Rivers Hospital
Quality Accounts
2012/2013
Contents
Introduction Page
Welcome to Ramsay Health Care UK and Rivers Hospital
4 -6
Introduction to our Quality Account
6
PART 1 – STATEMENT ON QUALITY
1.1
Statement from the General Manager
7
1.2
Hospital accountability statement
8
PART 2
2.1
Priorities for Improvement
2.1.1 Review of clinical priorities 2012/13 (looking back)
9
2.1.2 Clinical Priorities for 2013/14 (looking forward)
9
2.2
10
Mandatory statements relating to the quality of NHS services provided
2.2.1 Review of Services
10
2.2.2 Participation in Clinical Audit
11
2.2.3 Participation in Research
12
2.2.4 Goals agreed with Commissioners
12
2.2.5 Statement from the Care Quality Commission
13
2.2.6 Statement on Data Quality
13
2.2.7 Stakeholders views on 2012/13 Quality Accounts
14
PART 3 – REVIEW OF QUALITY PERFORMANCE
15-16
3.1
Patient Safety
17
3.2
Clinical Effectiveness
18-20
3.3
Patient Experience
21
3.4
Case Study
22
Appendix 1 – Services Covered by this Quality Account
23
Appendix 2 – Clinical Audits
24
Quality Accounts 2012/13
Page 2 of 25
Welcome to Ramsay Health Care UK
Rivers 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, Clinical
Commissioning Groups 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)
Quality Accounts 2012/13
Page 3 of 25
Welcome to Rivers Hospital
The Rivers is a private hospital set in quiet landscaped grounds in Sawbridgeworth, Hertfordshire. It
is one of the largest hospitals within Ramsay Health Care UK. It opened in March 1992, and has
become popular with patients from the Hertfordshire and Essex region. It is easily accessible with
free car parking.
The Rivers has 59 in patient bedrooms; all have en-suite bathrooms to ensure patient comfort and
privacy. Additionally there is a dedicated day case suite with 9 bays, and a minor ops theatre. The
hospital has four operating theatres, which are well equipped with the latest surgical technology.
The Outpatient Department has 15 Consulting rooms and 3 private treatment rooms, with a modern
equipped physiotherapy department and gym, a well equipped imaging department with x-ray,
ultrasound, CT & MRI scanning facilities, Digital Mammography and DEXA scanning (Osteoporosis).
All 200 plus Consultants are subject to strict vetting procedures to ensure only those with the
appropriate experience and qualifications are granted Practising Privileges and hence can offer
treatment at Rivers Hospital.
The Staff at the Rivers are professional and friendly, and deliver high levels of customer service. In
2010 the hospital won the Harlow and District Business Awards for Customer Care and has also been
successful in achieving Top 10 places in the Healthcare 100 Best Employer Awards (IPSOS Mori) over
recent years.
We provide fast, convenient, effective and high quality treatment for patients of all ages (children
over the age of 3 years as inpatients), whether medically insured, self-pay, or NHS funded.
Patients may self refer for Vive Cosmetic Surgery consultation, and for Physiotherapy services.
The Rivers offers a range of elective surgical, non-surgical and outpatient treatments across the
following specialities: Allergy Clinic, Bariatrics, Breast /Reconstructive surgery, Cardiology (Cardio-thoracic Surgery at
Orwell Suite), Colo-rectal surgery, Cosmetic surgery, Dermatology, Diabetes/Endocrinology,
Diagnostic Services, Dietician, Ear, Nose and Throat, Endoscopy, Fertility services, Gastro-enterology,
General Medicine, General surgery, Gynaecology, Haematology, Health Screening, Laparoscopic
Surgery, Neurology, Neuro-Radiology, Oncology, Ophthalmology, Oral and Maxillo-Facial Surgery,
Orthopaedic Surgery, Paediatric Services, Pain Medicine, Pharmacy, Physiotherapy, Plastic Surgery,
Private GP & Practice Nurse service, Psychiatry, Psychotherapy, Rheumatology, Spinal Surgery ,
Urology including Brachytherapy, , Vascular, Weight loss Clinics (Bariatric surgery at Springfield
Hospital).
The Hospital attracts referrals from sister hospitals within Ramsay Eastern region as a specialized
centre for services such as Brachytherapy (Prostate Cancer), Chemotherapy
services (Cancer),
DEXA scanning (Osteoporosis), Phototherapy (Skin conditions), and on site CT scanning (Diagnostic
Imaging).
The Rivers acts as a satellite for other centres to offer services through a hub & spoke system. These
include Fertility services (Bridge Fertility Centre) and Cardio-thoracic surgery (Ramsay Orwell Suite).
Quality Accounts 2012/13
Page 4 of 25
Last Year the Rivers admitted a total of 12900.
An experienced Resident Medical Officer is on site 24 hours/day to provide high quality medical care
to patients under the direction of their Consultants.
Permanent hospital staff include Registered Nurses, Health Care Assistants, Operating Department
Practitioners, Physios, Pharmacists, Radiographers, administrative staff, caterers, housekeepers and
porters.
All clinical and support staff have the relevant training and skills to fulfil their roles and this is an
ongoing process. There is also a Rivers Hospital Staff Bank which provides extra support and
flexibility to the service where needed.
The Rivers Hospital has worked closely with local Primary Care Trusts in Hertfordshire and West
Essex, to support commissioning of healthcare services for the local NHS population. The hospital
also has close links with Princess Alexandra NHS Trust (Harlow) and East and North Herts NHS Trust
Hospitals (WGC and Stevenage), including histopathology services and emergency transfer provision.
The hospital looks forward to working with the new Clinical Commissioning Groups (CCG’s) and
other NHS bodies over the coming period.
The Rivers employs a GP liaison officer to ensure local GPs are well informed about the services
offered at the hospital.
The hospital also provides a programme of educational seminars for healthcare professionals
including specialist sessions and basic life support.
The Rivers is closely associated with the Helen Rollason Cancer Charity, which has a Holistic therapy
centre and offices within the hospital site.
The hospital supports local schools, charities and associations through sponsorship and fund raising
events throughout the year.
Introduction to our Quality Account
This Quality Account is the Rivers Hospital 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 patients’ 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.
Quality Accounts 2012/13
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Part 1
STATEMENT ON QUALITY
1.1 Statement on quality from the General Manager, Mr Andy Haysman, Rivers Hospital
Rivers Hospital has a tradition of working closely with consultants and patients to ensure the best
quality healthcare is consistently being delivered. Our hospital staff are fully trained in the latest
procedures and thus maintain all areas to the highest standards. Working within the Department of
Health guidelines we focus on patient safety and cleanliness to minimize infection. Any patient who
wants to satisfy themselves on the quality of the hospital and its Consultants can be reassured by
the Care Quality Commission (CQC) Audits undertaken by the Department of Health which support
the hospital’s excellent reputation. As General Manager of Rivers Hospital, I take great pride in the
service we offer our patients and relatives; this is only achieved through a cohesive team effort and
approach.
The Rivers Hospital Vision Statement is to be a leading provider of health care services by delivering
high quality outcomes for patients and ensuring long term profitability. This vision is reflected
throughout the Quality Report in that the hospital will constantly strive to improve the quality and
suitability of its services to patients by ensuring there are adequate core policies and skills, effective
feedback mechanisms on the quality and efficacy of its activities and processes in place to affect
improvement at all levels of the organisation.
In preparing this report, the hospital has taken into account the views of a wide range of
stakeholders in the hospital’s activities, including staff, consultants and the Ramsay organisation, but
most importantly the views of patients and their families which have been sought though
questionnaire survey, comment sheets and focus groups. Furthermore, you are invited to feedback
on this document by sending any comments in writing to me at the hospital
Quality Accounts 2012/13
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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.
Mr Andy Haysman
General Manager
Rivers Hospital
Ramsay Health Care UK
This report has been reviewed and approved by:
Mr David McKiernan, Consultant ENT Surgeon MBBS FRCS, MAC Chair
Medical Advisory Committee Chair
Signature…………………………………………………..
Date………………………..
Mr Richard Parsons, Regional Director East
Signature…………………………………………………..
Date………………………..
Siobhan Jordan, West Essex CCG Director of Nursing and Quality
Signature………………………………………………….
Date…………………………
Signature………………………………………………….
Date…………………………
Quality Accounts 2012/13
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Part 2
2.1
Quality priorities for 2013/2014
Plan for 2013/14
On an annual cycle Rivers 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 ongoing 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 2012/2013 (looking back)
Reflection on priorities 2012/2013
The Doctor’s Laboratory (TDL) opened a lab on site in March 2012 to serve Ramsay East
Region.
Blood Audit Release System (BARS) and Point of Care Testing (POCT) training were
introduced in March 2012, to ensure higher patient safety by the implementation of
electronic and networked systems. There has been on -going training and audit of these
systems throughout the year. Regular meetings have been held between TDL and the
Hospital to ensure smooth processes and early identification and action of any matters
arising.
Never Events – there were no “never events “during the year.
The Day Unit has continued to treat patients efficiently to high standards of care. We have
continued to monitor this through a variety of methods such as patient / consultant
feedback, returns to theatre and re-admission rates.
We have continued to monitor patient feedback. We have endeavoured to ensure patients
receive written information on discharge and this remains an ongoing objective.
Allocate, an electronic rostering system, has been introduced and teams are working
towards full implementation with the Head Office team.
Quality Accounts 2012/13
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2.1.2 Clinical Priorities for 2013/14 (looking forward)
Continue to maintain and improve standards of care and patient satisfaction levels.
Ensure robust systems in place to ensure full compliance with all training and development
activities including e-learning. Ensure staff support through mentorship is more structured
and evidenced.
To work further with Riskman, our new electronic incident and near-miss reporting system.
Improvements anticipated including clearer analysis of trends and more involvement at
department level in incidents / near miss handling.
To continue to make progress with Care of the Child competencies with our team caring for
paediatrics within the Hospital.
To further promote Safeguarding awareness through training and development – to raise its
profile and ensure all staff are fully aware of its importance and action to take if issues are
raised.
Pulse (Staff satisfaction) survey
A staff survey was untaken in March 2013 and the results are currently being compiled and analyzed.
Patient experience – informing patient choice
Patient satisfaction scores are very high with an overall satisfaction score (excellent, very good,
good) of 99.1% in Quarter 4 2012 and a recommendation score of 100%. Areas for improvement in
2013/14 are:
The provision of written information regarding proposed treatment and post discharge
Patients receiving copies of letters sent between Consultants and GPs
Ensuring patients/visitors are aware of staff always washing their hands or using alcohol gel
The waiting time from admission to procedure.
The Leadership Factor (TLF) working group which was formed in 2011/2012 has helped to increase
our rate from 76 responses in Q1 2011 to 107 in Q4 2012. In January 2013 TLF surveys were
discontinued and replaced by QA Research on-line and telephone surveys, and feedback from these
is now emerging. It is anticipated that as the months progress and participation increases, a clearer
picture of patient satisfaction across the Group and at individual sites will form.
Our patient Group has continued to meet successfully and other patient feedback methods (e.g. we
value your opinion leaflets) are also used to maintain and improve standards.
Quality Accounts 2012/13
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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 2012/13 the Rivers Hospital provided and/or subcontracted 35 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 hospitals senior managers and their teams, together with
regional and Corporate Managers. 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 2012/13, the indicators on the scorecard which affect patient safety and quality
were:
Human Resources
HCA Hours as % of Total Nursing
Agency Hours as % of Total Hours
% Staff Turnover
% Sickness
Total Lost Worked Days
Appraisal %
Mandatory Training %
Staff Satisfaction Score
Number of Significant Staff Injuries
Patient
Formal Complaints per 1000 HPD's
Patient Satisfaction Score
Number of Significant Clinical Events
Readmission per 1000 Admissions
Quality
Workplace Health & Safety Score
Infection Control Audit Score
Consultant Satisfaction Score
Quality Accounts 2012/13
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2.2.2
Participation in Clinical Audit
During 1 April 2012 to 31 March 2013, Rivers Hospital participated in all national clinical audits to
which it was invited and was eligible.
National Clinical Audits (NA = not applicable to the services provided)
Name of Audit
Participation
(NA, Yes, No)
%
cases
submitted
Long term conditions
N/A
N/A
Elective procedures
Hip, knee and ankle replacements (National Joint Registry)
Elective surgery (National PROMs Programme)
Yes
Yes
63%
65.9%
Clinical Outcome Review Programme
Medical & Surgical Programme National Confidential Enquiry into No Deaths
Patient Outcome & Death
Local Audit
There is a local audit system in place, based on a Group-wide template, covering areas such as
medical records, infection prevention and control, consent, controlled drugs and radiology. Further
audits include paediatric care and cosmetics. The local Clinical Governance Committee reviews audit
results and recommends/supports appropriate action.
Actions have been identified to improve Audit Scores where necessary. E.g. Consent score rose from
92% to 98% with a focus on the 2nd stage Consent process, whereby the Consent Form is signed by
the patient and a Health Care Professional for a 2nd time, to ensure there are not changes or
questions left unanswered. Some areas remained consistently high 96 - 100% e.g. surgical site
infection, hand hygiene.
2.2.3
Participation in Research
There were no applications during 2012/13 to participate in research approved by a research ethics
committee.
Quality Accounts 2012/13
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2.2.4 Goals agreed with our Commissioners using the CQUIN (Commissioning for Quality and
Innovation) Framework
A proportion of Rivers Hospital’s income in from 1 April 2012 to 31 March 2013 was conditional on
achieving quality improvement and innovation goals agreed between them 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.
Measures in 2012/2013 were:
Patient experience (see Section 2.1.2)
NHS Safety Thermometer (100% completion rate)
Pressure ulcer elimination (no pressure ulcers to report)
VTE (Venous Thrombo-embolism – clots) (see below)
VTE assessment
The graph above demonstrates that Rivers Hospital achieved an “excellent” rate of VTE assessment
(i.e. Identifying patients at risk of a thrombosis), at 97% with a target of 90%.
Going forward measures will include:
Dementia Screening
NHS Safety Thermometer
Alcohol screening
Quality Accounts 2012/13
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2.2.5 Statements from the Care Quality Commission (CQC)
Rivers Hospital is required to register with the Care Quality Commission and its current registration
status on 31st March is full registration without conditions.
The Care Quality Commission has not taken any enforcement action against
Rivers Hospital during 2012/2013.
In March 2013 Rivers Hospital was inspected by the CQC and was found to be fully compliant in all
areas inspected:
Consent to care and treatment
Supporting workers
Assessing and monitoring the quality of service provision
Safeguarding people who use services from abuse
Care and welfare of people who use services.
2.2.6 Data Quality
Data Quality Statements
NHS Number and General Medical Practice Code Validity
The Ramsay Group submitted records during 2012/2013 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; and
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; and
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/
Quality Accounts 2012/13
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Clinical coding error rate
Results of the Clinical Coding audit during 2012/2013:
Hospital Site
Rivers
Audit
Date
Jan 13
Re Audit
Date
Primary
Diagnosis
95.0%
Secondary
Diagnosis
94.04%
Primary
Procedure
100%
Secondary
Procedure
100%
2.2.7 Stakeholders views on 2012/13 Quality Account
A Draft copy of this document was sent to the Regional Director (Ramsay East), the Medical
Advisory Committee Chair (Rivers Hospital) and the Director of Nursing and Quality (West Essex
Clinical Commissioning Group). Their comments have been taken into consideration in the final
version of this Quality Account. The Statement of Endorsement from the Director of Nursing and
Quality (West Essex Clinical Commissioning Group) is below.
Quality Accounts 2012/13
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Part 3 REVIEW OF QUALITY PERFORMANCE 2012/2013
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 2012/2013
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
Quality Accounts 2012/13
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Ramsay Health Care Clinical Governance Framework
The diagram below demonstrates the key elements of the Clinical Governance Framework within
Ramsay Health Care. These areas are addressed within local teams, centrally and across both
through effective communication channels. For example, a Group Clinical Governance Committee
exists with representation from local and Head Office teams, including the Consultant body.
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 NHS
Commissioning Board Special Health Authority.
Ramsay has systems in place centrally for scrutinising all national clinical guidance and selecting
those that are applicable to our business and thereafter monitoring their implementation.
Quality Accounts 2012/13
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3.1 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. There have been no “Never Events” and no unexpected deaths during 20122013.
3.1.1 Infection Prevention and Control
Rivers Hospital has a very low rate of hospital acquired infection (0.04%) and has had no reported
MRSA Bacteraemia for at least 6 years.
We comply with mandatory reporting of all Alert organisms including MSSA/MRSA Bacteraemia and
Clostridium Difficile infections and have had none to report during the year.
Ramsay participates in mandatory surveillance of surgical site infections for orthopaedic joint
surgery and these are also monitored. No concerns have been raised during the year.
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. We have excellent links with the IPC
team at the local Trust and these assist us in all our IPC practices.
Programmes and activities within our hospital include:
Training (e.g. Handwashing awareness), audits, campaigns.
Surveillance of all infections including the participation in hip/knee studies with the Health
Protection Agency.
Close monitoring of any infections including causes, trends and actions.
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3.1.2 Cleanliness and Hospital Hygiene
Assessments of safe healthcare environments also include Patient Environment Assessment Team
(PEAT) audits.
These assessments include rating of privacy and dignity, food and food service, access issues such as
signage, bathroom / toilet environments and overall cleanliness. In 2012 the results for Rivers
Hospital were:
Environment – good
Food – good
Privacy and dignity – excellent
PEAT Audits are to be replaced nationally by Patient Led Assessment of the Care Environment
(PLACE) and the first inspection at Rivers Hospital will be held in May 2013.
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 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 1.1 Safety Incidents
per 1000 Admissions demonstrates the results of safety training and local safety initiatives. The
Ramsay Group figure is 1.7.
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.
3.2 Clinical Effectiveness
Rivers Hospital has a Clinical Governance Committee that meets 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. Incident and near-miss reporting is encouraged to ensure effective learning
in a no-blame culture. There were no “Never Events” during the year at Rivers Hospital.
In August 2012 an electronic reporting system, Riskman, was introduced in Ramsay Hospitals to
replace existing systems. This has been embedded and implemented. Going forward, it is anticipated
that reports generated will provide a robust method with which to gain an overview of incident and
near-miss types and trends.
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3.2.1 Return 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 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. During the period the rate of patients returning to Theatre at
Rivers Hospital was 0.14%.
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 with 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. However we
encourage patients to contact us with any queries or concerns post-discharge should they arise and
where appropriate ensure they are re-admitted in order for any issues to be resolved. At Rivers
Hospital during the year, the re-admission rate was 0.17%.
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 and
kept on their file. Positive comments are shared widely via the Head of Department team, in written
format for sharing, with the patient’s details anonymised. 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 shared with the relevant staff. All
staff are aware of our complaints procedures should our patients be unhappy with any aspect of
their care.
Patient experiences are fed back via the various methods below, and are regular agenda items on
Local Governance Committees and HODs meetings for discussion, trend analysis and further action
where necessary. Escalation and further reporting to Ramsay Corporate and Department of Health
(DH) bodies occurs as required and according to Ramsay and DH policy.
Quality Accounts 2012/13
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Feedback regarding the patient’s experience is encouraged in various ways via:








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.
Written feedback via letters/emails
Patient focus group
Patient Reported Outcome Measures (PROMs) surveys
Care pathways – patient are encouraged to read and participate in their plan of care
Staff appraisal system
3.3.1 Patient Satisfaction Surveys
In Q4 2012 97.8% of patients said that they would recommend Rivers to others. During 2012 / 2013
we have continued to focus on areas for improvement such as providing written information and the
visibility of hand hygiene measures.
In the forthcoming year we will also aim to increase the number of patient receiving copies of letters
from hospital doctors to GPs by liaising with consultants and medical secretaries.
Our patient satisfaction surveys have been managed by an independent company called ‘The
Leadership Factor‘(TLF). In January 2013 this role was allocated to QA Research and the process of
feedback collection has been reviewed accordingly.
Patient satisfaction scores for overall quality show the majority of patients feel they receive
excellent quality of care and service in Rivers Hospital. To record a satisfaction index over 90%, a
very high proportion of our patients have scored 9 or 10 out of 10 for their satisfaction with all the
requirements. This is underlined by comparing our hospitals Satisfaction Index against those
achieved by other organisations across all sectors of the UK economy where the full range of
customer satisfaction is 50% to 95% with the median just below 80%.
With an overall satisfaction score of 94.5%, Rivers Hospital has continued to be rated in the top 2-3%
of organisations in the UK.
3.3.2 Patient Reported Outcome Measures (PROMs)
Rivers Hospital participates in the Department of Health’s PROMs surveys for hip and knee surgery,
hernias and varicose veins for NHS patients. This is a survey to identify health and lifestyle benefits
gained by patients after their surgery. Outcomes are published openly and benchmarking can take
place with other facilities. For example, those published overleaf show results for England overall,
Rivers Hospital and the local Trust.
As a Group, Ramsay also conducts its own hip, knee and cataract PROMs surveys specifically for
private patients.
Quality Accounts 2012/13
Page 20 of 25
To access Rivers Hospital PROMs scores:
http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1295
Provider
England
RIVERS HOSPITAL
THE PRINCESS ALEXANDRA
HOSPITAL NHS TRUST
Hernia
Hip-HG
HipSD
KneeHG
KneeSD
-0.432
2.916
20.094
18.774
8.998
8.86
15.146
*
9.612
*
-0.946
18.945
9.838
15.268
10.102
Average health gain
EQ-5D VAS - casemix adjusted
Groin Hernia
4
3
2
1
0
-1
England
RIVERS HOSPITAL
-2
THE PRINCESS
ALEXANDRA HOSPITAL
NHS TRUST
Adjusted average health gain
Oxford Hip Score
35
30
25
20
15
10
5
0
England
RIVERS HOSPITAL
THE PRINCESS
ALEXANDRA HOSPITAL
NHS TRUST
Quality Accounts 2012/13
Page 21 of 25
3.4
Rivers Hospital Case Study
A report by the Pharmacy Manager on an approach to painkillers which enable a good
post-operative recovery by keeping pain to a minimum.
Peri-operative Multimodal Analgesia in Hip and Knee Replacement
Multimodal analgesia has been developed as a means to resolve issues encountered with traditional
pain management in hip and knee replacement which is associated with considerable post operative
pain, judged to be severe in 60% and moderate in 30% of patients. Good pain relief is important and
may affect outcome. A number of types of before, during and after operation analgesia have been
reported in the literature. Spinal analgesia is of proven benefit but may be associated with
headache, bladder problems, low blood pressure, respiratory depression, pulmonary hypertension,
heart problems as well as the risk of spinal infection. Morphine type pain relief which is patient
controlled (PCA) is useful but may be associated with nausea, vomiting, respiratory depression,
drowsiness, pruritus, reduced gut motility, urinary retention. Peri-operative local analgesia has
minimal systemic side effects and analgesia injected directly into joints is also proven to reduce post
operative pain relief requirements.
A multi-drug approach therefore has a number of advantages with synergistic pharmacological
activity. It is known that surgical trauma during knee replacement modifies the responsiveness of
the nervous system in two ways: - (a) peripheral sensitisation by reduction of the threshold of the
nerve pain receptors and also by increasing the excitability of spinal nerves. Together these
contribute to postoperative pain sensitivity; Peri-operative use of Morphine, Ketorolac,
Levobupivacaine and Adrenaline as a multi-drug “around the joint” injection reduces post operative
analgesia requirements and reduces pain on early mobilisation. Morphine is known to bind to
peripheral opiate receptors expressed (within hours) at the site of surgery, within inflamed tissues
and widely in the brain, spinal cord and digestive tract. Ketorolac, like all anti-inflammatory drugs,
inhibits the production of prostaglandins which are key mediators of peripheral nerve sensitisation.
Levobupivacaine, a local anaesthetic, has anaesthetic and analgesic effects and compared to an
earlier version, Bupivacaine, is associated with fewer side effects. Adrenaline, is used to constrict
blood vessels to slow local absorption and potentially reduce systemic toxicity by maintaining a
localised action.
There are a number of different multi-drug “mixtures” reported in the extensive published scientific
literature. A common thread indicates generally improved post operative pain control, with a
reduction in the use of conventional (morphine like) post operative pain relief. The reduction in use
of morphine type medicines leads to a reduction in post operative nausea, constipation and
therefore the need for anti-sickness and laxative medication. Improved pain control leads to earlier
and easier mobilisation and reduced length of hospital stay. This may in turn lead to a reduction in
the incidence blood clots as a complication of surgery.
David Houghton
Pharmacy Manager
Quality Accounts 2012/13
Page 22 of 25
Appendix 1
Services covered by this quality account
Regulated Activities – Rivers Hospital
Regulated Activities – Rivers Hospital
Treatment of
Disease,
Disorder
Or injury
Surgical
Procedures
Services Provided
Bariatrics, Breast care, Cardiology,
Clinical neuro physiology, Colorectal,
Continence care, Cosmetics,
Dermatology, Dietetics, Elderly care,
Endocrinology, Fertility,
Gastroenterology, General Medicine,
Haematology, Manual lymphatic
drainage, Medicine, Nephrology,
Neurology, Nurse led sclerotherapy,
Oncology, Ophthalmic, Orthoptics,
Orthopaedic, Out patient satellite
clinics, Paediatrics, Pain management,
Physiotherapy, Podiatry, Private GP
services, Prosthetics services,
Psychiatry (OPD only), Psychology,
Psychotherapy, Renal medicine,
Rheumatology, Sexual health, Speech
therapy, Sports medicine
Breast surgery, Brachytherapy,
Colorectal, Cosmetics inc laser, Day
and Inpatient Surgery, Dermatology,
Ear, Nose and Throat (ENT) inc laser,
Gastrointestinal, General surgery,
Gynaecology inc laser, Neurosurgery,
Ophthalmic inc laser, Oral
maxillofacial, Orthopaedic, Plastic
Surgery, Sentinel node biopsy,
Urological inc laser, Vascular
Peoples Needs Met for:
All adults 18 yrs and over
Children - 3 -12 yrs ambulatory and day surgery only. 12 yrs and above,
inpatients included.
Children 0-3 yrs, outpatients only.
All adults 18 yrs and over and children 3 yrs and above excluding:
Patients on renal dialysis
Patients with history of malignant hyperpyrexia
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
Patients with serious mental health illness
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
Termination of
Pregnancy
Allergy testing, Audiology, Aortic
aneurysm screening, CT (inc heart
scan), Dexa scanner, Echocardiology,
Endoscopy, GI physiology, Health
screening, Imaging services,
Mammography, MRI, Nerve conduction
and EMG, Neuroradiology, Nuchal
scans, Obstetric Ultrasound,
Pathology, PET and CT scanner,
Phlebotomy, Urinary Screening Aortic
aneurysm screening, and Specimen
collection, Urodynamics
Surgical Termination of
Pregnancy
Children - 3 yrs and above ambulatory and day surgery only. 12 yrs and
above, inpatients included.
All adults 18 yrs and over
All children 0-18 yrs, outpatients appointments only
All patients aged 16 yrs and over
Quality Accounts 2012/13
Page 23 of 25
Appendix 2 – Clinical Audit Programme
Each arrow links to the audit to be completed in each month. This Appendix demonstrates the topics and the frequency of the Ramsay Audit Programme.
Quality Accounts 2012/13
Page 24 of 25
Rivers 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 Andy Haysman using the
contact details below.
For further information please contact:
01279 600282
www.rivers-hospital.co.uk
Quality Accounts 2012/13
Page 25 of 25