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Inspection Summary


Overall summary & rating

Good

Updated 8 February 2018

St Anthony’s Hospital is operated by Spire Healthcare. The hospital has 92 beds in en-suite rooms. Facilities include six operating theatres (three with laminar flow), a cardiac catheter laboratory for cardiac procedures and an eight-bed level three critical care unit, and X-ray, outpatient and diagnostic facilities.

St Anthony’s provides surgery, including critical care, medical care, services for children and young people, and outpatients and diagnostic imaging. In this inspection we only inspected critical care and services for children and young people. These services had been suspended at the time of our inspection in September 2016 and had since re-opened. The children’s outpatient service opened in 2016 and sees about 150 children a month. The children’s ward, for day case surgery for children over three years old, opened in late February 2017.

The hospital carries out some surgery for adult NHS patients some of whom might be in critical care.

This inspection was a focused inspection looking only at critical care and services for children and young people (including children’s outpatients not inspected as part of outpatients in September 2016). We visited unannounced on 6 June 2017, and made two follow up visits by arrangement with the hospital on 12 and 13 June 2017 to observe children’s outpatients and a children’s surgery list which had not been able to inspect on 6 June 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.

Services we rate

We rated critical care as requires improvement for safe and good for responsive and well led. We rated children’s services as good for Safe, Responsive and Well-led. We did not consider there was sufficient evidence to rate Effective and Caring for either service because there were few outcome measures for either service and we saw only a small number of patients during our inspection.

Inspection areas

Safe

Requires improvement

Updated 8 February 2018

Effective

Not sufficient evidence to rate

Updated 8 February 2018

Caring

Good

Updated 8 February 2018

Responsive

Good

Updated 8 February 2018

Well-led

Good

Updated 8 February 2018

Checks on specific services

Medical care (including older people’s care)

Not sufficient evidence to rate

Updated 11 January 2017

Surgery

Requires improvement

Updated 8 February 2018

Is surgery safe?

We rated safety as requires improvement because:

  • The hospital was not reporting all serious incidents requiring to be reported externally, promptly and systematically. One never event had not been reported.
  • Ward staff did not always react promptly to patients who were becoming more unwell because nursing records were not always correctly completed.
  • There were no mortality or morbidity meetings.
  • Procedures in theatre were sometimes carried out without patients being fully pre-assessed for risk factors before surgery.
  • Theatre lists sometimes overran and continued into theevening.

However;

  • Equipment was well maintained and cleaning and infection control was good.
  • Medicines were generally well managed.
  • There were enough staff on duty during our inspection.

Is surgery effective?

We rated effectiveness as good because;

  • Policies followed NICE and other guidelines for clinical practice.
  • Pain was assessed and managed appropriately.
  • Consultants were on call 24 hours and two RMOs were available 24 hours a day, seven days a week. 
  • On call pharmacy advice was available 24 hours a day.

However,

  • There was limited data on patient outcomes. The hospital was submitting current data to the Private Healthcare Information Network (PHIN), an organisation that publishes independent hospital data to help patients make informed healthcare decisions, so data would be available in the following year.
  • Multidisciplinary working and recording of MDT discussions was still at an early stage of development.

Is surgery caring?

We rated caring as good because:

  • All staff introducing themselves and interacted in a friendly way with patients.
  • There were systems to collect patient feedback and patients' views were largely positive.
  • Nurses had sufficient time to spend with patients to reassure them.
  • Most consultants visited patients daily, although sometimes quite late in the evening.

However;

  • Some self-paying patients were anxious about unanticipated costs.

Is surgery responsive?

We rated responsive as good because:

  • Patients had timely appointments and treatment, that were convenient to them
  • Appointment times were flexible including evenings and weekends.
  • Cancelled appointments were re-scheduled within 28 days.
  • Visitors could come to see patients at any time.

However,

  • The hospital should review its support elderly patients and those living with dementia.
  • There was little evidence of change of practice in relation to complaints.
  • A few patients were not satisfied with their admission experience, although 81% thought it was excellent.

Is surgery well-led ?

We rated well led as requires improvement because:

  • The control of risks needed strengthening to reflect all the risks and to include explicit mitigation actions.
  • There were shortfalls in the management of some consultants who booked patients late, did not use pre-operative assessment and did not observe the WHO checklist.
  • The analysis of the causes of serious incidents did not go into sufficient depth, and did not translate quickly enough into learning and improving practice.
  • The hospital governance structure was very new and processes were not embedded. It was too early to assess its impact.

However;

  • The hospital had a clear vision and values.
  • There was effective and inclusive leadership in theatres.
  • The views of patients were gathered.

Intensive/critical care

Requires improvement

Updated 8 February 2018

Is critical care safe?

We rated safe as requires improvement because:

  • The duty of candour had not been activated in any relevant reported incidents.

  • Not all patients were reviewed by a doctor twice a day and 30% of doctors did not record the time of visits or provide evidence of reviewing treatment plans daily. Following the inspection, we were told that the hospital was acting on these results and reminding consultants of these requirements via email and verbally when in the unit to improve compliance.

  • Half the reported incidents were about unexpected admissions to critical care, which potentially impacted on staffing. Some of this was the result of weaknesses in hospital processes outside the critical care service itself, such as pre-assessment not being carried out or surgery bookings being made without recognising the need for time in ITU.

However

  • The critical care unit was visibly clean and we observed staff complying with infection control policies.
  • Staff were 96% compliant with mandatory training topics.
  • Systems and processes for incident reporting, and medicines management were reliable and appropriate.

Is critical care effective?

  • We did not rate this service because the numbers of patients were small and there was therefore limited data.

Is critical care caring?

  • We did not rate because there were too few patients to make a judgement

Is critical care responsive?

We rated responsive as good because:

  • Staff took account of the different individual needs of people using the service.
  • The admission and exclusion criteria were clear.
  • There was adequate capacity on the unit.
  • Staff were aware of how to support patients with dementia.

Is critical care well-led?

We rated well-led as good because:

  • There was clear leadership.
  • Staff felt well supported by senior staff who were approachable.
  • There was evidence of learning and improvement from audit results.

Services for children & young people

Good

Updated 8 February 2018

Are children and young people’s services safe?

We rated safe as good because:

  • The service managed staffing effectively in relation to activity. There were enough staff with the appropriate skills, experience and training to keep children and young people safe and to meet their care needs.
  • There was a lead consultant and lead anaesthetist for children and young people.
  • We found high standards of cleanliness
  • There were child and young people friendly rooms and a dedicated recovery suite for children

However

  • Staff did not consistently measure the inter-operative temperatures of children in theatre.

Are children and young people’s services effective?

  • We did not rate this service because the numbers of patients were small and there was therefore limited data.

Are children and young people’s services caring?

  • We did not rate this service because the number of patients was small and there was limited outcome data.

Are children and young people’s services responsive?

We rated responsive as good because:

  • Staff took account of the different individual needs of the different age groups using the service.
  • Parents and their children could choose the timing of their appointments and procedures.
  • Parents or other adults could spend time with children on the ward.
  • Waiting times were short and there had been no surgical cancellations by the hospital.
  • Children were able to provide feedback using a child-friendly patient survey.

Are children and young people’s services well-led?

We rated well-led as good because:

  • There was clear nursing leadership within services to lead effectively.
  • Staff felt well supported by senior staff who were approachable
  • There were high levels of staff and patient engagement and satisfaction.

Outpatients

Good

Updated 8 February 2018

Are outpatient and diagnostic imaging services safe?

We rated safe as good because:

  • Staff understood their responsibilities to raise concerns and report incidents and near misses.
  • Medicines were managed and stored safely.
  • Clinical and waiting areas were visibly clean and we observed good infection prevention and control measures.
  • All staff had received mandatory training that was relevant to their role.

However:

  • Some patients could have two hospital numbers which meant that records may not be complete.
  • There had been no MRI resuscitation simulation training sessions. This meant that if there was an emergency within the scanner, staff may find it more difficult to remove a patient quickly.

Are outpatient and diagnostic imaging services effective?

We did not rate effective.

We found:

  • There was a good multidisciplinary team approach to care and treatment.
  • Staff had the right qualifications, skills, knowledge and experience to do their job.
  • Work had started on measures to reduce the radiation dose level that patients received.
  • There were many opportunities for continuous learning provided within the department.However we also found:
  • Not all staff had received appraisals in line with the provider’s policy.
  • Local clinical pathways and policies kept within the outpatients department did not appear to have been reviewed recently and it was not clear if they were up to date in line with best practice guidelines.

Are outpatient and diagnostic imaging services caring?

We rated caring as good because:

  • Patients received supportive care and treatment.
  • Staff were very caring towards patients and supported them emotionally.
  • Interactions between staff and patients were positive.
  • Information about care and treatment was made available when requested by patients.

However:

  • The process for clarifying costs of blood tests with the patient was unclear. This could mean that patients were not informed of all the costs of tests taken before agreeing to them.

Are outpatient and diagnostic imaging services responsive?

We rated responsive as good because:

  • Services were planned and delivered to meet the needs of the local population. New equipment had been introduced in response to patient needs.
  • Services coordinated appointments to enable patientsto see a number of health care professionals in one day.
  • There were clear examples of changes that had been made following complaints to improve the service provision.

However:

  • In a 2016 assessment the department had 11 failures out of 22 dementia-friendly environment measures.

Are outpatient and diagnostic imaging services well-led?

We rated well-led as good because:

  • The vision for the hospital was clearly understood by all staff within the department.
  • With the change of provider, there had been large-scale changes; however most governance processes now appeared to be robust and working well.
  • Staff were focussed on providing the best service they could for all patients.
  • There were regular opportunities for staff to communicate with senior managers and all staff told us that there was a friendly and supportive management structure.

However:

  • The paediatric governance provisions were not yet in place and the strategy not completed, although the service was intended to re-start within three months.
  • Team meetings were not yet planned on a regular basis in the outpatients department, which meant that there was the potential for missing the opportunity to share information.