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Inspection Summary


Overall summary & rating

Outstanding

Updated 30 June 2017

The Lister Hospital is operated by HCA International Ltd. The hospital employs over 500 consultants and nursing staff and has 61 beds. Facilities include four operating theatres, a six bedded level 3 critical care unit and an endoscopy suite.

The hospital provides surgery, medical care, critical care, and outpatients and diagnostic imaging. All services at this hospital were inspected during our visit.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 28 February – 2 March 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.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service section.

Services we rate

We rated this hospital as ‘outstanding’ overall because:

  • Patients were treated with compassion and their privacy and dignity were maintained. Patient feedback forms were positive, as were comments we received from patients themselves.

  • The needs of individuals were taken into account when planning care and treatment. Patients could access care when they needed it. There was a choice and flexibility around appointments and most procedures were elective.

  • The hospital was managed by a team who had the confidence of both patients and their teams. Staff felt motivated and supported by the management team. The vision and strategy of the service was embedded and staff spoke very highly of their management team.

  • There were adequate systems to keep people safe and learn from incidents. Learning from incidents that occurred in other departments was shared across the service.

  • The environment at the hospital was visibly clean and well maintained. There were appropriate measures in place to ensure the spread of infection was prevented.

  • There were systems in place to ensure safe storage, use and administration of medicines.

  • There were sufficient nursing and medical staff to ensure patient safety was maintained at all times.

  • Care was planned and delivered in line with current evidence-based guidance, standards and best practice. Patient outcomes were collected and monitored to improve care.

  • We observed evidence of collaborative working and positive relationships across all departments within the hospital.

  • There were effective governance structures in place.

We found areas of ‘outstanding’ practice in surgery services and critical care services:

  • Within surgery, we found that staff went above and beyond their duty to accommodate patients’ individual needs in different ways.

  • We found a culture of friendly professionalism, support and respect at all levels throughout the surgical division.

  • In critical care, staff demonstrated a consistent approach to providing highly individualised care that contributed to emotional wellbeing and a positive recovery. This included facilitating family visits at mealtimes, and learning Arabic to communicate effectively with patients and their families. Individual examples included ordering fresh flowers to decorate a patient’s hair ready for discharge, and inviting a relative to eat lunch with staff each week.

  • A consultant intensivist led a critical care post-discharge support programme (PDSP), that was based on a holistic model of care. This meant the service provided support for improved physical health and wellbeing, as well as for psychological health. The PDSP had an international scope. Patients who were discharged to countries outside of the UK had access to this by video link.

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

  • The hospital should ensure that the quality of documentation of consultants is monitored and any issues are addressed.

  • Not all staff had access to the same system for documentation.

  • Not all staff had completed their mandatory training, and in many cases the hospital target of 85% was not met.

  • Not all complaints in the medical service were responded to within the 20 day timeframe.

  • We found high vacancy rates for inpatient and theatre staff and high turnover rates of inpatient nurses.

  • In radiology, we found that that prescription pads were not stored securely and there was no system in place to log usage of prescription pads.

  • The safeguarding children's policy was out of date as it had not been reviewed in June 2016.

  • The outpatients department did not have a separate waiting area for children. 

Following this inspection, we told the provider that they should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 30 June 2017

We rated safe as good because:

  • There were systems in place to report safety incidents and near misses. Learning from incidents that occurred in other departments was shared across the service.

  • Medicines were managed and stored appropriately. Staff told us the pharmacy services were easily available and pharmacists visited the wards daily.

  • Sufficient infection prevention control (IPC) measures were taken throughout the wards and endoscopy department.

  • Nursing staff demonstrated an awareness of safeguarding procedures and how to recognise if someone was at risk, or had been exposed to abuse. They knew how to escalate concerns and were up-to-date with appropriate levels of safeguarding training.

  • Patients were assessed for a variety of risks on admission to the wards, using nationally recognised tools. Processes were in place to identify and control patient risks. A critical care outreach team was available to provide support and advice when a patient’s condition deteriorated.

  • There were sufficient nursing and medical staff to ensure patient safety was maintained at all times.

  • Staff had awareness of what actions they would take in the event of a major incident, including a fire.

  • In the critical care unit, nurse and medical staffing consistently met the requirements of the Faculty of Intensive Care Medicine (FICM) and Intensive Care Society (ICS) Core Standards for Intensive Care Units. This included in relation to nurse to patient rations, consultant review time and the availability of intensivists out of hours. A dedicated team of registered medical officers (RMOs) provided medical support 24-hours a day, seven days a week.

However,

  • There were no dedicated hand washing sinks in patient rooms. This meant there was a risk of cross infection from ineffective hand hygiene.

  • We noted high vacancy rates for inpatient nursing and theatre staff and high turnover rate for inpatient nurses.

  • We identified issues with the legibility of some paper based medical records, where poorly photocopied forms were often used. In one case, a paediatric food chart was used for an adult patient. Some entries by medical staff were not signed and were illegible. We also found that not all inpatient notes contained full records of consultant-led ward round or review within 12 hours of patient admission. The issue of consultants not reviewing patients regularly and documenting this had been highlighted on the hospital risk register.

  • In radiology, prescription pads were only stored securely at night and there was no system in place to record or log the usage of prescription pads.  This did not meet best practice guidelines for the use of controlled drug stationery.

  • Not all staff had completed their mandatory training, and in many cases the hospital target of 85% was not met.

Effective

Good

Updated 30 June 2017

We rated effective as good because:

  • Hospital policies were current and referenced according to national guidelines and recommendations.

  • Nursing and medical staff completed a variety of local audits to monitor compliance and improvement.

  • Pain was assessed and well managed on the wards, with appropriate actions taken in response to pain triggers.

  • The majority of staff received annual appraisals on their performance, which identified further training needs and set achievable goals. Staff were satisfied with the quality of the appraisal process. The hospital was supporting nurses with the revalidation process.

  • There was evidence of effective multidisciplinary working within wards and across departments.

  • Nursing and medical staff showed a good knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

  • A consultant intensivist led a critical care post-discharge support programme that supported patients after they left the unit, in order to maintain good standards of physical and psychological health. 

  • All CCU nurses had completed the provider’s critical care foundation course. A further 76% had a post-registration qualification in intensive care nursing, which was better than the Intensive Care Society (ICS) target guidance of 50%.

However:

  • Most agency staff did not have access to the electronic care planning system. The hospital instead provided them with paper documentation to record patient progress and risk assessments. This meant there were gaps in the electronic record and the records were disjointed. This issue was highlighted on the hospital risk register, which stated that all paper notes should be scanned as soon as possible (aiming for within 48 hours of discharge) onto the electronic system. However, this did not tackle the issue of agency staff not having full access to all relevant information to care for each patient. The hospital planned to give all agency staff access to the electronic system.

Caring

Good

Updated 30 June 2017

We rated caring as good because:

  • Patients were cared for in a caring and compassionate manner by staff throughout their stay. The hospital performed well in their inpatient survey. The diagnostic imaging department used their own satisfaction survey. The results showed a consistently high level of satisfaction with the service.

  • Patients’ privacy and dignity was maintained throughout their hospital stay.

  • Staff ensured that patients and their families were informed about their care and were fully involved in any treatment decisions.

  • Patients had access to psychological support and counselling services.

  • Patients had access to multi-faith spiritual support.

Responsive

Outstanding

Updated 30 June 2017

We rated responsive as outstanding because:

  • Patients were able to access care and treatment in a timely way. There were clear admission processes and no problems with flow or discharge throughout the hospital.

  • Within the hospital menu, there were many options to cater for those with different nutritional requirements.

  • The needs of individuals with differing complex needs were well considered and largely met by the service.

  • Translation services were readily available.

  • Appointments could be coordinated between OPD and diagnostic imaging so that patients could be offered one stop clinics. Evening and Saturday appointments were also available.

However:

  • There was no multi-faith room on site.

  • Not all complaints in the medical service were dealt with within the hospital mandated time scale.

Well-led

Outstanding

Updated 30 June 2017

We rated well-led as outstanding because:

  • The hospital had developed a vision and strategy and communicated this to staff of all levels, enabling them to feel invested in the development of their respective services and the hospital as a whole.

  • The leadership team promoted an open and approachable culture, and staff felt comfortable to approach managers with their concerns. Staff felt supported by managers. They were encouraged in their career development to learn and improve.

  • The service actively sought patient feedback and initiated improvements according to results.

  • Staff feedback results showed good staff engagement and staff felt proud and committed to doing their very best.

  • Governance processes and structures reflected the needs of patients, staff and safety standards. There were clear lines of accountability and a range of specialist committees and working groups provided clinical governance oversight and quality assurance.

Checks on specific services

Medical care (including older people’s care)

Good

Updated 30 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 the surgery section.

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

Critical care

Outstanding

Updated 30 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 hospital has four level three intensive care beds in private rooms and two level two high dependency beds in a bay. Critical care services are provided in a dedicated unit with direct access from theatres and a critical care outreach service is provided 24-hours, seven days a week.

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

Outpatients and diagnostic imaging

Good

Updated 30 June 2017

Outpatients and diagnostic imaging services were present at the hospital. There were a total of 47,836 outpatient attendances between October 2015 and September 2016.

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

Surgery

Outstanding

Updated 30 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.

The operating area had four theatres and patients were admitted to the day surgery unit and a mixed surgical and medical ward.

There had been 9526 inpatient and day case attendances between October 2015 and September 2016.

The service mainly offered in-vitro-fertilisation and gynaecological procedures, followed by orthopaedic surgeries.

Staffing was managed jointly with medical care.

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