We visited First Trust as part of our scheduled inspections and looked at outcomes 2, 4, 9, 12 and 16. We found the provider was compliant with theses outcomes. We spoke with two day patients who were listed to have surgery on the day of the inspection. Patients told us that the consent to surgical procedures had been explained to them from the outset.

The hospital had appropriate arrangements in place to obtain blood for transfusion in emergency situations and also had a transfer arrangement in place with the Lancashire Critical Care Network in the event any patient transfer was required.

Patients were aware of their post operate recovery and follow up and who to contact should they need to.

We saw that safe medicine arrangements were in place so patients could be supplied with the right medicines during and after their treatment.

We saw that staff were recruited appropriately and an induction programme was in pace for new or less experienced staff.

We found that the manager continued to develop the quality assurance process and was in the process of transferring all paper based processes and documents into the information technology system in use so process could be completed more quickly via the use of a computer.

• Senior staff were aware of their responsibilities relating to duty of candour legislation and gave us examples of when it had been implemented. The trust had a duty of candour process in place to ensure people had been appropriately informed of an incident and the actions that had been taken to prevent recurrence. Duty of candour is a regulatory duty that relates to openness and transparency and requires providers of health and social care services to notify patients (or other relevant persons) of ‘certain notifiable safety incidents’ and provide reasonable support to that person.

• The hospital told us that all the patients attending for surgical procedures had previously been identified, by their referring companies, as low risk for anaesthesia. We did see evidence in all of the records we reviewed of a pre-operative assessment, which included an assessment of risk of VTE and blood clotting factor. However, we were not sure who was assessing the patient pre-operatively, as there was no clear evidence of the profession or competencies of the professional undertaking the pre-operative assessment, included on the assessment sheet. However although there was there was a written patient exclusion policy in operation at FTH the hospital was dependent upon the robustness of the pre-operative assessment undertaken by another provider.

• There was a lack of clinical oversight in the recovery area, where we observed that patients were not being monitored in line with national guidelines, a blood-filled suction tube being used after it had been used in theatre and patients’ privacy and dignity being compromised. We raised these issues during our inspection and they were addressed immediately by managers and clinical leadership.

• There was a system in place to analyse each incident as it occurred which included the cascading of the investigation to relevant staff. The process of identifying themes and trends was embryonic and required further development. We saw little evidence themes and trends were discussed regularly at team meetings.

• There was no monitoring of compliance with the hospital hand hygiene policy. We observed poor compliance with the hand hygiene policy and patient feedback had identified that ward staff were not always washing their hands before touching them.

• Three pieces of anaesthetic equipment were out of date for servicing according to the label on them.