We went to the Circle Hospital in Bath in early January 2014 and found the hospital needed to improve its cleaning regime. The hospital sent us an action plan laying out how it would achieve this, and we went back in February 2014 to check on the improvements made.

The hospital now had a high standard of cleanliness in all areas. Improvements had been made which included incorporating the housekeeping staff into the four departmental teams. This had led to an improvement in work-practices and a team approach to maintaining standards of cleanliness and infection prevention and control.

Patients who were using this service were given a range of information to enable them to make decisions about their care. One person told us, "I was told what was wrong with me and given the alternative treatments I could have and the impact of these. This helped me make the best decision for me at this time.”

Patients we spoke with told us they had been provided with a range of information at all stages of their patient journey, saying, "I am completely happy with the care and treatment. The doctors, nurses and other staff gave me information and I was always able to ask for what I needed.” and “If I needed to know anything I could ask and I always got an answer.” One person told us, “The physiotherapy is great, they gave me some really good exercises to help me recover, I am very pleased with the service.”

Patients we spoke with told us that the staff are caring and professional, one patient told us, “ I feel very safe and secure knowing I am in good hands here, the staff know what they are doing.”

Patients told us that they were aware of the records that the hospital kept and that they are able to view these. One patient said, “I know what they write and was involved in my care where I needed to be.”

Patients using the service were satisfied with the way their medication was managed, They said, “I get my pain relief when I need it.” and "Staff are clear about what medication I need and give this to me when I am supposed to have it.”

Patients that we spoke with told us that they had been provided with a range of information at all stages of their patient journey, saying “I couldn’t fault the information which I have been given” and “everyone has been excellent and friendly also making my family feel welcome”.

The hospital provides a service to adults and children, parents that we spoke with told us that they had signed a consent form with full explanations which left them “feeling that there were no surprises” and they had been fully informed.

Patients were complimentary about the food telling us “I get a menu for each meal” and “lovely food”.

Patients using the service that we spoke with told us that staff met their needs telling us “I ring the bell if I want some painkillers” and “I felt sick and am able to ask the staff if I want anything, they also try to keep me pain free”.

Patients that we spoke with told us that they were aware that their views of the hospital and their experience would be gathered after their procedure.

Circle Bath is an independent hospital operated by Circle Hospital Bath Ltd. The hospital has 30 inpatient beds and 22 day surgery unit ‘pods’. Facilities include four operating theatres, and outpatient and diagnostic facilities (including magnetic resonance imaging (MRI), x-ray, ultrasound and computed tomography (CT) scanner).

The hospital provides surgery and outpatients and diagnostic imaging. We inspected both services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 and 21 December 2016, along with an unannounced visit to the hospital on 7 January 2017.

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 good overall.

We found good practice in relation to surgery:

• 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.
• Patients spoke of high quality, compassionate care by all staff.
• The service carried out thorough root cause analysis and learning when things went wrong.
• Patients had good outcomes in line with national average, and care and treatment was planned and delivered in line with evidence-based guidance, standards and best practice.
• Staff provided care that was compassionate and treated patients with dignity and respect at all times.
• Services were planned and delivered in a way that met the needs of the local population.
• The service had an effective system to effectively investigate, monitor and evaluate patient’s complaints and concerns, and learning was shared throughout the hospital.
• Comprehensive governance arrangements were in place.

However, we found areas of practice that required improvement:

• We observed patients’ notes unattended outside a patient’s room while nursing staff attended a patient.
• The service was not meeting its target of 90% of patients receiving treatment within 18 weeks of referral.

Across the hospital staff were overwhelmingly positive about the strong and visible leadership. Staff felt engaged.

We found areas of outstanding and good practice in outpatients and diagnostic imaging:

• There was outstanding care provided to patients. Staff treated patients with dignity, kindness and respected. Feedback from patients was overwhelmingly positive, and patients and those close to them were involved as active partners in their care.
• The outpatients and diagnostic imaging service had a good track record on safety. Staff were encouraged to report concerns and incidents, and investigated them to identify and share learning.
• People’s needs were assessed and their care and treatment delivered in accordance with legislation, standards and evidence-based guidance.
• Services were responsive to the needs of the population and ensure flexibility, choice and continuity of care, and premises and facilities were appropriate for the services that were planned and delivered.
• The local leadership team was well respected, visible and accessible. Staff were inspired by and supported by a strong and cohesive leadership team.

However, we found areas of practice that required improvement:

• The availability of chaperones to accompany patients during consultations and examinations was not publicised in outpatient departments.
• There was no private space available in outpatients, which could be used by, for example, breast feeding mothers or people who wished to have private conversations.

• Patient information on medical conditions and treatments was available in English only.
• The outpatient department had not recruited to the unit lead position, which had been vacant for over 12 months. The deputy lead had taken over managerial responsibilities but had little protected time to fulfil these responsibilities.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Edward Baker