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Inspection carried out on 3rd, 4th & 14th February 2015

During a routine inspection

Spencer Private Hospital (Margate) is an independent hospital that is one of two sites run by East Kent Medical Services Ltd.

The Spencer Private Hospital (Margate) opened in 1998, and is built on the site of the local NHS trust to which it is physically linked via a corridor.

The Care Quality Commission (CQC) carried out a comprehensive inspection on 3rd and 4th February 2015 and undertook an unannounced inspection on 14th February 2015.

We inspected this hospital as part of our second wave independent hospital inspection programme, using the Care Quality Commission’s new inspection methodology.

This location has been given a shadow rating. Shadow ratings apply to inspections which are undertaken during the development of our approach and before our final methodology is confirmed and published.

The hospital has 22 ensuite private bedrooms on the first floor and five outpatient consulting rooms, two physiotherapy rooms and an endoscopy unit on the ground floor.

Services for Operating Theatres, Intensive Care, High Dependency, Coronary Care, Pathology, Medical Records, Estates and Maintenance, Supplies, X-ray and diagnostic imaging, Pharmacy and Medical Gases are procured by the hospital from the local NHS trust under a service level agreement (SLA).

Referrals are received from self-funding patients, patients with medical insurance and NHS patients through a contract with the local NHS trust. The majority of the hospital’s work is NHS-funded through Choose and Book, commissioned by the Clinical Commissioning Group (CCG).

The hospital provides a small amount of medical in-patient care and children and young person’s services including minor surgery.

75% of the hospitals case mix is adult elective surgery, predominantly orthopaedic.

For the purpose of the comprehensive inspection we undertook an on-site review of surgery and outpatient services and have included our findings of the small volume of medical care, children and young person’s services and end of life care within these core services. The hospital does not provide maternity or termination of pregnancy services.

The on-site element of the inspection involved a team of specialist clinical advisors (experienced healthcare professionals) and CQC inspectors.

Prior to the on-site inspection, the CQC considered a range of quality indicators and we sought the views of a range partners and stakeholders.

The inspection team make an evidence-based judgment to ascertain if services are:

• Safe

• Effective

• Caring

• Responsive

• Well-led.

Overall the rating for the Spencer Private Hospital (Margate) was good. The service was rated good in all five domains in both its inpatient and outpatient services.

Our key findings were as follows:

• CQC had received no complaints, safeguarding concerns or alerts or whistle-blower enquiries in the last 12 months.

• East Kent Medical Services Ltd had a robust process for appointing medical staff to the service under practicing privileges arrangements.

• Robust Clinical Governance processes were in place with no never events occurring within the last year.

• Serious incidents including anaesthetics, surgical site infections and all mortality and morbidities were being monitored and reported. These were low and lessons were learnt.

• There was a robust complaint management process that included Duty of Candour. East Kent Medical Services Ltd is a member of the Association of Independent Healthcare Organisations (AIHO) which gives access to the Independent Sector Complaints Adjudication Service (ISCAS) for Non-NHS patients and the provider liaises with the local Clinical Commissioning Group (CCG) for patients whose care is funded by the NHS.

• Patients completed a patient experience survey upon discharge. These showed a high level of satisfaction. Areas requiring improvement were fed back to the appropriate staff at departmental meetings and changes implemented.

• MRSA and C. Difficile is monitored and there have been no hospital- acquired cases in the last 12 months.

• East Kent Medical Services Ltd has an admission policy that sets out safe criteria for people using the service.

• There were systems for the effective management of staff that included an annual appraisal, including medical staff with practising privileges.

• East Kent Medical Services Ltd carried out a number of audits to monitor and improve services including collecting Patient Reported Outcome Measures (PROMS) for Hip and Knee replacement surgery and infection control data.

• There was an organisational risk register for all risks including Clinical, Health and Safety and financial risks.

• East Kent Medical Services Ltd uses an advance recovery programme for orthopaedic surgery. The NHS Institute for Improvement and Innovation introduce an enhanced recovery programme to improve patient outcomes and reduce the patient's recovery time after surgery. This is designed to reduce complications, improve the patient experience and reduce the time patients stay in hospital. Spencer Hospitals (Margate) were one of the top three Independent Providers for their Enhanced Quality and Enhanced Recovery in Kent, Surrey and Sussex.

• There is a Business Continuity Plan in place; this includes an agreement for the transfer of patients between the local NHS Trust and the hospital in the case of an emergency.

• East Kent Medical Services Ltd is accredited with ISO 14001 Environmental Standard and management systems.

• East Kent Medical Services Ltd is accredited to ISO9001 quality management systems.

• East Kent Medical Services Ltd is accredited as an Investor in People.

• East Kent Medical Services Ltd exceeds the national standard for Harm Free Care.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Review the arrangements for the storage of all medicines and ensure they are stored securely and at the recommended temperatures to maintain their efficacy.

• Review the arrangements for delivering safeguarding training to staff against the intercollegiate framework for safeguarding children which recommends face to face training at level 3.

• Ensure that care pathway documentation be reviewed to include references to NICE or Royal College of Surgeons Guidelines.

• Be able to demonstrate that cosmetic surgery is carried out in line with the professional Standards of Cosmetic Practice, Royal College of Surgeons (RCS Professional Standards).

• Develop care pathway documentation that is made available for patients having cosmetic surgery.

• Audit DNA CPR forms to ensure these are meeting appropriate standards.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 5 February 2014

During a routine inspection

We spoke to three patients and two relatives of patients during our inspection of the service. All of the people we spoke to were positive about their experiences of care at the hospital. One person told us “I am a very satisfied customer”.

The provider had effective mechanisms in place to gather feedback from users of the service and to monitor the quality of care provided, and acted upon the information received. The provider published an annual quality report that demonstrated high standards of quality of care and positive customer feedback.

Patients experienced safe and effective care when treated at the hospital. The provider had put effective measures in place to minimise the risk of harm to patients, visitors and staff.

There were enough staff to care for the needs of the patients at the hospital. One person told us “they have time to stop and give you the help you need”.

Inspection carried out on 13 March 2013

During a routine inspection

We spoke with two people who used the service. They both told us that they were consulted before any care or treatment was given to them. One person said, "They tell me about what they are going to do and say, "Is that okay?". Both of the people we spoke with said that they were very happy with the care and treatment that they received. One person told us, "The staff are very friendly and courteous. They listen to what I say and are very nice."

We looked at the care and treatment plans for six people who used the service. Each plan included a care or treatment pathway dependent on the reason for their admission. Each plan was personalised for the individual and contained risk assessments that were reviewed on a daily basis throughout the person's stay. We saw that people's care and treatment plans were stored in a locked trolley kept in the reception area whilst they were being cared for and treated in the hospital.

All the areas of the hospital that we saw looked clean and bright. In each room people were provided with individual antiseptic wipes. We spoke with two people who used the service. They both told us that nurses and doctors always used the antiseptic hand gel just inside the door to their room before providing any care or treatment for them.

We saw from the two staff files that we looked at that people had only started work after a full Criminal Records Bureau (CRB) check had been received. Two references had been obtained for each new staff member.

Inspection carried out on 29 February 2012

During a routine inspection

People told us they were very satisfied with their care and treatment being provided. They said they had been consulted about their care and were informed of all aspects of their treatment. They said that the staff were kind and respectful. They were always available when they were needed and responded to their calls quickly.

People said that they had been asked if they were happy with the service and were given the opportunity to express their views on the care being provided.

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