All the people we spoke with told us that the care at Nuffield Health was very good. One person told us, "I am really happy with everything about the service". Another person said, “All the staff are very kind and efficient". We observed staff treated people with dignity and respect. One person told us, “The staff make a real effort to get to know you and how you like things done".

We found that care records were clear and provided comprehensive information about each stage of their care. People told us they were fully involved in all aspects of their treatment and care.

We saw that the accommodation was clean. We found that there were systems and procedures in place to protect people from the risk of infection. People told us that the hospital was very clean.

We found the provider could not provide evidence that staff in theatres had completed assessments of competence in some areas. Staff were also not clear about the policy regarding extended roles. We agreed immediate action with the provider to ensure the safety of people.

People we spoke with told us that they were aware of the complaints process. They told us they felt confident about the process. We saw that complaints received by the provider had been appropriately investigated and responded to.

The people we spoke with were very satisfied with their care and treatment at the hospital. Everyone we spoke with had confidence in the doctors and nursing staff looking after them. One person told us, “The treatment would be no different anywhere else, but the experience and quality of care is very different.” Everyone had detailed care plans in place to ensure that they received the right care, at the right time.

People told us that they had been informed of what would happen during their treatment or operation. They also told us that any substantial risks involved had been discussed before they gave their consent for anything to take place. One person said, “I own my treatment.”

All the staff we spoke with had a good understanding of what steps they would take if they had any concerns with people’s safety. All the necessary checks had been completed to ensure that doctors, nurses and other staff working in the hospital were appropriately qualified,competent and suitable to be working in the hospital.

We had not visited this service for sometime and did not have any recent information about the service. We visited this service to check that people were being cared for safely.

An Expert by Experience took part in this inspection and spent time talking with patients about their experience of the care they received. They took some notes and wrote a report about what they found and details were included in this report.

People were involved in discussions about their care and treatment and had been given

the opportunity to ask questions. People said that were given information about the risks and benefits of treatment. People said that their consent to treatment was was always sought.

People were positive about the care and treatment they received. They felt that the staff were caring, friendly and polite. People felt that they were treated with respect and that their privacy and dignity were promoted.

People said they had a choice of food and that the menu was varied and catered for special diets. One person told us that they could have food not on the menu if they wished.

People said there were enough staff on duty and that in most instances the nurse bell was answered promptly. Any delay was only of a short duration and people were confident that staff would come as soon as they were available.

The provider had a range of systems in place to review and monitor the care they provided. Where areas for improvement were identified action plans were in place.

Nuffield Health North Staffordshire Hospital was opened in 1978 and is one of 31 in the Nuffield Health Group. The hospital provides mostly surgical services but also carries out some chemotherapy services. We did not specifically inspect this service but have included some aspects of the service delivery in our report on outpatients and diagnostic imaging.

At the time of the inspection, the hospital was in the process of opening a new CT/MRI scanning facility, in partnership with a private diagnostics service provider. Catering and estates management services are outsourced.

We inspected this service as part of the comprehensive inspection programme and visited the hospital on 9 and 10 February 2016 as part of our announced inspection. We also visited unannounced to the hospital on 23 February 2016.

Overall, we have rated the hospital as good, with one requires improvement rating in the safe domain for surgery.

Are services safe at this hospital?

• Staff were able to demonstrate they understood their responsibilities under Duty of Candour regulations. We were provided given specific examples of where Duty of Candour had been used following incidents to be open and transparent with patients.

• There were clear policies and procedures in place in regard to safeguarding. All staff we spoke to were aware of what to do if they were concerned about a child or vulnerable adult. The outpatient sister and hospital matron were trained to level 3 in both adult and child safeguarding.

• There had been 331 clinical incidents reported between October 2014 and September 2015. We saw that staff were encouraged and supported to report incidents. All incidents were investigated and reported to the quality and safety committee so that lessons could be learnt and learning applied. Staff received feedback.

• The World Health Organisation (WHO) Five Steps to Safer Surgery checklist was not embedded in theatre daily practice and not consistently adhered to. Audit processes to confirm compliance with the checklist were not robust, observational audits were not routinely completed.

Are services effective at this hospital?

• Hospital staff followed local policies and procedures such as wound care pathways and specific consultant post-operative preferences. NICE guidelines were reviewed and discussed at the hospital quality and safety meetings and departmental meetings.

• The hospital had a well-established governance system for signing off policies and procedures. We observed that the Medical Advisory committee had clear over-sight of changes to practice and the introduction of new drugs or procedures.

• The hospital participated in patient reported outcome measures (PROMS) audits. Knee and hip replacement (primary) were both within the expected range of the England average relating to five questions about their health.

• All readmissions either to the hospital or an NHS trust were recorded on an electronic data collection system, the hospital reported six unplanned readmissions within 29 days of discharge between October 2014 and September 2015.

• There were 166 doctors working under practising privileges at the hospital The hospital used an electronic database to monitor compliance, with due dates identified for doctors’ appraisals, revalidation, renewal and indemnity, as a part of the practising privileges process. We looked at nine randomly selected personnel files for medical practitioners and found all the relevant documentation in place.

• Staff were aware of their responsibilities about informed consent and they were clear about the procedures to follow for those patients who lacked capacity including involvement of those close to the patient. Staff demonstrated an understanding of the mental capacity assessment process

Are services caring at this hospital?

• Patients spoke highly of staff in areas across the hospital. Patients described caring staff that were supportive and treated them with dignity and respect. We observed that staff were courteous, polite and friendly when responding to patients’ individual needs. Patients told us they were given good explanations of their treatments and were given opportunity to ask questions. Survey data confirmed that patients had confidence in being treated at the hospital.

Are services responsive at this hospital?

• Services were planned and delivered in a way that took people’s needs and preferences into account. There were regular monthly meetings with the local clinical commissioning group to discuss service provision for NHS patients. We saw minutes of these meetings where quality and service delivery issues were discussed.

• Patients told us they had received all the information they required prior to their procedure or surgery. They told us they understood the reason for their admission to hospital and staff had clearly explained the risks and benefits to them.

• The needs of patients living with dementia or those who had a learning disability were identified at pre-assessment. Patients with complex needs were risk assessed by physiotherapists and occupational therapists and their care plans were then based on the risk assessments and professional advice.

• There were effective systems and processes to respond to and learn from complaints

Are services well led at this hospital?

• There was a clear vision and strategy for the hospital, held by the senior management team and shared widely with the hospital staff. The hospital director used a range of mechanisms to communicate the vision and strategy to staff and keep them updated. Staff we spoke with understood the vision and their role in achieving it.

• Governance, risk management and quality measurement processes were well established. There was a clear line of sight for the senior management team from the ward to the board and the MAC were well engaged in the hospitals quality management processes. The MAC maintained oversight of the process for agreeing and reviewing practising privileges.

• The senior management team had been in post for approximately three years and provided stable and cohesive leadership at the hospital. The matron and hospital director had a clear grip on hospital issues and were well known to the staff.

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

Importantly, the provider must:

• Ensure that surgical safety procedures are consistently carried out in theatre and theatre documentation and observational audits are routinely carried out and staff are made fully aware of the findings to provide ongoing assurance.
• Ensure that all medication is secure in theatre.

In addition the provider should:

• Ensure that learning from audits is disseminated to staff including the process, outcomes and the risk register progress.
• Ensure that the findings of the privacy, dignity and well-being 2015 PLACE score are addressed.
• The hospital should ensure that out of date radiology equipment is replaced as soon as possible.

Professor Sir Mike Richards

Chief Inspector of Hospitals