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First Trust Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 19 February 2020

First Trust Hospital is operated by Anaster Limited. The hospital has 14 bedrooms, nine of which are en-suite.

The hospital provides cosmetic surgery including breast augmentation, rhinoplasty (nose correction surgery) and lipoplasty (removal of fat through a cannula) to adults. The provider did not see anyone under 18.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 5 and 6 November 2019.

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 service did not always control infection risk well. There was no set criteria that determined which patient was screened for methicillin-resistant staphylococcus aureus.

  • Staff did not always complete and update risk assessments for each patient and removed or minimised risks.

  • The emergency resuscitation box was out of date and medicines were not handled or stored in line with Medicines and Healthcare Products Regulatory Agency guidance.

  • The service did not follow best practice when completing the World Health Organisation surgical safety checklist.

  • Staff did not always keep detailed records of patients’ care and treatment, for example we found incomplete records

  • We found no evidence that staff advised or referred patients to lead healthier lives.

  • Information systems were not always reliable – for example, World Health Organisation checklist audits were based on document audits and not observational audits.

However:

  • The service had enough staff to care for patients and keep them safe. Staff had received training in key skills, understood how to protect patients from abuse, and managed safety well. The service managed safety incidents well and learned lessons from them.

  • Staff provided appropriate care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Patients were supported to make decisions about their care and had access to useful information. All records we reviewed showed patients were given a 14-day cooling off period. Staff worked well together for the benefit of patients, and key services were available seven days a week.

  • Staff treated patients with compassion and kindness. We saw friendly interactions between patients and staff. Staff respected all the patients’ privacy and dignity and took account of their individual needs. They provided emotional support to patients. We saw staff reassuring anxious patients who were waiting for surgery.

  • The service planned care to meet the needs of the patients. Staff took account of patients’ individual needs and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

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. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Inspection areas

Safe

Requires improvement

Updated 19 February 2020

We rated safe as Requires improvement because:

  • The service did not control infection risk well. Staff did not always use equipment and control measures to protect patients, themselves, and others from infection.

  • Staff were not trained in safeguarding level 1 safeguarding children as per the intercollegiate guidelines.

  • Staff did not have systems in place to assess the psychological state of patients identified with psychological concerns, so that they could remove or minimise risks.

  • Staff did not complete all elements of the World Health Organisation surgical safety checklist in line with guidance.

  • Records were not stored securely and were incomplete.

  • The service did not always use systems and processes to safely prescribe, administer, record and store medicines.

  • When things went wrong, staff did not always offer patients suitable support.

However:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • All staff we spoke with understood how to protect adults from abuse. Staff were provided with level two safeguarding training for vulnerable adults.

  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.

  • The service managed patient safety incidents well. Staff reported incidents. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

  • Managers ensured that actions from patient safety alerts were implemented and monitored.

Effective

Good

Updated 19 February 2020

We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.

  • Staff gave patients enough food and drink to meet their needs and improve their health. Staff followed national guidelines to make sure patients were informed about fasting before surgery.

  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.

  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements.

  • The service made sure staff were competent for their roles. We reviewed staff files that showed staff were assessed against a competency framework. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

  • Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients' liberty.

  • Consent was a two-stage consent process which followed national guidelines. All 10 consent forms we reviewed were completed and signed. Patients were given 14day cooling-off period to ensure they had time to make an informed decision about their treatment.

However, we also found the following issues that the service provider needs to improve:

  • Policies did not have version numbers on them and therefore we were not assured if the policy was the most up to date version.

  • Practical support and advice to lead healthier lives was limited, staff asked about smoking and alcohol consumption, but they did not signpost patients and did not have any information to support patients with becoming healthier.

Caring

Good

Updated 19 February 2020

We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families, and carers to minimise their distress. They understood patients’ personal, cultural, and religious needs.

  • Staff supported and involved patients, families, and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 19 February 2020

We rated it as Good because:

  • The service planned and provided care in a way that met the needs of referred patients.

  • Due to the nature of the service the hospital did not admit patients with complex needs. The service provided a translation service, a hearing loop service, and leaflets in large font for those visually impaired.

  • People could access the service when they needed to and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients was timely.

  • It was easy for people to give feedback and raise concerns about care received, complaints were appropriately investigated in with their policy.

Well-led

Requires improvement

Updated 19 February 2020

We rated it as Requires improvement because:

  • Leaders did not always operate effective governance processes, throughout the service. For example, we found no assurance to support that the WHO checklist followed best practice.

  • The service collected data to inform change, however, the service carried out limited observational audits and therefore audits were based on documentation which we found did not always identify gaps in clinical practice.

  • Staff identified and escalated relevant risks to senior managers and actions were identified to reduce their impact. However, clinical risks were not always identified such as the need for psychological assessments or storage of medical gases.

However

  • Leaders were visible and approachable in the service for patients and staff. They supported staff to develop their skills.

  • Staff felt respected, supported, and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.

Checks on specific services

Surgery

Requires improvement

Updated 19 February 2020

Surgery was the only activity at the hospital.

We rated this service as requires improvement because both the safe and well-led domains were rated as requires improvement. We found effective, caring, and responsive to be good. The service used bank and agency to staff the ward and theatres.