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Inspection Summary


Overall summary & rating

Good

Updated 1 June 2017

We inspected the following core services:

  • Medicine

  • Surgery

  • Critical care

  • Children and young people

  • Outpatients and diagnostic screening.

We undertook an announced inspection 18 and 19 October 2016, with an unannounced visit on 1 November 2016. We visited all departments, theatres and wards at different times of the day and evenings.

We reviewed a wide range of documents and data we requested from the provider. These included policies, minutes of meetings, staff records and results of surveys and audits. We placed comment boxes at the hospital prior to the inspection, which enabled staff and patients to provide us with their views. We received ninety three comments from patients and relatives, of which 96% contained positive comments.

We spoke with 56 staff including; registered nurses, health care assistants, reception staff, medical staff, operating department practitioners, and senior managers. We spoke with 19 patients and relatives. We also received ninety three tell us about your care’ comment cards which patients had completed prior to our inspection. During our inspection, we reviewed 33 sets of patient records.

There were no special reviews or investigations of the hospital ongoing by the CQC at any time during the 12 months before this inspection. The hospital had last been inspected in October 2014 and we found areas needing improvement. We found breaches of four regulations. These were regulations relating to cleanliness and infection control, safety and suitability of premises, supporting staff with training and assessment and ensuring there were enough suitably trained staff when treating children. We reviewed improvements in these areas specifically.

There were 326 consultant surgeons and anaesthetists who worked at the hospital under practising privileges across anaesthetics, orthopaedic surgery, plastic surgery, ophthalmology, gastroenterology, rheumatology and oncology.

The hospital employed seven resident medical officers (RMO), who worked on a ‘one in five’ 24 hour shift pattern Monday to Friday and one in five weekend rota.

There were 124 contracted staff which equated to 106 full time equivalent (FTE) nurses and operating department practitioners and 27 contracted healthcare assistants which equated to 23 FTEs. The accountable officer for controlled drugs (CDs) was the registered manager.

Activity (July 2015 to June 2016)

  • In the reporting period July 2015 to June 2016 there were 10,842 inpatient and day case episodes of care recorded at the hospital; of these 28% were NHS-funded and 72% other funded.

  • There were 8,554 visits to theatre in the reporting period July 2015 to June 2016.

  • 45% of all NHS-funded patients and 58% of all other funded patients stayed overnight at the hospital during the same reporting period.

  • There were 70,740 outpatient total attendances in the reporting period; of these 82% were other funded and 18% were NHS-funded.

    Track record on safety (July 2015 to June 2016)

  • 1 Never event in surgery

  • 1157 clinical incidents – higher rate than in other independent acute hospitals: 1 serious injury (patient fall); 15 deaths of which 9 were unexpected

  • 0 incidence of hospital acquired Methicillin-resistant Staphylococcus aureus (MRSA),

  • 0 incidence of hospital acquired Methicillin-sensitive staphylococcus aureus (MSSA)

  • 1 incidence of hospital acquired Clostridium difficile (c.diff)

  • 1 incidence of hospital acquired E-Coli

  • 10 complaints received by CQC

Services accredited by a national body:

  • Macmillan Quality Environmental Mark

  • Pathology ISO accreditation

  • Sterile Services Department CE accreditation with SGS Yardsley

  • VTE Exemplar Status.

Services provided at the hospital under service level agreement:

  • Critical Care transfer agreement

  • Multidisciplinary Team for oncology

  • Gynaecology CNS

  • Sterile Services

Inspection areas

Safe

Requires improvement

Updated 1 June 2017

We rated safe as requires improvement because:

  • Environmental risks had not been fully identified, managed or mitigated. Theatre equipment was not risk assessed adequately and there was unsuitable storage of endoscopes and critical care equipment.

  • Staff had not managed the cold storage of medicines safely, by ensuring fridges were locked and the temperature of fridges was measured and safely controlled.

  • Staff did not follow the hospital policy when checking controlled drugs.

  • The theatre log books were not consistently completed but this was actioned immediately when brought to the attention of the senior management team.

  • There was not always sufficient staffing in theatres to allow time for staff break relief and theatre overruns. Ward staffing levels at night did not always comply with the requirements of planned hospital ratios.

  • The critical care outreach service did not meet the recommendation of the Guidelines for the Provision of Intensive Care Services 2015, to provide a service day and night.

  • There was no neurosurgical care pathway.

However,

  • Staff reported incidents and there were systems for investigating and learning from incidents.

  • There were low infection rates and infection control procedures were in place and followed.

  • Staff understood the duty of candour.

  • There was suitable medical cover from the resident medical officer and consultants.

  • Staff understood safeguarding and followed agreed procedures for reporting concerns.

  • There were emergency procedures and transfer arrangements in place, with links to the local NHS acute hospital.

  • Staff completed their mandatory training.

Effective

Good

Updated 1 June 2017

We rated effective as good because:

  • Staff provided care that took account of guidance from national bodies, such as the National Institute for Health and Care Excellence (NICE), and care and treatment followed best practice.

  • Staff managed patients’ pain effectively and the hospital had introduced and end of life care plan since the last inspection

  • Staff worked in multidisciplinary teams to coordinate patient care both within the hospital and across other hospital sites and the NHS.

  • Patient outcomes were good when benchmarked against national standards. The provider engaged in the Private Healthcare Information Network to support benchmarking and shared learning across the sector.

  • Doctors and nurses and allied healthcare professionals had relevant competencies and skills for their roles. Consultants provided evidence of assurance of their skills to maintain their practicing privileges agreements.

  • The hospital ensured new staff completed induction training and offered preceptorships to newly qualified registered nurses.

  • Systems for obtaining consent were compliant with legislation and national guidance.

However,

  • The provider had not implemented a neurosurgical pathway, and this had been noted in the 2014 inspection.

  • There were no outcome measures for endoscopy procedures, but this omission was being addressed.

Caring

Good

Updated 1 June 2017

We rated caring as good because:

  • Staff treated patients with dignity and respect and offered emotional support. Patients said staff respected their privacy and we observed staff in theatres being mindful of patients’ dignity when they were in a vulnerable condition.

  • Patients and their relatives said they were treated well and staff spoke with patients in a caring and reassuring manner.

  • The hospital had employed customer service coordinators to meet and greet patients and support them with any practical issues needing addressing.

  • The hospital has introduced roles such as patient pamper nurses and customer services liaison to ensure patients receive quality time with staff to relax and talk to them about fears or concerns. The patients spoke highly of the care and relaxation treatments attention the ‘pamper nurses’ gave them.

  • Results of patient surveys were better when compared with other hospitals, for example for patient satisfaction and the NHS Friends and Family test.

However,

  • Results of the patient led assessment of the care environment (PLACE) were lower compared with other hospitals in privacy, dignity and wellbeing.

Responsive

Good

Updated 1 June 2017

We rated responsive as good because:

  • Services were planned to support self funded, insured and NHS patients, through liaison with commissioners and NHS providers.

  • Some clinics were planned to offer patients appointments outside normal working hours.

  • The environment met patients’ specific needs. For example, the oncology unit had been awarded the MacMillan Quality Environment Mark in 2014 and the hospital had improved the capacity of the day surgery service. The car parking for outpatients had improved since the last inspection.

  • Staff pre-assessed patients to determine their specific needs, and supported patients living with dementia. Services for children were planned to accommodate practical considerations such as school holidays and the school day.

  • Information for patients was provided in different formats, and staff could call upon interpreters when necessary.

  • The hospital actively encouraged patient feedback on a daily basis with the patient liaison service to listen to patients and to respond to any concerns.

  • The complaints process was available to patients and their carers. Staff reviewed complaints and implemented learning.

  • The hospital held planning meetings to schedule care appropriately. Although the hospital had not met the target referral to treatment times for NHS patients in the year to June 2016, it was working with commissioners to improve the pathways.

However,

  • Staff in critical care said their service was under increased pressure following the increased surgical capacity

Well-led

Good

Updated 1 June 2017

We rated well-led as good because:

  • Staff were aware of the vision, values of the hospital and wider organisation, and demonstrated commitment to them in their care practices and personal development plans.

  • There was an effective governance system and managers shared learning from incidents, complaints and patient feedback.

  • The medical advisory committee was effective in advising the senior management team. It monitored the quality and safety of services andthe consultant group and granted and reviewed practicing privileges.

  • There were strong links with the local NHS to develop innovative practices and services.

However,

  • The hospital risk register did not capture all the key service level risks, such as those relating to the environment, equipment or management arrangements.

  • Critical Care staffing did not fully meet the Guidelines for the Provision of Intensive Care Services 2015, as there was no dedicated supernumerary nurse on duty each shift.

Checks on specific services

Medical care (including older people’s care)

Good

Updated 1 June 2017

Medical care services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in surgery section.

We rated this service as good because it was safe, effective, caring and responsive and well led.

We rated safe, effective, caring, responsive and well led as good.

  • Openness and transparency about safety was encouraged. Staff understood their responsibilities to raise concerns and report incidents. When something went wrong, thorough investigation took place involving all relevant staff. Lessons were learned and communicated widely to support improvement in other areas as well as services that were directly affected.
  • Staffing levels and skill mix for the endoscopy, oncology and cardiology services were planned, implemented and reviewed to keep people safe at all times. There were effective handovers and shift changes, to ensure staff could manage risks to people who used services.
  • Staff were knowledgeable about the hospital’s safeguarding policy and clear about their responsibilities to report concerns.
  • Weekly endoscopy rinse water checks and annual microbiological tests were being undertaken, and sent to Public Health England.
  • Hospital-wide mandatory training compliance was 81% at October 2016.
  • Staff were appropriately qualified, had the skills to carry out their roles effectively, and took account of best practice. The learning needs of staff were identified and training put in place to meet their learning needs. Staff were supported to maintain and further develop their professional skills and experience.
  • The services were taking action to meet current evidence based guidance. The endoscopy lead had an action plan in place to drive towards achieving joint advisory guidance (JAG) accreditation in gastrointestinal endoscopy.
  • Staff were supported in their role through appraisals, and there was 100% compliance in oncology. Staff were encouraged and supported to participate in training and development to enable them to deliver good quality care Staff obtained appropriate consent from patients.
  • During the inspection, we saw that staff were caring, compassionate and sensitive to the needs of patients. Patients commented positively about the care provided from all of the endoscopy, oncology, cardiac catheter laboratory and ward staff. Patients felt well informed and involved in their procedures and care.
  • The service was responsive to patients in the inclusion criteria, with waiting times of one to four weeks. Care and treatment was coordinated with other providers. The needs of different people were taken into account when planning and delivering services.
  • Staff were clear about the vision and strategy for their areas, that were driven by quality and safety. The staff we spoke with described an open culture and leaders were visible and approachable. There was a governance structure for senior staff to report concerns/ issues to be discussed.

However

  • Ventilation in the theatre used for endoscopies did not meet national guidance. This was being monitored, and there were plans to upgrade the system.
  • Some health and safety and environmental risk assessments in the medical service were overdue for review.

  • A system was not in place to monitor outcomes following gastrointestinal endoscopy, but was under development.

Surgery

Requires improvement

Updated 1 June 2017

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

Ward staffing was managed jointly with medical care.

We rated the service provided by Spire Southampton Hospital over the whole hospital as good. We rated effective, caring, responsive and well led as good. However, we rated safe as requires improvement.

We rated surgery as requires improvement because safety and well led required improvement. However, we rated effective, caring and responsive as good.

  • There were not consistent completion of theatre logs, cleaning of theatre environment and equipment, and disposal of dirty instruments within theatres.

  • There was not always sufficient staffing in theatres to allow time for staff break relief and theatre overruns.

  • Ward staffing levels at night did not always comply with requirements of planned hospital ratios.

  • Ward nurses did not always reassess patient risks following surgery.

  • There was not a consistent daily record of medical reviews of patients seen within inpatient records which were inspected.

However,

  • The processes for reporting, investigating and learning from incidents were well established and implemented.

  • Staff had a good understanding about hospital safeguarding procedures. Surgical safety checks were adhered to.

  • Medicines were stored safely and there were processes to audit procedures

  • Staff worked especially hard to make the patient experience as pleasant as possible. They were caring and compassionate.

  • Staff recognised and responded to the holistic needs of their patients. Staff knew how to support people with complex or additional needs and made adjustments wherever possible. We saw good responses to referrals, pre-operative risk assessment before admission, and then planning for their patient’s discharge from the hospital.

  • Care and treatment took account of current legislation and nationally recognised evidence-based guidance. There was a local and corporate annual audit programme, which measured the hospital’s compliance against policies and national guidance.

  • The service participated in national audits where applicable and outcomes were good, particularly for cardiac surgery. The hospital was fully engaged in the Private Healthcare Information Network (PHIN) work to develop outcome measures for private patients.

  • Staff were well trained and competency assessed, all had received annual appraisal.

  • The complaints process was available to patients and their carers. Staff reviewed complaints and implemented learning.

  • Staff were aware of the mission, vision, values of the hospital and wider organisation, and demonstrated commitment to them in their care practices and personal development plans within their appraisals.

  • The services were generally well led and staff spoke passionately about the service they provided and the care they offered to patients.

Intensive/critical care

Good

Updated 1 June 2017

Critical care services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

The critical care unit has seven beds for patients who require level 2 or level 3 care.

We rated critical care services as good because it was effective, caring, responsive and well-led although it required improvement for being safe.

  • There was a culture of reporting and learning from incidents and staff had a good understanding about safeguarding procedures.

  • There were sufficient numbers of nursing, medical and allied health professional staff to deliver care and treatment over a seven day period.

  • Staff followed established processes for the management of deteriorating patients.

  • Care pathways, nurse competency assessments, policies and procedures supported staff to deliver care and treatment according to current national guidelines.

  • Staff completed mandatory training.

  • The critical care unit was visibly clean. Staff followed infection control and prevention procedures. Equipment, including emergency resuscitation equipment, was available and in working order.

  • All staff demonstrated a caring and compassionate approach in their care and treatment of patients.

  • Staff felt the unit manager provided good support and leadership. There was a cardiothoracic and a general intensivist consultant lead for the service.

  • The governance structure of the hospital and critical care service meant all staff had an overview and an understanding of their role in issues affecting the hospital and the development of the hospital services.

However,

  • There was a risk that people could access the medicines fridge, which was not locked.

  • Records did not fully evidence care and treatment was consistently provided in line with national recommendations and guidance.

  • Staff did not always follow best practices in their recording in patient records.

  • Staff did not act to lessen all identified risks. The medicine fridge was unlocked and its temperature was recorded as outside the recommended range. Storage facilities were cluttered, and posed a risk to the safety of staff. There was no assessment of risks relating to the availability of the critical care outreach team.

Services for children & young people

Good

Updated 1 June 2017

Children and young people’s services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring, responsive and well led.

  • Children were protected from avoidable harm and the service had a good safety record.

  • The hospital safeguarded children and young people appropriately. Although there were no children-only waiting rooms or consulting rooms, staff accompanied children through the process, limiting the risk.

  • The children’s nurses had specialist training and the lead nurse promoted skills in nursing children, training non-specialist nurses in paediatric lifesaving skills. A range of risk assessments were in place.

  • Care and treatment was planned and delivered with current evidence based guidance and standards with a holistic approach to care.

  • Relevant audits were used to assess compliance with best practice.

  • Staff were qualified and had the relevant skills for their role and were encouraged to undertake specialist training in their field of expertise.

  • Parents said their children had received compassionate care and they were fully informed and involved in decisions about their child’s treatment and care.

  • Children’s and young people’s services provided access at times to suit children, young people and their parents.

  • The service supported child inpatients by introducing them to the environment through a visit and a pre-assessment appointment, so that everything would be familiar.

  • The service had a developed a vision for the expansion of children’s services and facilities and this was shared with staff. The appointment of a lead children’s nurse had improved the services.

However

  • Staff and managers understood they needed to strengthen quality and performance monitoring and introduce learning from audits and benchmarking.

Outpatients

Good

Updated 1 June 2017

Outpatients and Diagnostic imaging services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, caring and responsive and well led. We inspected but did not rate ‘effective’ as we do not currently collate sufficient evidence to rate this.

  • There was an open and transparent safety culture in the outpatients and diagnostic imaging departments. Staff understood their responsibilities to raise concerns and report incidents.
  • Staffing levels and skill mix were planned and reviewed to ensure the safety of patients.
  • Staff were knowledgeable about the hospital’s safeguarding policy and clear about their responsibilities to report concerns.
  • Staff were appropriately qualified, had the skills to carry out their roles effectively, and took account of best practice. The learning needs of staff were identified and training put in place to meet their learning needs. Staff were supported to maintain and further develop their professional skills and experience.
  • Staff were supported in their roles through the appraisals process, there was 100% compliance in OPD and Diagnostic Imaging. Staff were encouraged and supported to participate in training and development to enable them to deliver good quality care.
  • Staff always sought consent from patients.
  • Staff in the outpatients department (OPD) and diagnostic and imaging service were caring, compassionate and sensitive to the needs of patients. Patients commented positively about the care provided from department staff.
  • The service had improved its reporting times for CT and MRI scans.
  • The needs of different people were taken into consideration when services were planned and delivered.
  • Staff were clear about the vision and strategy for their areas, that were driven by quality and safety. The staff we spoke with described an open culture where leadership was visible and approachable. There was an appropriate governance structure for staff to report concerns or issues to be discussed.

However,

  • The service did not always meet the target response times for treating NHS patients, due to changes in commissioning pathways.