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First Trust Hospital Requires improvement

Reports


Inspection carried out on 5 to 6 November 2019

During a routine inspection

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  • The emergency resuscitation box was out of date and medicines were not handled or stored in line with Medicines and Healthcare Products Regulatory Agency guidance.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 carried out on 5,6 and 12 July 2016

During a routine inspection

  • Senior staff were aware of their responsibilities relating to duty of candour legislation and gave us examples of when it had been implemented. The trust had a duty of candour process in place to ensure people had been appropriately informed of an incident and the actions that had been taken to prevent recurrence. Duty of candour is a regulatory duty that relates to openness and transparency and requires providers of health and social care services to notify patients (or other relevant persons) of ‘certain notifiable safety incidents’ and provide reasonable support to that person.

  • The hospital told us that all the patients attending for surgical procedures had previously been identified, by their referring companies, as low risk for anaesthesia. We did see evidence in all of the records we reviewed of a pre-operative assessment, which included an assessment of risk of VTE and blood clotting factor. However, we were not sure who was assessing the patient pre-operatively, as there was no clear evidence of the profession or competencies of the professional undertaking the pre-operative assessment, included on the assessment sheet. However although there was there was a written patient exclusion policy in operation at FTH the hospital was dependent upon the robustness of the pre-operative assessment undertaken by another provider.

  • There was a lack of clinical oversight in the recovery area, where we observed that patients were not being monitored in line with national guidelines, a blood-filled suction tube being used after it had been used in theatre and patients’ privacy and dignity being compromised. We raised these issues during our inspection and they were addressed immediately by managers and clinical leadership.

  • There was a system in place to analyse each incident as it occurred which included the cascading of the investigation to relevant staff. The process of identifying themes and trends was embryonic and required further development. We saw little evidence themes and trends were discussed regularly at team meetings.

  • There was no monitoring of compliance with the hospital hand hygiene policy. We observed poor compliance with the hand hygiene policy and patient feedback had identified that ward staff were not always washing their hands before touching them.

  • Three pieces of anaesthetic equipment were out of date for servicing according to the label on them.

Inspection carried out on 13 August 2013

During a routine inspection

We visited First Trust as part of our scheduled inspections and looked at outcomes 2, 4, 9, 12 and 16. We found the provider was compliant with theses outcomes. We spoke with two day patients who were listed to have surgery on the day of the inspection. Patients told us that the consent to surgical procedures had been explained to them from the outset.

The hospital had appropriate arrangements in place to obtain blood for transfusion in emergency situations and also had a transfer arrangement in place with the Lancashire Critical Care Network in the event any patient transfer was required.

Patients were aware of their post operate recovery and follow up and who to contact should they need to.

We saw that safe medicine arrangements were in place so patients could be supplied with the right medicines during and after their treatment.

We saw that staff were recruited appropriately and an induction programme was in pace for new or less experienced staff.

We found that the manager continued to develop the quality assurance process and was in the process of transferring all paper based processes and documents into the information technology system in use so process could be completed more quickly via the use of a computer.

Inspection carried out on 8, 11 October 2012

During a routine inspection

We spoke with three patients. One patient had undergone surgery the day before and was waiting discharge and another was having surgery that day. They told us: �I have been very happy with the treatment I have received here, the staff have been very good�, �Everything was explained again to me and it was confirmed that I still wanted the procedure�. The hospital had appropriate arrangements in place to obtain blood for transfusion in emergency situations and also had a transfer arrangement in place with the Lancashire Critical Care Network in the event any patient transfer was required. The patients we spoke with said:�I think the hospital is very clean, the nurses always use the hand gel and my room is clean and tidy� and �I have no problem with the cleanliness here, everything is very clean and organised�.

We found that the manager had undertaken a number of audits at the hospital and had identified some gaps in the training of some of the staff. An action plan was found to be in place, and arrangements had been made to ensure the staff received appropriate training and support.

Reports under our old system of regulation (including those from before CQC was created)