We found there were suitable processes in place for ensuring people understood their planned care and treatment and the processes for gaining informed consent were compliant. We also found people's care was effectively planned and risks were identified and managed appropriately.

We found no concerns in relation to the maintenance and safety of the premises and the processes for managing all aspects of the environment worked effectively. We found that staffing levels were suitable and there were clear processes in place for assessing staffing levels and skill mix.

We found there were clear governance structures in place, appropriate lines of accountability and flow of information. In addition, the experiences of people who used the service were well captured. We spoke with four people who used the service and all were positive about their experiences and spoke highly of the care and support they received.

One person we spoke with said, “The nurses were lovely and they were happy with the whole process.” Another person we spoke with said, “Staff attitude is fantastic and nothing is too much trouble.” The third person we spoke with said, “Everything had been excellent”. And they also said, “Things have been better than their previous stay four years earlier.” The final person we spoke with said, “There was good patient focus and the premises were very good.”

We spoke with seven people who used the hospital. They told us the associated risks and benefits of their treatment was explained to them. They said they were given information to take away and had time to decide if the treatment was right for them. However, despite the positive comments people made, we found evidence the provider did not have suitable arrangements in place to ensure consent was obtained from people before they received care or treatment.

People told us they found the hospital to be clean and tidy. One person said staff were “bang on with hygiene”. Another said the hospital was “a clean fantastic environment”.

People we spoke with were happy with the standard of care and treatment they had received at the hospital. One person told us, “I feel like I had individual care and it was 10 out of 10 right from the start”. Another person said the hospital provided a “really good quality of care”. They said staff were approachable, respectful and spent time engaging with people.

Six of the seven people we spoke with told us they had never complained about the service. They said if they had a concern they would raise this with staff and felt they would be listened to. One person said, “I have complained about a minor issue in the past. It was dealt with quickly and I got an apology. I was happy with the outcome.”

The patients we spoke to were positive about the care they received from staff at the hospital.They told us that the staff were caring and that they received good information relation to their treatment.

Some of the things the told us were:

'I had all the information I needed about my procedure before I decided to go ahead'

'I have been impressed by how caring the staff have been and feel in safe hands'

The Yorkshire Clinic Hospital is part of the Ramsay Health Care UK Operations Limited. The hospital has 56 beds and 12 ambulatory bays. Facilities include five operating theatres, a four-bed level two care unit, an endoscopy unit, angiography suite, physiotherapy, pharmacy, central sterile services department (CSSD) and X-ray, outpatient and diagnostic facilities. The Lodge is a separate building but still part of the hospital, which has one theatre, consulting and treatment rooms and is the dedicated ophthalmology centre.

The Yorkshire Clinic provides surgery, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery, outpatients and diagnostics and services for children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 18 to 20 October 2016, along with an unannounced visit to the hospital on 3 November 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 core services. See surgery section for main findings.

We rated this hospital as good overall.

We found good practice in relation to surgery, diagnostics and outpatient care and services for children and young people:

• 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.
• Staff were encouraged to report incidents and we saw good sharing of learning following incidents. Staff were aware of the two never events and subsequent changes in practice.
• Mandatory training compliance levels were high and we observed good practice in relation to infection prevention and control and medicines.
• Documentation was good and patient care and treatment was evidence based. There were clear pathways of care and staff were able to recognise and respond to signs of deteriorating health.
• Patients were involved in their care and treated with dignity and respect.
• Service provision was focused around the needs of the people using the hospital.
• The provider met national indicators for referral to treatment (RTT) waiting times.
• Staff spoke positively about their leaders and managers.
• The governance arrangements in place ensured that quality, performance and risks were managed.

We found some areas of outstanding practice, these were:

• The pharmacy department had undergone external benchmarking of their aseptic department.
• The new senior children’s nurse was building links to the local authority safeguarding children’s board and had attended a recent link meeting.
• The senior registered sick children’s nurse had started weekly two hour information and advice safeguarding children ‘drop ins’. These had proved popular and provided a link between local and national developments and staff.

There were no breaches of regulations. However, there were areas where the provider should make some improvements, even though a regulation had not been breached, to help the service improve. These were:

• The provider should consider making designated areas more child focused.
• The provider should ensure that all staff receive an annual appraisal.
• The provider should ensure best practice guidance is followed in relation to mental capacity assessment and best interest’s decisions.

Ellen Armistead

Deputy Chief Inspector of Hospitals