We spoke with eight patients in three different outpatient areas of the hospital. We also spoke with staff and two relatives along with the management team responsible for clinical services, human resources and complaints.

Staff were seen to be courteous when patients’ approached the outpatients reception desk. One patient said “the reception staff are very good, they don’t keep you waiting long”, “they always acknowledge you when you come to the desk”. Everyone we spoke with gave us positive feedback about the quality of their care overall. Patients were happy with the amount of information they had been given about their surgery or medical condition and said staff kept them informed and respected their choices.

People experienced care, treatment and support that met their needs and protected their rights. Patients health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

Patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had effective recruitment and selection processes, and appropriate checks were undertaken before staff began work.

People felt that all the staff were well trained and that they were able to raise any concerns or complaints with the customer services.

We spoke with three patients on one of the inpatient wards. Everyone we spoke with gave us positive feedback about the quality of their care overall. Patients were happy with the amount of information they had been given about their surgery and said the ward staff kept them informed and respected their choices. People said they received enough pain relief and the nursing staff were very friendly and helpful. Everyone we spoke with was complimentary about their surgeon. People felt that all the staff were well trained and that they were able to raise any concerns with the customer services.

We found patients were treated with dignity and respect. They were able to make decisions and were supported to express their opinions. Before people received any care or treatment they were asked for their consent and their wishes / opinions respected. The care pathway records for surgical patients showed people were involved in discussions with their consultant surgeon and anaesthetist. People experienced care, treatment and support that met their needs and protected their rights with the provider responding appropriately to any allegation of abuse. There were systems in place to ensure the cleanliness of the hospital premises and protect people from infection. The staff received appropriate training to meet the wide range of patient needs. The provider had an effective system to regularly assess and monitor the quality of service that people received.

We inspected the following core services:

• Medicine

• Surgery

• Critical care

• Children and young people

• Outpatients and diagnostic screening.

We undertook an announced inspection 18 and 19 October 2016, with an unannounced visit on 1 November 2016. We visited all departments, theatres and wards at different times of the day and evenings.

We reviewed a wide range of documents and data we requested from the provider. These included policies, minutes of meetings, staff records and results of surveys and audits. We placed comment boxes at the hospital prior to the inspection, which enabled staff and patients to provide us with their views. We received ninety three comments from patients and relatives, of which 96% contained positive comments.

We spoke with 56 staff including; registered nurses, health care assistants, reception staff, medical staff, operating department practitioners, and senior managers. We spoke with 19 patients and relatives. We also received ninety three tell us about your care’ comment cards which patients had completed prior to our inspection. During our inspection, we reviewed 33 sets of patient records.

There were no special reviews or investigations of the hospital ongoing by the CQC at any time during the 12 months before this inspection. The hospital had last been inspected in October 2014 and we found areas needing improvement. We found breaches of four regulations. These were regulations relating to cleanliness and infection control, safety and suitability of premises, supporting staff with training and assessment and ensuring there were enough suitably trained staff when treating children. We reviewed improvements in these areas specifically.

There were 326 consultant surgeons and anaesthetists who worked at the hospital under practising privileges across anaesthetics, orthopaedic surgery, plastic surgery, ophthalmology, gastroenterology, rheumatology and oncology.

The hospital employed seven resident medical officers (RMO), who worked on a ‘one in five’ 24 hour shift pattern Monday to Friday and one in five weekend rota.

There were 124 contracted staff which equated to 106 full time equivalent (FTE) nurses and operating department practitioners and 27 contracted healthcare assistants which equated to 23 FTEs. The accountable officer for controlled drugs (CDs) was the registered manager.

Activity (July 2015 to June 2016)

• In the reporting period July 2015 to June 2016 there were 10,842 inpatient and day case episodes of care recorded at the hospital; of these 28% were NHS-funded and 72% other funded.

• There were 8,554 visits to theatre in the reporting period July 2015 to June 2016.

• 45% of all NHS-funded patients and 58% of all other funded patients stayed overnight at the hospital during the same reporting period.

• There were 70,740 outpatient total attendances in the reporting period; of these 82% were other funded and 18% were NHS-funded.

  Track record on safety (July 2015 to June 2016)

• 1 Never event in surgery

• 1157 clinical incidents – higher rate than in other independent acute hospitals: 1 serious injury (patient fall); 15 deaths of which 9 were unexpected

• 0 incidence of hospital acquired Methicillin-resistant Staphylococcus aureus (MRSA),

• 0 incidence of hospital acquired Methicillin-sensitive staphylococcus aureus (MSSA)

• 1 incidence of hospital acquired Clostridium difficile (c.diff)

• 1 incidence of hospital acquired E-Coli

• 10 complaints received by CQC

Services accredited by a national body:

• Macmillan Quality Environmental Mark

• Pathology ISO accreditation

• Sterile Services Department CE accreditation with SGS Yardsley

• VTE Exemplar Status.

Services provided at the hospital under service level agreement:

• Critical Care transfer agreement

• Multidisciplinary Team for oncology

• Gynaecology CNS

• Sterile Services