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Oaks Hospital Quality Accounts 2012/13

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Contents Introduction Page

Welcome to Ramsay Health Care UK and Oaks Hospital

Introduction to our Quality Account

PART 1 – STATEMENT ON QUALITY

1.1 Statement from the General Manager

1.2 Hospital accountability statement

PART 2

2.1 Priorities for Improvement

2.1.1 Review of clinical priorities 2012/13 (looking back)

2.1.2 Clinical Priorities for 2013/14 (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 2012/13 Quality Accounts

PART 3 – REVIEW OF QUALITY PERFORMANCE

3.1 Patient Safety

3.2 Clinical Effectiveness

3.3 Patient Experience

3.4 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, Spain, Indonesia and France. Within the UK, Ramsay Health Care is one of the leading providers of independent hospital services in England, with a network of 22 acute hospitals. We are also the largest private provider of surgical and diagnostics services to the NHS in the UK. Through a variety of national and local contracts we deliver 1,000s of NHS patient episodes of care each month working seamlessly with other healthcare providers in the locality including GPs, PCTs and acute Trusts.

“Ramsay Health Care UK is committed to establishing an organisational culture that puts the patient at the centre of everything we do. As Chief Executive of Ramsay Health Care UK, I am passionate about ensuring that high quality patient care is at the centre of what we do and how we operate all our facilities. This relies not only on excellent medical and clinical leadership in our hospitals but also upon our overall continuing commitment to drive year on year improvement in clinical outcomes.

“As a long standing and major provider of healthcare services across the world, Ramsay has a very strong track record as a safe and responsible healthcare provider and we are proud to share our results. Delivering clinical excellence depends on everyone in the organisation. It is not about reliance on one person or a small group of people to be responsible and accountable for our performance.” Across Ramsay we nurture the teamwork and professionalism on which excellence in clinical practice depends. We value our people and with every year we set our targets higher, working on every aspect of our service to bring a continuing stream of improvements into our facilities and services.

(Jill Watts, Chief Executive Officer of Ramsay Health Care UK)

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Introduction to our Quality Account This Quality Account is the Oak’s 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. The first Quality Account for 2010/11 was developed by our corporate office. Thereafter, each site within the Ramsay Group developed their own Quality Accounts for 2011/12 which included some group wide initiatives, but also described the many excellent local achievements and quality plans that we would like to share. This Quality Account 2012/13 is in the same format as the previous years.

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Part 1 1.1 Statement on Quality from the General Manager Vanessa Childs, General Manager, The Oaks Hospital, Colchester 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. The 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 (G.P) 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 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 July 2012 which supports the hospital’s excellent reputation. As General Manager of the 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. 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

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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. All professional and management teams at local level have been represented in producing this account.

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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. Vanessa Childs General Manager The Oaks Hospital Ramsay Health Care UK

Signature… ……………………….. Date……10/05/2013………. This report has been reviewed and approved by: Mr Donald Menzies, Consultant General and Laparoscopic Surgeon Medical Advisory Committee Chair

Signature…… …………… Date…………10/05/2013… Mr Gerald Rix, Consultant Urologist Clinical Governance Committee Chair

Signature… ………………….Date………… 10/05/2013 Mr Richard Parsons, Regional Director

Signature………………………………………………….. Date……10/05/2013………

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Welcome to The Oaks Hospital The Oaks Hospital offers a comprehensive range of specialist surgical and medical procedures, along with the development of new services in line with patient needs. 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, is courteous and professional and we take great pride in our ability to innovate and look at new ways of working. We have developed a competency based education programme for our clinical staff to ensure they maintain a wide, evidence based and skills framework. 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. The hospital is strictly regulated and audited by the Care Quality Commission, the governing body responsible for maintaining standards in healthcare, and the latest report can be found at www.cqc.org.uk. We are registered with the Care Quality Commission for 57 bedrooms, our inpatient facilities include two rooms which can accommodate paediatric patients and their relatives, as well as two high dependency rooms which enable closer monitoring of patients who may require it during their stay. We have four theatres which includes a theatre for minor procedures and Endoscopy, three of our theatres have laminar flow ventilation. Our outpatient facilities include an ophthalmology suite, fourteen consultant rooms and two treatment rooms. We have a new designated 11 bay Ambulatory Unit which was built to meet the growing need of day care facilities. We also have radiology and physiotherapy departments within the hospital. 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. Diagnostic services include X-ray, mammography accessed by our sister hospital in Chelmsford, ultrasound and mobile CT and MRI. Other registered services that are available at the Oaks Hospital please see Appendix 1 Statement of Purpose. 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. The Oaks Hospital is situated on the outskirts of Colchester. There is ample free parking which has also been expanded to accommodate our growing business and the hospital is easily accessible via train or bus. In 2013 we treated a total number of 81068 patients. 56.21% of our admitted patients were NHS and 43.79% were Private patients. The nursing staff to patient ratio is 1: between 5 and 8 depending on patient dependency. There is an experienced Resident Medical Officer on site 24 hours a day.

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Our Staffing contract establishment includes:

Consultants 156 Non Consultants 23 Registered Nurses 40 Healthcare Assists 15 Support Staff 25 Admin Staff 50 Physiotherapists 11 Radiographers 5 Operating Department Practitioner’s 6 Management Personnel 5

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 and Histopathology. 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 the Oaks Hospital with some of the chemotherapy drugs which are administered to our private oncology patients. We work closely with our local PCT to provide a range of services under the standard acute contract via the choose and book electronic referral system and via 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). 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. The 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 half-time of the Colchester vs. Preston North End match. The entry fee for the race contributed to the total amount raised, along with bucket collections made at the match.

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We also actively get involved in supporting the local CHAPS men’s health charity, attending their men’s health day which, following its inaugural event last year went ahead for a second year running in March 2013.

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Part 2 2.1 Quality priorities for 2012/2013 Plan for 2012/13 On an annual cycle, the Oaks Hospital develops a business operational plan to set objectives for the year ahead which each department is then committed to working with their teams to achieve these. 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. This Quality Account has been written to incorporate the core set of indicators that the Department of Health have encouraged Independent sector providers to consider including in their accounts for this reporting year. Monitor has updated the requirements for Mandatory indicators within the NHS Foundation Trusts annual reports and therefore we have taken on board their recommendations. Priorities for improvement 2.1.1 A review of clinical priorities 2012/13 (looking back) Patient Safety

1. ‘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/ The 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.

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2. 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 no reported incidences of Venous Thromboembolism at the Oaks Hospital. We continue to abide by policy and ensure all patients are risk assessed and have appropriate prophylaxis.

This graph shows the VTE assessment submissions for 2012/13 up until March 2013.

3. Infection Control The Oaks Hospital carried out regular infection control audits throughout this reported year. The results showed improved scores in all areas especially the environmental audit and patient environmental action team audit which is now being replaced with the PLACE audit (Patient-Led Assessments of the Care Environment).

4. Real time incident reporting A new reporting system RISKMAN has been established for Ramsay. This is the new software tool for reporting clinical and safety incidents, complaints and compliments that Ramsay has adopted. This will capture all the data required to meet the requirements placed on the business without paper format. Through a positive attitude to reporting incidents we can learn and improve the safety of our facilities and care provided for patients, staff and visitors. This will assist us locally in relevant data being inputted more efficiently and reporting tools more widely available in order to improve patient safety outcomes. The Oaks Hospital was one of the pilot sites for the implementation of the system before it was rolled out to all other units. 5. Acute Care Competencies

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Ensuring safe, competent staff are available to care for patients. All of our clinical staff have completed the acute care competencies and training is underway for staff to address any learning outcomes. We have a corporate hospital training matrix for mandatory training and a hospital training tracker where all staff’s training is recorded.

Clinical Effectiveness

1. Allocate Rostering System – This project has being rolled out across the Eastern region of the Ramsay group with plans underway to improve our rostering and man hours management. This will allow units to have a better allocation of staff, looking at skill mix which will enable patient centred focus and direct patient care. The Oaks Hospital was part of the pilot phase which commenced in May 2012.

2. 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. Ramsay continues to launch Children’s services and will be rolling out to units who undertake this service in due course. This service aims to encourage children as well as parents and carers to become involved in decisions about their care. We already provide Children’s services to the highest possible standard for aged three years and above and with investment this will enable us to continue to provide the best possible paediatric care within the community/local area. There are corporately developed care of the child competencies for staff that directly see, care or treat children which are being rolled out to units alongside Paediatric Intermediate Life Support Training (PILS) as part of the Ramsay Policy.

3. Ambulatory Day Care Ambulatory Care (or Day Surgery Care) is the admission of selected patients (both medical and surgical) to hospital for a planned procedure, returning home the same day i.e. the patient does not incur an overnight stay. Since January 2012 our staff have been treating day case patients successfully under this new streamlined service.

4. Group pre operative assessments for major joint replacements The Oaks provide group sessions for patients prior to coming into hospital for joint replacements, giving information in an environment which encourages group interaction and discussion as well as post operative group sessions for education and exercise classes. This service has been developed and we have also introduced a designated area for inpatient group physiotherapy gym sessions. 5. Improve National Benchmarking – how do we compare? It was recognised that we needed more transparency between ourselves and other independent sector providers/the NHS in order to monitor and improve our services. This is even more important now we are working in partnership with the NHS. Many areas of benchmarking are now in place including VTE risk assessment monitoring, outcome study and customer satisfaction results.

PHIN Public Health Information Network is a national initiative for advancing fully capable and interoperable information systems in public health organisations. The initiative

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involves establishing and implementing a framework for public health information systems.

The available benchmarks are reported monthly to the local NHS commissioning CCG and regular meetings are held to discuss any improvements or action plans.

6. Improve ward efficiency by adopting the Productive Ward initiative 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. The Ward Staff at The Oaks launched the project in May 2011 and have embraced the concept and change processes to enable more time to be spent with patients. The Oaks Hospital completed its foundation modules and implemented changes to practice such as reorganisation of patient folders, clinical documentation, utility areas and store rooms. The ward successfully completed a further module on ‘patient observations’ focusing on training staff on the early warning scoring systems and reorganisation of observational equipment. The next productive ward module chosen will focus on discharge planning of patients to coincide with the recent revision of the Ramsay policy on discharge planning. 7. Improved patient information We continued to focus on improving patient information by reviewing regularly our patient satisfaction survey results. This is important as even though we always tell our patients everything they need to know before going home, a written reminder ensures that they have the same information should they need to refer to it at a later date. Our results for quarter 4 from The Leadership Factor (TLF) for 2012 scored 83.2 % with a continual drive to address the areas of concern and improve results. Ramsay have now changed the process of gathering patient information by adding in the friends and family survey and a new web based patient satisfaction survey which replaces the TLF. Please see section 2.1.2 for further information.

8. CQUIN The commission for quality and innovation (CQUIN) payment framework enables commissioners to reward excellence by linking a proportion of provider’s income to the achievement of local quality improvement goals.

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Each commissioner agrees a number of different CQUIN’s at the beginning of the financial year with each of their providers. These include in year targets as well as final outcome targets. The Oaks Hospital income from 1st April 2012 to 31st March 2013 was conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework during this period. For 2012/13 The Oaks Hospital had six CQUIN:

Goal Number

Goal Name Description of Goal Goal weighting (% of CQUIN scheme available)

Final Score achieved

1 VTE % of all adult inpatients who have had a VTE risk assessment on admission to hospital using the clinical criteria of the national tool

20% 20%

2 Patient experience

Improve NHS patient experiences The indicator is a composite, calculated from 5 compatible TLF survey questions.

20% 20%

3 NHS Safety Thermometer

Improve collection of data in relation to pressure ulcers, falls, urinary tract infection in those with a catheter, and VTE This CQUIN incentivised the collection of data on patient harm using the NHS Safety Thermometer harm measurement instrument (developed as part of the QIPP Safe Care national work stream) to survey all relevant patients in all relevant NHS providers in England on a monthly basis.

20% 20%

4 Avoidable Pressure ulcer reduction and elimination

The Elimination of avoidable grade 2, 3 and 4 pressure ulcers This CQUIN required monthly measurement of all grade 2, 3 and 4 pressure ulcers indicating the elimination of all avoidable grade 2, 3 and 4 pressure ulcers. This performance was required to be sustained through quarter 4 2012/13.

10% 10%

5 Supporting patients with high BMI

Support patients to lose weight 1. Inpatients had their weight recorded and BMI calculated 2. Patients with a BMI of over 30 were given information on the risks of obesity and contact details of the Local NHS Weight Management Service

10% 10%

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3. If Patients accepted, a Referral could be made to their GP in a discharge letter and patient information leaflet.

6 Improving Medicines Management

To reduce missed doses in Antibiotic therapy, Warfarin, insulin and Parkinsons Drugs This CQUIN incentivised the collection of data on patient harm related to missed Antibiotic, Warfarin, Insulin, oral Methotrexate and Parkinsons drug doses to enable delivery of a reduction in the number of missed doses. Monthly audits to review missed doses at the end of patient’s course of treatment were undertaken to identify missed doses within the previous 24 hours. The audit process enabled real time issues and actions to be identified and facilitate a reduction in missed antibiotic Warfarin, Insulin, oral Methotrexate and Parkinsons drugs doses.

20% 20%

Totals: 100.00% 100.00% Patient Experience – informing patient choice

1. Increasing the use of Patient Reported Outcomes Studies (PROMs) • We continue to monitor the national PROMS results for Hip. Knee, Varicose Veins and

Hernia surgery by offering all patients who undergo this type of surgery the opportunity to complete a questionnaire before and after surgery to monitor improvement in their quality of life. Encouraging their use identifies poor outcomes and allows us to review their practice where necessary.

• We share the results with the multi-disciplinary team within the Oaks and the local Clinical Governance Committee and encourage them to use the results to review their practice by meeting and discussing with their teams and benchmarking against other sites.

See section 3.3.2 for 2012/13 results.

2.1.2 Clinical Priorities for 2013/14 (looking forward) Patient Safety

1 VTE risk assessment. In September 2008, the Department of Health issued its guidance on Risk Assessment for Venous Thromboembolism (DH 2008).

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The objective is to improve the quality of patient care by minimising the risk of VTE incidents. We will continue to abide by policy and ensure all patients are risk assessed and have appropriate prophylaxis. We will continue to audit monthly and action and report low scores where appropriate to the relevant clinical committees and ensure re auditing is commenced if required.

2 Infection Control The Oaks Hospital will continue to carry out regular infection control audits throughout the coming year and report to the local CCG if any scores are below 95% with relevant action plans put in place. We will re audit where necessary. 3 Riskman This software tool for reporting clinical and safety incidents, complaints and compliments has been fully implemented. It has already proved to be beneficial in capturing all the data necessary to meet the requirements placed on the business without paper format. It will continue to assist us locally in relevant data reports to use in local committees so that relevant information is disseminated efficiently and effectively in a timely manner. Staff will continue to be encouraged to report efficiently and effectively. More modules to assist human resources and training are being looked into. This 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.

4 Training Ensuring safe, competent staff are available to care for patients and are customer focused. All of our staff will 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 will continue to monitor training via yearly professional development reviews and identify learning opportunities and re evaluate the competencies yearly.

Clinical Effectiveness

1. Allocate Rostering System This project continues to be rolled out across the Eastern region of the Ramsay group and for the rest of Ramsay during the early part of 2013. This system is being monitored both locally and corporately.

2. Productive Ward initiative The next productive ward module chosen will focus on discharge planning of patients to coincide with the recent revision of the Ramsay policy on discharge planning. The ward continues to re visit the foundation and previous modules already completed so that standards are maintained and more time is released to care for patients efficiently. 3. Barcoding and Stock Control One of the key performance improvement targets for Ramsay Health Care UK is the significant reduction in the level of stock held within our units. There are only two points

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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, this task is extremely 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 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.

4. Chemotherapy Services for private patients We have employed a chemotherapy trained nurse to support the consultants and nursing team at the Oaks Hospital in identifying areas of improvement and service provision within this speciality in order to offer and deliver expert high quality service to our patients. 5. Tissue Viability Our Oaks Hospital Outpatients Manager is on the Ramsay working party for tissue viability/wound management. This group is in the process of developing a new wound management policy in line with national guidance to provide the best possible service to our patients.

6. 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 up any areas of improvement by involving patient representatives and staff.

5 Paediatrics This service aims to encourage children as well as parents and carers to become involved in decisions about their care. We will continue to provide Children’s services to the highest possible standard for aged three years and above this will enable us to continue to provide the best possible paediatric care within the community/local area.

6 New Services The Oaks Hospital is continually looking at new services and ventures to enhance the patient’s journey.

Patient Experience – informing patient choice

1. 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

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to all Insured and Self Pay patients receiving Inpatient and Daycase admissions. The Oaks started this as of April 1st 2013.

2. Web based Patient Satisfaction Survey

A decision was made to move from paper (TLF survey) to web based survey in Spring 2012 following a procurement exercise whereby companies were short listed and asked to demonstrate proposals. ‘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.

3. Public Private Partnership entry - Independent Health Award (Laing & Buisson)

Ramsay’s Eastern Region Team and NHS North East Essex commissioning Team have been working in partnership. This partnership was created with the mutual aim of improving the quality of care and delivering better health benefits to 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.

We are delighted to announce that we as a region have been selected as a finalist in Laing & Buisson’s 2013 Independent Healthcare Awards.

2.2 Mandatory Statements 2.2.1 Review of Services During 2012/13 the Oaks Hospital provided and/or subcontracted 40 NHS services. The 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 1st April 2012 to 31st March 2013 represents 100% per cent of the total income generated from the provision of NHS services by the Oaks Hospital for 1st April 2012 to 31st March 2013. Ramsay continues to use a balanced scorecard approach to give an overview of audit results across the critical areas of patient care. The indicators on the Ramsay scorecard continue to be reviewed each year. The scorecard is reviewed each quarter by the hospitals senior managers together with regional and Corporate Managers. The balanced scorecard approach continues to be an extremely successful tool in helping the company benchmark against other hospitals and identifying key areas for improvement.

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In the period for 2012/13, the indicators on the scorecard which affect patient safety and quality were: Human Resources HCA Hours as % of Total Nursing 10.3% Agency Hours as % of Total Hours 1.65% % Staff Turnover 11.2% % Sickness 3.88% Total Lost Worked Days 5764 Number of Significant Staff Injuries 0 2.2.2 Participation in clinical audit The national clinical audits and national confidential enquiries that the Oaks Hospital participated in, and for which data collection was completed during 1st April 2012 to 31st March 2013, 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. This list has been compiled on behalf of the Department of Health by the Healthcare Quality Improvement Partnership (HQIP), against criteria previously agreed by National Advisory Group on Clinical Audit & Enquiries. The accompanying table provides details of all audits and enquiries meeting the required criteria for inclusion. National Clinical Audits for Quality Accounts 2012-2013 For information/reports on audits participated in please go to the following link: http://www.hqip.org.uk/ncas-for-qa-introduction/

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No.

National Clinical Audits Acronym Contact details for supplier

Category National Clinical Audit and Patient Outcomes Programme (NCAPOP)*

1. Elective surgery (National PROMs Programme)

NHS IC, Leeds (headquarters): 1 Trevelyan Square, Boar Lane, Leeds, LS1 6AE

Other No

2. National Cardiac Arrest Audit

NCAA Intensive Care National Audit and Research Centre (ICNARC), Entrance A, Tavistock House, Tavistock Square, London, WC1H 9HR

Heart No

3. National comparative audit of blood transfusion

National Comparative Audit of Blood Transfusion, NHS Blood and Transplant, John Eccles House, Robert Robinson Avenue, Oxford Science Park , Oxford OX4 4GP

Blood and Transplant

No

4. National Joint Registry NJR National Joint Registry Centre, Northgate Solutions, Peoplebuilding 2, Peoplebuilding Estate, Maylands Avenue, Hemel Hempstead, Herts, HP2 4NW

Acute Yes

5. Medical and Surgical programme: National Confidential Enquiry into Patient Outcome and Death

NCEPOD National Confidential Enquiry into Patient Outcome and Death (NCEPOD), Ground Floor, Abbey House, 74-76 St John Street, London, EC1M 4DZ

Acute Yes

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*The NHS standard contracts for acute hospital, mental health, community and ambulance services set a requirement that provider organisations shall participate in appropriate national clinical audits that are part of the National Clinical Audit and Patient Outcome Programme (NCAPOP). We have reviewed the National NCEPOD reports that have become available to us and these have been shared with the clinical teams. We will continue to consider participation in any national audits as required and appropriate to the Oaks Hospital’s case mix and service criteria. Local Audits The reports of 62 (which includes 12 infection prevention and control audits, 3 blood transfusion, 4 physiotherapy and 7 radiology. These audits run from 1st July 2012 to 31st June 2013 and are reviewed by the Corporate and local Clinical Governance Committees and the Oaks Hospital intends to take actions appropriately to improve the quality of healthcare provided. The clinical audit schedule can be found in Appendix 2. We also undertake any additional local audits that the local commissioning CCG may require. 2.2.3 Participation in Research There were no patients recruited during 2012/13 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 Details of the agreed goals for 2013/14 and for the following 12 month period once agreed with the commissioning CCG will be available electronically at www.oakshospital.co.uk and are outlined below: Goal Number

Goal Name Description of Goal Goal weighting (% of CQUIN scheme available)

Quality Domain (Safety, Effectiveness, Patient Experience or Innovation)

1 Friends and Family Test

Creating a revolution in patient and customer experience: the friends and family test

15% Effectiveness and Patient Experience

2 NHS Safety Thermometer

Improve collection of data in relation to pressure ulcers, falls, and urinary tract infection in those with a catheter

10% Patient Safety

3 Dementia Improve awareness and 15% Patient Safety,

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diagnosis of dementia, using risk assessment, in a hospital setting

Effectiveness and Patient Experience

4 VTE Reduce avoidable death, disability and chronic ill health from Venous-thromboembolism (VTE)

10% Patient Safety, Effectiveness and Patient Experience

5 Alcohol status: Making Every Contact Count

Improve the health of the community by recording alcohol intake of patients and signposting to local support services as required

10% Innovation

6 Early Warning Score Risk Assessment

Reduce clinical risk to patients by undertaking Medical Early Warning Assessments

40% Patient Safety, Effectiveness and Patient Experience

Totals: 100.00% 2.2.5 Statements from the Care Quality Commission (CQC) The Oaks Hospital is required to register with the Care Quality Commission and its current registration status on 31st March is registered without conditions. The Oaks Hospital had an unannounced inspection from the CQC on the 26th July 2012. 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/. The Care Quality Commission has not taken enforcement action against the Oaks Hospital during 2012/13. The Oaks Hospital has not participated in any special reviews or investigations by the CQC during the reporting period. We have had local walkabouts from the previous PCT now the CCG, who looked at areas of patient safety, infection control, patient documentation and patient pathways, positive reports were received.

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2.2.6 Data Quality The Oaks Hospital will be taking the following actions to improve data quality. The unit’s data quality super user is continuing to monitor the 18 week and data quality patient pathway issues weekly and is reviewing processes internally and throughout the administration functions.

NHS Number and General Medical Practice Code Validity The Ramsay Group submitted records during 2010/11 to the Secondary Users Service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data included: The patient’s valid NHS number: • 99.98% for admitted patient care; • 99.95% for outpatient care; and • 0% for accident and emergency care (not undertaken at Ramsay hospitals). The General Medical Practice Code: • 99.99% for admitted patient care; • 99.99% for outpatient care; and • 0% for accident and emergency care (not undertaken at Ramsay hospitals). Information Governance Toolkit attainment levels Ramsay Group Information Governance Assessment Report score overall for 2012/13 was 77% and was graded ‘green’ (satisfactory). This information is publicly available on the DH Information Governance Toolkit website at: https://www.igt.connectingforhealth.nhs.uk/ Hospital Site Audit

Date Re Audit Date

Primary Diagnosis

Secondary Diagnosis

Primary Procedure

Secondary Procedure

Oaks Jan 13 91.67% 94.38% 100% 97.80% Clinical coding error rate The Oaks Hospital was not subject to the Payment by Results clinical coding audit during 2012/13 by the Audit Commission. Table of Coding Errors January 2013 Internal Audit Oaks Hospital Audit January 2013

Total From Episodes Audited

Incorrect Total Incorrect

% Incorrect

Coder Error

Non Coder Error

Primary Diagnosis 60 5 0 5 8.33%

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Secondary Diagnosis 160 9 0 9 5.63% Primary Procedure 60 0 0 0 0% Secondary Procedure 91 2 0 2 2.20% Overall 371 16 0 16 4.31%

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2.2.7 Stakeholders views on 2012/13 Quality Account A copy of our Quality Account was sent to our relevant Local Involvement Network (LINk) and the leading Clinical Commissioning Group (CCG) North East Essex for comments prior to publication. These comments are as follows: Please see below on next page

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Part 3: Review of quality performance 2012/2013

Statements of quality delivery Matron, Juliet Driver

Review of quality performance 1st April 2012 - 31st March 2013 Introduction

‘Our overriding commitment is to provide safe and effective care; the guiding principle is to put our patients’ interests first and key to this is our capacity to listen, be responsive and to act on their feedback. We already take patient views and ratings into account in any assessment of our performance but now we will increasingly draw on effective real-time information and this includes on-line patient surveys. Added to which there are more opportunities to use new measures of quality of care and patient safety and be able to make a difference to improvements in future practice. Importantly these new metrics should ensure performance which needs improving, can be quickly identified and fixed’.

(Jane Cameron, Director of Safety and Clinical Performance, Ramsay Health Care UK)

Ramsay Clinical Governance Framework 2013 The aim of clinical governance is to ensure that Ramsay develop ways of working which assure that the quality of patient care is central to the business of the organisation.

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

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

• Infrastructure • Culture

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• Quality methods • Poor performance • Risk avoidance • Coherence

Ramsay Health Care Clinical Governance Framework

NICE / NPSA guidance Ramsay also complies with the recommendations contained in technology appraisals issued by the National Institute for Health and Clinical Excellence (NICE) and Safety Alerts as issued by the National Patient Safety Agency (NPSA). Ramsay has systems in place for scrutinising all national clinical guidance and selecting those that are applicable to our business and thereafter monitoring their implementation, working closely with the commissioning CCG’s as part of the Standard Acute Contract. 3.1 Patient safety We are a progressive hospital and focussed on stretching our performance every year and in all performance respects, and certainly in regards to our track record for patient safety.

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Risks to patient safety come to light through a number of routes including routine audit, complaints, litigation, adverse incident reporting (Riskman) 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 that follow. Absolute Numbers:

Rate per 100 discharges:

These graphs show a spike in 2011/12 simply because of the changeover from the previous RIMS reporting system to the new Riskman system which allows you to record more accurate information and incidents. This is also due to improved reporting of all incidents for

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all departments within the hospital by empowering the staff to report and be honest and open culture embracing the Riskman system.

3.1.1 Infection prevention and control The Oaks hospital has a very low rate of hospital acquired infection and has had no reported MRSA Bacteraemia in the past 5 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. At the Oaks our Infection Control Nurse is also the Eastern Regional lead for Ramsay Health Care. The Oaks Hospital are also involved with the local North Essex Cluster IPC committee and attend regular meetings. Programmes and activities within our hospital include:

• The Oaks has an in house infection control team led by an infection control nurse involving staff members from every department and a Consultant Microbiologist from the local trust. The infection control team meet quarterly to review all aspects of infection control including audits, training, infection control issues. Infection control is mandatory for all staff and is part of the Ramsay e learning programme. In addition to the mandatory training the infection control nurse carries out hand hygiene training and audits monthly as per the infection control audit programme as seen in appendix 2 and for assurance with the local CCG as part of the Standard Acute Contract. The results of all audits are discussed at the local infection control meetings, the Clinical Governance Committee and Heads of Department meetings.

3.1.2 Cleanliness and hospital hygiene Assessments of safe healthcare environments also include a Patient Environment Assessment Team (PEAT) audit which is now being replaced with the PLACE audit (Patient-Led Assessments of the Care Environment). After piloting the PLACE audit at the Oaks in 2012 this will be undertaken nationally in May 2013 therefore no score is available at present. These assessments include rating of privacy and dignity, food and food service, access issues such as signage, bathroom / toilet environments and overall cleanliness.

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PEAT Audit

75

80

85

90

95

100

2008 2009 2010 2011 2012

Year

% %

Every catering establishment within East Essex have to undertake an annual inspection from the Food Standards Agency to ensure compliance and standards are met. We achieved the highest score of 5 stars, which is an excellent achievement for our catering department.

• The Oaks has an in house housekeeping team who take great pride in the cleanliness of the hospital and carry out self audits to ensure standards are being met. There is also a three monthly environmental audit of all departments that audits the standards of cleanliness in relation to infection control. The catering department is also on site which allows patient’s access to a wide range of appetising and nutritious meals appropriate to their needs. All staff are aware of the absolute requirement to treat all patients with dignity and respect and this is monitored via our external and internal patient questionnaires.

We have received our 2013 score from the information centre for health and social care. The Environmental score = 4 Good, the Food score = 5 Excellent and the Privacy and Dignity score = 5 Excellent. We have strived to improve our score by maintaining high standards of cleanliness, catering facilities and the general environment of the hospital. Much improved score over the last 5 years has been steadily improving each year, mainly due to the implementation of cleaning schedules and staff’s commitment.

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Absolute Numbers:


The infection rates year on year have slowly declined. The infection scores for 2012 of 0.7% were below the national average of between 1-2% 3.1.3 Safety in the workplace Safety hazards in hospitals are diverse ranging from the risk of slip, trip or fall to incidents around sharps and needles. As a result, ensuring our staff have high awareness of safety has been a foundation for our overall risk management programme and this awareness then naturally extends to safeguarding patient safety. Our record in workplace safety as illustrated by Accidents per 1000 Admissions demonstrates the results of safety training and local safety initiatives.

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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. Absolute Numbers:


There has been an increase in these figures which reflects the number of patients admitted to hospital having increased since the previous reporting period, therefore the number of incidences have increased.

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The Oaks Hospital has a local Health & Safety committee that meets bi-monthly to discuss all matters relating to health and safety and to review any adverse events that have occurred. There is a comprehensive system in place to test all equipment (facilities and medical). A slips, trips and falls action plan and corporate policy with a falls risk assessment is used to reduce the number of patient’s falls. 3.2 Clinical effectiveness The Oaks Hospital has a local Clinical Governance committee that meet bi-monthly 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 the Medical Advisory committee to ensure results are visible and tied into actions required by the organisation as a whole.

3.2.1 Return to theatre/Re-operations 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 still remains very low consistent with our track record of successful clinical outcomes.

Absolute Numbers:

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As can be seen in the above graph our re-operations have decreased over the last year and remains low. 3.2.2 Readmission to hospital Monitoring rates of readmission to hospital is another valuable measure of clinical effectiveness. As with return to theatre, any emerging trend with specific surgical operation or surgical team in common may identify contributory factors to be addressed. Ramsay rates of readmission remain very low and this, in part, is due to sound clinical practice ensuring patients are not discharged home too early after treatment and are independently mobile and not in severe pain. Absolute Numbers:

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As can be seen from the above graph our readmissions rate is lower than last year, there has been no significant trends identified. There is now available data (SUS) THAT Ramsay can source regarding patients that have been re admitted within 30 days of an elective admission to hospitals which take emergencies. During the period of this Quality Account there has been 61 patients recorded that have been re admitted to other establishments but have not been recorded on the graph above. Absolute Numbers:

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As you can see the above graphs show that the transfers of patients to external establishments are lower than the previous year.

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 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 and a report of all feedback is disseminated to the heads of department to cascade to their staff in their teams. 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 pathway. Patient experiences are feedback via the various methods below, and are standard agenda items on Local Committtees for discussion, trend analysis and further action where necesary. Escalation and further reporting to Ramsay Corporate and DOH bodies occurs as required and according to Ramsay and DOH policy. Feedback regarding the patient’s experience is encouraged in various ways via:

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Patient satisfaction surveys ‘We value your opinion’ leaflet – available from the hospitals Verbal feedback to Ramsay staff - including Consultants, the management team which

includes Matron, General Manager, Support Services Manager and Heads of departments whilst visiting patients and CCG/CQC visit feedback.

Written feedback via letters/emails/cards 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 Please see previous section 2.1.2 which explains going forward the methods of gathering this information. 3.3.2 Patient Reported Outcome Measures (PROMs) The Oaks Hospital participates in the Department of Health’s PROMs surveys for hip and knee surgery, hernias and varicose veins for NHS patients. The National Joint Registry have recently started to collect pre surgery elbow and shoulder replacement surgery PROMS from 2012. As a Group, Ramsay also conducts its own hip, and knee PROMs surveys specifically for private patients. The graphs below are for NHS data returns.

As the graph above shows, the Oaks PROMS scores for Groin Hernia, is lesser than the National average, this is due to the volumes of these types of procedures undertaken and the data returns.

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As the graph above shows, the Oaks PROMS scores for Varicose veins surgery, is lesser than the National average, this is due to the volumes of these types of procedures undertaken and the data returns due to the NHS restriction criteria.

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As the above graphs show we score slightly higher than our local NHS Trust Colchester Hospital University Foundation Trust (CHUFT) showing again positive results around the patient’s quality of life.

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3.4 The Oaks Hospital Case Study The Oaks Hospital has chosen this year for its case study to focus on a patient positive experience. This patient has signed a written consent to allow us to use all his patient details for this quality account. Mr Bowman was a recent inpatient under the care of an ear, nose and throat consultant who wished to express in an email his gratitude for the service, care and attention he received at the Oaks Hospital. Please see below correspondence received Monday 15th of April 2013; Dear Mr X, I hope my e‐mail finds you ok, as I wanted to write to you to say a BIG Thank You for my recent experience with the Oaks Hospital. People quite often complain, but positive feedback where it’s due should also be highlighted when someone feels they have received exceptional service ‐ like I have. I was referred to Mr X as an NHS patient from my Doctors due to some problems breathing through my nose. Following my consultation appointment and some investigation I then had to have a Septoplasty procedure. Throughout my time under the care of Mr X I found him to be extremely professional, clear with his information to tell me what was happening and he made me feel completely at ease ‐ which for me is a huge thing, given the fact that I can’t stress enough how nervous I am at even just the thought of hospitals! The day that I was in the Oaks, I was greeted and taken to my room by a member of staff, I had been in previously before for another procedure a few years ago (through the NHS) so I knew kind of what to expect, and again your rooms were very clean and as comfortable as they could be (for a hospital). Mr X came to see me and again made me feel relaxed, explaining everything for me to understand. All members of staff I encountered during my stay were fantastic. The anaesthetist gentleman was brilliant and made me feel really relaxed with his jovial attitude and the surgeon chap in the prep room, the only one I remember before falling asleep, was very good too. When I came round there was someone sat beside me filling in some paperwork and ready to give me some water to help with my dry throat and to explain to me that I was ok and that the procedure was complete. The first night for me was awful, but to be honest Mr X had already warned me of that I would be uncomfortable and in pain, but the nurses checked on me throughout the night and made me feel as good as I could. The following day the service continued to be of a very high standard, with regular check‐ups and helping me to remain comfortable before I was discharged. Mr X did come and visit to make sure I was ok and to explain the next steps and I was still feeling a bit woozy he arranged for me to stay for a few extra hours and for me to have some lunch before I left, which really helped and made me feel very well looked after and not just another number. I attended a follow up consultation appointment with Mr X, after 2 agonising weeks of splints in my nose for him to remove them, he and his nurse could tell I was REALLY nervous about this, but again with the nurse by my side the whole time and Mr X talking to me to keep me relaxed etc, when he was finished I didn’t know what I was worried about. He then explained to me what I needed to do to take care of myself to help with the healing process (Nasal Rinse etc). My last appointment with him was a few weeks ago to check the healing progress and see how I was doing. Again I was made to feel very welcome and relaxed and I was very pleased to hear that everything is absolutely fine. So, overall I am extremely pleased with the Oaks, the professionalism, efficiency and friendliness of the staff and the whole process from start to finish, with excellent communication. Everyone who I liaised with in some way were fantastic,

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especially Mr X for his superb services. Considering I was referred as an NHS patient I’d like to say that I was given a top class service. A huge thank you from a very happy patient (who can now breathe properly through his nose) Yours sincerely Mr Steve Bowman This positive patient feedback is disseminated to the Oaks Hospital teams and is also logged onto our RISKMAN system so that trends for consultants can be identified. Here at the Oaks we value all patient feedback and opinions. We encourage as many patients as possible to complete the satisfaction surveys, ‘We value your opinion forms’ or simply contact us to let us know about their experiences.

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Appendix 1

Services covered by this Quality Account Oaks Hospital

Oaks Hospital has 57 beds including 3 twin bedded rooms. The hospital has four theatres (3 with laminar flow) and a new ambulatory care unit. Patients requiring level 2 care are treated and cared for by a well trained team of staff in a dedicated area either theatre recovery or a high dependency room prior to transfer to a critical care facility. 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, Radiology, Physiotherapy and mobile MRI/CT. Oaks Hospital undertakes a range of surgical and medical activity provided by a highly dedicated professional team. Regulated Activities Location: Oaks Hospital, Oaks Place, Mile End Road, Colchester, Essex CO4 5XR. Registered Manager: Vanessa Childs [email protected] Regulated Activities – Oaks Hospital

Services Provided Peoples Needs Met for: Treatment of Disease, Disorder Or injury

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

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

GI physiology Imaging services inc. heel, Cardiology testing, Phlebotomy, Urinary

All adults 18 yrs and over All children 3 yrs and above - outpatients appointments only

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screening screening and specimen collection, general imaging services, interventional radiology, mobile MRI/CT, ultrasound and mammography.

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Appendix 2 – Clinical Audit Programme. Each arrow links to the audit to be completed in each month.

Quality Accounts 2012/13 of 48

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 752 121

www.oakshospital.co.uk Neurological Centres

oaks hospital

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