We spoke with ten people who used the service. All were happy with the care they received. People told us that the staff were polite, knowledgeable and gave them information about their treatment including discussing their treatment options.

All areas inspected were clean, tidy and fresh. One person told us, “It’s beautifully clean here and everywhere smells lovely. It doesn’t seem like a hospital at all, more like a hotel.” Another commented, “The surrounding are nice and it’s quiet. It makes me feel relaxed.”

We found that appropriate checks had not been undertaken for all staff before they began work. This was brought to the attention of the manager during our visit. She took immediate steps to make sure that the appropriate checks were carried out.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us that they had received good information from medical staff about their treatment options, including surgical procedures and anaesthesia. They told us they had been advised about the benefits, potential risks and complications which enabled them to understand their treatment and to give informed consent for their operation.

We spent time on two wards where people were cared for before and after surgery. All of the people that we spoke with were satisfied with the way that they were being cared for. One person said that they had received the care that they needed and that they had had good pain relief after their surgery.

People using the hospital and their relatives told us they had not been asked to voice their opinions on the quality of care and were not aware of any formal systems to collect their views. Each bedroom contained a hospital information folder in which there was a leaflet called “We value your opinion.” This explained how best to contact the hospital with comments and complaints. We saw similar leaflets in the out-patient waiting area. None of the people we spoke with realised the leaflet was there.

Woodland Hospital is operated by Ramsay Healthcare UK Operations Ltd. The hospital provides surgery, outpatients and diagnostic imaging services. We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 24 and 25 October 2018.

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 service report.

Services we rate

Our rating of this hospital improved. We rated it as Good overall.

• The hospital provided staff with appropriate training to enable them to complete their roles and responsibilities.
• The hospital premises were clean and well maintained. Services managed infection control risks well. When we escalated concerns relating to hand washing, the hospital responded immediately, implementing additional training and audits to improve practice.
• Equipment was well maintained and replaced as necessary.
• There were systems in place to support staff to assess patients’ risks to ensure the safe provision of care and treatment.
• 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.
• Medicines were stored, prescribed and managed safely.
• Safety incidents were managed using an effective system. There were processes in place to ensure shared learning.
• Staff were able to identify potential harm to patients and understood how to protect them from abuse. Services knew how to escalate concerns.
• The hospital provided staff with policies, protocols and procedures which were based on national guidance.
• Staff ensured that patients were provided with adequate food and hydration, offering varied diets to meet nutritional or religious preferences.
• Staff competency was assured through monitoring and regular appraisals.

• Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Patients were supported to make decisions and were kept informed of treatment options. Staff treated patients with dignity and respect.
• Services were planned to meet the needs of the patients, with additional support available for patients who had additional needs.
• Services provided by the hospital were flexible to meet the needs of patients, enabling additional clinics, appointments or out of-hour services as able. Waiting times from treatment and arrangements to admit, treat and discharge patients were in line with good practice.
• Complaints were taken seriously, with concerns being investigated and responses made within agreed timescales. Staff shared learning from complaints and encouraged patients to identify areas for improvement.
• Managers and leaders were appropriately skilled and knowledgeable to manage teams and services. Leaders were accessible and respected by staff.
• Managers promoted a positive culture which supported and valued staff, creating a sense of common purpose based on shared values.
• There was a hospital vision and strategy which was developed in collaboration with the clinical team and reflected a focus on patients and staff.
• The service had processes in place to monitor performance and used these to encourage staff to provide high standards of clinical care and treatment.

We found the following areas for improvement:

• There were inconsistencies with patient records. Risk assessments were not always completed within surgical services and outpatient notes lacked details of actions taken and were not always signed and dated.
• Locally, some managers did not have oversight of equipment used within their departments/clinical areas.
• Outpatient services did not routinely monitor the effectiveness of care and treatment.
• There were inconsistencies in the documentation of consent for minor operations within outpatients.

• Complaints’ files did not always reflect actions taken to resolve concerns raised.
• There was not always effective oversight of some aspects of risk, safety and governance. Risk registers did not always accurately reflect risks identified by staff.
• Staff in outpatients did not always have oversight of performance, and there was no evidence to suggest that performance data was shared with teams.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We issued the provider with one requirement notice. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals