Our key questions

Our focus is on five key questions that ask whether a provider is:

Safe? – people are protected from abuse and avoidable harm

Effective? – people’s care, treatment and support achieves good

outcomes, promotes a good quality of life and is based on the best

available evidence

Caring? – staff involve and treat people with compassion,

kindness, dignity and respect.

Responsive? – services are organised so that they meet people’s

needs

Well-led? – the leadership, management and governance of the

organisation assure the delivery of high-quality care, supports

learning and innovation, and promotes an open and fair culture.1

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E1: Are people’s needs assessed and care and treatment delivered in line with legislation, standards and evidence-based guidance?

▪ Use and monitoring of best practice guidance including NICE

▪ Avoidance of discrimination

▪ Meeting nutrition and hydration needs

▪ Assessment and management of pain

▪ Use of technology to enhance care

▪ Adherence to Mental Health Act

Effective KLOEs

E2: How are people’s care and treatment outcomesmonitored and how do they compare with other services?

▪ Outcome data collected and monitored

▪ Outcome data shows intended outcome achieved

▪ How do outcomes compare?

▪ Participation in national audits, peer review, accreditation

▪ Use of outcome analysis to improve service

▪ Involvement of staff in outcomes analysis

Effective KLOEs

E3: Do staff have the skills, knowledge and experienceto deliver effective care and treatment?

▪ Staff have the right qualifications, skills, knowledge and experience to do their job

▪ Staff have appropriate training to meet their learning needs

▪ Staff given opportunities to develop

▪ Appraisals, coaching and mentoring, clinical supervision and revalidation

▪ Poor staff performance identified and effectively managed. Staff are supported to improve

Effective KLOEs

E4: How well do staff, teams and services work togetherto deliver effective care and treatment?

▪ All necessary staff, including in different teams, involved in assessing, planning and delivering care

▪ Care delivered in a coordinated way when different teams or services are involved

▪ Staff work together to assess and plan ongoing care, including referral, discharge and transition

▪ People discharged from a service at an appropriate time of day, all relevant teams and services are informed and ongoing care is in place

Effective KLOEs

E5: Do staff have all the information they need to deliver effective care and treatment to people who use services?▪ All information needed to deliver effective care and

treatment available, test and imaging results, care and risk assessments, care plans and case notes

▪ At referral, discharge, transfer and transition, information needed for ongoing care is shared, in a timely way and in line with relevant protocols

▪ Systems that manage information are effective, coordination between electronic and paper-based systems and appropriate access for staff to records

Effective KLOEs

E6: Is people’s consent to care and treatment always sought in line with legislation and guidance?

▪ Consent and decision making requirements of legislation and guidance, including the Mental Capacity Act 2005 and the Children’s Acts 1989 and 2004

▪ People supported to make decisions

▪ Mental capacity to consent to care or treatment assessed and, where appropriate, recorded

▪ Staff make ‘best interests’ decisions in accordance with legislation

Effective KLOEs

Outstanding Effective Services at:The Horder Centre:

Rachel Dixon – Operations Director, Horder Healthcare

Our specialist services

• A nationally recognised Centre of Excellence for orthopaedic surgery

• Independent healthcare provider and charity

• High quality care for both NHS and private patients

• Member of the National Orthopaedic Alliance

• 4,500 orthopaedic procedures in 2018

• 2,500 major joint replacements in 2018

• Only 23 Consultant Surgeons under PPs

• Partner and provider in community MSK triage service

Are services Effective?

Key areas raised on CQC report:

• Informed patient consent

• Competent, specialist staff

• Theatre efficiencies

• Collection and review of patient outcome data

Patient Consent

• What matters to you? Notwhat is the matter with you?

• Consent to treatment by Advanced Practitioners

• Shared decision making training and evidence

• Patient information written and reviewed with patients

• Montgomery principles

Competent Specialist Staff

• Accredited competency framework for healthcare assistants – in preparation for nurse associates & scrub

• Enhanced Recovery competencies for all clinical staff

• Safeguarding requirements, capacity issues

• Dementia training - Butterfly

• Advanced Practitioners development programme for physios, FCP

• Surgical care practitioners – OPD clinics

• Surgeons all specialists

Theatre Efficiencies

• High throughput, 7-8 joints per list

• Exceptional outcomes

• Very low clinical complications▪0.14% re-admission rates▪0.07% re-operation rates

• 100% WHO compliancy

• Team work

“Typical” Theatre Horder Centre Theatre

Operating theatre

Recovery

Anaesthetic room

Recovery

Operating theatre

Anaesthetic room

Orthopaedic Outcomes

‘Formal systems in place for collecting data on patient outcomes’

• Patient Reported Outcome Measures (PROMs) for hip and knee replacements are above the national average.

• 100% compliance to PROMS data collection

• Regular review and benchmark data

• Clinical focus group to trial improvements

• Patient forums

• Physiotherapy outcomes, PROMS & PREMS

NJR Compliance

• 100% Patient Consent recorded on The National Joint Registry

• Informed use of NJR data

• Prostheses choice ODEP10

• Consultants in partnership

• Consultant confidential NJR data

• Consultant engagement framework

• GIRFT

Elements of success:

• Clear patient involvement

• Team work

• Use of data – not collection

• Maximise data available

• Shared learning with patients to make improvements

• Small steps

Effective – how we achieved outstanding

Ian Milne, Hospital Director

Sam Bower, Matron

Nuffield Health Ipswich Hospital

Our Hospital

• Purely private

• 60 in-patient beds

• 5 theatres

• Outpatient department

• Diagnostic Imaging including CT &

MRI

• Physiotherapy

• Pharmacy

• 156 staff

• 110 consultants

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Effective – outstanding highlights from our report

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• Practising privileges

• Professional development

• Patient outcomes

• Policies

• People

Practising Privileges - Competent staff

• There was a robust system for the granting and monitoring of practising privileges.

• The medical advisory committee (MAC) provided scrutiny of all applications and

reviews for consultants practicing privilege rights.

• Privileges were reviewed informally annually and formally every two years, and this

included review of General Medical Council registration, indemnity insurance,

appraisal, training and revalidation.

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Professional Development - Competent Staff

• Staff appraisal rates were high. For example, on the ward area 98% of staff had

completed an appraisal in the last year.

• The hospital provided regular training events for local GPs, which demonstrated

outstanding practice.

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Patient Outcomes - NJR & Clinical Outcomes

• Outcomes for people who used the service were outstanding. The hospital

participated in certain national audits, including the National Joint Registry (NJR),

which showed 100% consent rate.

• We also found that clinical outcomes were robustly monitored and compared monthly

with other Nuffield Health hospitals, showing outstanding outcomes for people overall.

This included low return to theatre and readmission rates.

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Policies - Evidenced based care

• Staff had access to all the information they required to deliver effective care and

treatment.

• There were systems and processes in place to ensure that people’s consent was

sought in line with relevant legislation and guidance.

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People - Multi-disciplinary working

• Staff, teams and other services worked exceptionally well together. There was good

rapport observed between colleagues and care delivery was well co-ordinated when

different teams and services were involved.

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Our Staff

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Thank you.