of the support shown by nursing staff and confirmed that if they had any questions or queries; these were addressed promptly.

People also reported that they were satisfied with the level of care and attention shown by staff and some people were complimentary about the food provided and the kindness shown by individual staff.

We also spoke to two visitors to the service and they confirmed that they were happy with the standard of care that they had observed whilst visiting their relative.

People who had undergone surgery stated that they felt well informed about their care and treatment and that both doctors and nurses were good at keeping them up to date. They told us they were involved in the decision making regarding their care and treatment options and confirmed they had signed consent forms prior to going to theatre and were aware of the risks and benefits of surgery.

People we spoke with were complimentary about the staff at the Oaks Hospital. They told us that the care staff were helpful and caring in their approach and responded quickly when called. Privacy and dignity practices were good and the written information provided was helpful.