Springfield Hospital is operated by Ramsay Healthcare UK Operations Limited . The hospital has 64 beds. Facilities include six operating theatres, a three-bed close observation unit, 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 carried out a focussed follow up inspection to inspect the core services which we had rated as requires improvement during our previous inspection (October 2016). We inspected surgery services and children and young people’s services.

To get to the heart of patients’ experiences of care and treatment, we asked the questions; are they safe and well led for surgery services and are they effective and well led for services for children and young people. We asked only these questions because, during our previous inspection (October 2016), these were the areas we rated as requires improvement. 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 services for children and young people, 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 it as Good overall.

We found good practice in relation to surgery services:

• Ward staff were 84% compliant with mandatory training and theatre staff were 86% compliant. This was an improvement on our previous inspection.

• Environmental cleanliness audits showed 94% compliance in theatres and 94% compliance in the ward area. This was an improvement on our previous inspection where overall compliance was 87%.

• Staff stored equipment appropriately in the clean utility rooms and the medical devices room. This was an improvement on our previous inspection.

• Theatre staff could easily access the difficult airway trolley and the latest difficult airway guidelines were also on the trolley for staff to refer to. This was an improvement on our previous inspection.

• Staff did not pre draw up drugs for use in theatre, control drugs (CD) cupboards were locked and the fluid store was tidy and organised. This was an improvement on our previous inspection.

• Medical advisory committee meetings (MAC) were now well attended and the hospital risk register had been improved to be more specific. This was an improvement on our previous inspection.

We found good practice in relation to services for children and young people:

• There were comprehensive plans in place relating to service improvement and auditing which was an improvement from our previous inspection.

• Frequent resuscitation scenario training took place in theatres to ensure that staff were competent in their paediatric life support skills.

• There was a good understanding of Gillick competence and this was well recorded as part of the paediatric day case pathway.

• There was service representation throughout the hospital, from a service specific meeting, to the clinical governance and medical advisory committees.

We found areas of practice that require improvement in services for children and young people

• Nursing leadership for the service was still being recruited to, which meant that other staff were providing leadership in the interim.

We found areas of practice that require improvement in surgery services

• The theatre audit schedule was not up to date due to a lack of a permanent theatre manager.

• Forty nine percent of theatre staff had not completed appraisals due to lack of a permanent theatre manager.

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 on Behalf of the Chief Inspector of Hospitals

People we spoke with told us that they were very happy with the service, care and treatment that they received at Springfield Hospital. They told us that they were provided with detailed information about their proposed treatment and that their consent was sought before any treatment commenced.

We saw that there were appropriate arrangements for obtaining people's consent to their care and treatment. The intended benefits and risks associated with treatments were explained fully to people in a way that they could understand.

Care and treatments were planned and delivered with the involvement of people who were using the service. Risks to the health and safety of people were assessed and well managed.

People were cared for in clean premises. There were appropriate arrangements, which were monitored, to protect people using the service against the risks of health acquired infections.

People were cared for and supported by suitable numbers of appropriately skilled and qualified staff. There were arrangements for supporting staff to deliver care and treatment safely and to an appropriate standard.

The service had suitable arrangements for receiving, investigating and responding to complaints or concerns. Complaints were monitored to help identify trends and minimise recurrences so as to ensure that people using the service received safe and effective care and treatment.

We spoke with three patients, six staff, the registered manager and head of clinical services. During the inspection we observed that staff were kind and respectful towards patients. The staff and patients we spoke with said there had been sufficient staff available to accommodate patients’ needs.

We saw systems in place allowing patients and their relatives communicate their experiences of the hospital and the care it provided. We saw positive feedback had been given through the patient surveys about the staff and the care patients had received.

We saw patients’ needs had been assessed, risks identified and personalised plans of care developed for each person. There was evidence of support by healthcare professionals to ensure patients’ ongoing healthcare needs were met. The patients we spoke with confirmed they had been kept informed and had been given sufficient information about what to expect during their hospital stay. We saw a number of information leaflets and booklets available for patients.

During our note tracking we saw that the form called ‘recovery 2’ had not been completed in any of the four sets of notes. This score system was used to identify complications in the recovery areas. We have asked the provider to review this practice immediately.

People we spoke with were complimentary about the staff at Springfield Hospital. They told us that the care staff were helpful and caring in their approach and responded quickly most of the time. They also told us privacy and dignity practices were good and the written information provided was helpful.

People said that the staff were knowledgeable and they felt safe in their hands. They told us that staff were professional in their approach and gave good explanations about what was going to happen and why. They told us that the care and service provided by the staff of Springfield hospital was of a good standard.

Springfield Hospital is operated by Ramsay Health Care UK Operations Limited. The hospital has 64 overnight beds. Facilities include five operating theatres, a three-bed observational unit, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care and outpatients and diagnostic imaging services. We inspected surgery, medicine, children’s and young people’s services, and outpatient and diagnostic imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 04 October 2016 along with an unannounced visit to the hospital on 17 October 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 requires improvement overall.

We found areas of practice that require improvement in relation to outpatient services:

• Some patient’s medical records generated by doctors holding practice privileges were taken off the hospital site without copies being made. Referrals were not always assessed by a clinical practitioner and at times patients arrived for an appointment without staff expecting them. Departmental risk registers were not in place and the hospital-wide risk register did not reflect known risk. Staff had not received training in duty of candour.

We found areas of practice that require improvement in relation to surgery:

• Concerns were noted with infection control. Despite practice changes results of audits showed that compliance with hand hygiene and infection control had not improved significantly. The hospital had identified the upward trend in the rate of surgical site infections over the 12 months prior to our inspection.Staff only had access to the NHS patient records because the relevant consultants had taken away their privately funded patients records off site.

We found areas of practice that require improvement in services for children and young people:

• There were no local audits undertaken to demonstrate outcomes for the effectiveness of outpatients or children and young people’s services. Gillick competence was not being recorded in children’s records to demonstrate whether this had been considered as required or not. Oversight or information relating to children’s services had not been reported to the medical advisory committee. Risks identified during the inspections, specifically around monitoring of the service had not been identified as a risk by the service.

We found areas of practice that require improvement in medical care:

• There was no formal triage tool in place which staff on the ward could refer to if an oncology patient called the out of hours helpline feeling unwell. This system did not promote timely intervention for conditions such as sepsis, which require immediate medical assistance. Oversight or information relating to oncology service had not been reported to the medical advisory committee. Risks identified during the inspections, related to oncology had not been identified as a risk by the service.

However, we found the following areas of good practice:

• Patient feedback about receiving care or treatment at the service was positive in all services.

• Equipment used for safe care and treatment, such as resuscitation equipment, was regularly checked.

• Staffing levels in theatre, outpatients and on the ward were observed to be sufficient to meet the activity in the service.

• There was good local leadership in outpatients, medical care and children’s services.

• The service was responding to identified concerns and creating plans to address these.

• There was some good local innovation within services.

• Diagnostic imaging and physiotherapy appointments were coordinated to reduce the number of hospital outpatient appointments required where possible.

• The service made adjustments to meet the needs of patients with complex needs.

• Staff explained the child’s procedure in an age appropriate way using photographs and teddy bears when necessary.

• No children’s surgical procedures had been cancelled in the last 12 months.

• Cancellation rates for surgery were low.

• The service undertakes benchmarking though local audits on outcomes and PROMs, which are comparable across the Ramsay Health Care UK Operations Limited nationally.

• PROMs outcomes had seen an improvement in all areas except the Oxford knee score.

• The Endoscopy service had received accreditation form the Joint Advisory Group on Gastrointestinal Endoscopy (JAG).

• Practicing privileges were routinely reviewed by the hospital. There was RMO coverage 24 hours per day.

• The hospital had a local business continuity plan in place.

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.

Professor Ted Baker

Deputy Chief Inspector of Hospitals