The inspection was carried out by one Inspector over five hours, accompanied by a CQC Commissioner who was shadowing the Inspector on that day. During the visit we viewed all areas of the building, talked with patients, relatives and staff, and viewed documentation.

We found that the Treatment Centre had reliable processes in place for ensuring that patients were informed about the procedures being carried out, and gave their consent to treatment.

People spoke very positively about their experiences of visiting the centre. Some patients had previously received treatment there, and said they had chosen to go back there for further treatment because they had been looked after so well. People’s comments included: “It is brilliant here. I asked to come here. I am very happy with the way the staff look after us. I can ask the staff anything I don’t understand.” And: “I am very happy with everything here. It is a lovely place, the staff are friendly and helpful, and the car parking is easy.”

We inspected medication storage and management and found that there were suitable processes in place to ensure that people received the correct medication.

We viewed the premises, and saw that they were clean in all areas. Maintenance processes were appropriately carried out.

We found that there were robust staff recruitment procedures in place, ensuring that staff who were providing care were suitably trained, qualified and experienced.

We saw that the complaints procedure was easily available to people; and found that concerns and complaints were thoroughly investigated and responded to appropriately.

The inspection was carried out by two Inspectors over five hours. We talked with six people receiving treatments and their relatives; inspected documentation, and talked with seven staff as well as the registered manager.

The centre had established systems in place to carry out procedures, investigations or minor surgery as day cases; after an initial consultation.

People spoke very positively about their experiences of the centre, with comments such as:

“It is a very calm atmosphere here, and the staff are very friendly and helpful.”

“I have come in for my treatment in less than a week since my initial consultation, and the treatment I have received has been excellent from everyone.”

“I was treated like a private patient.”

“My husband has been through procedures here and was very impressed.”

We carried out a comprehensive inspection of the Will Adams NHS Treatment Centre (WATC) on 9 and 22 August 2016 as part of our national programme to inspect and rate all independent hospitals. The centre opened in 2005 and provides elective NHS services to people living in Rochester, Chatham and Gillingham in Kent. NHS treatment centres are private-sector owned and contracted by the local Clinical Commissioning Group (CCG) to treat NHS patients free at the point of use.

We inspected the two core services of surgery and outpatients and diagnostics and rated the centre overall as good.

Are services safe at this centre?

By safe, we mean that people are protected from abuse and avoidable harm.

• There were clear, open and transparent processes for reporting and learning from incidents. Staff reported incidents and managers shared learning locally and within the wider organisation. Staff were aware of the duty of candour requirements and there were arrangements to meet these if required.

• Medical and nursing staffing levels met patients’ needs. Staff completed a mandatory training programme and were competent to do their jobs.

• The centre was visibly clean and there were arrangements to prevent the spread of infection. The environment and equipment was well maintained and fit for purpose. Medicines were managed safely in accordance with legal requirements, although some documents related to medicines management were beyond their review dates. Patients’ records were complete, stored securely and available when required.

• There were appropriate management arrangements for safeguarding with an identified senior lead. Staff received training in the safeguarding of adults in vulnerable circumstances and children to an appropriate level and knew what action to take if abuse was suspected.

• Patients were assessed to ensure there were no safety risks that would prevent them being treated at the centre. Patients were monitored to ensure early identification of any deterioration and there were suitable arrangements to deal with emergencies including transfer of patients to a local NHS hospital.

Are services effective at this centre?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

• Patients received care and treatment in line with national guidelines which was referenced in the corporate policies in use at the centre.

• Patient outcomes were monitored using national and local audit programmes and generally were in line with national averages. There were fewer transfers out to NHS hospitals than other independent hospitals and no unplanned readmissions within 28 days.

• Patients received adequate pain relief. They were not fasted pre-operatively unnecessarily and received food and fluid that met their needs.

• Arrangements for obtaining consent met legal requirements, including where patients lacked capacity to give consent themselves. However, the competency assessment documents policy was beyond the review date.

Are services caring at this centre?

By caring, we mean that staff involve and treat patients with compassion, dignity and respect.

• Patients and those close to them were positive about their experience and we saw care maintained patients’ dignity and privacy. The friend and family test results showed that 99-100% of patients would recommend the centre.

• Patients said they were supported emotionally and their care was discussed with them in detail.

Are services responsive at this centre?

By responsive we mean that services are organised so they meet people’s needs.

• The centre worked with the local CCG’s and other NHS providers to give local people a choice in where they received their treatment. Patients were able to access the service in a timely way with over 95% beginning treatment within 18 weeks of referral. Patients could book treatment and appointments at times that suited them.

• There were arrangements to meet the individual needs of patients. Patients underwent a pre-assessment process that ensured they met explicit referral criteria and were suitable for treatment at the centre and any individual needs were identified and planned for. The organisation had a dementia strategy implemented and patients were screened for dementia. There were arrangements to support people with learning disability and the centre was accessible to wheelchair users.

• There was a complaints process that was understood by staff and was publicised to patients. Complaints were appropriately investigated in a timely manner, response letters generally sent within agreed timescales and learning points shared.

• Interpreters could be booked if needed; the centre did not allow relatives to translate for patients in line with best practice. However, patient information leaflets were not available in other languages.

Are services well-led at this centre?

By well-led, we mean that the leadership, management and governance of the organisation, assure the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

• Staff demonstrated an understanding and appreciation of the values and aims of Care UK and the centre. There were clear lines of leadership and accountability and staff had a good understanding of their responsibilities. There was visible leadership both at local and corporate levels and staff told us felt they felt supported by their managers. Staff were proud to work at the centre and there were high levels of work satisfaction.

• The centre acted on and made improvements from staff feedback. The feedback of patients was sought and the centre had an active patient forum which contributed to developments. The centre participated in local community events to raise awareness of the centre and its services.

• There was an appropriate governance structure which enabled the management team, and Care UK to monitor performance and benchmark this against the centre’s peers. Information relating to quality and safety was disseminated throughout the centre to relevant staff. There were arrangements to identify and manage risks via risk assessments and a risk register although some departmental managers lacked clarity about the location of risk registers. We noted a number of corporate documents used at the centre had passed their review dates.

Our key findings were as follows:

• The centre had a good safety record, and there were systems to investigate and learn from incidents and complaints.

• The centre was visibly clean and well maintained, and that there were effective systems to prevent infection. Performance in relation to healthcare associated infection was good.

• There were sufficient numbers of staff with the qualifications, skills and experience to meet patients’ needs.

• Patients received care that was based on national guidance and experienced good outcomes from treatment.

• Patients received adequate pain relief and appropriate food and drink.

• Patients were positive about their experience and received care that protected their privacy and dignity. They received adequate information about their care and emotional support.

• There were arrangements to safeguard children and adults in vulnerable circumstances and patient’s individual needs were considered and met.

• Staff understood the values of the organisation. There was effective and visible leadership and governance and risk management structures and processes that assured the quality of care and safety of staff and patients.

We saw several areas of outstanding practice including:

• The provision for patients to liaise in person with the appointment schedulers to arrange their next appointments prior to leaving the treatment centre.

• Real time theatre monitoring that enhanced the centre’s ability to provide an effective and efficient service, which reduced delays and inconvenience to patients.

However, there were also areas where the provider needs to make improvements.

The provider should:

• Improve document control related to medicines management protocols and patient group directions (PGDs) to ensure that staff are referring to up to date versions.

• Display posters relating to the chaperone policy and highlight the choice for the patient to request a member of staff as a formal chaperone.

• Make arrangements to ensure patient information leaflets are available in other languages.

• Ensure departmental managers are clear and aware of the location of the departmental risk registers and risk assessments.

Professor Sir Mike Richards

Chief Inspector of Hospitals