Blakelands Hospital

Quality Account 2013/14

Contents Introduction Page Welcome to Ramsay Health Care UK Introduction to our Quality Account PART 1 – STATEMENT ON QUALITY 1.1 Statement from the General Manager 1.2 Hospital accountability statement PART 2 2.1 Priorities for Improvement

2.1. Review of clinical priorities 2013/14 (looking back) 1 2.1. Clinical Priorities for 2014/15 (looking forward) 2 Mandatory statements relating to the quality of NHS services 2.2 provided 2.2. Review of Services 1 2.2. Participation in Clinical Audit 2 2.2. Participation in Research 3 2.2. Goals agreed with Commissioners 4 2.2. Statement from the Care Quality Commission 5 2.2. Statement on Data Quality 6 2.2. Stakeholders views on 2010/11 Quality Accounts 7 PART 3 – REVIEW OF QUALITY PERFORMANCE 3.1 The Core Quality Account indicators 3.2 Patient Safety 3.3 Clinical Effectiveness 3.4 Patient Experience 3.5 Case Study Appendix 1 – Services Covered by this Quality Account Appendix 2 – Clinical Audits Welcome to Ramsay Health Care UK

Blakelands Hospital is part of the Ramsay Health Care Group The Ramsay Health Care Group, was established in 1964 and has grown to become a global hospital group operating over 100 hospitals and day surgery facilities across Australia, the United Kingdom, Indonesia and France. Within the UK, Ramsay Health Care is one of the leading providers of independent hospital services in England, with a network of 31 acute hospitals. We are also the largest private provider of surgical and diagnostics services to the NHS in the UK. Through a variety of national and local contracts we deliver 1,000s of NHS patient episodes of care each month working seamlessly with other healthcare providers in the locality including GPs, Clinical Commissioning Group.

“As Chief Executive of Ramsay Health Care UK, I am passionate about ensuring that high quality patient care is our number one goal. This relies not only on excellent medical and clinical leadership in our hospitals but also upon an organisation wide commitment to drive year on year improvement in patient satisfaction and clinical outcomes. Delivering clinical excellence depends on everyone in the organisation. It is not about reliance on one person or a small group of people to be responsible and accountable for our performance. It is essential that we establish an organisational culture that puts the patient at the centre of everything we do and as a long standing and major provider of healthcare services across the world, Ramsay has a very strong track record as a safe and responsible healthcare provider and we are proud to share our results. Across Ramsay we nurture the teamwork and professionalism on which excellence in clinical practice depends. We value our people and with every year we set our targets higher, working on every aspect of our service to bring a continuing stream of improvements into our facilities and services.” (Jill Watts, Chief Executive Officer of Ramsay Health Care UK) Introduction to our Quality Account

This Quality Account is Blakeland hospitals annual report to the public and other stakeholders about the quality of the services we provide. It presents our achievements in terms of clinical excellence, effectiveness, safety and patient experience and demonstrates that our managers, clinicians and staff are all committed to providing continuous, evidence based, quality care to those people we treat. It will also show that we regularly scrutinise every service we provide with a view to improving it and ensuring that our patient’s treatment outcomes are the best they can be. It will give a balanced view of what we are good at and what we need to improve on.

Our first Quality Account in 2010 was developed by our Corporate Office and summarised and reviewed quality activities across every hospital and treatment centre within the Ramsay Health Care UK. It was recognised that this didn’t provide enough in depth information for the public and commissioners about the quality of services within each individual hospital and how this relates to the local community it serves. Therefore, each site within the Ramsay Group now develops its own Quality Account, which includes some Group wide initiatives, but also describes the many excellent local achievements and quality plans that we would like to share. Part 1 1.1 Statement on quality from the General Manager Julie Fraser General Manager, Blakelands Hospital As the General Manager of the Blakelands Hospital I am passionate about ensuring that we deliver consistently high standards of care to all of our patients. Our Hospital Vision is that;- “As a committed team of professional individuals we aim to consistently deliver quality holistic Acute Day Case Services with exemplary customer care. This we believe we are able to achieve by continually updating our staffs skills and competencies. We strive to further develop our knowledge in order to deliver evidenced based clinical practice”. Our Quality Account details the actions that we have taken over the past year in order to ensure that our high standards in delivering patient care are maintained and for those areas where we have identified as requiring improvements, these have been actioned. We have implemented changes to our processes in order to deliver high standards of care and changes of room usage within out patients to ensure privacy, dignity and confidentiality are maintained. Our Quality Account has been produced to provide accurate information about how we monitor and evaluate the quality of the services that we deliver throughout our Hospital. We hope to be able to share with the reader our progressive achievements that have taken place over the past year. Blakelands Hospital has a very strong track record as a safe and responsible provider of Day Case services and we are proud to share our results. To ensure that we continue to deliver clinical excellence involves everyone in our Hospital. Every individual member of staff is crucial to the success of our Hospital and they value the contribution that they make in delivering great customer care we have a training and education plan which involves all members of our administrative and clinical teams. Our Hospital has been in the Top 100 Best Employer Organisations on 3 occasions, along with continuous high patient satisfaction and staff satisfaction. Our Quality Accounts have been developed with the involvement of our staff who have been very much engaged with developing a systems approach to risk management which focuses on making every effort to reduce the likelihood and consequence of an adverse event or outcome associated with treatment of a patient. To ensure a coordinated approach to the delivery of care for patients and to monitor the adherence to professional standards and legislative requirements the Clinical Governance Committee and Medical Advisory Committee meet on a quarterly basis to review the clinical and safety performance of the Hospital. These committees have reviewed and commented on the details within this Quality Account. If you would like to comment or provide me with feedback then please do contact me on [email protected]. Or contact me on 01908 334200. 1.2 Hospital Accountability Statement To the best of my knowledge, as requested by the regulations governing the publication of this document, the information in this report is accurate. Julie Fraser, General Manager Blakelands Hospital Ramsay Health Care UK

This report has been reviewed and approved by: Mr.Cyril Marek, MAC Chair James Beach, Regional Director Milton Keynes CCG – Local Commissioners Welcome to Blakelands hospital Blakelands Hospital is a purpose built day case unit which was opened in 2006. It was designed to combine an exceptional standard of patient day case facilities with the technical equipment that modern medicine demands. The Centre provides NHS and private day care facilities for: General Surgery Ophthalmic Surgery including YAG Laser Orthopaedic Surgery Upper and lower diagnostic Endoscopy procedures, including direct referrals Podiatric Surgery Physiotherapy including Shockwave Therapy. Acupuncture Consultant Led Direct GP bookable Ultra Sound Service We provide safe, convenient, effective and high quality treatment for adult patients (excluding children below the age of 18 years), whether privately insured, self-pay, or from the NHS. A high percentage of our patients are referred from the NHS sector, patients choosing to use our facility through ‘Choose and Book’. Our services help to ease the pressure on Milton Keynes General Hospital and NHS facilities and we have worked closely with the Hospital Management Team and the CCG to ensure improved access for patients requiring day case surgery, diagnostics and physiotherapy. We are one of the approved providers for Acupuncture for local people referred from the Pain Clinic at Milton Keynes General Hospital. We have close links with GP surgeries, providing information, training and liaison in order to monitor their needs and the requirement of the local population. We have carried out over 2,319 procedures in the past 12 months of which 97% are for NHS Patients.

We currently employ the following staff at the Blakelands Hospital;-  Consultant Orthopaedic Surgeon, a Consultant Anaesthetist and a Consultant Endoscopist. We also have consultants who work on a regular basis and these include Consultant Ophthalmologist, Consultant General Surgeons and Consultant Radiologist, and Consultant Podiatrists.  1 Matron, 7 Registered Nurses and an Operating Department Practitioner and 1 Health Care Assistants  1 Radiologist and 1 Physiotherapist  6 Administrators, 1 PA/HR Coordinator  1 Supplies Co-coordinator and a Maintenance Assistant  Sales and Marketing/GPL coordinator  6 Sterile Services Technicians  2 House Keeping Staff

Blakelands Hospital employs a GP Liaison Officer (GPL) who maintains and establishes relationships with GP’s and the practice staff from Milton Keynes Surgeries and the surrounding areas. A GP visit schedule is maintained whereby surgeries are contacted and visited every month. GP’s are sent regular newsletters and updates via email and hard copies are also delivered. Information packs containing information, about the Hospital and how to refer are distributed via mail or during the visits held at the surgeries. Educational visits are set up during practice learning times whereby the consultant and GP Liaison Officer will visit GP’s with a topic of interest for a “Lunch & Learn” session. GP Educational evenings are also held at the Hospital. GP’s, Practice Managers and Medical Secretaries are invited and attend regular Choose and Book workshops at the Hospital. The following table lists all of the surgeries in Milton Keynes. Each surgery has been visited and has received an informational pack of information about the Hospital.

COBBS GARDEN BROUGHTON GATE HC CMK MC SURGERY

DRAYTON ROAD SYRGERY - FISHERMEAD MC GROVE SURGERY

MK VILLAGE HILLTOPS MC KINGFISHER SURGERY - SURGERY -

NEWPORT PAGNELL MC NEALTH HILL HC - PARKSIDE

PURBECK HC RED HOUSE SURGERY - SOVEREIGN MC

STONY STRATFORD STANTONBURY HC STONEDEAN PRACTICE - HC -

WALNUT TREE HC WATER EATON HC WATLING VALE MC

WESTFIELD ROAD WHADDON MEDICAL WESTCROFT HC - SURGERY - CENTRE

WILLEN VILLAGE SURGERY - WOLVERTON HC ASHFIELD MC

BEDFORD STREET SURGERY

 Outside activities include hosting Patient Participation Group meetings, meeting with group members and discussing services provided at the hospital. Meeting with members from Milton Keynes Health Link and involving them in the PLACE audits and presenting patient experiences at Milton Keynes CCG Board meeting.

 The Hospital also promotes its services to the community via advertising in local publications such as the Milton Keynes Citizen and Leighton Buzzard Citizen. The Scene Magazine and local Radio. Part 2 2.1 Quality priorities for 2013/2014 Plan for 2013/14 On an annual cycle, Blakelands Hospital develops an operational plan to set objectives for the year ahead. We have a clear commitment to our private patients as well as working in partnership with the NHS ensuring that those services commissioned to us, result in safe, quality treatment for all NHS patients whilst they are in our care. We constantly strive to improve clinical safety and standards by a systematic process of governance including audit and feedback from all those experiencing our services. To meet these aims, we have various initiatives on going at any one time. The priorities are determined by the hospitals Senior Management Team taking into account patient feedback, audit results, national guidance, and the recommendations from various hospital committees which represent all professional and management levels. Most importantly, we believe our priorities must drive patient safety, clinical effectiveness and improve the experience of all people visiting our hospital. Priorities for improvement 2.1.1 A review of clinical priorities 2013/14 (looking back)  JAG –Joint Advisory Group on GI Endoscopy is a nationally recognised Organisation. JAG accreditation is a quality mark which is aspired in any Endoscopy Suite. The hospital received JAG Accreditation in June 2011 at our first attempt. The auditors were extremely impressed with the way the service has been set up to accommodate and ease the patient’s journey, this has maintained during 2012 and 2013. The next review will take place in 2015.  Implementing a Glaucoma Management clinic assisted by Nurses trained in carrying out tests and examinations required, to ensure smooth running of the clinics  Implemented direct access for Endoscopy patients, which reduces the amount of visits to the hospital for the patients  Displayed information on each Consultant in the waiting room for patient information and assist with choice.  Displayed a patient information board in the waiting room, offering advice on general well being, including smoking cessation, weight loss, healthy living and alcohol reduction.  To enhance the protection of vulnerable adults in our care the staff at Blakelands Hospital have underertaken training in not only identifying vulnerable adults but also in the care of people with dementia. This training was really well received by staff as a particularly good skill to have in order to improve the management of these patients and their families. The Matron also attended Vulnerable Adult training organised by the local Safeguarding team 2.1.2 Clinical Priorities for 2014/15 (looking forward)  Changes to Ramsay’s National Audit Programme ensures that patients who are at risk of their condition deteriorating receive the very best care by means of an ‘early warning score’. This specific auditing of the medical records of this group of patients has now been implemented. This ensures that all aspects of the service delivery can be reviewed and changes implemented so that the best and most safe outcomes are achieved. One Clinical Priority for 2104 is to increase the number of staff trained on the ALS, Advanced Life Support training, to recognise deteriorating patients and manage medical emergencies and maintain patient safety.

 Staff Survey 2013 We believe as a Management Team that happy and well trained staff enhances patient care and the quality of the services we provide. The results of the staff survey for 2013 was excellent, Blakelands Hospital come top of several aspects with the Ramsay region and third highest hospital score overall. A Staff engagement group has been formed to review the results and identify areas of improvement  Pain management Through the patient survey we will gather information on how well patient pain was controlled and that they thought staff did everything they could to help control their pain. This will improve the patient experience and identify areas of improvement and staff training. Progress will be monitored through the patient satisfaction survey.  Discharge information Through the patient survey we will gather information that patients were given written information about what they should or should not do following their procedure. This will ensure patient safety following a procedure is maintained and identify areas to improve the patient experience. Progress will be monitored through the patient satisfaction survey. 2.2 Mandatory Statements

The following section contains the mandatory statements common to all Quality Accounts as required by the regulations set out by the Department of Health. 2.2.1 Review of Services During 2013/14 the Hospital provided and/or subcontracted 6 NHS services. Blakelands Hospital has reviewed all the data available to them on the quality of care in 6 of these NHS services. The income generated by the NHS services reviewed in 1 April 2013 to 31st March 14 represents 99.9% per cent of the total income generated from the provision of NHS services by the Blakelands Hospital hospital/centre for 1 April 2013 to 31st March 14 Ramsay uses a balanced scorecard approach to give an overview of audit results across the critical areas of patient care. The indicators on the Ramsay scorecard are reviewed each year. The scorecard is reviewed each quarter by the hospitals senior managers together with Regional and Corporate Senior Managers and Directors. The balanced scorecard approach has been an extremely successful tool in helping us benchmark against other hospitals and identifying key areas for improvement. In the period for 2013/14, the indicators on the scorecard which affect patient safety and quality were: Human Resources Staff Cost % Net Revenue – 24.85% HCA Hours as % of Total Nursing – 10.96% Agency Cost as % of Total Staff Cost – 5.17% Ward Hours PPD – N/A Staff Turnover – 28.6% Sickness – 8.7% Lost Time – 22.2% Appraisal - 88% Mandatory Training - 85% Staff Satisfaction Score – 4.86 Number of Significant Staff Injuries – 0 Patient Formal Complaints per 1000 HPD's – 2.29 Patient Satisfaction Score – 99% Significant Clinical Events per 1000 Admissions – 10.99 Readmission per 1000 Admissions – 0.46 Quality Workplace Health & Safety Score – 98% Infection Control Audit Score – 94.6% 2.2.2 Participation in clinical audit During 1 April 2013 to 31st March 2014 Blakelands Hospital didn’t participated in national clinical audits as we either didn’t undertake the procedures or have enough patient activity to warrant participation. Local Audits The reports of 70 local clinical audits from 1 April 2013 to 31st March 2014 were reviewed by the Clinical Governance Committee and Blakelands Hospital intends to take the following actions to improve the quality of healthcare provided. The clinical audit schedule can be found in Appendix 2.  Reinforce at staff meeting the importance of completing patient documentation and medical notes to ensure clinical safety and all entries and dated and signed by the member of staff.  Ensure posters are displayed that inform patient how they can access their medical records notes if required  Reinforce at staff meeting with staff the need to sign amendments of drug administration correctly

2.2.3 Participation in Research There were no patients recruited during 2013/14 to participate in research approved by a research ethics committee. 2.2.4 Goals agreed with our Commissioners using the CQUIN (Commissioning for Quality and Innovation) Framework A proportion of Blakelands Hospital income in from 1 April 2013 to 31st March 2014 was conditional on achieving quality improvement and innovation goals agreed Blakelands Hospital and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework. Further details of the agreed goals for 2013/14 and for the following 12 month period are available on request.

2.2.5 Statements from the Care Quality Commission (CQC) Blakelands Hospital is required to register with the Care Quality Commission and its current registration status on 31st March is registered without conditions/registered with conditions. Blakelands Hospital has not participated in any special reviews or investigations by the CQC during the reporting period. A positive unannounced inspection was carried out by the CQC in February 2014; all areas reviewed in the inspection conclude full compliance. 2.2.6 Data Quality Blakelands Hospital will be taking the following actions to improve data quality.  Blakelands has implemented the Ramsay Medical records management policy 1S025 regarding the transportation of patient notes between both Ramsay units and various outreach clinics to ensure confidentiality is maintained.

NHS Number and General Medical Practice Code Validity Blakelands Hospital submitted records during 2013/14 to the Secondary Uses Service (SUS) for inclusion in the Hospital Episode Statistics (HES) which are included in the latest published data. The percentage of records in the published data which included: The patient’s valid NHS number:  100% for admitted patient care; 100% for outpatient care; and  0% for accident and emergency care (not undertaken at our hospital).

The General Medical Practice Code:  100% for admitted patient care;  100% for outpatient care; and  0% for for accident and emergency care (not undertaken at our hospital).

Information Governance Toolkit attainment levels Ramsay Group Information Governance Assessment Report score overall score for 2013/14 was 83% and was graded ‘green’ (satisfactory).

Clinical coding error rate Blakelands Hospital was not subject to the Payment by Results clinical coding audit during 2013/14 by the Audit Commission. 2.2.7 Stakeholders views on 2013/14 Quality Account The CCG can confirm that the information in the Quality Account is accurate and that the range of services described and priorities for improvement is representative. The document focuses on a specific range of achievements and future focus for improvement. The CCG is supportive of the four priorities for improvement for 2014/15: the recognition and care of the deteriorating patient; staff survey performance; pain management and discharge information. All priorities support protecting patients from avoidable harm, improve clinical outcomes and patient experience and are aligned with CCG priorities. Details in relation to past improvement are representative. Achievement in relation to the Joint Advisory Group Gastro-intestinal Endoscopy Accreditation is to be commended. Direct access to endoscopy and the establishment of glaucoma management clinics supports improved access to services, and protection of vulnerable adults training and dementia training underpins effective safeguarding adult arrangements.

Ramsey Blakelands Healthcare has responded appropriately to a range of national initiatives including the Francis Report, Keogh Review and the Berwick Report. The CCG welcomes the opportunity to continue to work collaboratively with the provider to support continuous improvement in care, and looks forward to the publication of the Quality Account. Jill Wilkinson Director of Nursing and Quality Milton Keynes Clinical Commissioning Group Part 3: Review of quality performance 2013/2014 Statements of quality delivery Janet Brackley, Matron Review of quality performance 1st April 2013 - 31st March 2014 Introduction “This publication marks the fifth successive year since the first edition of Ramsay Quality Accounts. Through each year, month on month, we analyse our performance on many levels, we reflect on the valuable feedback we receive from our patients about the outcomes of their treatment and also reflect on professional opinion received from our doctors, our clinical staff, regulators and commissioners. We listen where concerns or suggestions have been raised and, in this account, we have set out our track record as well as our plan for more improvements in the coming year. This is a discipline we vigorously support, always driving this cycle of continuous improvement in our hospitals and addressing public concern about standards in healthcare, be these about our commitments to providing compassionate patient care, assurance about patient privacy and dignity, hospital safety and good outcomes of treatment. We believe in being open and honest where outcomes and experience fail to meet patient expectation so we take action, learn, improve and implement the change and deliver great care and optimum experience for our patients.” (Jane Cameron, Director of Safety and Clinical Performance, Ramsay Health Care UK)

Ramsay Clinical Governance Framework 2014 The aim of clinical governance is to ensure that Ramsay develop ways of working which assure that the quality of patient care is central to the business of the organisation.

The emphasis is on providing an environment and culture to support continuous clinical quality improvement so that patients receive safe and effective care, clinicians are enabled to provide that care and the organisation can satisfy itself that we are doing the right things in the right way. It is important that Clinical Governance is integrated into other governance systems in the organisation and should not be seen as a “stand-alone” activity. All management systems, clinical, financial, estates etc, are inter-dependent with actions in one area impacting on others.

Several models have been devised to include all the elements of Clinical Governance to provide a framework for ensuring that it is embedded, implemented and can be monitored in an organisation. In developing this framework for Ramsay Health Care UK we have gone back to the original Scally and Donaldson paper (1998) as we believe that it is a model that allows coverage and inclusion of all the necessary strategies, policies, systems and processes for effective Clinical Governance. The domains of this model are:

• Infrastructure • Culture • Quality methods • Poor performance • Risk avoidance • Coherence Ramsay Health Care Clinical Governance Framework

National Guidance Ramsay also complies with the recommendations contained in technology appraisals issued by the National Institute for Health and Clinical Excellence (NICE) and Safety Alerts as issued by the NHS Commissioning Board Special Health Authority. Ramsay has systems in place for scrutinising all national clinical guidance and selecting those that are applicable to our business and thereafter monitoring their implementation. 3.1 The Core Quality Account indicators Mortality: Period Best Worst Average Period Blakelands 2012/13 RKE 0.65 RXL 1.17 Eng 1 2012/13 NVC31 0 2013/14 RKE 0.63 RBT 1.15 Eng 1 2013/14 NVC31 0

Expected Period Best Worst Average Period Blakelands deaths: Apr12 - Mar13 RBA 0.1 RWH 44.0 Eng 20.4 2012/13 NVC31 0.0 Jul12 - Jun13 RBA 0.0 RWH 44.1 Eng 20.2 2013/14 NVC31 0.0

Blakelands hospital considers that this data is correct for the Hospital as there have been no deaths reported. PROMS: Period Best Worst Average Period Blakelands Hernia Apr12 - Mar13 NT415 0.157 NVC27 0.015 Eng 0.085 Apr12 - Mar13 NVC31 * Apr13 - Sep13 RTG 0.138 RNA 0.019 Eng 0.086 Apr13 - Sep13 NVC31 *

PROMS: Period Best Worst Average Period Blakelands Veins Apr12 - Mar13 RV8 5.14 NT350 -15.92 Eng -8.374 Apr12 - Mar13 NVC31 Apr13 - Sep13 RTD -9.74 RLN -10.52 Eng -9.46 Apr13 - Sep13 NVC31

PROMS: Period Best Worst Average Period Blakelands Hips Apr12 - Mar13 NT209 24.68 RKE 17.21 Eng 21.32 Apr12 - Mar13 NVC31 Apr13 - Sep13 NT318 25.44 RHQ 18.34 Eng 21.61 Apr13 - Sep13 NVC31

PROMS: Period Best Worst Average Period Blakelands Knees Apr12 - Mar13 NT219 20.37 RAP 12.46 Eng 16.01 Apr12 - Mar13 NVC31 Apr13 - Sep13 RDE 20.09 RM1 14.32 Eng 16.74 Apr13 - Sep13 NVC31

Blakelands hospital considers that this data is correct as of these procedures only Hernias are performed but in insufficient quantities to produce a PROMS score although patients are encouraged to participate in the study.

Responsiveness Period Best Worst Average Period Blakelands to personal 2011/12 RYR 73.3 RF4 67.4 Eng 75.6 2012/13 NVC31 0.0 needs 2012/13 RYR 75.9 RJ6 68.0 Eng 76.5 2013/14 NVC31 0.0

Blakelands hospital considers that this data is correct as this relates to the care of inpatients and as Blakelands Hospital is a day case unit only, we do not qualify.

VTE Assessment: Period Best Worst Average Period Blakelands 13/14 Q3 Several 100% NT244 63.2% Eng 95.8% 13/14 Q3 NVC31 100.0% 13/14 Q4 Several 100% NT205 67.0% Eng 96.0% 13/14 Q4 NVC31 100.0%

Blakelands hospital considers that this data is correct and has maintained the 100% compliance for all patients.

C. Diff rate: Period Best Worst Average Period Blakelands per 100,000 2012/13 Several 0 RNA 58.2 Eng 22.2 2012/13 NVC31 0.0 bed days 2013/14 Several 0 RVW 30.8 Eng 17.3 2013/14 NVC31 0.0

Blakelands hospital considers that this data is correct as there have never been any incidents of C.Diff at the Hospital.

Incident Rate: Period Best Worst Average Period Blakelands Patient Safety 2011/12 RP6 2.6 TAJ 84.4 Eng 13.5 2012/13 NVC31 1.49 2012/13 RRF 2.0 RAT 85.6 Eng 14.8 2013/14 NVC31 4.13

Blakelands hospital considers that this data is correct the increase in reporting is due to a more robust electronic reporting system along with encouraging staff to record all incidents. F&F Test: Period Best Worst Average Period Blakelands Jan-14 Several 100 RPA02 27 Eng 73 2012/13 NVC31 95 Feb-14 Several 100 RPA02 18 Eng 73 2013/14 NVC31 97

Blakelands hospital has a consistently high friends and family recommendation score. The data is collected daily and analysed monthly.

3.2 Patient safety We are a progressive hospital and focussed on stretching our performance every year and in all performance respects, and certainly in regards to our track record for patient safety. Risks to patient safety come to light through a number of routes including routine audit, complaints, litigation, adverse incident reporting and raising concerns but more routinely from tracking trends in performance indicators. 3.2.1 Infection prevention and control Blakelands hospital has a very low rate of hospital acquired infection and has had no reported MRSA Bacteraemia in the past 3 years. We comply with mandatory reporting of all Alert organisms including MSSA/MRSA Bacteraemia and Clostridium Difficile infections with a programme to reduce incidents year on year. Ramsay participates in mandatory surveillance of surgical site infections for orthopaedic joint surgery and these are also monitored. Infection Prevention and Control management is very active within our hospital. An annual strategy is developed by a Corporate level Infection Prevention and Control (IPC) Committee and group policy is revised and re-deployed every two years. Our IPC programmes are designed to bring about improvements in performance and in practice year on year. A network of specialist nurses and infection control link nurses operate across the Ramsay organisation to support good networking and clinical practice.

Infection Rates 0.14 ) s n

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 Infection rates remain static with one patient identified with a notable infection in each of the past two years.  Infection control remains a priority for the Hospital with a robust screening process in place.  3.2.2 Cleanliness and hospital hygiene Assessments of safe healthcare environments also include Patient-Led Assessments of the Care Environment (PLACE)

PLACE assessments occur annually at Blakelands Hospital, providing us with a patient’s eye view of the buildings, facilities and food we offer, giving us a clear picture of how the people who use our hospital see it and how it can be improved.

The main purpose of a PLACE assessment is to get the patient view.

The 4 elements of the audit were reviewed at Blakelands Hospital, although some are not relevant as the hospital is a day case unit which affected the overall score. The 4 elements were  Cleanliness – 98.89%, good standards are in place to ensure cleaning is a priority  Food- 0% as meals are not served at the hospital due to it being a day case hospital  Privacy, Dignity and Well being – 70%, the hospital does not have TV, radios or individual bathroom facilities as it is a day case hospital  Condition, appearance and maintenance – 90%, the hospital has a robust maintenance programme in place,

3.2.3 Safety in the workplace Safety hazards in hospitals are diverse ranging from the risk of slip, trip or fall to incidents around sharps and needles. As a result, ensuring our staff have high awareness of safety has been a foundation for our overall risk management programme and this awareness then naturally extends to safeguarding patient safety. Our record in workplace safety as illustrated by Accidents per 1000 Admissions demonstrates the results of safety training and local safety initiatives. Effective and ongoing communication of key safety messages is important in healthcare. Multiple updates relating to drugs and equipment are received every month and these are sent in a timely way via an electronic system called the Ramsay Central Alert System (CAS). Safety alerts, medicine / device recalls and new and revised policies are cascaded in this way to our General Manager which ensures we keep up to date with all safety issues.  The Hospital maintenance co-ordinator and decontamination manager attended a course to update health & safety and maintenance schedules within the decontamination areas.  Internal decontamination and Endoscopy audit concluded 97% compliance with all standards.  All staff have received updates on fire safety and a recent fire drill carried out showed an improvement in evacuation and compliance with policy.

3.3 Clinical effectiveness Blakelands hospital has a Clinical Governance team and committee that meet regularly through the year to monitor quality and effectiveness of care. Clinical incidents, patient and staff feedback are systematically reviewed to determine any trend that requires further analysis or investigation. More importantly, recommendations for action and improvement are presented to hospital management and medical advisory committees to ensure results are visible and tied into actions required by the organisation as a whole. 3.3.1 Return to theatre Return to Theatre Score 0.14 ) s n

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Ramsay health care is treating significantly higher numbers of patients every year as our services grow. The majority of our patients undergo planned surgical procedures and so monitoring numbers of patients that require a return to theatre for supplementary treatment is an important measure. Every surgical intervention carries a risk of complication so some incidence of returns to theatre is normal. The value of the measurement is to detect trends that emerge in relation to a specific operation or specific surgical team. Ramsay’s rate of return is very low consistent with our track record of successful clinical outcomes.  In the last 12 months there was one patient that returned to theatre on the same day due to equipment related issues.

3.3 Patient experience All feedback from patients regarding their experiences with Ramsay Health Care are welcomed and inform service development in various ways dependent on the type of experience (both positive and negative) and action required to address them. All positive feedback is relayed to the relevant staff to reinforce good practice and behaviour – letters and cards are displayed for staff to see in staff rooms and notice boards. Managers ensure that positive feedback from patients is recognised and any individuals mentioned are praised accordingly. All negative feedback or suggestions for improvement are also feedback to the relevant staff using direct feedback. All staff are aware of our complaints procedures should our patients be unhappy with any aspect of their care. Patient experiences are feedback via the various methods below, and are regular agenda items on Local Governance Committees for discussion, trend analysis and further action where necessary. Escalation and further reporting to Ramsay Corporate and DH bodies occurs as required and according to Ramsay and DH policy. Feedback regarding the patient’s experience is encouraged in various ways via: 1. Continuous patient satisfaction feedback via a web based invitation 2. Hot alerts received within 48hrs of a patient making a comment on their web survey 3. Yearly CQC patient surveys 4. Friends and family questions asked on patient discharge 5. ‘We value your opinion’ leaflet 6. Verbal feedback to Ramsay staff - including Consultants, Matrons/General Managers whilst visiting patients and Provider/CQC visit feedback. 7. Written feedback via letters/emails 8. Patient focus groups 9. PROMs surveys 10.Care pathways – patient are encouraged to read and participate in their plan of care

3.3.1 Patient Satisfaction Surveys Our patient satisfaction surveys are managed by a third party company called ‘Qa Research’. This is to ensure our results are managed completely independently of the hospital so we receive a true reflection of our patient’s views. Every patient is asked their consent to receive an electronic survey or phone call following their discharge from the hospital. The results from the questions asked are used to influence the way the hospital seeks to improve its services. Any text comments made by patients on their survey are sent as ‘hot alerts’ to the Hospital Manager within 48hrs of receiving them so that a response can be made to the patient as soon as possible. Satisfaction Scores NHS/Private Patients 120

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a 98.1 98.0 f

s 40 i t a S 20 0 2012/13 2013/14 Blakelands Hospital

 Patient satisfaction remain consistently high at Blakelands Hospital 3.4 Blakelands Hospital Case Study A patient attended the Ophthalmology clinic for examination and confirmation of cataract surgery. During the examination and consultation the patient could hear details of another patient and raised concerns over confidentiality. Following a review of the clinic set up by the General Manager and the Matron they concluded that in some cases confidentiality was not always maintained. Following discussions with out- patient staff, the Consultant and the patient, it was agreed to move the eye examination room to another area within outpatient that would ensure confidentiality was maintained at all times. The room moves took place immediately and when the patient returned for surgery she was shown the new examination room and thanked for raising this concern which enables staff to take action to improve patient confidentiality and experience. The patient was satisfied with the actions and outcomes. Appendix 1 Services covered by this quality account  Orthopaedic  Ophthalmology  Endoscopy, including direct access  General Surgery  Podiatry  Direct GP Bookable Ultra Sound Service  Physiotherapy Appendix 2 – Clinical Audit Programme 2013/14. Each arrow links to the audit to be completed in each month.

Quality Accounts 2013/14 Page 24 of 25 Blakelands hospital Ramsay Health Care UK

We would welcome any comments on the format, content or purpose of this Quality Account.

If you would like to comment or make any suggestions for the content of future reports, please telephone or write to the General Manager using the contact details below.

For further information please contact: Julie Fraser General Manager Blakelands Hospital Smeaton Close Blakelands Milton Keynes MK14 5HR 01908 334200

Quality Accounts 2013/14 Page 25 of 25