Oaks Hospital
Quality Account
2013/14
Contents
Introduction Page
Welcome to Ramsay Health Care UK
Introduction to our Quality Account
PART 1 – STATEMENT ON QUALITY
1.1
Statement from the General Manager
1.2
Hospital accountability statement
PART 2
2.1
Priorities for Improvement
2.1.1 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
3.5
Case Study
Appendix 1 – Services Covered by this Quality Account
Appendix 2 – Clinical Audits
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Welcome to Ramsay Health Care UK
Oaks Hospital is part of the Ramsay Health Care Group
The Ramsay Health Care Group, was established in 1964 and has grown to become a global
hospital group operating over 100 hospitals and day surgery facilities across Australia, the
United Kingdom, Indonesia and France. Within the UK, Ramsay Health Care is one of the
leading providers of independent hospital services in England, with a network of 31 acute
hospitals.
We are also the largest private provider of surgical and diagnostics services to the NHS in the
UK. Through a variety of national and local contracts we deliver 1,000s of NHS patient episodes
of care each month working seamlessly with other healthcare providers in the locality including
GPs, Clinical Commissioning Group.
“As Chief Executive of Ramsay Health Care UK, I am passionate about ensuring that high
quality patient care is our number one goal. This relies not only on excellent medical and clinical
leadership in our hospitals but also upon an organisation wide commitment to drive year on year
improvement in patient satisfaction and clinical outcomes.
Delivering clinical excellence depends on everyone in the organisation. It is not about reliance
on one person or a small group of people to be responsible and accountable for our
performance. It is essential that we establish an organisational culture that puts the patient at
the centre of everything we do and as a long standing and major provider of healthcare services
across the world, Ramsay has a very strong track record as a safe and responsible healthcare
provider and we are proud to share our results.
Across Ramsay we nurture the teamwork and professionalism on which excellence in clinical
practice depends. We value our people and with every year we set our targets higher, working
on every aspect of our service to bring a continuing stream of improvements into our facilities
and services.”
(Jill Watts, Chief Executive Officer of Ramsay Health Care UK)
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Introduction to our Quality Account
This Quality Account is Oaks Hospital’s annual report to the public and other stakeholders about
the quality of the services we provide. It presents our achievements in terms of clinical
excellence, effectiveness, safety and patient experience and demonstrates that our managers,
clinicians and staff are all committed to providing continuous, evidence based, quality care to
those people we treat. It will also show that we regularly scrutinise every service we provide
with a view to improving it and ensuring that our patient’s treatment outcomes are the best they
can be. It will give a balanced view of what we are good at and what we need to improve on.
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
Douglas Watson, General Manager
Oaks Hospital
Ramsay Health Care UK is committed to establishing an organisational culture that puts the
patient at the centre of everything we do. As the General Manager, I am passionate about
ensuring that high quality patient care is our main focus and delivered to a high standard. This
relies not only on excellent medical and clinical leadership but also on our overall continuing
commitment to drive year on year improvement in clinical outcomes.
Oaks Hospital has a tradition of working closely with Consultants, Patients, external
stakeholders such as the local Clinical Commissioning Group (CCG), our region’s leading
commissioners, and General Practitioner (GP) surgeries to ensure the best quality healthcare is
consistently being delivered.
Our hospital staff are fully trained in the latest procedures and thus maintain the highest
standards in all areas. Working within the Department of Health (DOH) guidelines and the
National Institute for Clinical Effectiveness (NICE) guidelines we focus on patient safety and
cleanliness to minimise infection. Any patient who wants to satisfy themselves on the quality of
the hospital and its’ Consultants can be reassured by our Care Quality Commission’s (CQC)
report from 13th November 2013 which supports the hospital’s excellent reputation. As General
Manager of Oaks Hospital, I take great pride in the service we offer to our patients and relatives;
this is only achieved through a cohesive team effort and approach.
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Our Quality Account contains information for our patients and commissioners to assure we are
committed to sharing our progressive achievements from one year to the next. As a long
standing and major provider for healthcare services across the world, Ramsay has a very strong
record as a safe and responsible healthcare provider and we are proud to share our results. Our
vision is to ensure patients receive safe and effective care, feel valued and respected in
decisions about their care. We ensure they are fully informed about their treatment at each step
of their pathway from admission through to discharge. We especially value patient’s feedback
about their stay, treatment and clinical outcome.
Patient safety is our highest priority and we provide trained staff to deliver the service in a safe
environment. We ensure that our staff are competent through training programmes and a
robust recruitment process. We believe it is essential to have the right person in the right role at
the right time to deliver safe and effective treatment and care. Staff undergo competency based
assessments in practice and are trained on all the equipment they are required to use.
The development of this Quality Account was determined by the Executive Management Team
within Ramsay Health Care UK.
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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.
Douglas Watson
General Manager
Oaks Hospital
Ramsay Health Care UK
This report has been reviewed and approved by:
Mr Donald Menzies, Consultant General and Laparoscopic Surgeon
Medical Advisory Committee Chair
Signature
Mr Gerald Rix, Consultant Urologist
Clinical Governance Committee Chair
Signature
Mr Richard Parsons, Regional Director
Signature
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Pam Green, Head of Contracting
North East Essex Clinical Commissioning Group
Signature
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Welcome to Oaks Hospital
Oaks Hospital is part of the Ramsay Health Care Group and is the only private hospital in the
local area. The hospital opened in 1994 and is well equipped with the latest medical facilities
for diagnosis and treatment. Oaks Hospital is situated on the outskirts of Colchester. The
hospital is easily accessible via car and public transport. There is ample free parking which has
been recently expanded to accommodate our growing business.
Oaks Hospital offers a comprehensive range of specialist surgical and medical procedures.
Consideration for our patients is at the heart of everything we do. We are constantly seeking
new ways of working and bringing in fresh clinical practices that will improve outcomes for our
patients. Our approach to service delivery, which currently includes working in partnership with
the NHS under the Governments’ Patient Choice Programme, is courteous and professional
and we take great pride in our ability to be innovative. Patient education and information leaflets
are given as appropriate. We pride ourselves on the delivery of high quality safe effective care
in a manner and environment that respects and protects the privacy and dignity of our patients
both self funding or referred by the NHS.
The hospital is strictly regulated and audited by the Care Quality Commission (the government
body responsible for maintaining standards). The latest inspection report of the hospital can be
viewed at www.cqc.org.uk
The hospital is registered with the Care Quality Commission for 57 beds offering both Inpatient
and Day patient accommodation, with en-suite facilities, TV, radio and telephone to ensure
complete privacy and comfort. Meals are served within the patients bedrooms with a daily
selection available from a pre advised menu. Three of our rooms are twin en-suite rooms which
offer ideal accommodation and peace of mind for parents accompanying paediatric patients or
co-dependent relatives. We have a highly skilled nursing team and patients with additional care
requirements can be provided with Level 2 care within our two High Dependency Rooms which
enable closer monitoring of patients who may require it during their stay. Our experienced
teams are available to ensure all patients are assessed and receive a high standard of
individualised care. We have a designated 11 bay Ambulatory ‘Day Care’ Unit which was built
to meet the growing need of day care facilities.
Oaks Hospital has a suite of four theatres including a theatre for minor procedures and
Endoscopy and three of the theatres have laminar flow ventilation.
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The Outpatients department consists of 11 consulting rooms, one designated ENT suite and
two ophthalmic suites. We have two fully equipped treatment rooms, where we undertake
mainly dermatology, plastics, ophthalmic, hand and wrist, urology and general surgery local
anaesthetic procedures.
The department sees on average 4000 patients a month covering approximately 25 specialities.
We provide fast, convenient, effective and high quality treatment for patients (excluding children
below the age of three years), whether medically insured, self-pay, or NHS.
All patients must be admitted under the care of a Consultant. Only consultants and specialists
treat our patients. All Consultants undergo rigorous vetting procedures, ensuring only those who
are qualified and experienced are granted practicing privileges which are reviewed on a regular
basis.
Specialties at the hospital include orthopaedic surgery, ophthalmology, endoscopy, urology,
spinal, pain management, dermatology, ENT, dental, general, vascular, gynaecology,
cardiology, podiatry, oncology, breast and laparoscopic surgery. Cosmetic surgery is also
available for a wide range of procedures. Patients may self refer for Cosmetic Surgery
consultation, and for Physiotherapy services.
The Radiology Department provides diagnostic services such as x-ray, ultrasound, barium
examinations and various interventional procedures. The department also provides state of the
art 3D imaging through the use of mobile Magnetic Resonance Imaging (MRI) and access to
160 slice Computed Tomography (CT) scanning which can perform Virtual Colonoscopy
examinations.
Services can be delivered within an outpatient, inpatient and Day Care setting. Our Ward
Manager ensures that the appropriate skills and care levels are available within the department.
Patients are cared for by our friendly and highly trained team of nurses with the teams led by
our Sisters and Senior Staff nurses supported by our team of healthcare assistants. In addition
we have Nurse Specialists for Oncology, Chemotherapy, Plastic surgery and Breast Care.
An experienced Resident Medical Officer is on site 24 hours/day to provide high quality medical
care and support to patients under the direction of their Consultants.
For other registered services that are available at Oaks Hospital please see Appendix 1
Statement of Purpose.
During the year from 1st April 2013 to 31st March 2014 we have treated a total number of 7,620
patients, 37% of these were Private patients and 63% were NHS patients.
The nursing staff to patient ratio is 1: to between 1, 5 and 8 depending on patient acuity and
patient dependency. There is an experienced Resident Medical Officer on site 24 hours a day.
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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 an Oaks hospital Staff Bank which provides extra support and
flexibility to the service where needed.
Oaks hospital has developed a close association with Anglia Ruskin University and actively
supports student nurse training through the provision of appropriately trained mentors. We
have developed a strong working relationship with The Princes Trust by offering work
experience placements to young people as part of their 'Get into Health' Programme.
Oaks works closely with Health Education East of England to provide pre-professional
workforce training including Level 2 Apprentice in Health and Social Care as well as FdSc
Training for existing HCA's to become Assistant Practitioners.
Our staffing contract establishment includes:
Consultants
121
Non Consultants
24
Registered Nurses
71
HCAs
27
Support Staff
31
Admin Staff
63
Physiotherapists
26
Radiographers
9
ODPs
16
Management Personnel (SMT)
3
Total 250 staff
We also have services provided by The Doctors Laboratory (TDL) based at our sister hospital,
The Rivers at Sawbridgeworth for certain pathology. The Rivers also provide Oaks Hospital
with chemotherapy drugs which are administered to our private oncology patients.
We work closely with our local Clinical Commissioning Group to provide a range of services
under the standard acute contract via the choose and book electronic referral system and via
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paper referral pathway. We offer direct referral services for private/self pay/insured patients. All
patients requiring NHS services are referred via their GP directly to the hospital or via a clinical
assessment service (CAS/CRS).
We work closely with our local NHS Trust, Colchester Hospital University Foundation Trust
(CHUFT) where we have local agreements in place for provision of services which include
Pharmacy, Blood Transfusion, Histopathology and level 2-3 Critical care and emergency
transfer provision.
Oaks Hospital’s GP Liaison Officer continues to be committed to forging links and building and
maintaining relationships with GP Surgeries in the local catchment area and some out of area
surgeries.
Oaks Hospital has continued to support the Essex Air Ambulance and St Helena Hospice as
their chosen charities of the year. We have a Book Swap open to staff and visitors to bring in
their books for exchange and to make a donation to the Essex Air Ambulance, and we backed
their Go Yellow Week campaign by selling yellow ribbons to wear in support of the fund-raising
week.
St Helena Hospice organise an annual mascot race at Colchester United Football Club to raise
money for the Colchester-based charity, and Edna the Oaks Hospital’s mascot kangaroo
competed again this year with other local mascots to complete one lap of the pitch during halftime of the Colchester vs. Preston North End match and Oaks’ ‘Edna’ won the race! The entry
fee for the race contributed to the total amount raised, along with bucket collections made at the
match.
We also actively get involved in supporting the local CHAPS men’s health charity, attending
their men’s health day for a third year running in March 2014, where Oaks staff offered blood
pressure checks and AAA screening.
Oaks have also sponsored the jockeys at the Point to Point racing over the Easter weekend.
Oaks will be holding a stand at the Tendring show this July raising awareness about the Oaks
and services we can offer.
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Part 2
2.1 Quality priorities for 2013/2014
Plan for 2013/14
On an annual cycle, Oaks hospital develops an operational plan to set objectives for the year
ahead.
We have a clear commitment to our private patients as well as working in partnership with the
NHS ensuring that those services commissioned to us, result in safe, quality treatment for all
NHS patients whilst they are in our care. We constantly strive to improve clinical safety and
standards by a systematic process of governance including audit and feedback from all those
experiencing our services.
To meet these aims, we have various initiatives on going at any one time. The priorities are
determined by the hospitals Senior Management Team taking into account patient feedback,
audit results, national guidance, and the recommendations from various hospital committees
which represent all professional and management levels.
Most importantly, we believe our priorities must drive patient safety, clinical effectiveness and
improve the experience of all people visiting our hospital.
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Priorities for improvement
2.1.1 A review of clinical priorities 2013/14 (looking back)
Patient Safety
‘Never Events’ are serious, largely preventable patient safety incidents that should not occur if
the available preventative measures have been implemented.
For further details see:http://www.nrls.npsa.nhs.uk/resources/collections/never-events/
Oaks Hospital has a vigorous system of reporting clinical incidents and taking appropriate
actions to ensure that patient safety is paramount. During this reporting year there were no
never events to report.
VTE risk assessment.
In September 2008, the Department of Health issued its guidance on Risk Assessment for
Venous Thromboembolism (DH 2008). The objective is to improve the quality of patient care by
minimising the risk of VTE incidents. For this reporting year we had one reported incidence of
Venous Thromboembolism at Oaks Hospital. A thorough Root Cause Analysis investigation
was undertaken. We continue to abide by policy based upon NICE guidance and ensure all
patients are risk assessed and have appropriate prophylaxis.
Infection Control
Oaks Hospital continue to carry out regular infection control audits throughout the reporting year
and reported to the local CCG if any scores were below 95% with relevant robust action plans
put in place. Additional audits undertaken were Antibiotic Prevalence Survey on 3rd December
2013 and Urinary Catheter Prevalence Audit on 22nd November 2013. Our audit scores
improve year on year. We have quarterly local infection control committee meetings where
action plans are discussed.
Riskman
This software tool for reporting clinical and safety incidents, complaints and compliments was
fully implemented in 2012 – update on Riskman training has been delivered to ensure staff are
fully utilising the system to maximum effect. It has proved an effective tool to capture and
analyse all risks across the hospital and is reviewed by our Head Office. The reports entered
are reviewed at Oaks Clinical Governance Committee and reported to the Medical Advisory
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Committee. The system enables us to look back at events, ensuring lessons have been learnt
and for mechanisms to be put into place for staff and patient safety.
Additional modules were added to assist the human resource function with Wellbeing checks
and referrals.
Training
All of our staff continue to complete competencies and training relevant to their roles. We have
a corporate hospital training matrix for mandatory training and a hospital training tracker where
all staff’s training is recorded. We continue to monitor training yearly via the professional
development reviews and identify learning opportunities and re evaluate the competencies.
There has been a clean-up of the mandatory e learning system early in 2014 which now gives a
more accurate compliancy score for each member of staff. Overall compliancy reports are
monitored by heads of departments on a monthly basis and appropriate action is taken
regarding staff’s non compliance.
Clinical Effectiveness
Allocate Rostering System
The allocate rostering system is an electronic tool widely used in healthcare which has been
implemented and embedded into the hospital. Allocate provides an effective rostering tool to
assist managers to ensure they have appropriate staff on duty throughout the day for the levels
of activity.
Releasing time to care (Formally known as Productive Ward)
The Productive Ward (PW) Project is an NHS Initiative developed by the Institute for Innovation
and Improvement (2008). It focuses on the way ward teams work together and organise
themselves, in order to reduce the burden of unnecessary activities, and releasing more time to
care for patients in a reliable and safe manner within existing resources. The approach is very
much ‘bottom up’ with all ward staff suggesting ideas and ways in which they could improve
their environment and processes. Oaks Hospital staff continue to implement new ways of
working which enable Clinical staff to spend more time delivering patient care.
The productive ward continues to be an ongoing review of the foundation modules and
additional modules that have already been completed over the previous years. This is so that
standards are maintained and more time is released to care for patients efficiently. We revisited
elements of the Patient Observations module looking at our early warning scoring systems and
training staff on our revised policy and charts. We aim to focus this year’s module onto the shift
handover process and the discharge process.
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Barcoding and Stock Control
One of the key performance improvement targets for Ramsay Health Care UK continues to be
the significant reduction in the level of stock held within our units. There are only two points in
the year, when a full stock count process is undertaken, when we have the details of our overall
stock holding across sites. Unfortunately, as the stock count exercise is performed manually as
well as counting barcoded items, this task is time consuming, the level of accuracy
questionable, and requires involvement by clinical staff.
The introduction of a new stock control business process across the region has enabled us to
better manage our purchasing processes and give us the means in which to manage stock
levels across all sites, thus the potential of releasing cash back into the business. The use of
Bar-Coding technology has the potential to deliver this ability to us. This is being monitored both
locally and centrally within Ramsay.
Chemotherapy Services for private patients
We have developed a hub and spoke chemotherapy service with Springfield Hospital, our sister
hospital in Chelmsford. We employed a chemotherapy trained nurse to support the consultants
and nursing team at Oaks Hospital in identifying areas of service development within this
speciality in order to offer and deliver expert high quality care to our patients.
Tissue Viability
Our Oaks Hospital Outpatients Manager is on the Ramsay working party for tissue
viability/wound management. This group has updated the Wound Management policy and this
has now been implemented as of April 2014 in line with national guidance to provide the best
possible service to our patients.
Improved patient information
We will continue to focus on improving patient information by reviewing regularly our patient
satisfaction survey results via the friends and family survey and web based survey as previously
mentioned and efficiently and effectively acting upon any areas of improvement by involving
patient representatives and staff.
Our most recent online patient satisfaction survey for quarter 1, 2014 showed an overall
satisfaction score of 94.6% compared to quarter 4, 2013 93.1% There are always areas for
improvement regarding patient information and patient satisfaction.
The Patient information for consent ‘EIDO’ leaflets are completely reissued on an annual basis
following review and discharge leaflets are reviewed regularly via the Ramsay Clinical Practice
Development Committee.
Oaks Hospital was awarded the Private Healthcare UK Patients’ Choice 2013 Award. In 2013,
only eight hospitals and clinics qualified for this title so Ramsay is delighted that half of the
hospitals were Ramsay sites. The Patients’ Choice Awards recognise those hospitals that
deliver excellent customer care and a great patient experience.
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Paediatrics
Very few independent Hospitals offer a broad range of Paediatric services because they are
unable to comply with the strict regulations and recruit the necessary specialist staff. Here at the
Oaks we provide a high standard of care for children age 3 to 16 and young people up to the
age of 19 years within Children's services and with investment this will enable us to continue to
provide the best possible paediatric care within the community/local area. We have dedicated
paediatric nurses who are working to further establish our growing paediatric service who
undertake paediatric pre-operative assessment/meet and greet service. Our paediatric nurses
are always contactable via an on call system to give advice and answer any queries. Oaks
Hospital work as a family centred care unit, whereby children, parents and carers are
encourages to participate in decisions about their care.
Our aim is to reduce the anxiety of hospitalisation for all children and to continue to improve
Children's services.
New Services
The Oaks Hospital continually looked at new services and ventures that could be developed to
enhance the patient’s journey. We have numerous new services that are in the early stages of
development such as G.I physiology and urodynamics. We are also reviewing our
chemotherapy and HDU facilities.
Oaks Hospital completed its extensive refurbishment of the reception facilities; including a
premium care lounge, clear signage and designated waiting areas which enabled a more
streamlined admission process for both NHS and private patients. We are currently undergoing
a refurbishment of eight of the patient rooms on the ward as designated premium care rooms.
Patient Experience – informing patient choice
Friends and Family
In May 2012 David Cameron announced the introduction of the ‘Friends and Family’ test which
has the intention to identify the best and worst performing Hospitals across England. The
mandatory completion and submission of this test begins on the 1st April 2013 and all Ramsay
sites delivering inpatient care for NHS patients will be required to action this test. In addition
Ramsay have decided to extend this question to all Insured and Self Pay patients receiving
Inpatient and Daycase admissions. The Oaks started this as of April 1st 2013. We are now
expanding this survey to include the outpatient setting for private and NHS patients and to both
daycase private and NHS patients.
Web based Patient Satisfaction Survey
A decision was made to move from paper (TLF survey) to a web based survey in Spring 2012
following a procurement exercise whereby companies were short listed and asked to
demonstrate proposals.
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‘Qa Research’ were chosen as the new company to manage Ramsay Patient Satisfaction web
survey. A ‘Hot alerts’ system was established to feedback complaints, commendations and
comments promptly to hospital Matrons and General Managers. The data is analysed and
reported back monthly and quarterly, by hospital /region and Ramsay Group.
Public Private Partnership entry - Independent Health Award (Laing & Buisson)
Ramsay’s Eastern Region Team and NHS North East Essex Clinical Commissioning Group
have worked in partnership with the mutual aim of improving the quality of care and delivering
better health benefits to NHS funded patients in the East of England.
The partnership is based on a lead commissioner model, which has proven beneficial in the
efficiency of contract and data quality management, as well as the delivery of excellent quality
clinical care. Local NHS commissioners have worked closely with individual hospitals regarding
specific NHS activity, but the lead commissioner has overall responsibility for delivery of the
contract within cost and quality targets.
The unique aspect of this relationship is the shared focus on improving quality, and the open
approach to working together in the interests of the patient.
Patients’ Choice Award
Ramsay Health Care UK is delighted to announce that four of its hospitals have recently been
awarded the private healthcare UK patient’s choice 2013 award. Private healthcare UK is an
independent website which compares private hospitals and clinics throughout the UK and
allows patients to leave detailed reviews on the positive and negative aspects of their care. The
patient’s choice awards recognised those hospitals and clinics that deliver excellent customer
care and great patient experience. The section criteria includes the achievement of the overall
patient rating of 4.5 or higher out of 5. On the private healthcare UK reviews website in 2013,
only eight hospitals and clinics qualified for this title Oaks being one of those Hospitals.
2.1.2 Clinical Priorities for 2014/15 (looking forward)
Oaks Hospital has 3 priorities for improvement during 2014/15 which have been selected
because they relate to our CQUIN scheme and are a local commissioner clinical priority.
Falls Prevention, patient safety –to improve the safety of discharge patients at risk of falls.
Dementia, Clinical Effectiveness – to identify patients with dementia and other causes of
cognitive impairment alongside their other medical conditions, to prompt appropriate referral
and follow up after they leave Oaks Hospital.
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Friends and Family Test, patient experience – to improve the experience of patients in line
with Domain 4 of the NHS Outcomes Framework. The Friends and Family Test provides timely,
granular feedback from patients about their experience.
2.2 Mandatory Statements
The following section contains the mandatory statements common to all Quality Accounts as
required by the regulations set out by the Department of Health.
2.2.1 Review of Services
During 2013/14 Oaks hospital provided and/or subcontracted 35 NHS services.
Oaks Hospital has reviewed all the data available to them on the quality of care in 100% of
these NHS services.
The income generated by the NHS services reviewed in 1 April 2013 to 31st March 14
represents 100 per cent of the total income generated from the provision of NHS services by the
Oaks hospital for 1 April 2013 to 31st March 14
Add about the balanced scorecard e.g.:
Ramsay uses a balanced scorecard approach to give an overview of audit results across the
critical areas of patient care. The indicators on the Ramsay scorecard are reviewed each year.
The scorecard is reviewed each quarter by the hospitals senior managers together with
Regional and Corporate Senior Managers and Directors. The balanced scorecard approach
has been an extremely successful tool in helping us benchmark against other hospitals and
identifying key areas for improvement.
In the period for 2013/14, the indicators on the scorecard which affect patient safety and quality
were:
Human Resources
Staff Cost % Net Revenue – 24.3%
HCA Hours as % of Total Nursing 10.3%
Agency Cost as % of Total Staff Cost – 4.4%
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Ward Hours PPD – 4.5 hours
% Staff Turnover – 19.5%
% Sickness – 4.5%
% Lost Time – 18.1%
Mandatory Training - 96%
Staff Satisfaction Score – returns 40.7% previous year that increased to 60.5% for 2013.
Average Score achieved 4.08
Number of Significant Staff Injuries - 1
Patient
Formal Complaints per 1000 HPD's 0.87%
Patient Satisfaction Score 94.4%
Significant Clinical Events per 1000 Admissions 0.026%
Readmission per 1000 Admissions 0.12%
Quality
Infection Control Audit Score – 96.3%
Consultant Satisfaction Score – this year Oaks Hospital chose to focus on a G.P. Satisfaction
Survey and the results are awaited.
2.2.2 Participation in clinical audit
During 1 April 2013 to 31st March 2014 Oaks Hospital participated in 2 of the national clinical
audits which we were eligible to participate in.
The national clinical audits and national confidential enquiries that Oaks hospital participated in,
and for which data collection was completed during 1 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.
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The reports of the two national clinical audits from 1 April 2013 to 31st March 11 2014 were
reviewed by the Clinical Governance Committee and Oaks Hospital intends to take the following
actions to improve the quality of healthcare provided.
National Joint Registry (NJR) summary for the Ramsay group of hospital
Oaks Hospital does not perform ankle and elbow joint replacement surgery.
NJR:
Sum of Compliance
Site
Ankle
Elbow
Ashtead Hospital
Hips
Knees
Shoulder
89.52
97.97
45.45
Clifton Park Hospital
44.44
90.65
93.89
71.88
Duchy Hospital
33.33
90.00
96.40
66.67
Euxton Hall Hospital
88.28
91.97
100.00
Fitzwilliam Hospital
98.25
100.29
75.00
Fulwood Hall Hospital
99.11
100.39
50.00
Horton NHS Treatment Centre
90.25
88.24
40.00
90.41
91.50
58.33
New Hall Hospital
90.05
83.89
75.00
North Downs Hospital
93.44
86.67
40.00
94.92
95.25
33.33
33.33
75.82
83.41
53.85
0.00
94.89
93.81
29.41
79.91
76.88
0.00
92.41
90.10
57.14
Rivers Hospital
76.19
83.21
25.00
Rowley Hall Hospital
86.73
78.21
62.50
Mount Stuart Hospital
0.00
Nottingham Woodthorpe Hospital
44.44
Oaklands Hospital
0.00
Oaks Hospital
Park Hill Hospital
Pinehill Hospital
0.00
Quality Accounts 2013/14
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Springfield Hospital
0.00
100.00
85.15
79.61
100.00
0.00
99.07
93.53
42.31
The Yorkshire Clinic
96.56
96.05
0.00
West Midlands Hospital
88.62
90.40
50.00
96.48
94.48
70.00
66.67
73.45
76.15
10.34
Elbow
Hips
Knees
Shoulder
The Berkshire Independent Hospital
Winfield Hospital
50.00
Woodland Hospital
Sum of Compliance
Site
Ankle
Elective surgery (National PROMs Programme)
The PROMS one only contains data from Mar 13 to Dec 13 as this is all that is available from
the HSCIC for the year in question.
Local Audits
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The reports of 70 local clinical audits from 1 April 2013 to 31st March 2014 were reviewed by
the Clinical Governance Committee and Oaks hospital intends to take the following actions to
improve the quality of healthcare provided. The clinical audit schedule can be found in
Appendix 2.
Additional local audits are carried out at Oaks Hospital for:
•
•
•
•
•
•
•
•
•
•
•
Facilities / Health & Safety
Disability Discrimination
Fire Risk Assessment
Patient NHS notes coding
Waste or Access/ Egress or storage audits
There is a new programme of 2 workplace safety inspections per annum to be
implemented for this year
Revenue capture audit
External Auditors on nursing and medical records – annual audit
Internal auditors on nursing and medical records – if unit is selected
Internal Food Hygiene/Catering health & safety yearly audit
Internal Monthly catering audits
Additional audits are carried out as required to implement best practice or where the results of
an audit and the action plan has requested that this needs to be carried out.
The key main audits that have been identified from 1 April 2013 to 31st March 2014 with robust
action plans in place for improvement in the scores and practice include:
•
•
•
Physiotherapy - Record keeping and information governance
Medical Record
Care Pathway Audit
2.2.3 Participation in Research
There were no patients recruited during 2013/14 to participate in research approved by a
research ethics committee.
2.2.4 Goals agreed with our Commissioners using the CQUIN
(Commissioning for Quality and Innovation) Framework
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A proportion of Oaks hospital income in from 1 April 2013 to 31st March 2014 was conditional
on achieving quality improvement and innovation goals agreed Oaks hospital and any person or
body they entered into a contract, agreement or arrangement with for the provision of NHS
services, through the Commissioning for Quality and Innovation payment framework.
Further details of the agreed goals for 2013/14 and for the following 12
month period are available electronically at www.oakshospital.co.uk.
2.2.5 Statements from the Care Quality Commission (CQC)
Oaks hospital is required to register with the Care Quality Commission and its current
registration status on 31st March is registered without conditions.
The Care Quality Commission has not taken enforcement action against Oaks hospital during
2012/11.
The Oaks Hospital had an unannounced inspection from the CQC on the 13th November 2013.
The visit was a positive experience with a full compliance statement. The full report can be
found on the CQC website http://www.cqc.org.uk/.
Oaks hospital has not participated in any special reviews or investigations by the CQC during
the reporting period.
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2.2.6 Data Quality
Statement on relevance of Data Quality and your actions to improve your Data Quality
Oaks hospital will be taking the following actions to improve data quality.
Data quality is a very good indicator of the overall care quality delivered within the hospital. We
closely monitor all clinical and non clinical audits to identify areas of good practice and those for
further improvement. Initial accurate data entry reduces the requirement for business office
staff to follow up with members of the clinical or front of house administrative teams to double
check their information and provides a more efficient service.
Good quality data supports and reinforces our statements on quality.
Oaks Hospital has an audit program that provides an effective tool to monitor and improve our
data quality – the audit program is set out in the appendix.
NHS Number and General Medical Practice Code Validity
Oaks hospital submitted records during 2013/14 to the Secondary Uses Service (SUS) for
inclusion in the Hospital Episode Statistics (HES) which are included in the latest published
data. The percentage of records in the published data which included:
The patient’s valid NHS number:
•
•
•
99.97% for admitted patient care;
99.96 for outpatient care; and
0% for accident and emergency care (not undertaken at our hospital).
The General Medical Practice Code:
•
•
•
100% for admitted patient care;
100% for outpatient care; and
0% for 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).
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Clinical coding error rate
Oaks hospital/centre was not subject to the Payment by Results clinical coding audit during
2013/14 by the Audit Commission.
Quality Accounts 2013/14
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2.2.7 Stakeholders views on 2013/14 Quality Account
This Quality Account has been sent to the lead Clinical Commissioning Group for review, but no
comments were received prior to the required publication date.
Quality Accounts 2013/14
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Part 3: Review of quality performance 2013/2014
Statements of quality delivery
Review of quality performance 1st April 2013 - 31st March 2014
Introduction
“This publication marks the fifth successive year since the first edition of Ramsay Quality
Accounts. Through each year, month on month, we analyse our performance on many levels,
we reflect on the valuable feedback we receive from our patients about the outcomes of their
treatment and also reflect on professional opinion received from our doctors, our clinical staff,
regulators and commissioners. We listen where concerns or suggestions have been raised and,
in this account, we have set out our track record as well as our plan for more improvements in
the coming year. This is a discipline we vigorously support, always driving this cycle of
continuous improvement in our hospitals and addressing public concern about standards in
healthcare, be these about our commitments to providing compassionate patient care,
assurance about patient privacy and dignity, hospital safety and good outcomes of treatment.
We believe in being open and honest where outcomes and experience fail to meet patient
expectation so we take action, learn, improve and implement the change and deliver great care
and optimum experience for our patients.”
(Jane Cameron, Director of Safety and Clinical Performance, Ramsay Health Care UK)
Ramsay Clinical Governance Framework 2014
The aim of clinical governance is to ensure that Ramsay develop ways of working which assure
that the quality of patient care is central to the business of the organisation.
The emphasis is on providing an environment and culture to support continuous clinical quality
improvement so that patients receive safe and effective care, clinicians are enabled to provide
that care and the organisation can satisfy itself that we are doing the right things in the right
way.
It is important that Clinical Governance is integrated into other governance systems in the
organisation and should not be seen as a “stand-alone” activity. All management systems,
clinical, financial, estates etc, are inter-dependent with actions in one area impacting on others.
Several models have been devised to include all the elements of Clinical Governance to provide
a framework for ensuring that it is embedded, implemented and can be monitored in an
organisation. In developing this framework for Ramsay Health Care UK we have gone back to
Quality Accounts 2013/14
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the original Scally and Donaldson paper (1998) as we believe that it is a model that allows
coverage and inclusion of all the necessary strategies, policies, systems and processes for
effective Clinical Governance. The domains of this model are:
•
•
•
•
•
•
Infrastructure
Culture
Quality methods
Poor performance
Risk avoidance
Coherence
Ramsay Health Care Clinical Governance Framework
National Guidance
Ramsay also complies with the recommendations contained in technology appraisals issued by
the National Institute for Health and Clinical Excellence (NICE) and Safety Alerts as issued by
the NHS Commissioning Board Special Health Authority.
Ramsay has systems in place for scrutinising all national clinical guidance and selecting those
that are applicable to our business and thereafter monitoring their implementation.
Quality Accounts 2013/14
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3.1 The Core Quality Account indicators
Mortality:
Period
Best
Worst
Average
Period
Oaks
2012/13
RKE
0.65
RXL
1.17
Eng
1
2012/13
NVC13
0
2013/14
RKE
0.63
RBT
1.15
Eng
1
2013/14
NVC13
0
Oaks Hospital considers that this data is as described for the following reasons:
Oaks Hospital has had no reported deaths during this Quality Account period.
Oaks Hospital intends to take the following actions to continue to maintain this low number, and
so the quality of its services, by minimising risk through the continual audit of clinical practice,
maintaining a robust pre-operative assessment process and higher dependency care standards
within the Hospital setting and continual training for staff on Immediate Life Support for all
trained clinical staff.
Proms Hernia:
Period
Apr12 Mar13
Apr13 Sep13
Best
Worst
Average
NT415
0.157
NVC27
0.015
Eng
0.085
RTG
0.138
RNA
0.019
Eng
0.086
Period
Apr12 Mar13
Apr13 Sep13
Oaks
NVC13
0.115
NVC13
*
Oaks Hospital considers that this data is as described for the following reasons:
Oaks Hospital has not received data returns for our PROMS Hernia results to include in this
report.
Proms Veins:
Period
Apr12 Mar13
Apr13 Sep13
Best
Worst
Average
RV8
5.14
NT350
-15.92
Eng
-8.374
RTD
-9.74
RLN
-10.52
Eng
-9.46
Period
Apr12 Mar13
Apr13 Sep13
Oaks
NVC13
NVC13
*
Oaks Hospital considers that this data is as described for the following reasons:
Oaks Hospital has not received data returns for our PROMS Veins results to include in this
report.
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Proms Hips:
Period
Apr12 Mar13
Apr13 Sep13
Best
Worst
Average
NT209
24.68
RKE
17.21
Eng
21.32
NT318
25.44
RHQ
18.34
Eng
21.61
Period
Apr12 Mar13
Apr13 Sep13
Oaks
NVC13
23.969
NVC13
*
Oaks Hospital considers that this data is as described for the following reasons – we have not
received data returns for our PROMS Hips results to include in this report.
Proms Knees:
Period
Apr12 Mar13
Apr13 Sep13
Best
Worst
Average
NT219
20.37
RAP
12.46
Eng
16.01
RDE
20.09
RM1
14.32
Eng
16.74
Period
Apr12 Mar13
Apr13 Sep13
Oaks
NVC13
16.869
NVC13
*
Oaks Hospital considers that this data is as described for the following reasons – we have not
received data returns for our PROMS Knees results to include in this report.
Readmissions:
Period
Best
Worst
Average
Period
Oaks
2010/11
RF4
0.0
RYR
15.8
Eng
11.04
2012/13
NVC13
7.38
2011/12
RF4
0.0
RYR
15.8
Eng
11.08
2013/14
NVC13
6.84
Oaks Hospital considers that this data is as described for the following reasons:
Oaks Hospital has scored lower than the National average for readmissions to the hospital and
has improved even further since 2010/11. All readmissions are recorded onto our internal
reporting system ‘Riskman’. Each readmission is monitored and any trends in readmissions are
investigated with a thorough root cause analysis if required to identify key trends and
recommendations for practice.
Oaks Hospital has taken the following actions to improve this proportion, and so the quality of its
services, by undertaking a root cause analysis for all NHS patients readmitted within 48 hours
who return to theatre.
Responsiveness to personal needs:
Period
Best
Worst
Average
Period
Oaks
2011/12
RYR
73.3
RF4
67.4
Eng
75.6
2012/13
NVC13
92.5
2012/13
RYR
75.9
RJ6
68.0
Eng
76.5
2013/14
NVC13
92.6
Quality Accounts 2013/14
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Oaks Hospital considers that this data is as described for the following reasons:
This data looks at the "Positive Experience of Care" taken from CQC Inpatient Survey.
Section 4b ‘Patient experience of hospital care’. Score Scale of 0-100 where 0 is the worst
score and 100 is the best score. Oaks score is higher than the national average and the best
scoring NHS facility which is an excellent achievement.
Oaks Hospital intends to take the following actions to improve this score, and so the quality of
its services, by continuing to measure patient experience of inpatient care based on a selection
of questions from the National Inpatient Survey. We have a rolling programme of customer
excellence training for all clinical and non-clinical staff.
VTE Assessment:
Period
Best
Worst
Average
Period
Oaks
13/14 Q3
Several
100%
NT244
63.2%
Eng
95.8%
13/14 Q3
NVC13
98.3%
13/14 Q4
Several
100%
NT205
67.0%
Eng
96.0%
13/14 Q4
NVC13
99.5%
Oaks Hospital considers that this data is as described for the following reasons:
Oaks Hospital has scored higher than the national average on the VTE assessment of our
patients. There has been an increase in the percentage since 2013/14 showing improvement in
this area.
Oaks Hospital has taken the following actions to improve this percentage, and so the quality of
its services, by auditing the VTE assessments and feeding back results to the clinical teams via
the clinical governance committee.
C.Diff rate per 100,000 bed days:
Period
Best
Worst
Average
Period
Oaks
2012/13
Several
0
RNA
58.2
Eng
22.2
2012/13
NVC13
0.0
2013/14
Several
0
RVW
30.8
Eng
17.3
2013/14
NVC13
9.7
Oaks Hospital considers that this data is as described for the following reasons:
This was not a hospital acquired infection at Oaks Hospital. It refers to one case where a
patient with an underlying bowel condition was found on investigation to be colonised with
Clostridium Difficile but had no clinical signs. A large proportion of patients are colonised with C
Diff. This result should read in essence 0.
The Oaks hospital has taken the following actions to improve this rate, and so the quality of its
services, by robust infection controls measures and auditing.
Incident rate patient safety:
Quality Accounts 2013/14
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Period
Best
Worst
Average
Period
Oaks
2011/12
RP6
2.6
TAJ
84.4
Eng
13.5
2012/13
NVC13
6.77
2012/13
RRF
2.0
RAT
85.6
Eng
14.8
2013/14
NVC13
3.68
Oaks Hospital considers that this data is as described for the following reasons:
Oaks Hospital has scored lower than the national average on incident rates regarding patient
safety and has decreased this score since the last reporting period in 2011/12. This shows the
Hospitals commitment to patient safety with risk assessments in place for all patients
undertaken on admission to Oaks Hospital if clinically indicated.
Oaks Hospital has taken the following actions to improve this number, and so the quality of its
services, by recording any untoward incidences on Riskman and reviewing incidences at the
relevant health and safety committee meetings and clinical governance committee meetings.
Friends and Family Test – Patient.
Period
Best
Worst
Average
Period
Oaks
Jan-14
Several
100
RPA02
27
Eng
73
2012/13
NVC13
79
Feb-14
Several
100
RPA02
18
Eng
73
2013/14
NVC13
100
Oaks Hospital considers that this data is as described for the following reasons:
The Friends and Family Test (FFT) is a single question survey which asks patients whether they
would recommend the NHS service they have received to friends and family who need similar
treatment or care. Oaks Hospital has scored 100 for the reporting period 2013/14 which is an
excellent score and puts us in the best category of hospitals for this period. There has been a
marked improvement since last year.
Oaks Hospital intends to take the following actions to maintain this score, and so the quality of
its services, by rolling out this survey to outpatients and day case patients.
3.2 Patient safety
We are a progressive hospital and focussed on stretching our performance every year and in all
performance respects, and certainly in regards to our track record for patient safety.
Risks to patient safety come to light through a number of routes including routine audit,
complaints, litigation, adverse incident reporting and raising concerns but more routinely from
tracking trends in performance indicators.
Our focus on patient safety has resulted in a marked improvement in a number of key indicators
as illustrated in the graphs below.
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3.2.1 Infection prevention and control
Oaks hospital has a very low rate of hospital acquired infection and has had no reported
MRSA Bacteraemia in the past 4 years.
We comply with mandatory reporting of all Alert organisms including MSSA/MRSA Bacteraemia
and Clostridium Difficile infections with a programme to reduce incidents year on year.
Ramsay participates in mandatory surveillance of surgical site infections for orthopaedic joint
surgery and these are also monitored.
Infection Prevention and Control management is very active within our hospital. An annual
strategy is developed by a corporate level Infection Prevention and Control (IPC) Committee
and group policy is revised and re-deployed every two years. Our IPC programmes are
designed to bring about improvements in performance and in practice year on year.
A network of specialist nurses and infection control link nurses operate across the Ramsay
organisation to support good networking and clinical practice.
Our Infection Control Lead regularly attended the North Essex Infection Prevention Control
Committee meetings held in Chelmsford.
All bacteraemia and serious infections are reported to the CCG and a Serious Incident initial
Notification are completed as well as a 7 day and 45 day report if deemed necessary.
Programmes and activities within our hospital include:
•
local Infection Prevention Control initiatives at Oaks Hospital includes ANTT training
commenced in January 2014, which is part of our IV training so all staff are compliant in
aseptic non touch technique for all aseptic procedures.
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Infection Rates
Infection Rates
(percentage of Admissiosns)
2.5
2
1.5
1
0.5
0
2011/12
2012/13
2013/14
Oaks Hospital
Bar graph showing local infection rates as a % of admissions for the last 3 years.
As can be seen in the above graph our Infection Control Rates has decreased significantly over
the last year. In comparison to the national average of 1-2% this is an excellent result. This is
due to regular audits and the introduction and implementation of ANTT.
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 Oaks Hospital, providing us with a patient’s eye view
of the buildings, facilities and food we offer, giving us a clear picture of how the people who
use our hospital see it and how it can be improved.
The main purpose of a PLACE assessment is to get the patient view.
Please find attached our Place results and Action Plan for 2013:
Oaks final HCAI
Action plan docx 2013
Place Audit action
plan final copy 19th N
Quality Accounts 2013/14
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Quite a bit of building work was being carried out at time of audit on the ward as the main
corridor around the ward was being painted. Patients were moved from the areas where dust
was being created and sections partitioned off.
Cleanliness around the hospital was very good and most areas were very well maintained.
Although food was of a high quality there was a long gap between supper and breakfast and
although patients could have snacks if they asked most were not aware of this hence the lower
score for the food section.
All areas of the action plan have now been implemented.
3.2.3 Safety in the workplace
Safety hazards in hospitals are diverse ranging from the risk of slip, trip or fall to incidents
around sharps and needles. As a result, ensuring our staff have high awareness of safety has
been a foundation for our overall risk management programme and this awareness then
naturally extends to safeguarding patient safety. Our record in workplace safety as illustrated by
Accidents per 1000 Admissions demonstrates the results of safety training and local safety
initiatives.
Effective and ongoing communication of key safety messages is important in healthcare.
Multiple updates relating to drugs and equipment are received every month and these are sent
in a timely way via an electronic system called the Ramsay Central Alert System (CAS). Safety
alerts, medicine / device recalls and new and revised policies are cascaded in this way to our
General Manager which ensures we keep up to date with all safety issues.
3.3 Clinical effectiveness
Oaks hospital has a Clinical Governance team and committee that meet regularly through the
year to monitor quality and effectiveness of care. Clinical incidents, patient and staff feedback
are systematically reviewed to determine any trend that requires further analysis or
investigation. More importantly, recommendations for action and improvement are presented to
hospital management and medical advisory committees to ensure results are visible and tied
into actions required by the organisation as a whole.
3.3.1 Return to theatre
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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.
Return to Theatre Score
Retrnn to Theatre
(Percentage of Admissiosns)
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
2011/12
2012/13
2013/14
Oaks Hospital
As can be seen in the above graph our return to theatre score has decreased considerably over
the last year. This has been a focus for the clinical team this year that has demonstrably
improved through robust pre-operative assessment processes and increased clinical staff
training.
3.3 Patient experience
All feedback from patients regarding their experiences with Ramsay Health Care are welcomed
and inform service development in various ways dependent on the type of experience (both
positive and negative) and action required to address them.
All positive feedback is relayed to the relevant staff to reinforce good practice and behaviour –
letters and cards are displayed for staff to see in staff rooms and notice boards. Managers
ensure that positive feedback from patients is recognised and any individuals mentioned are
praised accordingly.
All negative feedback or suggestions for improvement are also feedback to the relevant staff
using direct feedback. All staff are aware of our complaints procedures should our patients be
unhappy with any aspect of their care.
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Patient experiences are feedback via the various methods below, and are regular agenda items
on Local Governance Committees for discussion, trend analysis and further action where
necessary. Escalation and further reporting to Ramsay Corporate and DH bodies occurs as
required and according to Ramsay and DH policy.
Feedback regarding the patient’s experience is encouraged in various ways via:










Continuous patient satisfaction feedback via a web based invitation
Hot alerts received within 48hrs of a patient making a comment on their web survey
Yearly CQC patient surveys
Friends and family questions asked on patient discharge
‘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 groups
PROMs surveys
Care pathways – patient are encouraged to read and participate in their plan of care
3.3.1 Patient Satisfaction Surveys
Our patient satisfaction surveys are managed by a third party company called ‘Qa Research’.
This is to ensure our results are managed completely independently of the hospital so we
receive a true reflection of our patient’s views.
Every patient is asked their consent to receive an electronic survey or phone call following their
discharge from the hospital. The results from the questions asked are used to influence the
way the hospital seeks to improve its services. Any text comments made by patients on their
survey are sent as ‘hot alerts’ to the Hospital Manager within 48hrs of receiving them so that a
response can be made to the patient as soon as possible.
Satisfaction Scores
NHS/Private Patients
Satisfaction Scores
100
80
60
40
94.3
92.0
20
0
2012/13
2013/14
Oaks Hospital
Satisfaction Index scores for last 3 years (from Patient Satisfaction Reports)
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This is a TLF/QaR combined graph related to the question, ‘Please give your overall opinion of
the quality of your care’.
The above graph shows the Patient Satisfaction Scores have decreased marginally over the
last year. This has being addressed through Customer Care Training for all staff in the hospital.
Quality Accounts 2013/14
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3.4 Oaks Hospital Case Study
Oaks hospital’s Case Study this year focuses on the training and development projects from
2013 of our existing staff and new apprenticeship scheme. These examples demonstrate how
Oaks Hospital is committed to improving our service delivery and quality patient care by
developing our own workforce and supporting apprenticeships.
Health Care Assistant Development is high on the agenda for Clinical Leads at Oaks Hospital. A
review of training and support for Health Care Assistants has taken place to look at ways to help
strengthen their roles and progress their careers. Four HCA’s have embarked on an FdSc
(Foundation Degree) course. The programme has been made possible by the support and
strong working relationship between Oaks, Health Education East of England (Essex Workforce
Partnership) and Anglia Ruskin University (ARU). The course requires the students to study a
broad range of topics and specialist subjects, along with a strong focus on work based learning.
On completion of the course, the HCA’s will be qualified to work as an Assistant Practitioner.
The Assistant Practitioner role is seen as a key position within future workforce developments
with the aim of enhancing cognitive skills, strengthening interpersonal skills, establishing
competencies in practice, and developing more effective inter-professional working through both
academic and work mediums this in turn will help Oaks Hospital drive forward improvement in
our quality patient care and outcomes.
A newly developed Apprenticeship Programme is underway with a small group of 3
Apprentices being recruited for the initial programme. The Apprentices have been given the
opportunity to work towards Health & Social Care Diploma Level 2, a recognised qualification
which provides the first step in a career in healthcare. The level 2 health and social care
qualification is the first step in a potential career path which could lead to nurse training.
Qualified apprentices will have the opportunity to apply for jobs within Oaks hospital, other
Ramsay hospitals or in the wider health service, opening the door to a future career in health
care.
The Apprentices are fully supported through mentorship and buddy schemes as well as being
given supernumerary status within staff rotas, to protect learning. Nursing staff with
qualifications in teaching provide structured tuition, and apprentices complete work books,
allowing assessment of competencies.
A further dimension to the Oaks apprenticeship programme has been the recruitment of
apprentices via work experience placements from the “Prince’s Trust Get into Health and Social
Care Course”, demonstrating Ramsay’s corporate commitment to social responsibility.
The apprenticeship programme will allow Oaks to “grow their own” HCAs and encourage a
culture of learning within the nursing team. Staff recruited after apprenticeship will “hit the
Quality Accounts 2013/14
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ground running” being familiar with the hospital and local processes and procedures, without the
need for an extensive induction period.
Oaks Hospital is totally committed to the concept, and plans to extend the scheme next year.
Quality Accounts 2013/14
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Appendix 1
Services covered by this quality account
Oaks Hospital
Oaks Hospital has 57 beds including 3 twin bedded rooms and a HDU. The
hospital has four theatres (3 with laminar flow) and an ambulatory care unit.
Oaks Hospital undertakes a range of surgical and medical activity for patients
who are ASA 1, ASA 2, or stable ASA 3. This is provided by a highly dedicated
professional multi-disciplinary team.
Oaks Hospital provides care and treatment for children over the age of three within the ward, theatre and outpatient
environment.
On site facilities include Outpatients, Physiotherapy, Radiology and mobile MRI/CT.
Regulated Activities
Location: Oaks Hospital, Oaks Place, Mile End Road, Colchester, Essex CO4 5XR.
Registered Manager: Douglas Watson
Douglas.watson@ramsayhealth.co.uk
Regulated Activities – Oaks Hospital
Treatment of
Disease,
Disorder
Or injury
Services Provided
Peoples Needs Met for:
Cardio respiratory medicine,
Cardiology, Care of the elderly,
Dermatology, Diabetology,
Endocrinology, Gastroenterology,
General medicine, Nephrology,
Neurology, Oncology, Pain
management, Psychiatry and
counselling, Physiotherapy,
Rheumatology, Sports Medicine,
Vascular foam sclerotherapy
All adults 18 yrs and over
Children - 3 yrs and above
Quality Accounts 2013/14
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Surgical
Procedures
Colorectal, Day and Inpatient
Surgery, Dermatology, Ear, Nose and
Throat (ENT), Gastrointestinal,
General surgery, Gynaecology,
Ophthalmic, Oral maxillofacial,
Orthopaedic, Plastics/Cosmetics,
Spinal, Pain Management,
Urological, Vascular
All adults 18 yrs and over 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
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.
All Children - 3yrs and above admitted for
ambulatory, day surgery or inpatients
Diagnostic
and
screening
GI physiology Imaging services inc.
heel, Cardiology testing,
Phlebotomy, Urinary screening and
specimen collection, general
imaging services, interventional
radiology, mobile MRI/CT,
ultrasound and mammography.
All adults 18 yrs and over
All children 3 yrs and above - outpatients
appointments only
Quality Accounts 2013/14
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Appendix 2 – Clinical Audit Programme 2013/14. Each arrow links to the audit to be completed in each month.
Quality Accounts 2013/14
Page 46 of 47
Oaks Hospital
Ramsay Health Care UK
We would welcome any comments on the format, content or
purpose of this Quality Account.
If you would like to comment or make any suggestions for the
content of future reports, please telephone or write to the
General Manager using the contact details below.
For further information please contact:
01206 7521521
www.oakshospital.co.uk
Quality Accounts 2013/14
Page 47 of 47