We spoke with three people who received care and treatment on the day of our inspection and some family members that were present at the time. Everyone told us that they were happy with the quality of care and treatment received which met their expectations. One person told us: “Very impressed with treatment” and: “All of the staff without exception have been exceptional. “ “Another person said: “I have had no lack of attention” and: “They (the staff) have been very caring, listen to me and talked to me. This is a place I feel that I can relax in.”

The three people we spoke with told us that they were well aware of why they had to be in hospital. People told us that they had been well informed about their surgical procedures. They said that staff spoke with them often and explained what was happening and why. One person told us: “Consultant showed me the x-rays and explained my options for treatment. I did not walk away with any questions as I felt very informed.”

We found that people’s care records were detailed and clear with any identified risks to people’s health and welfare documented. We also saw that the World Health Organisation (WHO) surgical checklist was in use to promote people’s safety before surgery commenced. Arrangements were in place to deal with medical emergencies to further ensure people were in safe hands during their hospital stay.

We saw that people who used the service had their medicines as prescribed at the right time and in the right way. This made sure people’s health needs were effectively met whilst they were in hospital and there were guidelines in place to ensure people’s pain was well managed.

We found that minimum staffing levels were maintained to ensure that the needs of people who used the service.

The registered manager and the registered provider had responsive systems in place to monitor and review people’s experiences and complaints. This meant that positive outcomes for people were continually developed, reviewed and improved upon when needed.

During our inspection we tracked through the care and operation procedure processes to check that relevant information had been gathered and recorded. We found that the hospital had robust systems in place to ensure that people received appropriate care. Risk assessments and safety checks had been carried out to protect people who had used the service from injuries and harm.

We spoke with two people who were receiving services and one who had previously had an operation at the hospital. They told us they had been well informed before making decisions about their procedure and care needs. We found evidence that people had given their written consent for the operation they were due to have. They also advised us that the standard of care they had received was good. One person who had recently had a procedure said, "I've stayed here myself and it's been absolutely perfect."

The hospital asked people for their views and experiences of care on a regular basis. We looked at the analysis of these surveys. The reports indicated that people were satisfied with their procedure and delivery of care. We found that very few negative comments had been made. We asked people if they knew how to make a complaint, they told us they did but had not needed to.

The Droitwich Spa Hospital is operated by BMI Healthcare Limited. The hospital has 46 registered beds offering ensuite facilities, satellite television and telephone amenities. Facilities include three operating theatres, an endoscopy unit, 11 outpatient rooms and diagnostic services including X- ray and magnetic resonance imaging (MRI) and a physiotherapy department.

The hospital provides a range of surgical procedures, outpatient clinics and diagnostic imaging facilities. During our inspection we visited all services within the hospital. Services included surgical procedures and outpatient appointments for preoperative and postoperative review, as well as outpatient treatments such as naso-endoscope and dermatology procedures. In the reporting period of August 2017 to July 2018, there were 683 inpatient procedures, 3,823 day-case episodes of care and 18,731 outpatient attendances. The outpatient appointments were a combination of patients accessing treatment and surgical outpatient consultations.

We inspected this service using our comprehensive inspection methodology. We carried out unannounced visits as part of the inspection on 22-23 January 2019 and 8 February 2019.

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 will also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

Services we rate

Our rating of this hospital/service stayed the same. We rated it as Requires improvement overall.

We found the following issues that the service provider needs to improve:

• Not all risk assessments were completed effectively in line with the hospital policy. All consultants are required to complete the venous thromboembolism (VTE) decision box, following assessment, to ensure that patients at risk are identified and appropriately treated
• In the diagnostic imaging service, processes were not in place to ensure quality testing programmes were completed and that diagnostic reference levels were created and monitored.
• Clinical audits were not completed within the diagnostic imaging service.
• Outstanding recommendations following external audits within the diagnostic imaging service required completion and review.
• Appraisal reviews and mandatory training compliance for some staff was below the hospital target.
• Regular reviews of the backlog of NHS patient record coding to promote assurance that future obligations are met.
• Ensure that sinks and taps conform to Health Building Note 00-10 ‘Part C Sanitary Assemblies’, in clinical areas to allow correct hand hygiene practices.
• The World Health Organisation’ five steps to safer surgery’ checklist for all surgical procedures carried out in the operating theatres were not always completed within all operative specialties.
• Not all radiography staff had completed the appropriate training and competencies regarding radiation risks and regulations in line with IR(ME)R 2017.
• Processes and procedures are required to be in place to record and audit consent.
• Agency staff within the diagnostic imaging department require specific induction for radiographers.
• To maximise efficiency of operating department time and available staffing resources effective working processes should be developed across departments, within the hospital.

We found good practice within the services:

• Services within the hospital such as surgery, medicine and outpatients provided mandatory training in key skills to staff.
• The surgical and outpatient services followed best practice when prescribing, giving and recording medicines. Storage of controlled medicines followed best practice. Patients received the right medication, at the right dose, at the right time.
• Surgical services in the hospital provided care and treatment based on national guidance and there was evidence of its effectiveness.
• The hospital controlled infection risk well. Staff kept themselves, equipment and the premises clean.

• There was effective multidisciplinary working across the hospital. Staff in different teams worked together to benefit patients. Doctors, nurses and other healthcare professionals, supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients were treated with dignity, respect and kindness during all interactions with staff.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment. They were communicated with and received information in a way that they could understand.
• Hospital services were planned and developed to meet the needs of the local population for both private and NHS patients.
• The service had suitable premises and equipment. Hospital premises were clean, well maintained, and suitably equipped. There was an equipment replacement programme to ensure that all large items of equipment were replaced when they became outdated.

• All services within the hospital engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
• The hospital was committed to improving by learning from when things went well or wrong, promoting training and innovation.

• Managers across the hospital promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• People could access the service when they needed it. Waiting times from treatment were and arrangements to admit, treat and discharge patients were in line with good practice.

Following this inspection, we told the provider that it must take some actions to comply with the regulations. Additionally, it should make other improvements, even though a regulation had not been breached, to help the service improve. We issued the provider with three requirement notices that affected diagnostic imaging, outpatient services and surgery. Details are at the end of the report.

Amanda Stanford

Acting Deputy Chief Inspector of Hospitals (Central)