19 to 21 December 2016, 3 January 2017
During a routine inspection
The Spire Alexandra Hospital is operated by Spire Healthcare Limited. The Spire Alexandra Hospital was previously owned by another independent healthcare company. However in 2007, the company sold its hospitals to a private equity company which trades under Spire Healthcare Limited and is now a PLC.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 to 21 December 2016, along with an unannounced visit to the hospital on 3 January 2017.
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.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
The main service provided by this hospital was surgical. Where our findings on surgical services also apply to other services, for example, management and governance arrangements, we do not repeat the information but cross-refer to the surgery core service report.
We rated this hospital as requires improvement overall.
-
Systems, processes and standard operating procedures were not always reliable or appropriate to keep people safe. Monitoring of whether safety systems were implemented was not robust.
-
Not all staff were aware of the term female genital mutilation (FGM) and their mandatory duty to report, despite having received a clinical briefing in April 2016.
-
Hospital audits showed consistent non-compliance to processes, which suggested action plans were not robust or implemented. For example, there was not always compliance with closure of sharp bins, staff left the operating theatre department doors open, and staff did not always follow hand hygiene and medicines management protocol.
-
The “admission and discharge policy”, which outlined the clinical risk assessment criteria for patients was not always followed.
-
Staff did not always follow the corporate “policy for the safe management of controlled drugs”.
-
There was a lack of signs to indicate segregation of clean and dirty equipment in some areas within the operating theatre department.
-
There was inconsistent practice of agency staff induction, which was not in accordance with Spire Healthcare induction policy.
-
There was a lack of dedicated hand washbasins for staff in patient bedrooms. Some hand washbasins did not comply with Department of Health’s Health Building Note 00-09: infection control in the built environment. However a documented risk assessment was in place for these.
-
There were medical devices which had not had an electrical safety testing, calibration or maintenance within the past year. This meant the equipment might not be fit for purpose.
-
Not all leaders had the necessary experience, knowledge, capacity or capability to lead effectively. Not all could demonstrate they had the skillset and training to enable them to fulfil their role and responsibilities and to provide specialist advice if required.
-
A hospital clinical governance brief meeting was held once a week. The senior clinical team discussed the incidents reported in the previous week and reviewed the progress of any on-going action plans. Clinical incidents were also discussed at heads of department meetings. We saw evidence of this in the meeting minutes. There was no evidence that the termination of pregnancy service was reviewed at any hospital committee meetings.
-
The termination of pregnancy service was poor but the provider took immediate action and deregistered the service.
However:
-
Staff were encouraged to report incidents. This enabled them to raise all incidents including near miss events. Serious adverse events underwent a thorough review or investigation that involved all relevant staff and people who use services. Following this, appropriate actions were taken. Lessons were learned and communicated widely to support improvement in all areas. Opportunities to learn from external safety events were also identified.
-
100% of staff working within surgical services and 96% of ward staff had completed their mandatory training which exceeded the Spire Healthcare target of 95%.
-
The hospital had a local business continuity and lock down in place in the event of potential emergencies. The plan covered major incidents, such as how to respond in the event of widespread fire or flood, electricity failure, gas leak and water failure.
-
When people received care from a range of different staff, teams or services, this was coordinated. All relevant staff, teams and services were involved in assessing, planning and delivering people’s care and treatment. Staff worked collaboratively to understand and meet the range and complexity of people’s needs.
-
Patients received a choice of meals and drinks and the chef catered for patient’s individual needs including those that required special diets. The hospital had access to a dietitian and other specialist services.
-
Managers supported staff to deliver effective care and treatment, including through meaningful and timely supervision and appraisal. There was a clear and appropriate approach to support and manage staff when their performance was poor or variable.
-
Staff responded compassionately when people needed help and support. They anticipated people’s needs, and respected people’s privacy and confidentiality at all times.
-
Patients and relatives feedback was consistently very positive about the care provided. Patients understood the care and treatment choices available to them and were given appropriate information and support regarding their care or treatment.
-
The hospital handled complaints in line with policy. Staff had a good understanding of the complaints process, and staff discussed complaints at monthly meetings. Information about the complaints procedure was available for patients and relatives.
-
Facilities and premises were appropriate for the services being delivered.
-
Delays and cancellations of operations were minimal and managed appropriately. Services ran on time. Staff kept patients informed of any disruption to their care or treatment.
-
At the referral stage, staff identified vulnerable adults, such as patients living with a learning disability, or those living with dementia. Staff took appropriate steps to ensure people were appropriately cared for.
-
Surgery at Spire Alexandra was all elective, meaning it was planned, so the hospital cancelled very few procedures.
-
We saw staff demonstrated the core hospital values in the care they provided. Staff were positive about the standard of care they provided.
We found the following issues that the service provider needs to improve:
-
The termination of pregnancy services was poor. It did not always reflect evidence based practice from relevant professional bodies or followed the hospitals policies or national guidance. There was no specific strategy for this service or evidence of specific training for staff. There was lack of monitoring or oversight for this service within the hospital’s governance processes.
Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected the termination of pregnancy service. The provider took immediate action and has de registered the activity of termination of pregnancy and no longer provides this service.