Horton Treatment Centre
Quality Account
2013/14
Contents
Introduction Page
Welcome to Ramsay Health Care UK
Introduction to our Quality Account
PART 1 – STATEMENT ON QUALITY
1.1
Statement from the General Manager
1.2
Hospital accountability statement
PART 2
2.1
Priorities for Improvement
2.1.1 Review of clinical priorities 2013/14 (looking back)
2.1.2 Clinical Priorities for 2014/15 (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 2010/11 Quality Accounts
PART 3 – REVIEW OF QUALITY PERFORMANCE
3.1
The Core Quality Account indicators
3.2
Patient Safety
3.3
Clinical Effectiveness
3.4
Patient Experience
Appendix 1 – Services Covered by this Quality Account
Appendix 2 – Clinical Audits
Welcome to Ramsay Health Care UK
Horton NHS Treatment Centre is part of the Ramsay Health Care
Group
The Ramsay Health Care Group was established in 1964 and has grown to
become a global hospital group operating over 100 hospitals and day surgery
facilities across Australia, the United Kingdom, Indonesia and France. Within the
UK, Ramsay Health Care is one of the leading providers of independent hospital
services in England, with a network of 31 acute hospitals.
We are also the largest private provider of surgical and diagnostics services to
the NHS in the UK. Through a variety of national and local contracts we deliver
1,000s of NHS patient episodes of care each month working seamlessly with
other healthcare providers in the locality including GPs and Clinical
Commissioning Group.
“As Chief Executive of Ramsay Health Care UK, I am passionate about ensuring
that high quality patient care is our number one goal. This relies not only on
excellent medical and clinical leadership in our hospitals but also upon an
organisation wide commitment to drive year on year improvement in patient
satisfaction and clinical outcomes.
Delivering clinical excellence depends on everyone in the organisation. It is not
about reliance on one person or a small group of people to be responsible and
accountable for our performance. It is essential that we establish an
organisational culture that puts the patient at the centre of everything we do and
as a long standing and major provider of healthcare services across the world,
Ramsay has a very strong track record as a safe and responsible healthcare
provider and we are proud to share our results.
Across Ramsay we nurture the teamwork and professionalism on which
excellence in clinical practice depends. We value our people and with every year
we set our targets higher, working on every aspect of our service to bring a
continuing stream of improvements into our facilities and services.”
(Jill Watts, Chief Executive Officer of Ramsay Health Care UK)
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Introduction to our Quality Account
This Quality Account is Horton NHS Treatment Centre’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 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.
Our first Quality Account in 2010 was developed by our Corporate Office and
summarised and reviewed quality activities across every hospital and treatment
centre within the Ramsay Health Care UK. It was recognised that this didn’t
provide enough in depth information for the public and commissioners about the
quality of services within each individual hospital and how this relates to the local
community it serves. Therefore, each site within the Ramsay Group now
develops its own Quality Account, which includes some Group wide initiatives, but
also describes the many excellent local achievements and quality plans that we
would like to share.
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Part 1
1.1 Statement on quality from the General
Manager
Gill Faure General Manager
Horton NHS Treatment Centre
As General Manager at Horton NHS Treatment Centre I am committed to
delivering consistently high standards of care to all of our patients.
Our Quality Account has been developed with the involvement of our staff to
provide information about the quality of the service we provide. We have reported
on our performance across the past year detailing both our results and the
actions we have taken to improve the quality of the service. To demonstrate our
commitment to continuous improvement we have shared our priorities for the
coming year. The report explains our governance framework and how we work
within this to continually monitor and evaluate the quality of the services that we
deliver.
I am extremely proud but not complacent about the quality results achieved within
this reporting period. By placing the patient at the centre of everything we do we
have consistently delivered good patient experiences and quality outcomes. The
results have been accomplished through the hard work, commitment and focused
attitude of the team to continually improve quality and patient care.
Our governance framework is robust and our approach to risk management
focuses on doing everything within our power to reduce the likelihood and
consequence of an adverse event or outcome.
Last year we invested significant resources to strengthen further our governance
framework. We engaged our Consultants and staff at all levels through education,
training, continuous development and appraisal.
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Our framework incorporates a range of committees who meet on a regular basis
to review quality. The meetings are open, collaborative and action orientated. Our
Medical Advisory Committee (MAC) in which our Consultants are empowered to
work alongside the General Manager and Matron to positively influence quality is
held quarterly. Our Clinical Governance and Clinical Effectiveness meetings are
held quarterly and attended by clinical staff across the unit. Our Health & Safety
Committee is bi-monthly and attended by staff of all levels. Quality is a key
agenda item for our monthly Senior Management, Head of Department and Team
Meetings. Infection control, blood transfusion, resuscitation leads have input into
these committees and are supported centrally from Ramsay’s corporate clinical
team.
We have a comprehensive audit programme in place which measures our teams’
adherence to professional standards and legislative requirements. We complete
internal review of audit findings and implement corrective action plans where
improvement is required, subsequent review is undertaken to ensure timely
completion of actions.
In the event of a clinical incident or complaint a thorough root cause analysis is
completed to identify the cause and an action plan implemented to reduce the risk
of re-occurrence. Risk registers are proactively managed through the governance
framework. Local risks are recorded electronically on a central database which
allows us to identify trend and enables further review by Ramsay’s corporate
clinical team.
Within the last year we introduced lower and upper limb audit meetings where
Consultant Surgeons, Radiologists, Clinical Heads of Department and
Radiographers meet to review surgical outcomes for patients undergoing implant
surgery. In addition to performing an audit function the multi-disciplinary meetings
encourage peer review and sharing of expertise and best practice.
When inspected by the Care Quality Commission (CQC) in January 2014 our
governance framework was examined in detail and findings confirmed that we
had an effective system to regularly assess and monitor the quality of service that
patients received. Full details of the inspection report can be found on the CQC
website at http://www.cqc.org.uk/location/1-128732838
We share detailed quality information with our lead commissioner Oxfordshire
Clinical Commissioning Group (OCCG) through monthly reporting and discussion
at regular contract review meetings. We extend invitation to OCCG colleagues to
visit the Treatment Centre unannounced, informally or in a formal capacity to
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attend internal quality meetings. We have been grateful for the support and
feedback received and hope to continue to develop this relationship further.
In addition to engaging with our commissioners, we have worked hard to develop
stronger relationships with our Consultants, General Practitioners (GPs) and Tier
2 (Triage) Service Providers through a collaborative approach. We have been
provided with the opportunity to make recommendations on services that impact
on patients before they are referred into our service and have worked diligently to
improve patient choice and the quality of the entire patient pathway.
We actively seek feedback from our patients and service users. On the few
occasions where we get things wrong we are not defensive. We act promptly and
openly to ensure that areas of dissatisfaction are addressed. Lessons learned are
shared openly throughout our governance framework to Consultants,
Management and most importantly to the staff caring for our patients every day.
We measure and celebrate success with our team through the many positive
questionnaires and handwritten, personalised patient compliment letters we
consistently receive.
If you would like to contact me with feedback or queries please do not hesitate to
do so on gill.faure@ramsayhealth.co.uk or 01295 755000.
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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.
Gill Faure
General Manager
Horton NHS Treatment Centre
Ramsay Health Care UK
This report has been reviewed and approved by:
Medical Advisory Committee (MAC) Chair: Mr Bijan Shafighian
Clinical Governance Committee Chair: Mr Bijan Shafighian
Clinical Governance Committee Deputy Chair: Mr Dusan Repel
Ramsay Health Care UK Regional Director: Mr James Beech
Oxfordshire Clinical Commissioning Group
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Welcome to Horton NHS Treatment Centre
Horton NHS Treatment Centre in Banbury is a modern 40 bedded hospital. It was
purpose built in 2006 as a specialist Orthopaedic Treatment Centre and was
designed to provide an excellent standard of care for impatient and daycase
patients through modern facilities and the technical equipment that modern
medicine demands.
Ramsay Health Care is registered as a provider with the Care Quality
Commission (CQC) under the Health & Social Care Act 2008.
Horton NHS Treatment Centre is registered as a location for the following
regulated services:
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Treatment of disease, disorder or injury
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Surgical procedures
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Diagnostic and screening procedures
The Services we provide include:
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Outpatient Consultation and Pre-Operative Assessment within a modern
Outpatient Department of 9 Consulting Rooms.
Dedicated Radiology Department providing X-ray, Ultrasound, and MRI
scanning.
Mobile Dexa Scanning service for direct GP referral.
Surgical Operations undertaken in a modern theatre suite composed of 3
well equipped theatres all with laminar flow air change.
Inpatient and day care utilising 40 inpatient beds with en-suite facilities and
an ambulatory day -case unit.
Physiotherapy treatments delivered to both inpatients and outpatients from
a dedicated department equipped with a large in-house gymnasium.
Provision of meals, with a relaxing restaurant for visitors and staff.
Onsite decontamination services.
Outreach clinics at Bicester Health Centre, Windrush Medical Practice in
Witney and Masonic House Surgery in Buckingham.
We provide safe, convenient, effective and high quality treatment for adult and
adolescent patients (excluding children below the age of 16years) whether
privately insured, self-pay, or from the NHS.
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The majority of our patients choose the Horton NHS Treatment Centre for
Orthopaedic Surgery. We specialise in hip and knee replacement and revision,
sporting injuries, shoulder, hand and wrist and foot surgery.
In addition to Orthopaedic Surgery we offer the following specialties:
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General Surgery
Cosmetic Surgery
Pain Management
Oral Maxillofacial Surgery
Spinal Surgery
Dermatology
Clinical Psychology
Allergy Management
A high percentage of our patients come from the NHS sector where patients have
chosen to use our facility through ‘Choose and Book’. Our services help to ease
the pressures on NHS facilities within Oxfordshire, Northamptonshire,
Warwickshire, Buckinghamshire and surrounding counties.
We work closely with neighbouring county NHS Trusts to support Trusts to treat
patients within 18 weeks and achieve national referrals to treatment targets
(RTT). Within this reporting period we have worked in association with
Buckinghamshire NHS Trust, South Warwickshire NHS Foundation Trust and
Northampton General Hospital NHS Trust.
We have worked with Oxfordshire Clinical Commissioning Group (OCCG) and
General Practitioner practices to ensure patients have improved access to our
services by providing information, training and liaison.
The introduction of outreach clinics has been welcomed by OCCG, Associate
Commissioners, GPs and patients as this allows patients, where clinically
appropriate, to be treated closer to home.
In the last 12 months we have performed 2266 procedures. 98.5% of these
procedures were performed for NHS patients who choose to have their surgery
will us.
To support the delivery of excellent clinical care, all of our services are led by
Consultant Specialists, Consultant Anaesthetists and Consultant Radiologists.
We have a Resident Medical Officer who remains on site 24 hours a day, 7 days
per week.
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Horton NHS Treatment Centre Team:
We currently engage the following Clinical Specialists at the Horton Treatment
Centre:
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Consultant Orthopaedic Surgeons
Consultant General Surgeons
Consultant Pain Specialists
Consultant Cosmetic Surgeons
Consultant Oral Maxillofacial Surgeons
Consultant Spinal Surgeon
Consultant Anaesthetists
Consultant Radiologists
Clinical Psychologist
Consultant Dermatologist
The General Manager is supported by:
Senior Management Team:
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Matron
Operations Manager
Finance Manager
Sales & Marketing Manager
All departments have a manager / lead and dedicated teams to ensure that our
services run smoothly and efficiently.
Clinical Departments:
Outpatient Department
Managed by an experienced Senior Sister and supported by 3 Registered Nurses
and 2 Health Care Assistants.
Physiotherapy Department
Managed by an experienced Senior Physiotherapist and supported by a team of 5
qualified Physiotherapists.
Inpatient Ward & Cay- Case Unit
Managed by an experienced Ward Manager and supported by a Deputy Ward
Manager and a team of 11 Registered Nurses and 7 Health Care Assistants.
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Theatre Department
Managed by an experienced Theatre Manager and supported by a Deputy
Theatre Manager and a team of 8 Registered Theatre Nurses and Operating
Department Practitioners and 4 Health Care Assistants.
Non Clinical Teams comprise:
• 4 Decontamination Technicians
• 24 Administration Staff
• 4 Receptionists
• 6 House Housekeepers
• 3 Chefs and 1 Catering Assistant
• 1 Supplies Coordinator
• 1 Engineer
• 3 Porters
• 1 GP Liaison
Primary Care:
To ensure that our patients experience the smoothest of patient pathways we
invest a significant amount of time building on the strong relationships we have
with GPs working in Primary Care and providers of Tier 2 Triage Services. Our
GP Liaison makes regular visits to surgeries in the local area to engage with staff
and both provide information and respond to queries. We welcome feedback from
our colleagues in primary care as this allows us to respond to issues arising in a
timely fashion.
Due to our location in the northern tip of Oxfordshire, we represent a convenient
choice of location for patients from several counties, including Oxfordshire, South
Warwickshire, Buckinghamshire, West Northamptonshire, East Gloucestershire,
West Berkshire, and Milton Keynes.
We receive patient referrals from GPs in more than 200 practices which
represents decisions from over 1000 GPs.
We work extremely hard to provide GP surgeries and Triage service teams with
up to date information on the services offered at the Treatment Centre. Within the
last year we revised the information we supply to include more detailed quality
data, admission criteria and appointment waiting times, all of these initiatives
have been positively received.
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Our Consultant Surgeons proactively support the continued professional
development of GPs by presenting educational seminars or informal question &
answer sessions both on site at the Horton NHS Treatment Centre and within GP
practices. Topics are agreed with GPs and ensure an exchange of information
which supports the ongoing relationships and clinical practice.
In addition we have provided workshops for Medical Secretaries working within
primary care on topics including Osteoporosis and use of the Choose & Book
system.
To support Practices Managers we provided workshops on the new CQC
requirements for GP practices and delivered Basic Life Support (BLS) training to
practices.
Patient Participation Group
In October 2013 we held our first Patient Participation Group with the aim of
seeking feedback from patients on where improvements to our services can be
made. We recruited representatives through phone calls, cards placed around
the Treatment Centre and an advert on our website.
At the first meeting patients highlighted the importance of ensuring staff always
introduce themselves with their name and their role, and making sure patients
always understand what will be happening. Additional training has been provided
for staff to reinforce this message. We are continuing to seek additional patients
to join the group to broaden representation.
Community Engagement
Our aim is to engage more broadly with the general public to grow awareness of
their right to choose the hospital in which they are treated in accordance with the
NHS Constitution. During the year we have run a series of articles in the local
newspaper and produced leaflets for display in GP surgeries to provide the
general public with information about the Government’s ‘Choice Programme’.
We have worked in partnership with various local organisations to support them in
their work. Examples include an event in conjunction with the Oxfordshire branch
of the National Osteoporosis Society to support them in recruiting new members
in the Banbury area. A Consultant gave a talk at the local Rotary Club to highlight
new options available for those suffering from hand and wrist issues. In addition
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we have prepared a talk for local branches of the Women’s Institute which has
been approved by the Board of Trustees of the Oxfordshire Federation. We have
also attended events run by the local Chamber of Commerce and hosted a
breakfast meeting for the local business networking club.
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Part 2
2.1 Quality priorities for 2013/2014
Plan for 2013/14
On an annual cycle, Horton NHS Treatment Centre 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 hospital’s Senior Management Team taking into
account patient feedback, audit results, national guidance, and the
recommendations from various hospital committees which represent all
professional and management levels.
Most importantly, we believe our priorities must drive patient safety, clinical
effectiveness and improve the experience of all people visiting our hospital.
Priorities for improvement
2.1.1 A review of clinical priorities 2013/14
1.
2.
3.
4.
5.
Patient safety, experience and clinical effectiveness
E Rostering
Introduction of Student Nurses to Horton NHS Treatment Centre
PLACE (Patient Led Assessment of the Care Environment) Audit
Improving the provision of special diets
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1. Patient safety, experience and clinical effectiveness
The first of our priorities last year was around improving patient safety,
experience and clinical efficiency, specifically by delivering care that is excellent
and compassionate as outlined in the Chief Nursing Officer’s ‘Compassionate
Care Strategy’
To achieve this objective we considered it essential to attract and retain the right
staff to work within the Horton NHS Treatment Centre. With that principle in mind
recruitment and retention was a key focus area.
We reviewed and improved compliance to our recruitment process to ensure that
only the best candidates were recruited and retained. We evaluated newly
appointed staff throughout a 6 month probationary period and followed a robust
review and sign-off process before confirming permanent employment. We
retained staff that achieve the appropriate standards and as a result of which are
able to ensure that all staff are capable of delivering the very best level of care to
our patients. Within this reporting period we have both confirmed staff into the
posts and terminated a contract for an individual who was not suitable. We feel it
is very important that our patients and their families have complete confidence in
the staff within the hospital.
Over the last year we have focused the team on the importance of the whole
patient experience and as a result have improved the satisfaction and experience
of patients using our services. This was achieved through review of feedback
received from our patients in addition to consistent and regular access to learning
and training for staff, with the intention of extending staff skills across all sections
of the hospital. A specific example of this includes a registered nurse who
successfully completed a national course on Diabetes who subsequently
implemented new protocols to the hospital and driven up standards for diabetic
patients using our service as a consequence.
We will continue to gather many types of feedback so that the services we
provide can be regularly reviewed through the clinical governance framework and
committee meetings. Patient safety, experience and clinical effectiveness will
remain a priority on the agenda for the Treatment Centre to ensure continued
quality improvement.
We collect patient feedback through monthly and quarterly surveys and were
pleased to be able to demonstrate a significant improvement in the scores
achieved for overall satisfaction but also specifically when patients were asked to
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rate the quality of care they received. We improved from a score of 88.2% in the
first quarter of this reporting period increasing to 100%, 96.7% and 95.7% across
the subsequent 3 quarters.
2. E Rostering
E Rostering was introduced into the Treatment Centre to improve the utilisation of
staff by giving Managers clear visibility of staff contracted hours and department
man hour demand. The system allows Managers to ensure that rosters are fair,
consistent and fit for purpose with the appropriate skill mix to ensure safe, high
quality standards of care.
The strict deadline process for Management approval has resulted in improved
planning. It has also allowed for greater flexibility when managing periods of staff
sickness and sudden shortages. The system is now embedded and used on a
daily basis.
3. The Introduction of Student Nurses to Horton NHS Treatment Centre
Working in close association with Oxford Brookes University we introduced a
Student Nurse Placement at Horton NHS Treatment Centre.
Across this reporting period we assisted with the training of 30 student nurses.
This project proved to be a huge success in several ways not only for the student
nurses themselves but also for the permanent staff who mentored these
individuals on a one to one basis.
All the students were supernumerary which allowed them to observe the best
practise as well as being monitored with hands on care. Feedback from our
patients has been extremely positive as has the feedback from Oxford Brookes
University and the students themselves. We are delighted to continue our
relationship with the University to play a part in ensuring that the next generation
of nurses are fully equipped to provide the highest standards of compassionate
patient care.
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4. PLACE (Patient Led Assessment of the Care Environment) Audit
The purpose of this audit was to give patients a voice in assessing the quality of
healthcare. The Horton NHS Treatment Centre results can be viewed later in this
report. Generally it was an excellent experience for both staff and patient auditors
although some improvements were suggested and have been acted upon. The
audit will be repeated every year going forward.
5. Improving the provision of special diets.
This priority came about as a result of the feedback from the patient satisfaction
survey. When we investigated the issue we found the matter to be a
communication problem which resulted from how information was relayed to the
appropriate departments and personnel.
The solution identified was to introduce a standardised way of sharing the
relevant information with the necessary staff members. This was discussed and
implemented and the feedback in the last year has demonstrated an improvement
in this aspect of the patients’ experience. We continue to monitor this aspect of
care regularly.
We collect patient feedback through monthly and quarterly surveys and were
pleased to be able to demonstrate a significant improvement in the scores
achieved when patients were asked to rate the choice of food they received. We
improved from a score of 87.5% in the first quarter of this reporting period
increasing to 100%, 100% and 97.4% across the subsequent 3 quarters.
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2.1.2 Clinical Priorities for 2014/15
Clinical priorities for 2014/15 have been chosen to improve our performance
across the following domains:
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Patient Safety
Clinical Effectiveness
Patient Experience
Priorities include:
1.
2.
3.
4.
Dementia Care
Patient Reported Outcome Measures (PROMS)
Fluid Management in Patients
Clinical Supervision
1. Dementia Care
Horton NHS Treatment Centre is committed to improving dementia care by
improving the way we identify people with dementia, assess and investigate
symptoms and appropriately refer for support.
When a person finds that their mental abilities are declining, they and their
families often feel vulnerable and in need of reassurance and support. By training
our staff appropriately we will provide them with the understanding of the disease
and skills to identify dementia, offer appropriate support whilst in our care and
appropriately refer for specialised support.
To deliver against the Commissioning for Quality & Innovation (CQUIN) 2014/15
indicator we will extend the assessment of patients attending pre assessment
appointments. All patients over the age of 75 years will be asked if they have
experienced any memory gaps. Patients who meet the criteria will then be asked
to take part in a short cognitive test. This will allow us to alert the patient’s GP so
that appropriate diagnosis and treatment can be provided. We will monitor the
levels of referrals back to the patients’ GPs to ensure all patients receive
appropriate onward referral where required. We will report our performance to our
Commissioners (OCCG) through monthly reports and discussion at contract
meetings.
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2. Patient Reported Outcome Measures (PROMS)
Patient Reported Outcome Measures (PROMS) is a measure of the health gain in
patients undergoing hip and knee replacement, varicose vein and groin hernia
surgery. Patients are asked about their health and quality of life before they have
an operation and their health and the effectiveness of the operation afterwards.
At Horton NHS Treatment Centre we specialise in Orthopaedic surgery and we
have been participating in this initiative for all patients undergoing hip and knee
replacement procedures.
We have been successful in ensuring patients complete the questionnaire preoperatively but as you will see later in this account the number of post-operative
surveys completed in this period did not reach an adequate level to allow
accurate calculation of health gain in all patients. This in turn prevented us from
pairing up the pre and post-operative responses.
We have reviewed our internal processes and can see that our success with preoperative completion is due to the fact that our Nurses are able to explain the
importance and assist the patients with completion of the form during their preoperative assessment appointment. We believe the lower completion results from
our inability to assist the patient in the same way as these forms are posted from
an independent company to the patient 6 months after surgery.
To improve the post-operative survey response and in turn allow more accurate
health gain measurement, we will be improving our communication to patients to
stress the importance of completion prior to discharge from our care. In addition
we will send reminder messages in the form of a letter and follow up call to our
patients at the 6 month point. We are confident that by explaining how this
information when collected adequately can support positive patient outcomes and
provide us with valuable information to continually improve our service, that
patients will support us. We will report our performance through the Health and
Social Care Information Centre (UK) (HSCIC) database.
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3. Fluid Management in Patients
Clinical assessment of hydration and the importance of fluid balance record
keeping are paramount to patient care and recovery. At Horton NHS Treatment
Centre we are committed to improving our management of this area to ensure we
give patients the very best standards of care.
As part of our standard audit programme, we have been monitoring the standard
of the documentation completed by Nurses to manage our patients’ fluid balance.
On review of our audit findings we identified that we had opportunity for
improvement in this area. As a consequence we have reviewed and revised the
paperwork we use and reflected and changed our practise around this subject. In
January 2014 we provided training to support the introduction of the revised fluid
balance chart and change in practise. Over the next 6 months we will continue to
audit our practise and learn from that information in order to improve the safety
aspects for our patients. We will monitor our performance through our internal
audit programme and report to our Commissioners (OCCG) through monthly
reports and discussion at contract meetings.
4. Clinical Supervision
At Horton NHS Treatment Centre we support our staff through comprehensive
inductions, mandatory training programmes, professional development
opportunities and appraisal. In January 2014 we introduced a programme of
Clinical Supervision in the Workplace. This took the form of using reflective
practice and shared experiences as a part of continuing professional
development. It is an activity that brings skilled supervisors and practitioners
together in order to reflect upon their practice and in turn improve the service that
we provide for our patients.
The clinical team at Horton NHS Treatment Centre have appreciated the
opportunity this has provided to allow them to reflect on their experience and as a
result of this positive feedback we have agreed to formalise clinical supervision
and have introduced a local policy which has been developed to support the
corporate policy. We are identifying staff to lead the topic so that all clinical staff
can have access to a ‘supervisor’ to talk through their concerns. Formal training
will be implemented and we will record in personal files when the offer of
supervision is taken up by staff. We will monitor through feedback from the
supervisors, concentrating initially on the uptake by staff of the clinical
supervision. Our performance will be reported through quarterly internal reports.
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2. Mandatory Statements
The following section contains the mandatory statements common to all Quality
Accounts as required by the regulations set out by the Department of Health.
2.2.1 Review of Services
During 2013/14 Horton NHS Treatment Centre provided elective Orthopaedic
services for young persons from the age of 16 and adult patients.
The Horton NHS Treatment Centre has reviewed all the data available to them on
the quality of care in all of these NHS services.
The income generated by the NHS services reviewed in the period 1st April 2013
to 31st March 2014 represents 98.5% per cent of the total income generated from
the provision of NHS services by the Horton NHS Treatment Centre for 1st April
2013 to 31st March 2014.
Ramsay uses a balanced scorecard approach to give an overview of audit results
across the critical areas of patient care. The indicators on the Ramsay scorecard
are reviewed each year. The scorecard is reviewed each quarter by the
hospitals’ senior managers together with Regional and Corporate Senior
Managers and Directors. The balanced scorecard approach has been an
extremely successful tool in helping us benchmark against other hospitals and
identifying key areas for improvement.
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In the period for 2013/14, the indicators on the scorecard which affect patient
safety and quality were:
Human Resources
Staff Cost % Net Revenue
20.46%
HCA Hours as % of Total Nursing
29.0%
Agency Cost as % of Total Staff Cost
6.2%
Ward Hours PPD
5.2%
% Staff Turnover
9.1%
% Sickness
8.7%
% Lost Time
34%
Appraisal %
81%
Mandatory Training %
95%
Staff Satisfaction Score (out of 7)
4.7
Number of Significant Staff Injuries
0%
Patient
Formal Complaints
25 (0.86%)
Patient Satisfaction Score
‘Overall, how would you rate the
Care you received?’
74.4%
Number/Rate of Patient Readmissions
22 (0.76%)
Number/Rate of Patient Returns to Theatre
2 (0.07%)
Quality Accounts 2013/14
Page 23 of 52
Quality
The yearly audit programme uses a ‘traffic light’ score in that completed audits
scores receive green, amber or red compliance rating.
Summary of Audits Scores:
Hand Hygiene
Urinary catheter care Bundle CCB
SSI
Blood transfusion
Prescribing
Theatre
MRSA positive
Cleaning standards
Medicine management
Controlled drugs
Anaesthetic Standards
Green
100%
Cool
Amber
90 - 99%
Amber
80 - 89%
Hot
Amber
70 - 79%
Red
69% and under
100
97
96
100
99
100
0
98
100
100
100
%
%
%
%
%
%
%
%
%
%
Infection Control Audit Score
The rolling audit schedule (appendix 2) ensures all aspects of Infection prevention
and control are audited and reviewed for trends to identify where improvements
can be implemented. The Infection Prevention and Control committee meets bimonthly to discuss the outcomes of audits and agrees actions to be taken.
Results from the audits during this period are as follows:
Quality Accounts 2013/14
Page 24 of 52
Infection Control Environmental Audit
98-99%
Minor issues were identified around the disposal of waste. As a consequence and
to improve performance extended training for staff was implemented.
Hand Hygiene Audit score
99-100%
Scores are consistently high with non-compliance centring on the wearing of staff
jewellery which has been addressed.
2.2.2 Participation in clinical audit
During 1st April 2013 to 31st March 2014 the Horton NHS Treatment Centre
participated in 2 national clinical audits.
The national clinical audits and national confidential enquiries that Horton NHS
Treatment Centre participated in, and for which data collection was completed
during 1st April 2013 to 31st March 2014, are listed below alongside the number of
cases submitted to each audit or enquiry as a percentage of the number of
registered cases required by the terms of that audit or enquiry.
Name of audit / Clinical Outcome
Review Programme
% cases
submitted
National Joint Registry (NJR)
98%
Hips
60.1%
Elective surgery (National PROMs Programme) for Hips
and Knees
Knees
65.7%
Quality Accounts 2013/14
Page 25 of 52
The reports of the 2 national clinical audits from 1st April 2013 to 31st March 2014
were reviewed by the Clinical Governance Committee and Horton NHS
Treatment Centre intends to take the following actions to improve the quality of
healthcare provided:
National Joint Registry (NJR)
We have improved the NJR data collection and input by identifying those patients
eligible for NJR on the basis of their episode data on our patient administration
system.
This has resulted in a significant improvement and our current performance for
data input in 2014 is 100%
Patient Reported Outcome Measures (PROMS)
To improve the percentage of PROMS questionnaires being completed a member
of staff has been identified to take on the role of ‘champion’ for this task .She will
oversee the co-ordination of the questionnaires to patients and ensure they are
sent to the National PROMS team. In order to improve the post-operative
completion and pairing of the pre and post-operative questionnaires the Horton
NHS Treatment Centre will write to patients and call to remind them of the
forthcoming questionnaire and explain the importance of their feedback.
Quality Accounts 2013/14
Page 26 of 52
Local Audits
The reports of 70 local clinical audits from 1st April 2013 to 31st March 2014 were
reviewed by the Clinical Governance Committee and Horton NHS Treatment
Centre and action plans formulated to improve the quality of healthcare provided.
Examples are shown below.

External sharps audit demonstrated that further staff training was required.
Action: Daniels representative has been asked to attend the hospital to
deliver staff training in January.
Action completed

Environmental Audit demonstrated that several chairs had exposed foam
on the arms of chairs presenting an infection control risk.
Action: Planned refurbishment to be discussed at SMT (Senior
Management team meeting). Refurbishment approved. Action completed

The results of a wound dressing audit showed that some wound dressings
were better than others for comfort, flexibility and reliability.
Action: Patients undergoing major procedures will have the most
appropriate dressing to reduce wound dressing changes. Action completed

Blood transfusion audit showed that some patients were not receiving an
information leaflet post transfusion.
Action: Nursing staff required to document that they talked to the patient
about the post-operative transfusion, alternatives of the transfusion, and
that leaflets were given to patients.
Action completed

Nutrition and hydration audit identified lack of compliance.
Action: A new fluid balance (EWS) chart to be implemented with training
for all staff to be provided. Re-audit for compliance.
Action completed
2.2.3 Participation in Research
There were no patients recruited during 2013/14 to participate in research
approved by a research ethics committee.
Quality Accounts 2013/14
Page 27 of 52
2.2.4 Goals agreed with our Commissioners using the CQUIN
(Commissioning for Quality and Innovation) Framework
A proportion of Horton NHS Treatment Centre income in from 1st April 2013 to
31st March 2014 was conditional on achieving quality improvement and
innovation goals agreed with Horton NHS Treatment Centre 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.
Horton NHS Treatment Centre performance across this reporting period is
detailed below:
CQUINS 2013/14
Friends & Family Test responses rate
NHS Safety Thermometer completion
Dementia
VTE
Hip & Knee care Bundle
Antibiotic review
QTR 1
82%
100%
100%
99%
99%
95%
QTR 2
54%
100%
100%
100%
99%
96%
QTR 3
76%
100%
100%
100%
99%
96%
QTR 4
100%
100%
100%
100%
100%
100%
Total
78%
100%
100%
100%
99%
97%
Quality Accounts 2013/14
Page 28 of 52
2.2.5 Statements from the Care Quality Commission (CQC)
Horton NHS Treatment Centre is required to register with the Care Quality
Commission and its current registration status on 31st March 2014 is registered
without conditions.
The Care Quality Commission (CQC) attended Horton NHS Treatment Centre on
27th January 2014 to perform a routine unannounced inspection. The inspection
team comprised 3 clinical inspectors who visited all clinical departments where
they interviewed patients and staff, reviewed documentation and considered the
processes and systems in place within the Treatment Centre.
The Care Quality Commission found Horton NHS Treatment Centre to have met
the standards required in all areas inspected. The detailed report can be found on
the CQC website http://www.cqc.org.uk/location/1-128732838.
2.2.6 Data Quality
Horton NHS Treatment Centre has taken the following actions to improve data
quality.


Our Clinical Coder completed the Foundation Coding Qualification and a
Connecting for Health Orthopaedic Workshop to improve the quality of
data capture.
Weekly Data Quality reports are issued to highlight any errors or omissions
in the data. These are reviewed and actioned as required.
Quality Accounts 2013/14
Page 29 of 52



We complete regular audits of our medical records. We have identified
opportunities for improvement and have tasked our Consultants to improve
their documentation. Regular re-audit is being completed.
Monthly exception reports are monitored to ensure that there are no
omissions in the data we are submitting to our commissioners through
Secondary Uses Service (SUS).
Periodic internal audits of our clinical coding are completed to ensure
accuracy of the data submitted.
NHS Number and General Medical Practice Code Validity
Horton NHS Treatment Centre submitted records during 2013/14 to the
Secondary Uses Service (SUS) for inclusion in the Hospital Episode Statistics
(HES) which are included in the latest published data. The percentage of records
in the published data which included:
The patient’s valid NHS number:



99.97% for admitted patient care
99.96% for outpatient care
0% for accident and emergency care (not undertaken at our hospital)
The General Medical Practice Code:



100% for admitted patient care
100% for outpatient care
0% for accident and emergency care (not undertaken at our hospital)
Information Governance Toolkit attainment levels
Ramsay Group Information Governance Assessment Report score overall score
for 2013/14 was 83% and was graded ‘green’ (satisfactory).
Clinical coding error rate
Horton NHS Treatment Centre was not subject to the Payment by Results clinical
coding audit during 2013/14 by the Audit Commission.
Quality Accounts 2013/14
Page 30 of 52
2.2.7 Stakeholders views on 2013/14 Quality Account
Horton NHS Treatment Centre Quality Account – Statement from
Oxfordshire Clinical Commissioning Group (OCCG)
OCCG has reviewed the quality account produced by Horton NHS Treatment
Centre for 2013/14 and considers that the report contains accurate information.
OCCG attend contract review meetings with Horton Treatment Centre to formally
discuss quality and receive assurance with the clinical quality of the services
provided. Currently, we believe that the Horton Treatment Centre has good
engagement with other local providers of healthcare and this is something that we
will continue to monitor.
OCCG were pleased to see that clinical priorities set 12 months ago have been
achieved by Horton Treatment Centre. The clinical priorities set out by the Horton
Treatment Centre for 2014/15 are in areas that OCCG agree with and we look
forward to the updates that we will receive on a regular basis.
This quality account is also open and honest as evidenced by the fact that the
Horton Treatment Centre is candid about the fact that there was a Never Event
that occurred in January 2014. OCCG were satisfied with the investigation into
the Never Event and were assured that lessons have been learned. OCCG feel
that there has been a positive shift in culture and this is an encouraging step
forward.
OCCG were also pleased to note that the Horton Treatment Centre were
inspected by the CQC and successfully met all of the standards measured.
The report does have a few instances where OCCG feel that readers might
struggle to follow what is described unless they have a detailed understanding of
the NHS. OCCG notes that the Provider has taken steps to minimise these
instances and that the Provider is constrained in part by national guidance as to
content and layout. The account includes all the nationally mandated sections
and OCCG has reviewed the data presented in the Quality Account which is in
line with other data published.
Overall, OCCG believe that patients at the Horton NHS Treatment Centre receive
a good quality of care.
Quality Accounts 2013/14
Page 31 of 52
Part 3: Review of quality performance 2013/2014
Statements of quality delivery
Matron, Gina Taylor
Review of quality performance 1st April 2013 - 31st March 2014
Introduction
“This publication marks the fifth successive year since the first edition of Ramsay
Quality Accounts. Through each year, month on month, we analyse our
performance on many levels, we reflect on the valuable feedback we receive from
our patients about the outcomes of their treatment and also reflect on
professional opinion received from our doctors, our clinical staff, regulators and
commissioners. We listen where concerns or suggestions have been raised and,
in this account, we have set out our track record as well as our plan for more
improvements in the coming year. This is a discipline we vigorously support,
always driving this cycle of continuous improvement in our hospitals and
addressing public concern about standards in healthcare, be these about our
commitments to providing compassionate patient care, assurance about patient
privacy and dignity, hospital safety and good outcomes of treatment. We believe
in being open and honest where outcomes and experience fail to meet patient
expectation so we take action, learn, improve and implement the change and
deliver great care and optimum experience for our patients.”
(Jane Cameron, Director of Safety and Clinical Performance, Ramsay
Health Care UK)
Ramsay Clinical Governance Framework 2014
The aim of clinical governance is to ensure that Ramsay develop ways of working
which assure that the quality of patient care is central to the business of the
organisation.
The emphasis is on providing an environment and culture to support continuous
clinical quality improvement so that patients receive safe and effective care,
clinicians are enabled to provide that care and the organisation can satisfy itself
that we are doing the right things in the right way.
Quality Accounts 2013/14
Page 32 of 52
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
Quality Accounts 2013/14
Page 33 of 52
National Guidance
Ramsay also complies with the recommendations contained in technology
appraisals issued by the National Institute for Health and Clinical Excellence
(NICE) and Safety Alerts as issued by the NHS Commissioning Board Special
Health Authority.
Ramsay has systems in place for scrutinising all national clinical guidance and
selecting those that are applicable to our business and thereafter monitoring their
implementation.
3.1 The Core Quality Account indicators
Mortality
Mortality:
Period
2012/13
2013/14
Best
RKE
0.65
RKE
0.63
Worst
RXL
1.17
RBT
1.15
Average
Eng
1
Eng
1
Period
2012/13
2013/14
Horton
NVC25
0
NVC25
0
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; the admission criteria to the Treatment Centre has some
limitations as it performs elective surgery and for that reason all patients with
planned surgery are assessed for the risks associated with that procedure to
minimise those risks and agree with the patient the type of anaesthetic most
suitable for them.
PROMS - Hips
PROMS:
Period
Hips Apr12 - Mar13
Apr13 - Sep13
Best
NT209 24.68
NT318 25.44
Worst
RKE
17.21
RHQ
18.34
Average
Eng
21.32
Eng
21.61
Period
Apr12 - Mar13
Apr13 - Sep13
Horton
NVC25
23.447
NVC25
*
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; the PROMS hip questionnaire is a before and after
assessment of the health gain that patients show following surgery. Unfortunately
there are not enough ‘paired’ surveys on the HSCIC database to provide an
adjusted health gain score for this period.
Quality Accounts 2013/14
Page 34 of 52
PROMS – Knees
PROMS:
Period
Knees Apr12 - Mar13
Apr13 - Sep13
Best
NT219 20.37
RDE
20.09
Worst
RAP
12.46
RM1
14.32
Average
Eng
16.01
Eng
16.74
Period
Apr12 - Mar13
Apr13 - Sep13
Horton
NVC25
17.26
NVC25
*
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; the PROMs knee questionnaire is a before and after
assessment of the health gain that patients show following surgery. Unfortunately
there are not enough ‘paired’ surveys on the HSCIC database to provide an
adjusted health gain score for this period.
Readmissions
Readmissions:
Period
2010/11
2011/12
Best
RF4
0.0
RF4
0.0
Worst
RYR
15.8
RYR
15.8
Average
Eng
11.04
Eng
11.08
Period
2012/13
2013/14
Horton
NVC25
6.34
NVC25
2.72
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; a review of the discharge process was undertaken to reduce
unnecessary readmissions. One of the changes we made includes a letter to the
patient in the discharge pack outlining their opportunity to contribute to the
process and read all the information they receive.
Responsiveness to personal needs
Responsiveness
to personal
needs
Period
2011/12
2012/13
Best
RYR
73.3
RYR
75.9
Worst
RF4
67.4
RJ6
68.0
Average
Eng
75.6
Eng
76.5
Period
2012/13
2013/14
Horton
NVC25
91.4
NVC25
92.9
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; a robust pre assessment process where the patient can
discuss their individual needs, coupled with the correct staffing at ward level
contributes to the improving score.
Quality Accounts 2013/14
Page 35 of 52
VTE Assessment
VTE Assessment:
Period
13/14 Q3
13/14 Q4
Best
Several 100%
Several 100%
Worst
NT244 63.2%
NT205 67.0%
Average
Eng
95.8%
Eng
96.0%
Period
13/14 Q3
13/14 Q4
Horton
NVC25
99.6%
NVC25
100.0%
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; a robust patient assessment process coupled with the
cooperation of all our Surgeons has ensured we can aim and reach full
compliance thereby minimising the risk of VTE for patients.
C Difficile Rate
C. Diff rate:
per 100,000
bed days
Period
2012/13
2013/14
Best
Several
Several
0
0
Worst
RNA
58.2
RVW
30.8
Average
Eng
22.2
Eng
17.3
Period
2012/13
2013/14
Horton
NVC25
0.0
NVC25
0.0
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; the Treatment Centre performs elective surgery where
patients’ medical issues can be identified and assessed prior to admission
thereby minimising the risk of infected diseases coming into the hospital.
Incident Rate
Incident Rate:
Patient Safety
Period
2011/12
2012/13
Best
RP6
2.6
RRF
2.0
Worst
TAJ
84.4
RAT
85.6
Average
Eng
13.5
Eng
14.8
Period
2012/13
2013/14
Horton
NVC25
5.65
NVC25
4.67
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; the Treatment Centre’s senior management team ensure that
incidents are investigated and when lessons are learned from these events they
are shared with staff across the Treatment Centre so that we can prevent the
same type of incidents happening again.
Serious Untoward Incidents (SUIs)
SUIs:
(Severity 1 only)
Period
Jul - Sep 12
Oct11 - Sep12
Best
NA
NA
Worst
NA
NA
Average
NA
Eng
11,563
Period
2012/13
2013/14
Horton
NVC25
2.9%
NVC25
0.04%
Horton NHS Treatment Centre considers that this data is as described as the data
includes the ‘Never Event’ which is described later in this report.
Quality Accounts 2013/14
Page 36 of 52
Friends & Family Test
F&F Test:
Period
Jan-14
Feb-14
Best
Several 100
Several 100
Worst
RPA02
27
RPA02
18
Average
Eng
73
Eng
73
Period
2012/13
2013/14
Horton
NVC25
96
NVC25
99
Horton NHS Treatment Centre considers that this data is as described for the
following reasons; the patient response rate for the Friends and Family Test for
the Treatment Centre has been consistently high thereby giving us a very good
indication of their positive recommendation.
3.2 Patient safety
We are a progressive hospital and focused 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.
Our focus on patient safety has resulted in an overall improvement in a number of
key indicators as illustrated in the graphs below.
Significant Clinical Events per 1000 Admissions
Adverse Events per 1000 HPDs
9.00
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
0.00
2009/10
2010/11
2011/12
2012/13
2013/14
Quality Accounts 2013/14
Page 37 of 52
The Horton NHS Treatment Centre has seen a small reduction in the number of
incidents in this reporting period. Unfortunately the Treatment Centre had its first
‘Never Event’ which resulted in the wrong procedure being undertaken for a
patient. This incident was reported to the Care Quality Commission (CQC),
Oxfordshire Clinical Commissioning Group (OCCG) and NHS England. The
report was also shared with Ramsay corporate colleagues.
A ‘Never Event’ is a serious, largely preventable patient safety incident that
should not occur if the correct preventable measures have been implemented.
This ‘Never Event’ involved a patient who was admitted to The Horton NHS
Treatment Centre to undergo a ‘Release of Trigger Thumb’ procedure. The
patient actually received a different hand procedure known as a ‘Carpal Tunnel
Release’. The investigation found that prior to surgery ‘Carpal Tunnel Release’
had been discussed with the patient as a potential future surgical procedure.
During surgery the procedure that was performed was found to be clinically
indicated, it was not however the planned procedure nor had the patient been
consented; therefore it clearly should not have been performed on this occasion.
A full investigation was undertaken which resulted in a Root Cause Analysis
(RCA) and a series of recommendations were made. The report and
recommendations were reviewed and endorsed by Oxfordshire Clinical
Commissioning Group (OCCG).
The main findings following the full investigation were as follows:
The standard local anaesthetic checklist was in place and was completed fully
prior to commencing surgery. However, upon further review the design of the
checklist was considered to have areas of weakness.
Skin markings to the patient’s hand were made prior to surgery to identify the site
of surgery. On further review it was concluded that the markings were ambiguous
and contributed to the fact that the incorrect procedure was performed.
Horton NHS Treatment Centre made a series of recommendations which
have been fully implemented and reviewed to ensure embedded.


Full report and findings including recommendations shared with the
specific Consultant and team involved the wider hospital team and
Consultant Surgeons to ensure lessons learned.
Local policy for pre-operative limb marking reviewed and revised to ensure
standardisation.
Quality Accounts 2013/14
Page 38 of 52







Corporate local anaesthetic (LA) checklist removed and replaced with
general anaesthetic (GA) checklist until local anaesthetic checklist has
been revised and considered fit for purpose.
Corporate policy CN006 Surgical Safety Checklist re-issued to all
appropriate staff and Consultants.
Programme of audit implemented across all theatres to measure and
ensure compliance to corporate and local policies.
Instructions for patients undergoing procedures under local anaesthetic
(LA) reviewed and revised to ensure fasting details adequate.
Full report shared with Ramsay Health Care Medical Director to ensure
that the Surgeon involved discusses the incident at their next appraisal.
Reported in detail through standard clinical governance framework
including Clinical Audit Meeting, Clinical Governance Meeting and Medical
Advisory Committee Meeting (MAC).
Reported to Ramsay Corporate Clinical Team for shared learning across
all Ramsay hospitals.
We are confident that lessons have been learned from this incident and that our
processes are more robust as a result of the lessons learned. Patients using our
services and our Commissioners can have every confidence in the management
of our safety systems within the Treatment Centre.
Re-admission per 1000 Admissions
Re-admission %
0.90%
0.80%
0.70%
0.60%
0.50%
0.40%
0.30%
0.20%
0.10%
0.00%
2009/10
2010/11
2011/12
2012/13
2013/14
Quality Accounts 2013/14
Page 39 of 52
The Horton NHS Treatment Centre recorded an overall reduction in readmissions within the reporting period. Monitoring rates of re-admission to the
Treatment Centre is another valuable measure of clinical effectiveness that we
are pleased to be able to demonstrate. We have further analysed all readmissions to identify any trend that may need addressing. A variety of reasons
were found for readmissions however no trends were identified and the discharge
process was reviewed fully and was confirmed robust.
Returns to Theatre in the same episode of care
Returns to Theatre per 1000 HPDs
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
2009/10
2010/11
2011/12
2012/13
2013/14
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.
This graph shows an improving picture year on year for the Treatment Centre. It
demonstrates that despite all surgical procedures having risks associated with
them; the Treatment Centre has continued to improve performance against this
measure. Advances have been seen as a result of improved pre-assessment
process and management of care pathways to minimise post-operative
complications.
Quality Accounts 2013/14
Page 40 of 52
3.2.1 Infection prevention and control
Horton NHS Treatment Centre has a very low rate of hospital acquired infection
and has had no reported MRSA Bacteraemia in the past 3 years.
We comply with mandatory reporting of all Alert organisms including
MSSA/MRSA Bacteraemia and Clostridium Difficile infections with a programme
to reduce incidents year on year.
Ramsay participates in mandatory surveillance of surgical site infections for
orthopaedic joint surgery and these are also monitored.
Infection Prevention and Control management is very active within the Horton
NHS Treatment Centre with regular audits taking place. 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.
Programmes and activities within our hospital include:

We chair bi-monthly infection control meetings with links to Microbiologists
at Oxford University Hospital NHS Trust.

We have access to Lead Consultants at Oxford University Hospital NHS
Trust for advice and support in instances of infection.

We report on a monthly basis on all aspects of infection control to our
Clinical Committees and Heads of Department meetings.
Quality Accounts 2013/14
Page 41 of 52
Horton NHS Treatment Centre rate of Infection
% Infections by admission
0.40%
0.35%
0.30%
0.25%
0.20%
0.15%
0.10%
0.05%
0.00%
2009/10
2010/11
2011/12
2012/13
2013/14
The graph shows a slight increase in the % of patient infections whilst still being a
very low number of actual incidents of infection. Within the Treatment Centre a
local committee meet bi-monthly to review the quality of the infection prevention
and control. This is a proactive group with representation from all departments to
ensure that each part of the patient’s pathway is safeguarded against the risks of
infections. Hand washing is high on our agenda and in addition to regular staff
training we have replaced all the hand washing gel units across the Treatment
Centre with non-touch units to minimise the risk of cross infection. Another
practical way in which we monitor compliance with hand washing is to monitor the
volume of gel used which informs us of any dip in usage.
3.2.2 Cleanliness and hospital hygiene
Assessments of safe healthcare environments also include Patient-Led
Assessments of the Care Environment (PLACE)
PLACE assessments occur annually at Horton NHS Treatment Centre,
providing us with a patient’s eye view of the buildings, facilities and food we
offer, giving us a clear picture of how the people who use our hospital see it and
feel it can be improved.
The main purpose of a PLACE assessment is to get the patient view. In order to
do this the audit team is made up of 50% of people who have used our services
as patients and 50% staff members.
Quality Accounts 2013/14
Page 42 of 52
In 2013 Horton NHS Treatment Centre scored above average on cleanliness,
condition, appearance and maintenance measures. Privacy, dignity and wellbeing
was below average. A key factor influencing this result was that patients felt
access to computer networks should have been made available to them. This
feedback has been acted upon and all patients can access WI-FI.
For food and catering we scored below national average, and as a result we have
reviewed the menus, quality and timing of meals. More fresh seasonal products
are being used to produce a nutritious and balanced diet for patients during their
stay. All hot meals are prepared to order on site on a daily basis by our Chefs.
As a result of these changes we have seen our patient satisfaction scores relating
to the quality of food improving consistently over the last 9 months.
3.2.3 Safety in the workplace
Safety hazards in hospitals are diverse ranging from the risk of slip, trip or fall to
incidents around sharps and needles. As a result, ensuring our staff have high
awareness of safety has been a foundation for our overall risk management
programme and this awareness then naturally extends to safeguarding patient
safety. Our record in workplace safety as illustrated by Accidents per 1000
Admissions demonstrates the results of safety training and local safety initiatives.
Effective and ongoing communication of key safety messages is important in
healthcare. Multiple updates relating to drugs and equipment are received every
Quality Accounts 2013/14
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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. Corporate colleagues review
all safety issues that occur within the Treatment Centre.
Each department maintains a register of risks which are review at least yearly or
more often if incidents occur, for example we have moved the staff signing in
book at reception further along the counter as a staff member was hit by the door
opening from the other side.
Adverse Events per 1000 HPDs
3.3 Clinical effectiveness
Horton NHS Treatment Centre has a Clinical Governance team and committee
that meet regularly through the year to monitor quality and effectiveness of care.
Clinical incidents, patient and staff feedback are systematically reviewed to
determine any trend that requires further analysis or investigation. More
importantly, recommendations for action and improvement are presented to
hospital management and medical advisory committees to ensure results are
visible and tied into actions required by the organisation as a whole.
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3.3.1 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.
Returns to Theatre in the same episode of care
Returns to Theatre per 1000 HPDs
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
2009/10
2010/11
2011/12
2012/13
2013/14
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3.4 Patient experience
Formal Complaints per 1000 HPDs
Complaints % of Admissions
1.80%
1.60%
1.40%
1.20%
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
2009/10
2010/11
2011/12
2012/13
2013/14
In 2013/14 we saw a small increase in the % of complaints in this period however
this is a relatively small number per 1000 hospital patient days (HPD) coupled
with the rise in patient expectations. There has been significant reduction in the
later part of the year 2013 and in the period January to March 2014 and we feel
this may be due to the fact that issues arising in the previous early period have
now been resolved and our processes are more robust. We expect to see a
reduction overall for the next reporting period.
We are guided by the following regulations:
Regulation 19, Health and Social Care Act 2008
“The registered person must have an effective system in place for
identifying, receiving, handling and responding to complaints and
comments made by service users or persons acting on their behalf in
relation to the carrying on of the regulated activity”
“Information from complaints is used to identify non-compliance or any
Quality Accounts 2013/14
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risk of non-compliance with the regulations and to decide what will be
done to return to compliance”
The Independent Healthcare Advisory Service (IHAS) Code of Practice on
Handling Patients’ Complaints (2009)
The NHS complaints procedure (2009)
3.4 .1 Patient Satisfaction Surveys
Our patient satisfaction surveys are managed by a third party company called ‘Qa
Research’. This is to ensure our results are managed completely independently
of the hospital so we receive a true reflection of our patients’ views.
Every patient is asked for their consent to receive an electronic survey or phone
call following their discharge from the hospital. The results from the questions
asked are used to influence the way the hospital seeks to improve its services.
Any text comments made by patients on their survey are sent as ‘hot alerts’ to the
Hospital Manager within 48hrs of receiving them so that a response can be made
to the patient as soon as possible.
Patient Satisfaction Score
Patient Satisfaction
120.0%
100.0%
80.0%
60.0%
40.0%
20.0%
0.0%
2009/10
2010/11
2011/12
2012/13
2013/14
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It is encouraging to have evidence to demonstrate that the hard work and
continued focus of the staff of the Treatment Centre has resulted in a year on
year improvement in patient staisfaction.
We welcome feedback from patients regarding their experience of Horton NHS
Treatment Centre. We are grateful of the time our patients take to provide this
information which is invaluable as it informs service development. We act
promptly to address constructive comments and use positive feedback to reenforce good performance.
Positive feedback is relayed to the relevant staff to reinforce good practice and
behaviour. We display letters and thank you cards on notice boards within our
staff rooms, taking care to comply with data protection and Caldicott principles.
Our risk reporting system ‘Riskman’ has the capacity to record feedback
electronically against individual Consultants. This allows us to provide our
Consultants with a report relevant to their practise.
The management team ensure that positive feedback from patients is recognised
and any individuals mentioned are praised accordingly. We have also intorduced
a monthly ‘Customer Service Excellence’ award where we encourage both staff
and patients to nominate staff who they feel have gone ‘above and beyond’ in
demonstrating their commitment to each other and our patients. The Senior
Management Team review all nominations and select staff members to receive a
token of appreciation for that month.
There are occasions where we receive negative feedback or suggestions for
improvement. On every occasion we openly investigate by reviewing our
processes and talking to our team. We feed all comments back to the relevant
staff using direct feedback to ensure that we continually improve our service.
Patient experiences are collected by the various methods as detailed below.
Patient feedback is a standard agenda item on our Clinical Governance
Committee for discussion, trend analysis and further action where necessary.
Escalation and further reporting to Ramsay Corporate and Department of Health
(DOH) bodies occurs as required and according to Ramsay and DOH policy.
Feedback from patients is encouraged in the following ways:





Patient satisfaction survey
Friends & Family survey
‘We value your opinion’ leaflets
Verbal feedback to Ramsay staff – including Consultants, Matrons/General
Managers whilst visiting patients and Provider/CQC visit feedback.
Written feedback via letters/emails.
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GPs also have the mechanism to feedback to the Treatment Centre either directly
or via the Quality Team at the Oxfordshire Clinical Commissioning Group
(OCCG).
Respect & Dignity
100.0%
98.0%
96.0%
94.0%
92.0%
90.0%
88.0%
86.0%
84.0%
Horton
Ramsay Group
NHS Average
This graph provides an indication that the majority of patients feel that the staff
ensure that their dignity is respected. We place a great emphasis on this aspect
of care as it sets the foundation for all other aspects of care.
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Appendix 1
Services covered by this quality account
injury
Cosmetics
Services Provided
Cosmetics, Physiotherapy, Trauma clinics, Orthopaedic,
General surgery, Spinal surgery and Maxillofacial
Peoples Needs Met for:
Young persons 16 to 18yrs
All adults 18 yrs and over
surgery. Audiology, Allergy testing , Dermatology
Clinical Psychology , Pain management ,Choose
and Book ‘Outreach’ Orthopaedic Outpatient
Service
Surgical
Procedures
Orthopaedic, Cosmetic, General surgery, Spinal
surgery and Maxillofacial surgery, Urology,
Upper and Lower Gastrointestinal surgery.
Ambulatory, Day and Inpatient Surgery
Diagnostic
and
screening
MRI, Imaging services, Ultra sound Phlebotomy, Urinary
Screening and Specimen collection.
Young persons 16 to 18yrs and all adults
excluding:

Patients with blood disorders (haemophilia,
sickle cell, thalassaemia)

Patients on renal dialysis

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

BMI > 40
Young persons 16 to 18yrs
All adults 18 yrs and over
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Appendix 2 - Clinical Audit Programme 2013/14
Each arrow links to the audit to be completed in each month.
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Horton NHS Treatment Centre
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:
Treatment Centre phone number
01295 755000
Hospital website
WWW.hortontreatmentcentre.co.uk
www.ramsayhealth.co.uk
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