Archived: Shepton Mallet Health Partnership

Updated 9 May 2017

Shepton Mallet NHS Treatment Centre is operated by Care UK.

The hospital is registered to provide the following regulated activities:

• Treatment of disease, disorder or injury
• Surgical procedures
• Diagnostic and screening procedures

The hospital is located in a semi-rural area in Shepton Mallet, Somerset. The hospital is sited adjacent to an NHS community hospital and within a building leased from NHS Property Services. The hospital provides surgery and outpatients and diagnostic imaging services to NHS patients and primarily serves the communities of Somerset. A registered manager has been in post since 1 April 2008.

Surgery services provide non-urgent surgery for adults who meet strict eligibility criteria to include being over the age of 18 years. Services delivered include orthopaedics, general surgery, ophthalmology and endoscopy, ear, nose and throat (ENT), gynaecology, urology and fracture management.

There are four theatres with normal operating sessions from Monday to Friday between 7.30am and 4pm and optional sessions on Saturdays from 7.30am to 4pm. Theatre 1 is for ophthalmology with capacity for emergency ophthalmic procedures. Theatre 2 is for general surgery, gynaecology, ENT, urology, and minor (non-joint space) orthopaedic procedures; this theatre has capacity for emergency surgical procedures. Theatres 3 and 4 are laminar flow orthopaedic theatres for major joint replacements, upper limb hand and shoulder, foot and ankle, and other orthopaedic procedures; these theatres have the capacity for emergency orthopaedic procedures. Theatre 5 is for recovery,day care, and endoscopy; this is a dedicated area providing colonoscopy, gastroscopy, sigmoidoscopy, and cystoscopy. Normal operating sessions are on Monday to Friday from 7.30am to 4pm with optional operating sessions available on Saturdays from 7.30am to 4pm.

There are eight recovery bays and 10 admission / discharge bays. There are two laminar flow Central Sterile Supplies Department (CSSD) rooms through which all equipment trays are steralised .

The inpatient ward has 34 beds, which are in the format of two / three bedded rooms with en-suite facilities, personal bedside telephones,TVs and free access to Wi-Fi.

Patients access the service at Shepton Mallet NHS Treatment Centre through referral by their GP or acute NHS trust and if eligible are seen in the outpatient clinic before an appointment is arranged for surgery.

The hospital also provides outpatient, physiotherapy and diagnostic imaging services to patients referred for treatment. Referrals are accepted from GPs and via the choose and book patient choice system as long as they meet the criteria for referral. Children or young person under the age of 18 are not treated in the departments.

The outpatient department sees patients from all specialties available within the hospital such as ear, nose and throat (ENT), general surgery, orthopaedic surgery, urology, ophthalmology and gynaecology.

The physiotherapy service provides a service to both inpatients and outpatients. They do not take external referrals, but only see patients having treatment at the hospital.

The diagnostic imaging department provides plain X-rays, ultrasounds and MRI (Magnetic Resonance Imaging) scans to patients attending the hospital.

The hospital was inspected in December 2014 which found that the hospital was meeting all standards of quality and safety it was inspected against.

Updated 9 May 2017

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Shepton Mallet NHS Treatment Centre is operated by Care UK. The hospital has 34 beds. Facilites include four theatres, one daycase and endoscopy theatre, sterile services department, and outpatient and diagnostic facilities.

The hospital provides surgery, and outpatients and diagnostic imaging. We inspected the core services using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 to 13 October 2016 and an unannounced visit on 26 October 2016.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

The main service provided by this hospital was surgery. Where our findings on surgery, for example, governance arrangements, also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated this hospital as outstanding overall.

We found areas of outstanding practice in both surgery and outpatients and diagnostic imaging:

• There were strong, comprehensive and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse.
• Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.
• A proactive approach to anticipating and managing risks was embedded and was recognised as being the responsibility of all staff.
• Patients had excellent outcomes and their care and treatment was planned and delivered in line with evidence-based guidance, standards and best practice.
• An extensive audit programme allowed early identification of areas for improvement and action plans were put in place as a result of any non-compliance.
• The continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care. Staff had the skills required to carry out their roles effectively and were proactively supported to maintain and develop their professional skills and experience.
• There was outstanding care provided to the patients. Patients were respected and valued as individuals and were empowered as partners in their care. Patients were highly satisfied with the care they received and we observed this in practice.
• Services were planned and delivered in a way that met the needs of the local population. Flexibility, choice and continuity of care were reflected in both services.

• The hospital had robust policies and processes in place to effectively investigate, monitor and evaluate patient’s complaints.
• Managers and staff were extremely proud of the organisation and the contribution they made to the healthcare of local people. Patient care was at the centre of everything they did.
• All departments had developed detailed objectives which outlined the quality and business plans for the next year in line with the hospital’s strategic objectives.
• There were comprehensive governance arrangements in place which allowed the hospital to work in line with best practice and deliver high quality care.
• Frontline staff and senior managers were passionate about providing a high quality service for patients with a continual drive to improve the delivery of care.
• There was excellent local leadership of the services. The senior management team had an inspiring shared purpose and were committed to the patients who used the services, and also to their staff and each other.

However, we also found areas of practice that required improvement:

• The store room in theatre required reorganising to ensure the efficient management of supplies.
• The average waiting time for patients attending their first outpatient appointment with a consultant required improvement. The average waiting time was 25 minutes and data showed 9% of patients had waited for longer than an hour.
• Staff in the outpatients department were not consistently aware of how to access information in different formats/languages, and did not follow best practice by using relatives to translate.

Professor Edward Baker

Deputy Chief Inspector of Hospitals (South West)

Updated 9 May 2017

• There were robust systems in place for incident reporting, investigation and learning lessons. Staff received feedback on incidents raised.
• All staff (100%) in outpatients, physiotherapy and diagnostic imaging had completed their mandatory training.
• Staff had knowledge and awareness of safeguarding and despite not seeing or treating children had been trained to level two in children’s safeguarding.
• The departments were visibly clean and tidy. Patient satisfaction scores and feedback from patients during our inspection confirmed the high levels of cleanliness.
• Robust systems were in place to make sure equipment was calibrated and serviced in line with manufacturer’s instructions so that it was safe to use.
• Procedures were in place for the safe storage, prescribing and administration of medicines.
• Every patient who attended the hospital had their medical notes readily accessible in paper and electronic form.
• Staff had a good understanding of what posed a risk to patients and plans were in place to mitigate that risk as much as possible.
• Staffing within outpatients, physiotherapy and diagnostic imaging was sufficient to meet the needs of their patients.
• The staff were well trained and had the knowledge and skills to do their job.
• The patient satisfaction scores showed consistently high rates of patient satisfaction. All the patients we spoke with during our inspection were very complimentary about the hospital, the staff and their care and treatment.
• We observed staff communicating with patients in a way they could understand and in a friendly, respectful and caring manner.
• Staff were aware of the needs of their individual patients and did everything they could to make the patients stay as good as it could be.
• Leadership was effective, approachable and visible. Managers were proud of their teams and the staff we spoke with were proud to work at the hospital.

Updated 9 May 2017

We rated this service as outstanding because:

• There were clear processes in place to ensure the safety of patients. Incidents were reported and investigated acted upon with feedback and learning provided to staff.
• All areas in theatre and on the ward were visibly clean to a high standard and staff demonstrated good infection control practice to reduce the risk of infection.
• There were policies and procedures to be followed for the safe management of medicines.
• Comprehensive risk assessments were carried out and regularly reviewed.
• Nursing and surgical staffing were planned and reviewed regularly in line with best practice guidance to ensure patients received safe care and treatment. Staff were knowledgeable and experienced in their roles.
• Treatment and care were effective and delivered in accordance with best practice and recognised national guidelines.
• Patients were well supported with nutrition, hydration and pain relief.
• Patients were at the centre of the service and the priority for staff.
• Patients received excellent care from dedicated, caring and well trained staff who were skilled in working and communicating with patients.
• Staff understood the individual needs of patients and designed and delivered services to meet them. Patients were kept involved with their care and staff ensured their full understanding.
• Patients spoke highly of the approach and commitment of the staff who provided the service. Feedback from those who used the service had been exceptionally positive. Staff went above and beyond their usual duties to ensure patients received compassionate care.
• There were clear lines of local management in place and structures for managing governance and measuring quality.
• The leadership and culture of the service drove improvement and the delivery of high-quality individual care.
• All staff were committed to patients and to their colleagues. There were high levels of staff satisfaction with staff saying they were proud of the hospital as a place to work. They spoke highly of the culture and levels of engagement from managers.
• There was a good track record of lessons learnt and improvements when things went wrong. This was supported by staff working in an open and honest culture with a desire to get things right.
• Innovation, high performance and the high quality of care were encouraged and acknowledged.