2013/2014
No reported MRSA bloodstream
infections in the past 4 years.
Contents
Introduction Page
Welcome to Ramsay Health Care UK and Duchy Hospital
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
2.1.1
Review of clinical priorities 2011/12 (looking back)
2.1.2
Clinical Priorities for 2012/13 (looking forward)
2.2
Mandatory statements relating to the quality of NHS services provided
2.2.1
Review of Services
2.2.2
Participation in Clinical Audit
2.2.3
Participation in Research
2.2.4
Goals agreed with Commissioners
2.2.5
Statement from the Care Quality Commission
2.2.6
Statement on Data Quality
2.2.7
Stakeholders views on 2011/12 Quality Accounts
PART 3 – REVIEW OF QUALITY PERFORMANCE
3.1
Patient Safety
3.2
Clinical Effectiveness
3.3
Patient Experience
Appendix 1 – Services Covered by this Quality Account
Appendix 2 - Consultants and staffing
Appendix 3 – Clinical Audit Programme
Welcome to Ramsay Health Care UK
Duchy 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 22 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, PCTs and acute Trusts.
Ramsay Health Care UK is committed to establishing an organisational culture that puts
the patient at the centre of everything we do. As Chief Executive of Ramsay Health Care
UK, I am passionate about ensuring that high quality patient care is at the centre of what
we do and how we operate all our facilities. This relies not only on excellent medical and
clinical leadership in our hospitals but also upon our overall continuing commitment to
drive year on year improvement in clinical outcomes.
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. 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.
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 Duchy Hospital’s 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.
In 2009/10 the Quality Account was developed by our Corporate Office and summarised
and reviewed quality activities across every hospital and centre within Ramsay Health
Care UK. It was recognised, however, 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 developed its own Quality Account for 2010/11 and this account for
2012/13 is the Duchy Hospital’s third submission.
Part 1
1.1 Statement on quality from the General Manager
Welcome to Duchy Hospital’s quality account. This report outlines the Hospitals
approach to quality improvement, progress made in 2012-13 and plans for the
forthcoming year.
Duchy Hospital has five key values which underpin everything we do as an
organisation:
• Put the patient first
• Work as one team
• Respect each other
• Strive for continual improvement
• Respect environmental sustainability
The aim of our Quality Account is to provide information to our patients and
commissioners to assure them we are committed to making progressive
achievements. For example, we participate in the Health Protection agency’s
Surgical Site Surveillance Service and our surgical site infection rates are
significantly lower than the national average.
Our emphasis is on ensuring patients receive safe and effective care, that they feel
valued and respected in decisions about their care and are fully informed about their
treatment at each step of the pathway.
The experience that patients have in our hospital is of the utmost importance and
we are committed to establishing an organizational culture that puts the patient at
the centre of everything we do. As well as being treated quickly and safely, our
patients receive a personalised service, enhanced by good communication and a
commitment to ensuring their privacy and dignity are respected at all times.
High quality patient care is at the centre of what we do and how we operate our
hospital. To do this we rely on excellent medical and clinical leadership plus an
overall continuing commitment to drive year on year improvement in clinical
outcomes.
We especially value patient’s feedback about their stay, treatment and clinical
outcome. In the last year we have taken part in the NHS Inpatients survey and
received excellent feedback. We are also delighted that the Health Gain scores for
our joint replacement patients were amongst the best in the country.
Chris Sealey, Hospital Manager
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.
Chris Sealey, General Manager
Duchy Hospital
Ramsay Health Care UK
This report has been reviewed and approved by:
Miss Bates, Consultant Gynaecologist, Medical Advisory Chair
Mr Kumaravel, Consultant Ophthalmic Surgeon, Clinical Governance Committee
Chairman
Helen White, Regional Director, Ramsay Health Care UK
Welcome to Duchy Hospital
Duchy Hospital, one of the South West’s leading independent hospitals, provides medical
and surgical services as outpatient or planned admitted care for adults and older
children; the full range of specialties offered is shown at Appendix 1. Where clinical need
requires it, our team of well trained, competent and experienced staff provide 1:1 care,
Level 2 critical care. In the unlikely event of that a higher level of care becomes
necessary, Level 3 Critical Care; there is a transfer arrangement in place with Royal
Cornwall Hospitals NHS Trust. Paediatric trained nurses are available to care for those
under the age of 18 years.
Additional onsite facilities include cosmetics, radiology, physiotherapy, mobile and
MRI/CT. We work closely with the Royal Cornwall Hospital NHS Trust which provides our
blood transfusion, pathology, and some pharmacy services.
On the 8 April 142 Consultants were registered as approved to practise at Duchy
Hospital. The full list of consultants with practising privileges along with a comprehensive
list of the disciplines and numbers of staff employed as of April 2013 can be found at
Appendix 2.
We pride ourselves on the delivery of high quality, safe, effective care in a manner and
environment that respects and protects the privacy and dignity of our patients be they
medically insured, self-funding or referred by the NHS. Our facilities and clinical and
support services are continually monitored to ensure that we are offering the very best
service to our patients.
At the start of 2012 the Duchy had 34 beds, a day case lounge with 7 recliners, 2
theatres, both with laminar flow, and a fully equipped endoscopy unit. During the year
significant investment has been made and extensive development taken place. Whilst the
number of inpatient beds had reduced to 28, the hospital now boasts a third laminar flow
theatre, a purpose built Ambulatory Care facility, a cardiac catheterisation laboratory and
additional outpatient consulting rooms and treatment facilities. Although it was anticipated
that all of the building work would be completed by the end of 2012, the final phase of
improvements to the main entrance, reception and waiting areas will come to fruition in
early summer 2013.
During the year from April 2012 to 31st March 2013 5,974 patients received treatment
here as day-cases or inpatients of which 4,099 were NHS patients (68%); of those 4,099
69% were treated as day cases compared to 66% last year. Only 25% of the day case
patients were treated on the inpatient ward compared to 52% in the previous year. This
has had a major impact on how efficiently the attendance and stay of these patients is
managed.
Mrs Miranda Field is our GP Liaison Officer. Miranda has close contact with both the
practice managers and the GPs at our practices throughout Cornwall. She organises
regular “Lunch and Learns”, taking Consultants into GP surgeries to offer training and
latest development awareness as well as running evening GP training seminars on a
regular basis.
We value our contact with GPs as “customers” and strive to ensure we actively work in
partnership with them to enhance patient care. Dr Andrew Craze, local GP, is a member
of the hospital’s Medical Advisory Committee (MAC). The Duchy management team is
also working hard to establish a good relationship with Kernow Clinical Commissioning
Group which took over responsibility for commissioning health care services for the
people of Cornwall on 1 April 2013.
We work closely with the Royal Cornwall Hospital NHS Trust which provides us with
blood transfusion, pharmacy services and access to level 3 critical care services.
Part 2
2.1 Priorities for improvement
On an annual cycle, Duchy Hospital develops an operational plan to set objectives
for the year ahead.
We are committed to respecting privacy and dignity, and providing safe, effective
treatment for all those who receive care from us, be they our private patients or
those for whom services are commissioned by the NHS. We constantly strive to
improve clinical safety and standards through a systematic process of governance
which includes audit and feedback from all those experiencing our services.
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.
2.1.1 A review of clinical priorities 2012 /13
World Health Organisation (WHO) Surgical safety checklist – completion of the
checklist is a key safety element for patients undergoing surgical procedures at
Duchy. All grades of clinical staff have been involved in achieving this aim and
we have worked with both our Corporate Clinical team and our local Trust to
share training packages and audit tools. Proper completion of the WHO checklist
is audited regularly and the results are consistently over 90% compliance. The
results of these audits will be submitted to Kernow Clinical Commissioning
Group quarterly and will form part of its quality monitoring process for Duchy
clinical services during 2013/14.
Venous-thromboembolism event (VTE) - which includes deep vein thrombosis
(DVT) and pulmonary embolism (PE), is universally recognised as a significant
patient safety issue. The Duchy Hospital has established a robust policy and
processes to ensure it can comply with NICE guidelines in order to reduce
avoidable death, disability and chronic ill health from VTE. We have reduced the
variance of prophylactic measures used at Duchy Hospital in order to minimise
human error and allow outcomes to be measured. The hospital has an excellent
VTE risk assessment compliance record.
Data submitted to UNIFY, a Department of Health national reporting system
shows 98% achievement from April 2012 to February 2013 inclusive
2012/13 - UNIFY VTE Submissions
March data excluded as not yet available.
Never events – completely avoidable, significant safety events. Preventative
measures have been implemented and there have not been any “Never events”
at Duchy in this reporting year.
Cleanliness and infection prevention - There have been no MRSA bacteraemia
at the hospital for over four years, or C Difficile infections at Duchy Hospital.
However we are not complacent and we continue to screen all patients for
MRSA prior to admission to Duchy and all staff have a mandatory requirement to
undertake hand hygiene training. We maintain our regular audit programme
which includes hand hygiene, urinary catheter and intravenous line care, and our
cleaning standards and physical environment. We participate in the Health
Protection Agency data collection for surgical site infections following hip and
knee joint replacements and we have not had cause to report any infections to
the HPA during the last year.
Meeting endoscopy standards – we have made good progress towards
achieving JAG accreditation (Joint Advisory Group for GI endoscopy). An
endoscopy lead nurse is in post and we submit data in line with the Global
Rating Scale (GRS) initiative for endoscopy. We will be formally assessed for
JAG accreditation during 2013
Releasing Time to Care (formerly known as The Productive Ward)– the Duchy
staff have continued to implement ways of working which enable clinical staff to
spend more time delivering patient care. The amount of non-clinical
administration has been reduced by taking on additional administrative staff, and
multi-disciplinary patient documents are now kept at the bedside to support
good, contemporaneous record keeping and communication; this reduces the
time spent on verbal questioning and handover, and supports consistent care.
Risk Management – During 2012 Ramsay UK introduced a new risk
management reporting system, called RiskMan, across the company. This has
enabled us to record and analyse clinical and other incidents and service user
feedback with a much greater degree of accuracy. There is now an improved
ability to identify areas concern relating to patient safety and calculate any
trends.
Using this system Duchy has seen the total number of incidents reported rise
but with the significant majority of incidents are classified as not causing harm
to anyone. This is an indicator of a safety conscious organisation; one which is
willing to report and analyze all incidents, whether they cause harm or not to
ensure we learn and improve further. This information is shared with the PCT
Quality team to provide assurance of the safety of our services and allows us to
be benchmarked against other providers. We will continue to share this type of
information with Kernow Clinical Commissioning Group during 2013/14.
Vulnerable adult, Deprivation of Liberty and Child protection – the hospital takes
its responsibility for safeguarding vulnerable members of society seriously.
Equality, diversity and human rights are a theme running through Ramsay
Health Care. The organisation’s integrated governance framework, Group
policies and practice comply with current legislation. All staff working within the
hospital are required to have a standard or, in the case of those with patient
contact, an enhanced CRB check. They receive in-house education about
Equality, Human Rights and workplace Diversity, vulnerable adult care,
deprivation of liberty and child protection training.
In addition, during 2012 senior nursing staff received external safeguarding
training from the local council Safeguarding Adults team to improve their
awareness of multi-agency safeguarding policy and procedure in Cornwall.
During 2012/13 staff contacted the Cornwall Safeguarding Children’s team for
advice on one occasion, the circumstances related to domestic arrangements
rather than any event within the hospital, but no Safeguarding Alerts have been
made.
An unannounced visit on 21st November 2012 by PCT sponsored Dignity in
Care Assessors, found that staff had a high level of respect for patient’s privacy
and dignity.
National Joint Register – The National Joint Register records the details of
patients undergoing major joint replacement surgery and the type of prosthesis
(new joint) they are given. This system is invaluable when there are nationally
identified concerns such as the recent ‘metal on metal’ hip joint alert; patient’s
details are only added to this register with their written consent. We continue to
submit data to the NJR. The key performance benchmark for NJR consent is
95%. Duchy consistently scores in excess of 90%
Data is 2012/13 - NJR Submissions
Competency training – ensuring well trained, competent staff are available to
care for patients is a high priority at Duchy Hospital. This year the staff have
undertaken competency based training in “recognising the signs of the
deteriorating patient” based on early warning scoring and trigger tools. The
critical care training remains competency based and all staff are expected to
achieve competence in infection prevention and control which includes hand
hygiene. Intermediate Life Support (ILS) and/or Advance Life Support (ALS)
training is mandatory for all clinical staff working in acute areas and this year we
also provided AIM (Acute Illness Management) training. All staff at Duchy who
are involved in any aspect of a blood transfusion or who handle blood products
have been formally assessed as competent in order to be allowed to participate
in this aspect of care.
Our current Health Care Assistants (HCAs) hold NVQ Level 3 in Health Care
and newly appointed staff undertakes an Apprenticeship in Health to the same
level. This ensures they have the proper knowledge skills and attitudes to
support the delivery of high standards of care.
Information Security – Duchy Hospital achieved the information security
accreditation IS0270001. The process of raising awareness of the importance of
data protection and information security has been very successful and fully
embraced by the staff at Duchy Hospital.
Staff Satisfaction - our staff satisfaction results are very important to us as
satisfied, well trained and competent staff will help to ensure patient safety. The
staff satisfaction survey is done annually and Duchy Hospital is bench marked
against the other Ramsay UK units.
In 2012 Duchy was in the top 4 Ramsay UK Units out of 37 sites surveyed.
(Excluding Directors and Head Office). Whilst a full staff survey has not yet
been undertaken in 2013, a ‘Pulse’ survey conducted in February showed a
very positive response from staff on key questions.
Question
I have confidence in the leadership skills of my manager
My manager regularly expresses appreciation when I do a
good job
I feel proud to work for this organisation
I believe I can make a valuable contribution to the success of
the organisation
Agree/
strongly
agree
83%
66%
80%
89%
However, as managers and heads of department, we must get better at
showing our appreciation to staff for all of the hard work they do.
2.1.2 Clinical Priorities for 2013/14
Patient Safety
WHO Surgical safety checklist – compliance with the checklist will remain an
on-going quality and safety priority at Duchy. We will audit our compliance and
report the results to Kernow Clinical Commissioning Group, which purchases
NHS services for the people of Cornwall, as one of our locally agreed quality
indicators for 2013/14.
Venous-thromboembolism assessment – will remain an ongoing quality initiative
and we will continue to audit our compliance to risk assessment and appropriate
prophylaxis. Audit results will be submitted as one of the nationally mandated
quality indicator.
Never events - preventing the occurrence of Never Events will remain a clinical
priority for 2013/14.
JAG accreditation - one of this year’s priorities is for the Duchy Hospital to
achieve this nationally recognised award. A lead nurse for endoscopy is in post
and we submit data for the Global Rating Scale. We are working closely with
other Ramsay units in the UK that have already achieved accreditation and are
confident that our clinical practice is already at JAG levels; it is only the
requirements relating to IT systems that holds us back. We aim to address this
during 2013/14.
National Joint Register – Duchy Hospital aims to maintain its consistently good
scores for data submission to the National Joint Register.
Clinical and other training – Duchy Hospital will continue to ensure that patients
are cared for by well trained, competent staff. Providing quality care for patients
is a high priority at Duchy Hospital and all relevant clinical staff will be supported
through training and protected time to achieve competency level education.
Safeguarding – the hospital takes its responsibility for safeguarding vulnerable
members of society seriously. We will continue to ensure that all staff working
within the hospital have the appropriate level of CRB check appropriate to their
role. We will continue to provide training, reviewing the content in light of local
multi-agency and Ramsay UK policies procedures, and ensure that staff have
the necessary resources available to enable them to manage any concerns
appropriately and in a timely manner.
Staffing – to ensure that adequate numbers of skilled staff are available to care
for our patients staff rotas are prepared in advance. When determining how
many staff and what skills are required, the dependency of patients and the
amount of time each requires is taken in to account. We have ‘as and when’
staff to provide additional cover as required
Ramsay has invested in an electronic rostering system called Allocate; we had
hoped would be in place by the end of 2012. Unfortunately it was unavoidably
delayed but we are confident it will be introduced during 2013. The system will
be set-up to produce rotas in line with patient numbers and specific local skill
mix requirements. It will also reduce the time spent on producing numerous
rotas throughout the hospital and will be accessible to all staff so they can log in
and make requests for leave, training etc. It is also designed to record training
hours and remind staff when they need to attend mandatory training sessions.
Clinical effectiveness
Ambulatory Day Care – better outcomes and improving patient experience.
Best practice has shown that by caring for short stay patients in a day care
facility, as opposed to a traditional ward, patient care will improve as the waiting
time and recovery period are reduced. The new Ambulatory Care Unit opened to
patients in October 2012 and patients are reporting excellent experiences. They
appreciate the efficiency of the system which enables them to have their
procedure in modern, comfortable surroundings and only have to spend a few
short hours in hospital. Over the coming months we aim to increase the number
of patients who receive their care on the Unit, so long as it is clinically
appropriate for them to do so. At present the percentage of day case admissions
at Duchy is 70%, compared to 60% in 2012. We will monitor this through
amended coding reports from our patient information system and through patient
satisfaction indices.
Pre-operative assessment – Duchy’s pre assessment team have worked hard
to develop the service to ensure patient’s fitness for surgery is assessed in
advance of their admission to reduce the chance of their operation being
cancelled for safety reasons. This work will continue in an improved environment
once the final phase of the building development is completed.
Ramsay is a member of PHIN – Private Hospitals Information Network which
will enable private providers to benchmark against other types of provider for key
performance indicators(activity/volumes, mortality, day case rates, unplanned
readmissions, average length of stay, unplanned transfers, reoperations, etc)
We will continue to benchmark our services against other providers nationally
wherever possible including:
VTE risk assessment compliance – benchmarking through the national
stats website
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/P
ublicationsStatistics/DH122283
PROMS results – benchmarking through national PROMS website.
http://www.hesonline.nhs.uk/Ease/servlet/ContentServer/siteID=1937&
categoryID-1295
Patient experience
Patient reported outcome studies (PROMS) – we continue to participate in the
national PROMS data collection for Hips, Knees, Varicose Veins and Hernia
surgery. The results, which are very encouraging for Duchy, are shared with the
medical and clinical staff through the Medical Advisory Committee, Clinical
Governance Committee, and Clinical Head of Department and Departmental
meetings. Reviewing this data also provides the opportunity to identify poor
outcomes and examine practice if and when it exists. Last year we participated
in a local Clinical Outcomes tool which was also being piloted by the Royal
Cornwall Hospital for orthopaedic patients. This project continues into 2012/13
Patient satisfaction survey – Duchy has always achieved a high level of patient
satisfaction. The most recent Ramsay Healthcare national inpatient survey was
distributed to patients discharged between January and August 2012 and uses a
‘mean rating score’ consistent with the Care Quality Commission to enable
benchmarking against other organisations. The mean rating score allocates a
‘weight’ to each response, with positive scores (e.g. excellent, very good, good)
allocated a higher score than negative responses (e.g. fair, poor). For every
evaluative question, each response category is weighted between 0 (most
negative) and 100 (most positive).
In response to the question “Overall how would you rate your experience”
Duchy achieved a rating of 92%.
2.2 Mandatory statements relating to the quality of NHS services provided
2.2.1 Review of Services
During 2012/13 the Duchy Hospital provided Outpatient consultations, diagnostics
and elective surgery in 10 NHS Specialties through the Choose & Book System.
Duchy has reviewed all the data available to them on the quality of care in 100% of
these NHS services.
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 hospital’s
senior management team together with regional and Corporate Managers. The
balance scorecard approach has been an extremely successful tool in helping us
benchmark against other hospitals and identify key areas for improvement.
In the period for 2012/13 the indicators on the scorecard which affect patient safety
and quality were:
Human Resources
HCA hours as % of total nursing – 28%
Agency hours as % of total hours – 0.18 %
staff turnover – 4.2% (3 retired, 1 left on maternity, 1 emigrated and 1 left through ill health)
Staff satisfaction – 83.3% (from the 2011 survey as 2013 survey still to be completed)
% sickness – 3.7%
Total lost worked days – 1,403
Patient
Formal complaints per 1000 HPDs – 4.5
Quality
Infection control audit score – > 95%
Re-admission per 1000 admissions – 1.5
2.2.2 Participation in clinical audit
During 2012/13 two national clinical audits and one national confidential enquiries
covered NHS services that Duchy Hospital provides.
National Clinical Audits
Participation
Bowel cancer
No insufficient
numbers
Diabetes (Adult) ND(A), includes National Diabetes
Inpatient Audit (NADIA)
No insufficient
numbers
% cases
submitted
National Joint Registry
Yes
100
Elective surgery (National PROMs Programme)
Yes
100
Clinical outcome review programmes
Medical and Surgical programme: National
Confidential Enquiry into Patient Outcome and Death
No deaths
Local Audits
Duchy participates in the Ramsay corporate clinical audit programme which,
between April 2012 and March 2013 comprised 62 separate audits: 15 infection
prevention and control, 3 transfusion, 4 physiotherapy and radiology clinical audits.
The results were reviewed by the Clinical Governance Committee and hospital’s
MAC.
All audit results showed a good degree of compliance and our main priority for
2013/14 will be to further improve our standards of documentation.
The environmental audits achieved a slightly lower standard than previously
reflecting the need for redecoration/refurbishment of inpatient areas, which will be
completed once the building development is finished; some has already
commenced.
2.2.3 Participation in Research
There were no patients recruited during 2012/13 to participate in research approved
by a research ethics committee.
Duchy is working with other providers and local university to enable us to be part of
appropriate clinical research projects during 2013/14.
2.2.4 CQUIN Goals agreed with our Commissioners.
Duchy Hospital income for achieving quality improvement and innovation goals
through the Commissioning for Quality and Innovation payment framework is
applicable from 1st April 2012 (SAC commencement) to March 31st 2013. We are
proud to have achieved all of our locally agreed CQUIN’s on patient safety and all of
the nationally mandated elements. Duchy has agreed revised CQUIN topics and
targets for 2013/14 to support our continuous drive to further improve our standards.
2.2.5 Statements from the Care Quality Commission (CQC)
The Duchy Hospital is required to register with the Care Quality Commission. On
the most recent CQC inspection on 21st January 2013 the Duchy was inspected on
outcomes 1, 2, 4, 7, 8, 10, 14 and 16 and found to be fully compliant. Thus our
current registration status on 31st March 2013 is ‘registered without conditions’.
The Care Quality Commission has not taken enforcement action against Duchy
Hospital during 2012/13.
Duchy Hospital has not participated in any special reviews or investigations by the
CQC during the reporting period.
2.2.6 Data Quality
We regularly use statistical data to monitor clinical services – we are constantly
striving to improve this data by regular quality control initiatives.
Data contained in medical records are audited on a monthly basis and actions are
taken to improve quality as required. This applies to both private and NHS patient
streams.
The hospital has a data quality super user who manages the SUS pathway
processes and continually reviews administration functions to ensure data quality.
NHS Number and General Medical Practice Code Validity
The Ramsay Group submitted records during 2010/11 to the Secondary Users
Service for inclusion in the Hospital Episode Statistics which are included in the
latest published data. The percentage of records in the published data included:
The patient’s valid NHS number:
99.98% for admitted patient care
99.95% for outpatient care
0% for accident and emergency care (not undertaken at Ramsay Hospitals).
The General Medical Practice Code:
99.99% for admitted patient care
99.99% for outpatient care
0% for accident and emergency care (not undertaken at Ramsay hospitals).
Information Governance Toolkit attainment levels
Ramsay Group Information Governance Assessment Report score overall for
2012/13 was 77% and was graded ‘green’ (satisfactory).
This information is publicly available on the DH Information Governance Toolkit
website at: https://www.igt.connectingforhealth.nhs.uk/
Clinical coding error rate
The Duchy Hospital is subject to the Payment by Results clinical coding audit and
we will be audited as a company in 2013. During 2012 we received a good result
from the internal audit.
2.2.7 Stakeholders views on 2012/13 Quality Account
The Duchy Hospital Quality Accounts were presented to the Network Leadership
Group of Kernow Clinical Commissioning Group on the 21st May 2013
Kernow Clinical Commissioning Group is pleased to have the
opportunity to comment on the Quality Account 2012/13 for Ramsay
Duchy Hospital and welcomes the approach the Hospital has
shown in developing and setting out its plans for quality
improvement. There are routine processes in place with the Duchy
to agree, monitor and review the quality of services throughout the
year covering the key quality domains of safety, effectiveness and
experience of care.
We have reviewed and can confirm the information presented in the
Quality Account appears to be accurate and fairly interpreted, from
the data collected. The Ramsay Duchy Hospital achieved
Commissioning for Quality and Innovation targets.
The Quality Account presents an overview of a range of quality
improvement work being undertaken. We particularly commend the
continued high patient satisfaction and patient reported outcome
measures. We note the continued high patient satisfaction and
patient reported outcome measures, and note the achievements at
the centre in the past year, such as no ‘never events’, good control
of infection outcomes and information security accreditation.
We are pleased to see that the priorities chosen for 2013/14 have
been identified with key stakeholder involvement; we are pleased to
see continued emphasis on patient safety, both through the surgical
safety checklist, the prevention of never events and Venousthromboembolism assessment.
We would like to see further work on ensuring that readmission
rates across providers are accurately recorded, and work to
understand the quality outcomes for the newly commenced Ramsay
Duchy angiography service.
Kernow Clinical Commissioning group looks forward to working with
the Hospital throughout the year to achieve more efficient pathways
delivering high quality services to patients.
Part 3: Review of quality performance 2012/13
Statements of quality delivery
Matron, Debby Blease
Review of quality performance 1st April 2012 - 31st March 2013
Introduction
‘Our overriding commitment is to provide safe and effective care; the guiding
principle is to put our patients’ interests first and key to this is our capacity to
listen, be responsive and to act on their feedback. We already take patient views
and ratings into account in any assessment of our performance but now we will
increasingly draw on effective real-time information and this includes on-line
patient surveys. Added to which there are more opportunities to use new
measures of quality of care and patient safety and be able to make a difference
to improvements in future practice. Importantly these new metrics should ensure
performance which needs improving, can be quickly identified and fixed’.
(Jane Cameron, Director of Safety and Clinical Performance,
Ramsay Health Care UK)
Ramsay Clinical Governance Framework
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
NICE / NPSA 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 National Patient Safety Agency (NPSA).
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 Patient safety
We are a progressive hospital focused on improving our performance year on year
in all aspects of our services, and certainly in relation to 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.
Our focus on patient safety has resulted in a marked improvement in a number of
key indicators as illustrated in the graphs below.
3.1.1 Infection prevention and control
Duchy Hospital has a very low rate of hospital acquired infection and has had no
reported MRSA Bacteraemia in the past 4 years.
We comply with mandatory reporting of all ‘Alert’ organisms including MSSA/MRSA
Bacteraemia and Clostridium Difficile infections with a programme to reduce/prevent
incidents year on year.
Ramsay participates in mandatory surveillance of surgical site infections for
orthopaedic joint surgery and these are also monitored.
We have pro-active Infection Prevention and Control management within our
hospital. An annual strategy is developed by a corporate level Infection Prevention
and Control (IPC) Committee and group policy is revised 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. At Duchy
Hospital the ward sister and one of the senior staff nurses have undertaken
additional training to lead the hospital’s infection control agenda.
Programmes and activities within our hospital include:
All staff (clinical and non-clinical) complete the corporate e-learning training
package about Infection Control. In addition they attend an annual in-house
training session which includes practical training in Hand Hygiene using the UV
light to show how effective each individual’s technique is. The infection control
nurses have also done similar sessions at hospital open days and at off-site
marketing events to promote hand hygiene awareness.
Hand hygiene remains a focus area for 2013/14. The appropriate use of alcohol
gel/foam and hand washing is vital for preventing the spread of infection and is
the responsibility of everyone. We focus on the World Health Organisation’s ‘5
moments’ when hand hygiene has to take place and plan to involve our patients
in auditing compliance to this.
There is a strong emphasis on cleanliness with an operational cleaning matrix
with cleaning records available in each department. Matron undertakes daily
rounds in all clinical areas and, with the Support Services Manager, conducts
periodic audits of the facilities to ensure high standards are maintained
Environmental audits have been undertaken this year which aim to ensure a
safe environment for all staff and patients.
Hospital Acquired Infections
The graph below shows the absolute numbers of Hospital acquired infections for
Duchy Hospital over the last 3 years. All of these cases were successfully treated
with antibiotic therapy.
There have been no cases of MRSA Bacteraemia.
The graph below shows the rate of infection for every 100 discharges.
3.1.2 Cleanliness and hospital hygiene
We continue to assess the hospitals facilities to ensure that we are providing a safe
environment and use the following audit tools:
Corporate - Environmental Audit – Quarterly
Corporate - Health, Safety & Facilities Audit – Annually
Patient Led Assessments of the Clinical Environment (PLACE) Assessments
Annually from April 2013
Environmental Audit
This audit was introduced in 2010, and is completed quarterly, the aim of this audit
is to ensure a safe environment for all staff and patients, the objectives are:
1. To identify users and user groups
2. To advise on infection control issues arising
3. To acknowledge
The audit consists of an inspection of the hospitals clinical areas and includes the
general environment, clinical equipment, decontamination, clinical practices, sharps
handling, waste disposal and hand washing.
Duchy’s environmental audit results are always at least 90%. As noted above, the
lower score for 2013 is as a result of the need for redecoration/refurbishment of
some of our inpatient facilities and there is a plan in place to complete this during
the 2013 calendar year.
We continue to focus on delivering a high standard of cleanliness and ensure that
staff are informed and updated at our mandatory training study days as well as
discussing the points raised at our bi-monthly Risk Management meetings.
PEAT audit
We participate in the national annual assessment for all NHS Trusts and some of
the independent sector; these assessments include rating of privacy and dignity,
food and food service and environment which assesses issues such as signage,
bathroom/toilet environments and overall cleanliness.
Duchy’s most recent PEAT audit undertaken in early 2012 scored Environment –
Excellent; Food – Excellent; Privacy and Dignity - Excellent .
From April 2013, PEATs will be replaced with Patient Led Assessments of the
Clinical Environment (PLACE).
Health, Safety & Facilities Audit
This audit, taken from Approved Codes of Practice (ACOPS) was introduced in
2009 and is completed annually. The standards are the minimum that an
organization must adhere to ensuring a safe workplace. The benchmark set for
2010 was 90% and this has been raised to 95% for 2011.
Duchy was audited in February 2013 and scored 89%. The areas that led to the
lower attainment relate to record keeping and issues created by the building works.
Actions were immediately put in place to maintain safety and correct the
deficiencies.
3.1.3 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 good
awareness of safety has been a foundation for our overall risk management
programme and this awareness then naturally extends to safeguarding patient
safety.
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 and
shared across the Hospital which ensures we keep up to date with all national
safety issues.
All safety incidents are reported on the corporate web based system and are
subject to corporate scrutiny as well as in-depth review locally and discussion at our
regular Risk Management meetings.
3.2 Clinical effectiveness
Duchy Hospital has a Clinical Governance Committee that meets regularly during
the year to monitor the quality and effectiveness of care. Clinical incidents and
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 Senior Management Team and
Medical Advisory Committees to ensure results are visible and tied into actions
required by the organisation as a whole.
3.2.1 Returns to theatre
Ramsay 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 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.
The graph below shows absolute numbers of unexpected returns to theatre over the
last 3 years.
The graph below gives the % of unplanned returns to theatre per 100 discharges
3.2.2 Readmission to hospital
Monitoring rates of readmission to hospital is another valuable measure of clinical
effectiveness. As with return to theatre, any emerging trend of specific surgical
operation or surgical team in common may identify contributory factors to be
addressed. Ramsay rates of readmission remain very low and this, in part, is due to
sound clinical practice ensuring patients are not discharged home too early after
treatment and are independently mobile, not in severe pain etc.
The graph below shows the absolute number of unplanned re-admissions over the
last 3 years.
The graph below shows the % of unplanned re-admissions per 100 discharges.
3.3 Patient experience
We welcome feedback (both positive and negative) from patients and other visitors
to our hospital regarding their experiences with Ramsay Health Care, and use it to
inform service development.
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.
Any negative feedback or suggestions for improvement are also fed back 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.
Feedback regarding the patient’s experience is encouraged in various ways via:
Written feedback via letters/emails
PROMs surveys
Care pathways – patient are encouraged to read and participate in their plan of
care
Patients can also share their experiences using a range of methods including:
Patient satisfaction surveys
‘We value your opinion’ leaflet
Verbal feedback to Ramsay staff - including Consultants, Matrons/General
Managers whilst visiting patients and Provider/CQC visit feedback.
Reviewing this feedback is a regular agenda item for meetings of the local Senior
Management Team and Clinical Governance Committee for discussion, trend
analysis and agreeing further action where necessary. Escalation and further
reporting to Ramsay Corporate and DH bodies occurs as required and according to
Ramsay and DH policy.
3.3.1 Patient Satisfaction Surveys
On behalf of Ramsay UK, Patient Perspective conducted a survey of NHS
inpatients discharged between January and August 2012. As a summary measure
for each question, Patient Perspective followed the approach adopted by the Care
Quality Commission in England for the National Patient Experience Survey
Programme which allows easy benchmarking with existing published national data.
The mean rating score allocates a ‘weight’ to each response, with positive scores
(e.g. excellent, very good, good) allocated a higher score than negative responses
(e.g. fair, poor). For every evaluative question, each response category is weighted
between 0 (most negative) and100 (most positive).
An average for each question is then calculated with higher scores indicating better
results (or a more positive patient experience) and 100 being perfect.
The response rate for patient treated at Duchy was 78%
Key questions and the mean rating score they attracted are shown below:
Were there enough staff (nurses) to care for you
95%
Were you involved enough in decisions about your care/treatment
90%
Were you given enough privacy when being examined/treated
98%
Overall were you treated with respect and dignity
96%
3.3.2 Patient Reported Outcome Measures (PROMs)
Duchy Hospital participates in the Department of Health’s PROMs surveys for hip
and knee surgery, hernias and varicose veins for NHS patients. The sample sizes
are small and survey results are evolving. Indications so far are that Duchy Hospital
patients report excellent outcomes, and results compare very favourably with other
providers.
Provisional data (subject to confirmation) for 2011/12 suggests the Duchy compares
to the England average as shown on the table below
Provider
Hip-Health
Gain
KneeHealth Gain
England
20.094
15.146
21.34
18.156
DUCHY HOSPITAL
Patient reported health gain by procedure is shown on the graphs below
As a Group, Ramsay also conducts its own hip, knee and cataract PROMs surveys
specifically for private patients.
Appendix 1
Services covered by this quality report
Duchy Hospital.
Duchy Hospital has 28 beds and an Ambulatory Care Unit with 12 patient spaces. The
Hospital has 3 theatres with laminar flow and a fully equipped endoscopy unit, plus a
Cardiac Catheter Laboratory.
Patients’ requiring level 2 care are treated and cared for by
a well trained team of staff in individual rooms. All Ramsay
Health Care UK Hospitals have transfer agreements in
place either with their local trust or critical care network.
Duchy Hospital provides consultations from birth and day case/inpatient care for children
over the age of 12. The hospital employs qualified children’s nurses to support this
service.
On site facilities include Outpatients, Cosmetics, Radiology, Angiography Physiotherapy and
Mobile MRI/ CT.
Our clinical facilities are continually monitored to ensure that we are offering the very best
service to our patients.
Regulated Activities – Duchy Hospital
Services Provided
Physiotherapy, Cardiology,
Treatment
of Disease, Endocrinology, General medicine,
Disorder
Haematology, Oncology,
Or injury
Neurology, Psychiatry,
Psychotherapy, Speech therapy,
Sports medicine, Urology, Medicine
management, Clinical neuro,
physiology, Allergy testing,
Diabetology, Occupational therapy
Cosmetic, Bariatrics,
Surgical
Procedures Dermatological, Ear, Nose and
Throat (ENT), Gastrointestinal,
Colorectal, Breast surgery, General
surgery, Gynaecological,
Ophthalmic (inc laser), Maxillofacial
/ oral, Orthopaedic, Urological,
Peoples Needs Met for:
All adults 18 yrs and over
All children 12 yrs and over
Consultations – from birth
All adults excluding:
Patients with complex blood
disorders (haemophilia, sickle
cell, thalassaemia) •
Patients on renal
haemodialysis •
Neurological, Ambulatory, Day and
Inpatient Surgery
Patients with history of
malignant hyperpyrexia •
Planned surgery patients with
positive MRSA screen are
deferred until negative •
Patients who are likely to need
ventilatory support post
operatively
Patients who are above a stable
ASA 3.
Any patient who will require
planned admission to ITU post
surgery
Dyspnoea grade 3/4 (marked
dyspnoea on mild exertion e.g.
from kitchen to bathroom or
dyspnoea at rest)
Poorly controlled asthma
(needing oral steroids or has
had frequent hospital
admissions within last 3
months)
MI in last 6 months
Angina classification 3/4
(limitations on normal activity
e.g. 1 flight of stairs or angina at
rest)
CVA in last 6 months
However, all patients will be
individually assessed and we
will only exclude patients if we
are unable to provide an
appropriate and safe clinical
environment.
Diagnostic
and
screening
Cardio physiology, ERCP, GI
All adults 18 yrs and over
physiology, Imaging services,
All children 12 yrs and over
Phlebotomy, Urinary Screening and
Consultations – from birth
Specimen collection
Diagnostic
and
screening
Imaging services, Phlebotomy,
Urinary Screening and Specimen
collection.
All adults 18 yrs and over
Children 3 years and above
Appendix 2 - Consultants and employed staff.
142 Consultants were approved to work from Duchy 142 as at 8 April 2013
Title
Initial
Surname
Specialty
Title
Initial
Surname
Specialty
Dr
Dr
Dr
D
R
W
Elliott
Ellis
English
Anaesthetist
Oncologist
Anaesthetist
Dr
Dr
Mr
S
K
J
Evans
Farmer
Faux
Cardiologist
Radiologist
General Surgeon
Mr
D
Fern
Mr
Mr
Mr
S
S
A
Adcock
Ahmad
Al-Shawi
Mr
Dr
Mr
P
S
G
Arumugam
Banks
Bartlett
Miss
S
Bates
Facio-maxillary Surgeon
General Surgeon
Orthopaedic
Surgeon
General Surgeon
Anaesthetist
Orthopaedic
Surgeon
Gynaecologist
Dr
Dr
Dr
Dr
Dr
Mr
Dr
J
J
H
J
C
C
J
Bebb
Beckly
Belcher
Berry
Blacker
Blake
Boyden
Gastroenterologist
Gastroenterologist
Radiologist
Anaesthetist
Psychiatrist
Urologist
Anaesthetist
Mr
Dr
Mr
Mr
Dr
Mr
Dr
I
W
A
P
P
T
S
Finlay
Fish
Fitton
Flanagan
Fortun
Germon
Gray
Mr
D
Bracey
Dr
J
Hancock
Dr
Mr
Dr
Mr
G
I
D
M
Brooker
Brown
Browne
Butler
Dr
Dr
Dr
Mr
A
W
A
B
Harvey
Harvey
Hobbs
Holland
Anaesthetist
Anaesthetist
Anaesthetist
Optician
Mr
Mr
Dr
Mr
Dr
Dr
Ms
Dr
Mr
Dr
Dr
D
P
P
H
T
J
K
P
R
A
D
Byrne
Callen
Carpenter
Chant
Chave
Cheung
Claridge
Cook
Cox
Craze
Creagh
Orthopaedic
Surgeon
Anaesthetist
General Surgeon
Endocrinologist
Orthopaedic
Surgeon
Gynaecologist
Gynaecologist
Anaesthetist
Vascular Surgeon
Dermatologist
Anaesthetist
Ophthalmologist
Radiologist
Urologist
G.P.
Haematologist
Orthopaedic
Surgeon
General Surgeon
Anaesthetist
Plastic Surgeon
ENT Surgeon
Gastroenterologist
Surgeon
General
Practitioner
Radiologist
Dr
Mr
Dr
Dr
Dr
Dr
Dr
Dr
Mr
Dr
Mr
N
R
P
H
D
J
W
R
D
K
R
Hollings
Holmes
Hopton
Hussaini
Hutchinson
Hyslop
Jewell
Johnston
Jones
Kandasamy
Kincaid
Mr
J
Dainton
Mr
S
Kumaravel
Dr
Mr
H
J
Dalton
Davies
Orthopaedic
Surgeon
Gastroenterologist
Vascular Surgeon
Radiologist
Gynaecologist
Anaesthetist
Gastroenterologist
Rheumatologist
Radiologist
Anaesthetist
Cardiologist
Ophthalmologist
Cardiologist
Orthopaedic
Surgeon
Ophthalmologist
Dr
Mrs
R
N
Langford
Lansley
Dr
M
Davis
Rheumatologist
Mr
C
Lansley
Dr
JM
De Beer
Anaesthetist
Mr
A
Lee
Dr
S
Devadathan
Cardiologist
Mr
E
Dr
Dr
Mr
A
P
S
Dingwall
Divekar
Dixon
Miss
Dr
Dr
F
TW
F
Prof
P
Drew
Mr
D
Mackenzie
Plastic Surgeon
Dr
A
Edwards
Anaesthetist
Dermatologist
Orthopaedic
Surgeon
Oncoplastic
Breast Surgeon
Radiologist
LloydDavies
Lone
Lucke
Luscombe
Dr
N
Marshall
Anaesthetist
Anaesthetist
Family
Psychotherapist
Facio-maxillary
Surgeon
Orthopaedic
Surgeon
General Surgeon
Gynaecologist
Dermatologist
Anaesthetist
Title
Initial
Surname
Specialty
Title
Initial
Surname
Specialty
Dr
G
Maskell
Radiologist
Dr
M
Proctor
Mr
J
Matthews
Mr
M
Regan
Dr
R
Mawer
Orthopaedic
Surgeon
Anaesthetist
Mr
T
Scott
Mrs
Mr
M
J
McDermott
McDiarmid
Audiologist
Plastic Surgeon
Dr
Mr
R
S
Searle
Sexton
Mr
Dr
Dr
P
B
N
McGannity
McLean
Michell
Dentist (Implant)
Neurologist
Gastroenterologist
Dr
Dr
Dr
DJ
A
G
Sim
Simaitis
Smith
Mr
Dr
Dr
Dr
Dr
Mr
Mr
Dr
Mr
J
M
K
S
A
R
N
JD
M
Middleton
Mitchell
Mitchell
Dr
Dr
Mr
Dr
Dr
Dr
Dr
Dr
Dr
M
W
N
T
R
H
A
S
M
Spivey
Stableforth
Sudhakar
Sulkin
Taylor
Thompson
Thomson
Thorogood
Thorpe
Dr
Dr
Mr
Dr
Mr
P
J
HJ
RG
S
Owens
Paddle
Parker
Parry
Parsons
Dr
Dr
Mr
Mr
Ms
R
P
D
W
A
Van Lingen
Waterhouse
Weerasirie
Westlake
Wheeler
Cardiologist
Anaesthetist
Dental Surgeon
Ophthalmologist
Dietitian
Mr
Mr
Mr
A
A
P
Paterson
Audiologist
Anaesthetist
Anaesthetist
Radiologist
Anaesthetist
Plastic Surgeon
Urologist
Physician
Orthopaedic
Surgeon
Cardiologist
Anaesthetist
Oral Surgeon
Physician
Orthopaedic
Surgeon
General Surgeon
Ophthalmologist
General Surgeon
General
Practitioner
Orthopaedic
Surgeon
Orthopaedic
Surgeon
Anaesthetist
Orthopaedic
Surgeon
Anaesthetist
Cardiologist
Neurologist
(Medico Legal
Only)
Anaesthetist
Gastroenterologist
Neurosurgeon
Radiologist
Anaesthetist
Anaesthetist
Oncologist
Radiologist
Paediatrician
Mr
Mr
Mr
D
A
D
Whinney
Wilde
Williams
Dr
Prof
Mr
A
J
R
Pickford
Pinkney
Poulter
Mr
Mr
Dr
N
KR
W
Wilson-Holt
Woodburn
Woodward
Dr
C
Powell
Anaesthetist
Physician
Orthopaedic
Surgeon
Anaesthetist
ENT Surgeon
ENT Surgeon
Orthopaedic
Surgeon
Ophthalmologist
Vascular Surgeon
Anaesthetist
Mohammed
Moore
Morris
Munro
Myers
Norton
Patwardhan
Peyser
Our total employed staff complement as of April 2013 is 185, made up of:
Physio & Occupational Therapists – 12
Nurses – 65
Porters – 3
Radiographers – 3
Admin staff – 40
HCAs – 26
Hotel services – 12
Catering – 15
TSSU – 4
Supplies – 2
Maintenance –3
Appendix 3 Ramsay Clinical Audit Programme
Duchy 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:
Duchy Hospital, Penventinnie Lane
Truro TR1 3UP
Telephone 01872 226100
or
http//www.duchyhospital.co.uk