The Care Quality Commission
  • Hospital
  • Independent hospital

Woodland Hospital

Overall: Good read more about inspection ratings

Rothwell Road, Kettering, Northamptonshire, NN16 8XF (01536) 414515

Provided and run by:
Ramsay Health Care UK Operations Limited

All Inspections

24 to 25 October 2018

During a routine inspection

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

8, 9 and 17 March 2016

During a routine inspection

We carried out an announced, comprehensive inspection visit of Woodlands Hospital on 8 and 9 March 2016 and an unannounced inspection on 17 March 2016.

Our key findings were as follows:

We inspected two core services, surgery and outpatients and diagnostic imaging. Overall the hospital requires improvement for safety and well led in surgery and well led in outpatients. However, caring and responsive was rated good in both core services we inspected. Effective was judged to be good in surgery, but was not rated in outpatients, because the Care Quality Commission’s view is that we are unable, at present, to collect enough evidence to rate this key question.

Are services safe at this hospital/service

Systems, processes and standard operating procedures were not always reliable or followed to protect patients from avoidable harm. For example, infection prevention and control measures did not ensure patient safety. Operating theatre staff did not use the correct theatre attire, including gowns and footwear, when leaving and returning to theatre from other areas of the hospital, or always clean their hands when entering and leaving the department. The ‘five steps to safer surgery’ were used. However the principle behind taking time out before commencing surgery was not fully practiced with all staff present and participating.

A National Early Warning Score (NEWS) was used to identify deteriorating patients and there was a service level agreement for the transfer of an acutely ill patient to the local NHS hospital, should the need for this arise.

When something went wrong, there was an appropriate investigation that involved relevant staff and lessons learned were communicated promptly to support improvement. In addition, staff understood their responsibilities in ensuring Duty of Candour ensuring patients were kept informed of near miss and actual incidents that involved them.

Staffing levels and skill mix were planned, implemented and reviewed.

There were systems, processes and standard operating procedures to keep people safe and safeguarded from abuse. These were understood by staff.

Plans were in place to respond to emergency situations, although information for staff was not up to date.

Are services effective at this hospital/service?

Patients care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. There was participation in relevant local and national audits, including clinical audits and other monitoring such as benchmarking and service accreditation in surgery and diagnostic imaging. However, in outpatients, audits were not undertaken.

Patient’s needs were assessed taking account of their physical, clinical and mental health, although there was limited knowledge of Mental Capacity Act (2005) in outpatients.

Staff were qualified and had the skills they needed to carry out their role effectively, this included appraisal and reflective practice. However, most were not trained to the correct level of safeguarding.

Staff could access the information they needed to assess, plan and deliver care to patients in a timely was and there were secure systems to manage care records.

Consent to care and treatment was obtained in line with legislation and guidance.

Are services caring at this hospital/service?

Patients were supported, treated with dignity and respect, and were involved in planning their treatment and care. Feedback from patients and those who were close to them was positive about the way staff treated and cared for them.

Patients were communicated with and received information in a way that they could understand.

There were appropriate arrangements to support and meet patients’ emotional needs.

Are services responsive at this hospital/service?

The needs of different patients were taken into account when planning and delivering services, for example, on the grounds of age, disability or gender. In addition care and treatment was coordinated with other services and other providers.

It was easy for patients to complain or raise a concern. Complaints and concerns were taken seriously, responded to in a timely way and listened to within most departments. However, in the outpatients department, complaints were not shared with the team in order to effect improvements.

Some improvements to the quality of service had been made in response to patient feedback and concerns.

Are services well led at this hospital/service?

There was a statement of the hospital’s values, based on quality and safety. However we found that staff had limited awareness of this statement.

There were integrated governance arrangements to minimise risk and ensure shared learning, however these were not always acted upon.

The risk register was not updated regularly. In addition, generally, staff were unaware of the contents of the risk register so that this could be used effectively.

There was poor compliance with some infection prevention and control practices of which the senior management team were unaware.

There were areas of poor practice where the provider needs to make improvements.

Action the hospital MUST take to improve

  • The hospital must ensure that risks are identified, recorded, reviewed regularly and timely action is taken to mitigate them.

  • Systems should be in place to ensure emergency equipment and medicines are safe and fit for purpose.

  • Staff who have responsibility for assessing, planning, intervening and evaluating children’s care, must be trained to level three in safeguarding.

Action the hospital SHOULD take to improve

  • The hospital should ensure that the work commenced following the inspection to ensure that theatre staff do not wear their theatre shoes outside the department and that their scrubs are covered, continues. This is in line with Association for Perioperative Practice guidelines.

  • The hospital should continue the work commenced following the inspection, to ensure that the operating department is not used as a thoroughfare for members of staff.

  • The hospital should ensure that all staff present within the operating theatre are recorded.

  • The hospital should ensure that the principle behind taking time out before commencing surgery is fully practiced with all staff present and participating.

  • The hospital should develop a local protocol for the management of changes to operating lists as specified in the hospitals operational policy for operating theatres.

  • Learning from complaints, audits and incidents should be reviewed and information about learning shared within a communication system with staff.

  • Locally devised clinical audits should be considered to monitor service improvements.

  • The hospital should monitor patient waiting times in response to patient feedback received, to try and improve patient experience.

  • The hospital should ensure that hard copies of histology and cytology results are kept in a secure area, not consultants post trays, in order to protect patients’ confidential information.

  • The hospital should ensure that there is a system in place to keep emergency contacts details up to date.

  • The hospital should ensure that there is an annual major incident scenario is undertaken, in line with Ramsay policy.

Professor Sir Mike Richards

Chief Inspector of Hospitals

17, 24 February 2014

During a routine inspection

Patients told us that the care they received was very good. A patient told us, 'My care was exactly as discussed with my consultant and the care was excellent.' Another patient said, 'Staff work round the clock to make sure we are comfortable, they are always there for you.'

We found that treatment choices had been explained to patients before they received any care or treatment and they were asked for their consent.

The provider had systems in place to protect patients and people that used the service from harm or abuse.

We found that the provider needed to make improvements to the way they supported their staff so they were appropriately trained.

There were effective systems in place to assess and monitor risks to people and to regularly check and monitor the care and quality of the service people received.

19 March 2013

During a routine inspection

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.

24 January 2012

During a routine inspection

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.