During our inspection on 14 November 2013 we spoke with four people and two relatives of people who used the service. They told us that before they had received treatment the doctors had explained what it involved with them. One person told us, "I see my doctor... [the doctor] tells me everything."

People told us that they were happy with the care and treatment that they had received. One person described the service as, "...lovely. I can't fault it." They told us that they were happy with the food and the choice of food available to them. One person told us, "The food is perfect...lovely. I cannot fault it."

On the day of our inspection we saw that the premises were clean and bright. We looked at a number of rooms and found that these were all clean and smelled fresh.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We looked at the prescription and medicines recording charts for ten of the 54 patients who used the service on the day of our inspection. We found these records were in good order, provided a good record of what medicines were prescribed and demonstrated that patients received their medicines as prescribed.

We looked at the recruitment files of three staff members and found robust procedures were in place to safeguard people who used the service.

We noted that there were leaflets that explained how people could make a complaint in the reception area.

When we inspected the Rivers Hospital on 07 March 2013 we spent time in all areas and spoke with four people. All of the people we spoke with were complimentary about their experience.

People told us that staff had explained their treatment and procedures and that information had been sent to them prior to admission. This included information about consent and any risks involved in their treatment.

People were assessed and care and treatment was planned in accordance with those needs. We found that documentation describing treatment for each stage of a person’s treatment pathway was detailed, precise and supported what we were told by staff. One person said, "The staff have been wonderful. All my needs have been met." Another told us, “My notes are always available, they follow me wherever I go.”

We found that people using the service were protected from the risk of abuse because the provider made information and training available to staff about safeguarding. However, some staff members were unclear about being able to identify abuse and so the effectiveness of the training was in doubt.

Staff at the hospital were supported to provide effective care and treatment through supervision and training.

We saw records that showed us that the staff at the hospital were continuously working to improve the quality of the services they provided through monitoring performance and implementing changes to deal with shortfalls that were identified.

We did not speak to people who used this service as part of this review. We looked at a sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Rivers Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital has 49 beds. Facilities include five operating theatres and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people (CYP), and outpatients and diagnostic imaging. We inspected all core services.

We inspected this service using our comprehensive inspection methodology. We carried out the short notice inspection on the 17,18 and 19 December 2018.

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 service level.

Services we rate

Our rating of this hospital improved. We rated Medicine, Surgery, Outpatients and Diagnostic Imaging as good and children and young people’s services as outstanding. The hospital was rated as Good overall.

• The hospital provided staff with appropriate training to enable them to complete their roles and responsibilities.
• The hospital premises were visibly clean and well maintained. Surgical, outpatient, diagnostic and children and young people services managed infection control risks well.
• Equipment was well maintained and replaced as necessary.
• There were systems in place to support staff to assess patients’ risks to ensure the safe provision of care and treatment.
• The service managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
• Medicines were stored, prescribed and managed safely.
• Safety incidents were managed using an effective system. There were processes in place to ensure shared learning.
• Staff were able to identify potential harm to patients and understood how to protect them from abuse. Services knew how to escalate concerns.
• The hospital provided staff with policies, protocols and procedures which were based on national guidance.
• Staff ensured that patients were provided with adequate food and hydration, offering varied diets to meet nutritional or religious preferences.
• Staff competency was assured through monitoring and regular appraisals.
• Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Patients were supported to make decisions and were kept informed of treatment options. Staff treated patients with dignity and respect.
• Services were planned to meet the needs of the patients, with additional support available for patients who had additional needs.
• Services provided by the hospital were flexible to meet the needs of patients, enabling additional clinics, appointments or out of-hour services as able. Waiting times from treatment and arrangements to admit, treat and discharge patients were in line with good practice.
• Complaints were taken seriously, with concerns being investigated and responses made within agreed timescales. Staff shared learning from complaints and encouraged patients to identify areas for improvement.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality child-centred care.
• Managers and leaders were appropriately skilled and knowledgeable to manage teams and services. Leaders were accessible and respected by staff.
• Managers promoted a positive culture which supported and valued staff, creating a sense of common purpose based on shared values.
• There was a hospital vision and strategy which was developed in collaboration with the clinical team and reflected a focus on patients and staff.
• The service had processes in place to monitor performance and used these to encourage staff to provide high standards of clinical care and treatment.

We found areas of outstanding practice in children and young people services:

• Parents’ and children were extremely positive about the care and treatment they received. Feedback on the care, compassion and quality of the children and young people’s services were unanimous in their praise for “for all aspects of the children’s service”. Six parents and two children who had experienced the day surgery pathway rated the service as ten out of ten and said, the service ‘could not have been any better’.
• We were told nurses, consultants and support staff were always friendly and welcoming to children and their families and were skilled in communicating with children and young people which helped to minimise their distress. We saw examples where staff had gone the ‘extra mile’ to adapt the service in a safe but personalised way to better meet the needs of children and young people and their families.
• Staff involved children and their families at pre-assessment clinics where they were shown the type of equipment that would be used during their admission to hospital. For example, syringes, cannulas and blood pressure cuffs. Younger children had the equipment demonstrated on toys and were able to familiarise themselves with the equipment through play.
• Children and young people services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
• Feedback from children and parents rated children’s services as being between 95% and 100% for all aspects of care including, overall rating of care 100%, being looked after 100%, and the care by nurses, doctors and physiotherapists was rated between 94% and 100%.
• Areas used were dedicated solely for the use of children and had been adapted where possible to make them more appropriate for any age of child. For example, beds for children and young people had special bed linen and activities were provided to entertain and distract children of all ages.
• Children and young people had short waiting times prior to consultations or appointments.
• Children and young people’s (CYP) services were overseen by a lead paediatric nurse (LPN) and a named consultant paediatrician. Staff told us the LPN had raised the profile of children’s services and was recognised as being the clinical expert in the care of children and young people. Staff told us they were approachable and could be contacted for advice and support.
• Children’s services were incorporated into the hospital vision and strategic direction for the hospital which was recognised by staff and integrated across children’s services.
• The children and young people service actively engaged with children and their parents and families in feedback and development of children’s services.

However, we also found the following issues that the service provider needs to improve:

• The service did not monitor outcomes for oncology patients.
• Some policies provided were not in date or reviewed in line with the recorded timeline.
• Competencies within oncology were not always evidenced. For example, there was no evidence to support that pharmacists had completed oncology specific competencies and the head of department had self-assessed their skills. 
• There were not always accessible handwashing sinks available in-patient rooms on the inpatient ward so staff could maintain good hand hygiene practices.
• Intravenous fluids were not always clearly prescribed or recorded.
• Some pain management audits were not always completed.
• A minority of patients did not always appear to have time between consent being completed and the date of operation.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central Region)