Rowley Hall Hospital is located in a Georgian listed building in five acres of Rowley Park, Stafford. The hospital opened in 1987 and currently has 13 ensuite bedrooms and 10-day case pods. The hospital is managed by Ramsay Healthcare UK Operations Ltd and is part of a network of over 36 hospitals, day surgery facilities and two neurological rehabilitation homes across England. In addition, they run hospitals in Australia, Indonesia and France.

We inspected the core services of surgical services and outpatients and diagnostic services as these incorporated the activity undertaken by the provider at this location.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 October 2016, along with unannounced visits to the hospital on 20 and 27 October 2016.

We rated both core services, and the hospital as good overall. However, we found that safety in surgical services required improvement because we had concerns that that safety checks in theatres were not consistently completed and infection rates for spinal and breast procedures were higher than the national average.

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 core service.

We rated this hospital as good overall because:

• Governance arrangements ensured that surgery was planned and co-ordinated effectively. Incidents were reported and investigated; staff felt incidents were dealt with appropriately and feedback was given. Staff told us they felt valued and listened to.
• Staff were caring and supported patients to make informed decisions based on sound clinical options. Staff had a genuine interest in the health and wellbeing of their patients. Patients were complimentary about the care they received pre and post-operatively.
• Patients with complex needs were supported and their carers encouraged to attend the hospital with them.
• The hospital had systems in place, which ensured that patients were protected from the risk of avoidable harm.
• Services were effective, practice was audited and learning shared to improve patient outcomes. Recognised pathways of care, and national guidance were understood and followed.
• Services were responsive to patients’ individual needs. The patient journey from one department to another was easy and waiting times were minimal.

We found areas of practice that require improvement in both surgery and in outpatients and diagnostic imaging services.

• Surgical safety processes were not embedded in theatres.
• Staffing in theatres was not in line with surgical first assist perioperative care collaborative guidelines. Staff undertaking the role had not completed the recognised training requirements and undertook dual roles for procedures greater than a minor operation.
• Not all staff who worked in recovery were trained in Advanced Life Support (ALS) which meant good practice guidelines were not being followed. Not all staff were clear about how to respond in emergency situations and update training had not been received.
• Staff were not up to date with mandatory training.
• The audit process in theatre had not been effective; the newly employed theatre manager was in the process of building a robust team of appropriately trained staff
• Only 34% of nurses working in outpatients had currently received an annual appraisal.

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 two requirement notices that affected surgery. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals