Agenda item

(To receive a report from Simon Evans (Health Scrutiny Officer) which provides the Committee with relevant information to enable completion of the draft statement for the 2016 Quality Account on Boston West Hospital.  Carl Cottam, General Manager, Boston West Hospital, will be in attendance for this item)

Consideration was given to a report from the Health Scrutiny Officer which provided the Committee with relevant information to enable completion of the draft statement for the 2016 Quality Account on Boston West Hospital.

Carl Cottam (General Manager, Boston West Hospital) was in attendance for this item.

Members were given the background of Boston West Hospital, part of Ramsay Health Care UK, which undertook a significant proportion of NHS-funded activity.  The information presented to the Committee had been compiled from the 2014/15 Quality Account of Boston West Hospital and the Care Quality Commission inspection report. 

The hospital was a purpose built facility which provided services for the assessment, diagnosis and treatment of medical conditions with a suite of outpatient and treatment rooms.  A theatre also undertook a range of surgical procedures and endoscopic (diagnostic) investigations.

The Hospital provided a wide range of services, covering NHS and private day-case facilities, for the following specialities:-

·       Orthopaedic;

·       Ophthalmology;

·       General Surgery;

·       Pain Management;

·       Gynaecology;

·       Gastroenterology;

·       Urology;

·       Physiotherapy;

·       Cosmetic Surgery; and

·       ENT.

Treatment was provided for adult patients (excluding children below 18 years of age) whether NHS-funded, privately insured or self-pay.  A high percentage of patients were through the NHS with patients choosing to use the facility through the NHS "Choose and Book" system.

It was confirmed that the hospital received the standard NHS tariff for NHS-funded patients which helped to ease the pressure on other NHS facilities, including Lincoln County Hospital and Pilgrim Hospital.

2980 (95%) patients admitted during 2014/15 were NHS-funded with an additional 590 patients seen through the Hospital's outpatient department.  The Hospital offered consultant led care which meant that all patients were seen by a consultant during their patient care pathway.

The Care Quality Commission had published the most recent inspection report on Boston West Hospital in October 2015.  The overall rating was 'good' but several areas of outstanding practice were highlighted as below:-

·       100% of staff had completed all mandatory training and appraisals in 2014/15;

·       The hospital had been awarded accreditation by the Joint Advisory Group (JAG) on gastrointestinal endoscopy and was the first independent hospital to achieve this; and

·       The hospital operated a 24 hour telephone helpline run by hospital staff which was available to all patients post procedure or operation.

In addition to the areas of outstanding practice, two areas of poor practice requiring improvement were highlighted:-

·       Ensure specialist personal protective equipment (PPE) in radiology, including lead aprons, was checked regularly; and

·       Ensure requests to repair equipment were made, recorded and completed using standard processes and procedures.

The 2014/15 Quality Accounts for Boston West Hospital had included the following priorities for 2015/16:-

·       Patient Experience;

·       Clinical Effectiveness; and

·       Patient Safety.

Members were given the opportunity to ask questions, following which the following points were noted:-

·       Although one of the issues highlighted by the CQC was in relation to the regular checks of the Personal Protective Equipment (PPE) in radiology, it was explained that all checks were undertaken but that incomplete record keeping had resulted in the observation;

·       Any negative comments from patients were followed up whether the feedback related to parking, administration or clinical experience.  Although the Hospital did not receive much negative feedback, each patient would be contacted personally to make further enquiries.  Should a complaint be received, this would be followed through the formal complaints policy but the Committee were assured that all patient contact was responded to;

·       NHS referrals came through the Choose and Book system, although a proportion of patients were referred by providers.  As part of the care pathway, patient need would be established and their ability to be safely discharged following the procedure or if admission would be required.  All these provisions were checked at the start of the patient pathway to ensure that all relevant provisions were in place;

·       A future initiative of the hospital was to submit a planning application for an x-ray facility.  In the meantime, a Service Level Agreement (SLA) was in place with United Lincolnshire Hospitals NHS Trust (ULHT) which meant that patients would have an x-ray at a hospital within ULHT following which the images would be sent to Boston West Hospital;

·       It was thought that NHS IT systems were generally accessible but this would be slightly more difficult if it were an external provider.  Images could now be requested through electronic means and, although this system was in its infancy, it was anticipated to quicken the process;

·       Under a Service Level Agreement (SLA) with ULHT, four diagnostic centres were used by the hospital.  Diagnostics were also undertaken at Peterborough Hospital.  It was acknowledged that some hospitals may result in patients travelling some distance, however this was subject to waiting times at each diagnostic facility and the requirement of the patient;

·       It was stressed to the Committee that the suggestion that this type of hospital charged a higher rate to see NHS patients was incorrect.  As part of the standard contract, commissioners were invoiced based on the national NHS tariffs.  In order to decide how much commissioners would be charged, the information of each patient was inputted in to NHS Payment Grouper system which provided a cost which could then be invoiced.  This framework was used by all providers;

·       Although Boston West Hospital had not used agency staff in this period, the Committee were advised that they had used an agency on one occasion.  Retention of nursing staff within Lincolnshire was acknowledged as a challenge but Boston West Hospital had been successful in retaining staff and building a good relationship with them;

·       The hospital employed one full-time anaesthetist but there was provision to employ another.  As part of the GC4 contract, it was explained that two surgeons, a general surgeon and an anaesthetist were employed on a full-time basis by Ramsay Health Care privately.  Additionally, a number of consultants were employed who were able to practice under licensing arrangements but were not under the employment of the hospital;

·       All consultants had to be approved by the General Medical Council (GMC) before they were able to practise. Ramsay Health Care also operated a Corporate Committee, chaired by the Medical Director, as part of a credentialing process which considered DBS checks, qualifications and clinical governance;

·       Patients were to meet access criteria before being referred to the hospital and that process would commence at the GP practice, following which diagnostic procedures would decide the requirement of the patient.  Should that result in the requirement for inpatient care, the case would be referred back to a more appropriate provider;

·       Boston West Hospital operated Monday to Saturday and opened at 7.30am.  Theatre closed somewhere between 7pm and 8pm;

·       All patients referred to Boston West Hospital were taken provided it was safe and appropriate to do so, bearing in mind the facility was a day-case unit;

·       Although a number of patients were attending Boston West Hospital rather than day-case units at Lincoln County Hospital or Boston Pilgrim Hospital, it was stressed that this was, in the majority of cases, patient choice;

The Chairman thanked Mr Cottam for addressing the Committee.

RESOLVED

1.    That the report and comments be noted; and

2.    That the information be used by the Committee to better inform its statement on the draft Quality Account of Boston West Hospital.