Quality Account Template - 2011 0411 2 doc FINAL · Quality Accounts 2010/11 Page 4 of 39...

Quality Accounts 2010/11 of 39

Contents

Introduction Page 2

Welcome to Ramsay Health Care UK 3

Welcome to The Yorkshire Clinic 4

Introduction to our Quality Account 5

PART 1 – STATEMENT ON QUALITY

1.1 Statement from the General Manager 6

1.2 Hospital accountability statement 7

PART 2

2.1 Priorities for Improvement

2.1.1 Review of clinical priorities 2010/11 (looking back) 8

2.1.2 Clinical Priorities for 2011/12 (looking forward) 10

2.2Mandatory statements relating to the quality of NHS services provided

2.2.1 Review of Services 15

2.2.2 Participation in Clinical Audit 16

2.2.3 Participation in Research 17

2.2.4 Goals agreed with Commissioners 17

2.2.5 Statement from the Care Quality Commission 18

2.2.6 Statement on Data Quality 18

2.2.7 Stakeholders views on 2010/11 Quality Accounts 20

PART 3 – REVIEW OF QUALITY PERFORMANCE 24

3.1 Patient Safety 25

3.2 Clinical Effectiveness 29

3.3 Patient Experience 31

3.4 Case Study 35

Appendix 1 – Services Covered by this Quality Account 36

Appendix 2 – Clinical Audits 37

Appendix 3 – Glossary of Abbreviations 38


Welcome to Ramsay Health Care UK The Yorkshire Clinic is part of the Ramsay Health Care Group

The Ramsay Health Care Group was established in 1964 and has grown to become

a global hospital group operating over 100 hospitals and day surgery facilities across

Australia, the United Kingdom, Indonesia and France. Within the UK, Ramsay

Health Care is one of the leading providers of independent hospital services in

England, with a network of 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)


Introduction to our Quality Account

This Quality Account is The Yorkshire Clinics 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 previous Quality Account for 2009/10 was developed by our Corporate Office

and summarised and reviewed quality activities across every hospital and centre

within the Ramsay Health Care UK. It was recognised that this didn’t provide enough

localised information for the public and commissioners about the quality of services

within each individual hospital and how this relates to the local community it serves.

Therefore, each site within the Ramsay Group will develop its own Quality Account

from this 2011 onwards, which will include some Group wide initiatives, but will also

describe the many excellent local achievements and quality plans that we would like

to share.


Part 11.1 Statement on quality from the General Manager

Rachel Bradbury, General Manager, The Yorkshire Clinic

“The Yorkshire Clinic is committed to being a leading provider of healthcare services by delivering high quality outcomes for patients.”

This is the first Quality Account to be submitted by The Yorkshire Clinic and has been produced to demonstrate our commitment to measuring all feedback from patients about their experience, clinical treatment and clinical outcomes. This allows us to continually review, reflect and improve the patient’s journey.

Patient safety is our highest priority and our robust recruitment processes and training programmes ensure that staff are competent and fully trained in all aspects of service provision.

The Yorkshire Clinic continually achieves consistent patient satisfaction scores and, by studying results throughout the year, we constantly seek ways to further improve the patient experience.

The Yorkshire Clinic is committed to ensuring that patients are kept fully informed about their treatment, which is also a significant factor associated with improving treatment outcomes. We involve our patients in treatment decisions at the earliest stage so that the options and benefits are fully discussed before patients consent to treatment. Our medical and clinical teams recognise the importance of devotingtime to patient preparation for surgery, which not only reduces risk but also improves patient understanding and confidence, reduces anxiety, improves rates of recovery and shortens lengths of hospital stay.

Whilst patient feedback and involvement is extremely important to us, we also rely heavily on other measures of safety and clinical effectiveness which we use to satisfy ourselves that treatment is evidence-based and delivered by appropriately qualified and experienced doctors, nurses and other key healthcare professionals. Examples of these are detailed in this Quality Account.

The Yorkshire Clinic is accustomed to the disciplines of regulatory and contractual requirements to assure healthcare commissioners of our clinical performance and to report complaints and serious incidents to regulators and commissioners. Wealso maintain a Risk Register and systematically review specific actions to achieve risk reduction.


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.

Rachel BradburyGeneral ManagerThe Yorkshire Clinic Ramsay Health Care UK

This report has been reviewed and approved by:

Professor Peter O’Donovan – MAC ChairmanMr James Halstead - Clinical Governance ChairMr Stefan Andrejczuk – Regional Director North


Welcome to The Yorkshire Clinic

The Yorkshire Clinic is a private hospital situated in the grounds of Cottingley Hall in Bingley, West Yorkshire. The hospital offers care to patients with private medical insurance, patients who wish to fund their own treatments and patient referred through the NHS Patient Choice Scheme.

The hospital provides a full range of high quality services, these include, outpatient consultation, outpatient procedures, investigations/diagnostics, surgery and follow up care. During the last 12 months the hospital has treated 12,606 patients, 60% of which were treated under the care of the NHS. All NHS patients treated at the hospital must be over 18 years of age as defined by the Standard Acute Contract.

Currently, 219 specialist Consultants work from the facility and are supported by a team of 65 Nursing staff, split between 65 Nursing staff, 28 Health Care Assistants, 58 support staff which includes porters/ hotel services plus 55 administration staff. The hospitals Resident Medical Officer is on site 24 hours a day, working alongside these teams.

The hospital has built excellent working relationships with Bradford Teaching Hospitals NHS Trust, Leeds Teaching Hospital NHS Trust and Airedale Foundation Trust in order to deliver a joint approach to patient care delivery across the patient economy.

Our GP Liaison Officer provides links to local General Practitioners to ensure that their needs and expectations are managed and through these links referral processes are developed in order to streamline processes.

The Yorkshire Clinic also works with local charities within the local community, hosting events in their support.


Part 2

2.1 Quality priorities for 2010/2011

Plan for 2010/11

On an annual cycle, The Yorkshire Clinic develops an operational plan to set objectives for the year ahead.

We have a clear commitment to our patients and work in partnership with the NHS ensuring that those services commissioned to us, result in safe, quality treatment for all 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 hospitals Senior Management Team taking into account patient feedback, audit results, national guidance, and the recommendations from various hospital committees which represent all professional and management levels.

Most importantly, we believe our priorities must drive patient safety, clinical effectiveness and improve the experience of all people visiting our hospital.

Priorities for improvement

2.1.1 A review of clinical priorities 2010/11

• Bar coding for patient identity bands – this priority did not progress last year, as the Department of Health’s Information Standards Board (ISB) advance notice was not followed up with a formal notice for implementation. Consequently the project was put on hold until further advice was received from the ISB. However, this is still on Ramsay’s agenda and will be introduced this year as it is still considered best practice and will prepare us for many patient care initiatives which will require patients to have a barcode on their wristbands. In preparation for this The Yorkshire Clinic electronically prints all patient identity bands as per the NPSA ‘Standardising Wrist Bands Alert’ 2007

• Safer Surgery Checklists – further work was undertaken and two more speciality specific checklists for radiology and cataracts have been implemented to further reduce the risk of wrong site surgery.


• Cleanliness – A environmental audit was completed and added to the Ramsay audit programme in July 2010. As per High Impact Intervention VIII (DoH ‘Saving Lives: Reducing Infection; Delivering Clean and Safe Care. 2007) this evidences two new areas implemented in the year, equipment cleaning compliance and mattress audit compliance. A cleaning matrix has been written and is available throughout the hospital identifying equipment to be cleaned; when; with what and by whom. The ‘green label system’ is used to evidence cleanliness to patients and staff. PEAT (Patient Environment Action Team) audits were also repeated and The Yorkshire Clinic showed an improvement of 13% in the twelve months

to April 2011.• The Yorkshire Clinic opened a new Endoscopy Suite in September 2009. We

participate in the Global Rating Score audit system (GRS) and are working towards a Joint Advisory Group (JAG) accreditation. Our endoscopy team have all successfully achieved their endoscopy competencies to enable The Yorkshire Clinic to meet the National Endoscopy Standards.

• As part of Ramsay’s National Project for Ambulatory Day Care services The Yorkshire Clinic has: -1. Undertaken a full Pre-Operative Assessment (POA) review; the

individualised patient care pathways are commenced at POA involving the patient in all areas of their journey from pre-admission to discharge. To continually improve and measure the service we offer, a quarterly audit of the POA documentation is carried out at The Yorkshire Clinic.

2. To ensure we provide and maintain a high standard of pre-operative care, all qualified POA staff have successfully completed Pre-assessment training (A & L Healthcare) and the Day Surgery Sister is a member of the British Association of Day Care Surgery (BADS).

3. In order to facilitate the ambulatory process we strive to place ambulatory day care patients first on operating lists or, as clinically indicated. The majority of patients attending for local anaesthesia procedures are allocated to The Lodge Theatre which is a dedicated day surgery unit.

4. The Yorkshire Clinic have introduced, where appropriate, staggered admission times to improve the patient experience, aiming to reduce the waiting time from admission to procedure.

5. To further enhance efficiencies at The Yorkshire Clinic a nurse led discharge service is operational within our Ambulatory Units.

6. On discharge, patients are provided with contact details should they have any post operative problems. All ambulatory patients receive a post discharge phone call within 48 hrs of admission.

• Releasing time to care – the Productive Ward project was successfully trialled at 5 Ramsay sites during 2010. An instruction manual has been developed by the project team and roll out sessions are being held regionally throughout the first half of 2011. In June 2011 The Yorkshire Clinic will be commencing this scheme.


2.1.2 Clinical Priorities for 2011/12

Patient Safety

1. Falls – ‘each year around 282,000 patient falls are reported to the National Patient Safety Agency (NPSA) from hospitals and other health units.’ (Jan 2011, NHS NPSA/20111RRR001). At The Yorkshire Clinic a project was undertaken during 2010 to monitor the number of patient falls, identify the risks and formulate an action plan to minimize slips/trips and falls: -To maximize patient safety all patients are asked to complete a medicalquestionnaire which is assessed by the POA team to identify any potential risks prior to admission. On admission a “risk of falls assessment” is performed for every patient by the admitting nurse, this is reviewed daily and care altered accordingly.Information for patients on how to minimize the risk of falls following surgery/procedures is available in the patient information folder in every room. Any slip/trip or fall is reported through our robust Risk Management Committee identifying any trends, formulating andimplementing action plans across the hospital to help improve patient safety.Slip/trips/falls recorded/reported during 2008 totaled 12, during 2009 – 21 and during 2010 – 7. The increase in 2009 was due to major development works throughout the hospital as the recorded incidents include staff, contractors, visitors and patients. The reduction during 2010 is clear and wholly attributed to the introduction of a comprehensive action plan.

2. ‘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-eventsThere are 25 recognised ‘never events’ of which 5 have been identified as core events: -

• Wrong site surgery – The Yorkshire Clinic have implemented the World Health Organisation (WHO) recommendations for Safer Surgery checklist. The checklist is a tool used throughout the peri-operative period by the relevant clinical team to improve the safety of surgery by reducing complications, ensuring anaesthetic safety and correct site surgery, avoiding surgical site infections and greatly improving communications within the team.

• Retained instrument post-operation – WHO checklist introduced as above plus the surgical count procedure including all swabs, needles and instruments used during surgery to eliminate this risk.

• Wrong route administration of Chemotherapy – The Yorkshire Clinic has patient specific chemotherapy prescription charts which clearly define route of administration. The chemotherapy is checked by two senior staff members prior to administration by our Oncology Nurse Specialist.


• Misplaced naso or orgastric tube not detected prior to use – rarely used at The Yorkshire Clinic, however, a pH test is undertaken prior to use of any naso- or oro-gastric tube

• Intravenous administration of mis-selected concentrated potassium chloride – stored in Pharmacy as a controlled drug only. Ordered, recorded and prescribed as a controlled drug. To discourage the use of the concentrated solution The Yorkshire Clinic pharmacy stock a dilute form of potassium and are working towards removing the concentrated solution from their stock.

The Yorkshire Clinic has experienced zero ‘Never Events’ in the last two years.

3. VTE risk assessment – The Yorkshire Clinic carry out a VTE risk assessment on all admitted surgical patients as per Ramsay Policy No CM001 and adhering to National Institute for Clinical Excellence (NICE) Guidance 2010. All pre-assessment staff have completed VTE competency assessment via DoH on line assessment tool and The Yorkshire Clinic aim to have all ward based nurses through this competency package in 2011.From 1st April 2011 The Yorkshire Clinic has entered into a contract for the provision of NHS services through the Commissioning for Quality & Innovation Payment Framework (CQUINs). Payment is conditional on achieving quality improvement and innovation goals, this includes VTE risk assessment. Compliance is audited through a robust corporate and local audit programme and results/action plans reviewed through Clinical Governance.Compliance results are benchmarked through the National Statistics at http://www.dh.gov.uk/en/publicationsandstatistics/Publications/PublicationsStatistics/DH

4. Infection Control -A comprehensive infection control audit programme has been undertaken throughout 2010, the main focus being to increase infection prevention and control awareness throughout the hospital. Audits undertaken were: -

1. Central venous catheter care2. Surgical Site Infection3. Hand hygiene4. Peripheral Venous catheter care5. Urinary catheter care6. Isolation7. PEAT – Patient environment action team.8. Sharps

Hand hygiene remains high on the Infection Control agenda at The Yorkshire Clinic for 2011. Aseptic Non Touch Technique (ANTT) will be introduced throughout the year aiming to reduce risk through staff training and transparency of care.


5. Real time incident reporting – The Yorkshire Clinic strives to report any incidents in real time through the Risk Information Management System (RIMS). The system immediately reports any incident into the Corporate Risk Management Team therefore trends can be identified throughout the Ramsay organisation. Locally all incidents are reported through Risk Management and Clinical Governance groups and action plans developed and implemented at a local level to improve safety.

Other National reporting mechanisms e.g. MHRA; CQC; local NHS networkare used as required following specific incidents alerting nationally recognised organisations of identified risks.

6. National Joint Registry – The Yorkshire Clinic participates in the National Joint Registry audit programme (NJR). Patients undergoing hip or knee replacement surgery are asked to consent to their information being placed upon the NJR including details of their prosthesis. The NJR provide a quarterly report to the Hospital regarding compliance. The Yorkshire Clinic exceeds the 90% benchmark figure for completion.

7. Pulse Staff satisfaction – Ramsay staff undertake an anonymous survey annually to identify areas where staff satisfaction can be improved upon. One area for action at The Yorkshire Clinic is ‘staff training and development.’ Our previous results show 2009 – 53.4%; 2010 – 57.7% A ‘Pulse action group’ was formed and a plan formulated to improve these results. In 2010 Ramsay e-learning training courses were introduced these can be accessed easily by all staff either at work or at home. Training is now an agenda item on all team meetings to raise awareness of both the Ramsay training programmes and external courses.

8. Acute Care Competencies / Vulnerable Adult training – ensuring safe, competent staff are available to care for patients. The Yorkshire Clinic staffcomplete annual mandatory training programmes and receive in-house practical training. An electronic training register is kept to monitor staff completion.

Clinical Effectiveness

1. Ambulatory Day Care – better outcomes and improving patient experience –

• 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.

• Over recent years, partly due to medical advances the number of day surgery patients has increased compared to those requiring in-patient care. In 2010 the percentage of day surgery patients we treated was 78.7%.


• At the Yorkshire Clinic we aim to ensure that 100% of our Ambulatory Day Care patients will be treated in one of our ambulatory care facilities.

• In order to achieve this The Yorkshire Clinic provides patients with a more efficient pathway through the hospital. We have a dedicated day surgery facility that is separate from our in-patient facility, best practice has shown that this improves waiting times and recovery periods are reduced.

• We will monitor the ambulatory day care experience through our patient satisfaction surveys.

2. Group pre-operative assessments for major joint replacements – The Yorkshire Clinic hold pre-operative group physiotherapy sessions for patientswho are coming into hospital for joint replacements; this gives information in an environment which encourages group interaction and discussion. The Yorkshire Clinic is taking part in the Ramsay pilot scheme to further enhance the POA for our patients.

3. Improve National Benchmarking - 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, e.g. benchmarking in the following areas:Hellenic

• Hellenic will provide national benchmark figures for key performance indicators (such as activity/volumes, mortality, day case rates, unplanned readmissions, average length of stay, unplanned transfers, returns to theatre).

VTE risk assessment compliance• Benchmarking through the national stats website. Link:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH

PROMS results• Benchmarking through national PROMS website. Link:

http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&category

Patient satisfaction figures• Using CQUIN indicators common to both NHS survey and our own

Ramsay Healthcare ‘The Leadership Factor’ survey. The YorkshireClinic asks all patients to complete a ‘We Value Your Opinion’ leaflet to enable us to collate patient opinion and act immediately upon any concerns.


4. Improve ward efficiency by adopting the Productive Ward initiative –more time to careThe 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. This initiative asks for staff suggestions for ways in which they could improve the hospital environment and processes empowering them to make changes essential to give them more time to care.

5. Improved patient information

It was recognised from our patient satisfaction survey results that our patients were not always receiving adequate written information. This is important as even though we always tell our patients everything they need to know pre and post-admission, a written reminder ensures that they have the same information should they need to refer to it at a later date. At The Yorkshire Clinic all written communications were reviewed and our survey results show an improvement with pre-operative information between Q4 2010 and Q1 2011 from 89% to 91.8%. However, our discharge information satisfaction according to our survey results in Q4 2010 to Q1 2011 has decreased from 91.4% to 90.5%. Actions are underway to improve this result.

Patient experience – informing patient choice

1. Increasing the use of Patient Reported Outcomes Studies (PROMs) – The Yorkshire Clinic use the National PROMS results for hip, knee, hernias, varicose vein and cataract surgery. These are used to gain a better understanding of treatment outcomes from a patient point of view. Results are shared with Consultants on an individual basis at our quarterly Medical Advisory Committee (MAC), and Clinical Governance meetings. All members of the multi-disciplinary team are encouraged to review the PROMs outcomes and changes made as required to improve the patient experience.

2. Patient Satisfaction survey – An area for development from our patient satisfaction survey was that patients were not always aware of staff hand washing. A pro-active approach was implemented to ensure patients were either able to view staff washing their hands or were informed that this was to happen. Staff were also provided with pocket hand-gel to further enhance the awareness of the importance of hand hygiene. This resulted in an improvement in patient recognition from 95% in Q4 2010 to 100% Q1 2011.


Mandatory StatementsThe following section contains the mandatory statements common to all QualityAccounts as required by the regulations set out by the Department of Health.

2.2.1 Review of Services

During 2010/11 the Yorkshire Clinic provided and/or subcontracted 17 NHS services.

The Yorkshire Clinic continually reviews all the data available to them on the quality of care provided.

The income generated by the NHS services reviewed from 1 April 2010 to 31 March 2011 represents 60% per cent of the total income generated from the provision of NHS services by The Yorkshire Clinic from 1 April 2010 to 31 March 2011.

Ramsay uses a balanced scorecard approach to give an overview of audit results across the critical areas of patient care. The indicators on the Ramsay scorecard are reviewed each year. The scorecard is reviewed each quarter by the hospitals senior managers together with regional and Corporate Managers. The balanced scorecard approach has been an extremely successful tool in helping us benchmark against other hospitals and identifying key areas for improvement.

In the period for 2010/11, the indicators on the scorecard which affect patient safety and quality were:

Human ResourcesHCA Hours as a % of Total Nursing hours is 18.2%Agency Hours as % of Total Hours is 0.3%5.4% Staff Turnover4.84% SicknessMandatory Training = 85%Staff Satisfaction Score = 90%Number of Significant Staff Injuries = 1

PatientFormal complaints 1st April 2010 to 31st March 2011 = 0.4%94.8% Patient Satisfaction Score2 significant reportable clinical events per 13.851 patients during 2010 = 0.0%.29 Readmissions per 12,606 patients in 20100 EMSA (Eliminating Mixed Sex Accommodation) breaches


Quality

A comprehensive Health, Safety and Facilities audit was carried out at the Yorkshire Clinic by the Estates Manager at the end of 2010. This internal audit returned a score of 87% compliance and an action plan has been developed to correct the key areas identified. A Disability Discrimination Act audit was carried out in March 2011.

2.2.2 Participation in Clinical Audit

During 1 April 2010 to 31 March 2011, 5 national clinical audits covered NHS services that The Yorkshire Clinic provides.

The national clinical audits and national confidential enquiries that The Yorkshire Clinic was eligible to participate in during 1 April 2010 to 31March 2011 are as follows: -

National Clinical Audits (NA = not applicable to the services provided)

Name of AuditParticipation(NA, Yes, No)

% cases submitted

Cardiac arrest (National Cardiac Arrest Audit) YES O%

Elective procedures Hip, knee and ankle replacements (National Joint Registry)

YES100%

Elective surgery (National PROMs Programme) YES 100%

Blood transfusion O neg blood use (National Comparative Audit of Blood Transfusion)

N/A

Numbers insufficient for Audit

Platelet use (National Comparative Audit of Blood Transfusion)

N/ANumbers insufficient for Audit

Additional AuditsNational Surveillance Programme (HPA) YES YES

PEAT YES YES

The reports of 5 national clinical audits from 1 April 2010 to 31 March 2011 were reviewed by the Clinical Governance Committee at The Yorkshire Clinic.


Local Audits

The Yorkshire Clinic participates in the Ramsay Corporate Audit programme (the schedule can be found in appendix 2) and also carries out a number of local clinical audits all of which go through the Clinical Governance Committee and actions taken to improve the quality of the healthcare provided:-

• MEWS – medical early warning score• Cardiac Arrest Scenario• Waterlow• Pregnancy test• Pre-operative assessment documentation• Critical Care Trolley• WHO – surgical safety check• VTE assessment

The MEWS audit identified a failure by recovery staff to record a MEWS score prior to the patient returning to the ward. This issue was addressed at Theatre Team meetings and ward staff were informed not to accept patients for transfer until a score had been documented. Further audit following implementation of the action plan has seen a substantial improvement in our compliance rate as illustrated below:

December 2010 72% complianceJanuary 2011 84% complianceMarch 2011 93% compliance

2.2.3 Participation in Research

There were no patients recruited during 2010/11to 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

The Yorkshire Clinic income from 1 April 2010 to 31 March 2011 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework because patient safety is our highest priority and we provide sufficient qualified and trained staff to deliver the service in a safe environment. We ensure that our staff are competent through a robust recruitment process and training programmes. We believe it is essential to provide the right person in the right role at the right time to deliver safe and effective treatment and care. Staff are trained on all the equipment they are required to use. They are not allowed to use equipment until they have been trained and deemed competent.


2.2.5 Statements from the Care Quality Commission (CQC)

The Yorkshire Clinic is required to register with the Care Quality Commission and its current registration status on 31st March is registered without conditions

The Care Quality Commission has not taken enforcement action against The Yorkshire Clinic during 2010/11.

The Yorkshire Clinic has not participated in any special reviews or investigations by the CQC during the reporting period.

2.2.6 Data Quality

The Yorkshire Clinic will be taking the following actions to improve data quality.

Data quality is one of our highest priorities to ensure we produce clean and accurate electronic data.

At The Yorkshire Clinic our electronic data quality is checked at every phase of the patient journey by our staff and monitored constantly by a dedicated data quality team using multiple reporting mechanisms and various checks to enable us to ensure the data is of the highest standard.

NHS Number and General Medical Practice Code Validity

The Yorkshire Clinic submitted records during 2010/11 to the SecondaryUses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included:

The patient’s valid NHS number was:

98.9% for admitted patient care;98.7% for out patient care; and0% for accident and emergency care (not undertaken at our hospital).

The General Medical Practice Code was:99.9 % for admitted patient care;99.7% for out patient care; and0% for accident and emergency care (not undertaken at our hospital).


Information Governance Toolkit attainment levels

Ramsay Group Information Governance Assessment Report overall score for 2010/11 was 79% and was graded ‘green’ (satisfactory).

Clinical coding error rate

The Yorkshire Clinic was subject to the Payment by Results clinical coding audit during 2010/11 by the Audit Commission and the error rates reported in the latest published audit for that period for diagnoses and treatment coding (clinical coding) were:

% Primary Diagnosis Incorrect

% Secondary Diagnosis Incorrect

% Primary Procedures

Incorrect

% Secondary Procedures

Incorrect7 20.8 5.2 0.7

The Yorkshire Clinic employs a full time Clinical Coder who is responsible for all procedure coding and is actively involved in all audit processes. All areas for improvement identified as part of the audit now completed. NHS Bradford and Airedale were present at the audit feedback and supportive of our action plan.


2.2.7 Stakeholders views on 2010/11 Quality Account

The Yorkshire Clinic

2010-2011 Quality Accounts

Statement by Bradford District LINk - Care Quality Working Group

(CQWG)

Bradford LINk CQWG welcomes this opportunity to submit a statement on the Yorkshire Clinic (YC)

Quality Accounts [QAs]. We wish to thank the management of the Yorkshire Clinic for their prompt

response to a number of queries we had about this QA and for their readiness to meet with us in the

course of the coming year to discuss their service.

The YC’s contribution to health care provision is the District is clearly explained and their approach to

managing the quality of care is well set out in this QA

QAs are intended to provide readily accessible information to the public and the Department of Health

[DH] have asked local LINks to consider carefully “whether or not the Accounts are presented in a patient

friendly way”. We welcome the inclusion of a glossary in this QA.

Whilst we appreciate the clarity of the document’s language and much of the detail provided we have

some suggestions that might further improve the usefulness of the information published.

We were disappointed that some information about the quality of care was not clearly set out in the

report for example:

• it was unclear to us what the PROMs data in section 3.3.2. amounted to and whilst the provision of

web links is useful it is not by itself adequate – not all of the public have readily available web

access and not all of the public have the skills to navigate a site such as Hospital Episode Statistics

on-line. The publication of some clearly explained data is also necessary.

• Similarly, it would be useful to publish more detail from patient satisfaction surveys (referred to

on page 13) beyond the headline statistic quoted on page 29.

The LINk team express deep concern that, within the timescale proscribed by the DH, they had not been

able to give more detailed consideration to YC’s Quality Accounts, nor to meet members of the Trust

responsible for compilation of the Accounts. They urge DH to reassess the timescale, with a view to

permitting the level of consideration which Quality Accounts clearly justify and to recognise, and reduce,

the ‘bunching’ that occurs where a number of Provider organisations request LINk consultations in the

same short time window and from a small pool of highly skilled, and available, LINk (unpaid) volunteers.


NHS Bradford and Airedale commissioner statement re: The Yorkshire Clinic (Ramsay Health Care UK) Quality Account 2010/11

NHS Bradford and Airedale (NHSBA), as lead commissioner, welcome the opportunity to comment on The Yorkshire Clinic Quality Account for 2010/11 – the second from the Ramsay Health Care Group since the national introduction of Quality Accounts and the first to provide localised information pertaining specifically to The Yorkshire Clinic.

As a commissioner of care services on behalf of the local population, we believe this account demonstrates a commitment to quality improvement and high quality services. The operating framework for the NHS in England requires quality to encompass three areas of safety, effectiveness and patient experience. The Quality Account provides an overview of these areas and is a fair reflection of achievement against delivery of quality in services.

The Yorkshire Clinic has reviewed the priorities for improvement in 2010 – 2011 and has provided evidence that the majority have been achieved whilst highlighting particular areas for improvement. The Yorkshire Clinic has made progress over the past 12 months and demonstrates through the Quality Account 2010/11 that it places quality at the heart of the services that it provides. NHSBA are especially pleased to note the following achievements:

• Patient identity wrist bands are being printed electronically in accordance withNational Patient Safety Agency (NPSA) guidance.

• Specialist specific checklists have been developed for radiology and cataractsurgery.

• Environmental audits have been extended further in relation to equipment cleaning and mattresses and a cleaning matrix has been developed along with a ‘green label’ identification system.

• There was a 13% improvement in the Patient Environment Action Team (PEAT) audit from the previous year.

• All endoscopy staff members have achieved competences that meet nationalstandards.

• Ambulatory day care services have been enhanced through a range of measures including a full pre-operative assessment (POA) review, quarterly documentation audits, staff training, consideration of optimal listing of operations and timing of admissions, nurse-led discharge and post-discharge follow up calls.

NHSBA welcomes the above achievements and looks forward to the benefits and positive outcomes for patients envisaged by The Yorkshire Clinic.


In reviewing the draft Quality Account, NHSBA would recommend that consideration is given to the following:

• A total of fifteen priorities have been identified for 2011/12. Whilst laudable, the commissioner would question whether it will be possible to achieve such an ambitious programme.

• It would be helpful to reference all of the national clinical audits and national confidential enquiries with an explanation as to which were applicable to The Yorkshire Clinic or otherwise and why any relevant audits or enquiries were not undertaken.

• There appears to be only one explicit reference to safeguarding adults and this was in relation to training. The report could be strengthened by demonstrating how the range of patient safety and quality initiatives link with safeguarding adults.

• It would be helpful to know what the potential outcomes of the proposed improvements for 2011/12 are expected to be and how these will be measured and reported next year. An action plan detailing the improvements planned with target dates would have been useful.

• There are some really good examples of how The Yorkshire Clinic uses feedback to identify potential improvements however the document would benefit from providing examples of specifically what improvements have been identified.

• In relation to seeking ways to improve patient experience, it would be useful to include evidence of where this has happened, or a link to where evidence of this has been included elsewhere in the account, in order to underline the importance accorded by the provider to patient feedback.

• It is stated that “The Yorkshire Clinic hospital rates in the top 2-3% of organisations” but, without any explanation, this statistic has little meaning. It would be helpful if a description of what this indicates could be included in the final Quality Account.

• To make the account more readable to members of the public, it would be helpful to provide explanation of some of the clinical terms used. Some of the charts and graphs would benefit from clearer ledgers. It is noted that the case studypresented described an event as a serious untoward incident and indeed the incident was investigated as such, however it is more accurate to say that this was a ‘near miss’ event and the patient came to no harm. The useful learning from this has resulted in more robust processes in relation to access to supplies of blood for transfusion in emergency situations.

NHSBA is pleased that data quality is one of the priorities for improvement as this has been an area of concern to the commissioner for which an action plan is currently being implemented by The Yorkshire Clinic.


Overall, this is a well presented report demonstrating that The Yorkshire Clinic is committed to providing high quality care for service users. NHSBA supports the future priority areas identified for 2011 – 2012 and agree with their relevance to and representation of services.

NHS Bradford and Airedale commend the work of The Yorkshire Clinic over the last year and support their continued commitment to quality improvement.

Simon Morritt Chief Executive NHS Bradford and Airedale


Part 3: Review of quality performance 2010/2011

Statements of quality delivery

Matron, Sue Swaine.Acting Matron, Sue Broadbent.

Review of quality performance 1 April 2010 - 31 March 2011

Introduction

“Ramsay operates a quality framework to ensure the organisation is accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.”

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

Ramsay Clinical Governance Framework 2011

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 at the Yorkshire Clinic 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• Quality methods• Poor performance• Risk avoidance• Coherence

Ramsay Health Care Clinical Governance Framework

The Matron at the Yorkshire Clinic actively promotes clinical governance and collaborates with NHS partners to ensure that the Yorkshire Clinic is informed of relevant initiatives to continually improve the safety and excellence of the services offered. Matron attends a number of district meetings to nurture relationships with key stakeholders/NHS/PCTs these include – Quality Performance Group, Serious Untoward events group, District dignity group and Drug Intelligence Network group.


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).

The Yorkshire Clinic has systems in place for scrutinising all national clinical guidance and selecting those that are applicable to our business and thereafter monitoring their implementation.

3.1 Patient safety

The Yorkshire Clinic is a progressive hospital focussed on improving its performance every year, particularly with regard to patient safety.

Risks to patient safety come to light through a number of routes including routine audit, complaints, litigation, adverse incident reporting and raising concerns but moreroutinely from tracking trends in performance indicators.

Our focus on patient safety has resulted in a marked improvement in a number of key indicators as demonstrated below: -

3.1.1 Infection prevention and control

The Yorkshire Clinic has a very low rate of hospital acquired infection and has had no reported MRSA Bacteraemia in the past 3 years.

We comply with mandatory reporting of all Alert organisms including MSSA/MRSA Bacteraemia, Clostridium difficile and E coli infections with a programme to reduce incidents year on year.

Ramsay participates in mandatory surveillance of surgical site infections for orthopaedic joint surgery and The Yorkshire Clinic remains below the lowest percentile for infection rates.

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.

The Yorkshire Clinic has its own Infection Prevention and Control Committee which meets quarterly to endorse all local Infection Control Policies, procedures and guidance. It provides advice and support for the implementation of corporate policies and infection prevention and control training to all staff.


Programmes and activities within our hospital include:

• All staff undertake mandatory annual infection prevention and control training. Our consultant Microbiologist also holds two training sessions a year for clinical staff. All training is logged on to our electronic training register which then identifies any shortfalls in an individual’s professional development which can then be addressed.

• Healthcare associated infections (HCAI) are acquired as a result of healthcare intervention. High standards of Infection Prevention and Control practice minimise the risk of occurrence and as can be seen from the bar chart below The Yorkshire Clinic has decreased its HCAI rate annually for the past 2 years and is well below the National Average of 28%.

Hospital Acquired Infections 2009

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HAI's Number 0 5 3 0 2 0 0 0 1 0 3 0

HAI's Rate 0.0% 0.6% 0.3% 0.0% 0.2% 0.0% 0.0% 0.0% 0.1% 0.0% 0.3% 0.0%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Hospital Acquired Infections 2010

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HAI's Number 0 1 0 2 0 0 0 0 0 1 0 0

HAI's Rate 0.0% 0.1% 0.0% 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.0%



3.1.2 Cleanliness and hospital hygiene

Assessments of safe healthcare environments also include Patient Environment Assessment Team (PEAT) audits.

These assessments include rating of privacy and dignity, food and food service, access issues such as signage, bathroom / toilet environments and overall cleanliness.

The graph below shows our patient satisfaction of the environment over the last 3 years, the areas of concern have been identified and action plans developed and implemented to improve the hospital environment.

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 The Yorkshire Clinic 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.

Effective and ongoing communication of key safety messages is important in healthcare. Multiple updates relating to drugs and equipment are received everymonth and these are sent as soon as received 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 Managers who ensurewe keep up to date with all safety issues.

Adverse Incidents reported at the Yorkshire Clinic:• 2008 = 100• 2009 = 91• 2010 = 103

Adverse incidents reported are comparative with the numbers of patients, visitors, staff, sub-contractors who utilise the Yorkshire Clinic every year. The above figuresshow an increase in incident reporting, reflecting a raised awareness of the importance of safety in the workplace.

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3.2 Clinical effectiveness

The Yorkshire Clinic has a Clinical Governance team and committee that meet regularly through the year to monitor quality and effectiveness of care. Clinicalincidents, patient and staff feedback are systematically reviewed to determine any trend that requires further analysis or investigation. More importantly,recommendations for action and improvement are presented to hospital management and medical advisory committees to ensure results are visible and tied into actions required by the organisation as a whole.

3.2.1 Return to theatre

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 ofcomplication so some incidence of returns to theatre is normal. The value of the measurement is to detect trends that emerge in relation to a specific operation or specific surgical team. Ramsay’s rate of return is very low consistent with our track record of successful clinical outcomes.


Unplanned Returns to Theatre 2009

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Unplanned Return to Theatre Number 0 1 2 0 3 1 1 2 1 0 2 1

Unplanned Return to Theatre Rate 0.0% 0.1% 0.2% 0.0% 0.4% 0.1% 0.1% 0.2% 0.1% 0.0% 0.2% 0.1%


Unplanned Returns to Theatre 2010

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Unplanned Return to Theatre Number 1 1 1 2 1 2 2 3 0 1 0 0

Unplanned Return to Theatre Rate 0.1% 0.1% 0.1% 0.2% 0.1% 0.2% 0.2% 0.3% 0.0% 0.1% 0.0% 0.0%


As can be seen in the above graphs our returns to theatre rate has remained the same over the last 2 years. These figures are constantly monitored throughout the year via our clinical governance and medical advisory committee framework.

3.2.2 Readmission to hospital

Monitoring rates of re-admission 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, not in severe pain etc.


Unplanned Re-admissions 2009

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Unplanned Re-admissions Number 5 7 4 2 2 5 2 2 2 1 4 0

Unplanned Re-admissions Rate 0.5% 0.8% 0.4% 0.2% 0.2% 0.5% 0.2% 0.2% 0.2% 0.1% 0.3% 0.0%


Unplanned Re-admissions 2010

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Unplanned Re-admissions Number 2 0 1 2 5 7 1 3 3 2 3 1

Unplanned Re-admissions Rate 0.2% 0.0% 0.1% 0.2% 0.4% 0.6% 0.1% 0.2% 0.3% 0.2% 0.3% 0.1%


As can be seen in the above graphs our readmission to hospital rate has changed little over the last 2 years. These figures are constantly monitored throughout the year via our clinical governance and medical advisory committee framework.

3.3 Patient experience

All feedback from patients regarding their experiences at The Yorkshire Clinic are welcomed and inform service development in various ways dependent on the type of experience (both positive and negative) and action required to address them.

All positive feedback is relayed to the relevant staff to reinforce good practice and behaviour – letters and cards are displayed for staff to see in staff rooms and onnotice boards. Managers ensure that positive feedback from patients is recognised and any individuals mentioned are praised accordingly.

All negative comments or suggestions for improvement are also communicated to the relevant staff using direct feedback. All staff are aware of our complaints procedures should our patients be unhappy with any aspect of their care.


Patient experiences are fedback via the various methods below, and are regularagenda items on Local Governance Committtees for discussion, trend analysis and further action where necessary. 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:

§ Patient satisfaction surveys§ ‘We value your opinion’ leaflet§ Verbal feedback to Ramsay staff - including Consultants, Matrons/General

Managers whilst visiting patients and Provider/CQC visit feedback. § Written feedback via letters/emails§ Patient focus groups§ PROMs surveys§ Care pathways – patients are encouraged to read and participate in their plan of

care.

3.3.1 Patient Satisfaction Surveys

Our patient satisfaction surveys are managed by an independent company called ‘The Leadership Factor‘(TLF). They print and supply a set number of questionnaire packs to our hospital each quarter which contain a self addressed envelopeaddressed directly to TLF, for each patient to use.

Results are produced quarterly (the data is shown as an overall figure but also separately for NHS and private patients). The results are available for patients to view on our website.

Patient satisfaction scores for overall quality show the majority of patients feel they receive excellent quality of care and service in The Yorkshire Clinic hospital. To record a satisfaction index over 92%, a very high proportion of our patients have scored 9 or 10 out of 10 for their satisfaction with all the requirements. This is underlined by comparing our hospitals Satisfaction Index against those achieved by other organisations across all sectors of the UK economy where the full range of customer satisfaction is 50% to 95% with the median just below 80%.


As can be seen in the above graph our Patient Satisfaction rate has increased over the last year from 90.0% to 92.6%. The Yorkshire Clinic hospital for patient satisfaction rates in the top 2-3% of organisations.

3.3.2 Patient Reported Outcome Measures (PROMs)

The Yorkshire Clinic hospital participates in the Department of Health’s PROMssurveys for hip and knee surgery, hernias and varicose veins for NHS patients. As a Group, Ramsay also conducts its own hip, knee and cataract PROMs surveys specifically for private patients. The graph below shows the PROMs data for NHS patients from May 2009 to April 2011.


Access to the Yorkshire Clinic and Ramsay PROMs results can be found at the following website: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&category


3.4 The Yorkshire Clinic Hospital Case Study

Patient admitted to The Yorkshire Clinic for routine surgery in October 2010. Whilst undergoing the procedure the surgical team observed an unusual amount of bleeding. The consultant performing the procedure called a Consultant colleague for assistance and they worked together to stabilise the patient. All appropriate action was taken by the theatre team as per the Emergency Surgery Protocol and blood transfusion was informed immediately.

The Hospital stock of O Rh negative blood was given and at 17.00 hrs the transfusion team ordered additional blood supplies from Leeds Blood Transfusion Centre as per our Service Level Agreement (SLA). Despite a ‘blue light’ request for the blood from Leeds it still took over an hour and a half to arrive because of the ‘rush hour traffic.’ The patient in theatre was at no time at risk as she had received the transfusion she required and subsequently made a full recovery. The incident identified that the delay in receiving further blood stock left both ward and other theatre patients vulnerable.

The case was tabled at The Bradford & Airedale Clinical Review Group Serious Untoward Incident Subcommittee and even though no harm was caused to the patient it was agreed that a full investigation and report would be carried out. The Serious Untoward Incident was reported to the CQC, PCT and the SHA.

A Level 1 concise investigation took place at The Yorkshire Clinic by The Clinical Services Manager; Theatre Manager and Pathology Manager. The Root Cause Analysis demonstrated that work place environmental factors were the main cause.

A review of the incident was carried out by all stakeholders and discussed via our robust Clinical Governance framework; Risk Management Committee; Blood Transfusion Committee and Medical Advisory Committee. By working in collaboration with a Consultant Haematologist; the pathology staff and Airedale General Hospital the decision was made that the SLA with the Leeds Transfusion Centre would remain, and a further SLA has been agreed with Airedale General Hospital to supply The Yorkshire Clinic with units of blood in emergency situations.

Report, actions and recommendations following this incident have been shared with all staff within The Yorkshire Clinic, our local PCT/NHS providers, all other Ramsay Units and our Corporate Clinical Governance Group.

The above incident highlighted a previously unknown risk at the Yorkshire Clinic. As a result, working in collaboration with all parties we have improved our existing processes to create a safer more reliable service for our patients.


Appendix 1

Services covered by this quality account

§ Anaesthetics§ Audiology§ Cardiology§ Cosmetic§ Dermatology§ Dietetics§ Endocrinology§ ENT§ Gastroenterology§ General Medicine§ General Surgery§ Gynaecology§ Haematology§ Nephrology§ Neurology§ Neurophysiology§ Oncology§ Ophthalmology§ Oral Surgery / Restorative Dentistry§ Oral and Maxillo Facial§ Orthopaedics§ Orthotics§ Paediatrics§ Pain Management§ Pathology§ Psychology§ Radiology§ Respiratory Medicine§ Rheumatology§ Sleep Studies§ Speech Therapy§ Urology§ Vascular§ Venerology


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


Appendix 3

GLOSSARY OF ABBREVIATIONS

ANTT Aseptic Non Touch Technique

BADS British Association Day Care Surgery

CAS Central Alert Agency

CQC Care Quality Commission

CQUINS Commissioning for Quality and Innovation

EMSA Eliminating Mixed Sex Accommodation

GRSA Global Rating Score

HCA Health Care Assistant

HCAI Health Care Associated Infection

IPC Infection Prevention and Control

ISB Information Standards Board

JAG Joint Advisory Group

MEWS Medical Early Warning System

MHRA Medicines & Healthcare Products Regulatory Agency

MRSA Methicillin-resistant Staphylococcus Aureus

NICE National Institute for Clinical Excellence

NJR National Joint Registry

NPSA National Patient Safety Agency

PEAT Patient Environment Action Team

POA Pre-Operative Assessment

PROMS Patient Reported Outcome Studies

PW Productive Ward

RIMS Risk Information Management System

SHA Strategic Health Authority

SLA Service Level Agreement

TLF The Leadership Factor

VTE Venous Thromboembolism

WHO World Health Organisation


The Yorkshire Clinic

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:

01274 550600www.theyorkshireclinic.co.uk

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