Standard Health Ltd is registered with the Care Quality Commission and provides orthopaedic day case surgical procedures on average one day a month at Victoria Hospital which is herein referred to as the host hospital. This Standard Health service is provided at the Victoria Hospital which is part of Dorset Healthcare University Foundation Trust (DHUFT) through a service level agreement.

We carried out a routine announced inspection on the 5 December 2016, as part of our national programme to inspect and rate all independent providers. We inspected the core service of surgery as this is the main activity carried out at this location by the provider Standard Health Ltd.

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 how the provider understood and complied with the Mental Capacity Act 2005.

The service provided by Standard Healthcare at this location was Orthopaedic day case surgery. Services were provided under a service level agreement with the host hospital. Some of these included:

• Theatres.

• Staffing including nursing and others.

• Infection control.

• Physiotherapy.

• Radiology and imaging

• Catering and laundry services.

• Clinical Waste disposal services.

• All equipment in theatres and day ward and their maintenance.

We rated this service as good overall because:

• The service had a good track record safety.

• There were appropriate systems to keep people safe and to learn from incidents.

• Staffing levels provided by the host hospital were planned to align with capacity which was part of service level agreement. This included sufficient staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.

• The provider followed the host hospital’s infection control policies and procedures to support safe care. The environment and equipment we inspected were clean and well maintained.

• Care was delivered in line with national guidance and the outcomes for patients were good.

• Patients could access care when they needed it and they were treated with compassion and their privacy and dignity was maintained at all times.

• Staff complied with peri- operative checklists and accurate records were maintained.

• The service had received consistently positive feedback from patients relating to their care and treatment.

We found areas that required improvements

• People were offered limited choices of food and fluids following day surgery.

• Staff did not always follow good practice guidance for the safe management of medicines in the anaesthetic room.

• The governance process was not robust as they did not reflect the processes taking place including the monitoring of service level agreement (SLA) and gaining assurances

We found the following areas of good practice in surgery:

• Patients’ satisfaction surveys for the provider were consistently high. In April 2016 100% of patients described their overall care as “very good or excellent.”

• Overall response to treatment times (RTT) rates for admitted patients for surgery and non- admitted patients were within expectations.

Ted Baker

Deputy Chief Inspector of Hospitals

We spoke to three people and one relative. All the comments were highly complimentary of the care and treatment they had received from the service. One person commented “very good, excellent. I was well looked after.” Another person commented “very comfortable and very efficient.”

People gave informed consent prior to treatment. The risk and benefits were explained to them by a doctor and people were given time to reflect on their decision. One person stated “everything was explained all the time.

Care was assessed and treatment delivered in a way to meet the needs of people who used the service. People were involved in discussions about their condition and were able to make informed choices about their treatment.

People and staff considered there were sufficient staff to meet the needs of people who used the services. People told us they had confidence in the staff and felt safe and secure in the care provided. One person said the staff were ''very efficient.”

There was no complaints procedure in place that was accessible to people using the service. People told us they would feel confident to make a complaint if required but they had not felt the need to do so.