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Spire Gatwick Park Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 4 January 2016

Gatwick Park Hospital is run by Spire Healthcare Limited which is a part of Spire Healthcare Group Plc. An acute hospital with 55 beds, Spire Gatwick Park Hospital provides private hospital services to self-funding and insured patients and NHS patients referred under the Standard NHS Acute Contract, predominantly from the Surrey and Sussex area.

The organisation offers a range of services and facilities including: two bed HDU (Level 1 enhanced care); a dedicated endoscopy unit; a dedicated day care unit; an in-house ISO accredited sterile services department; a 64-slice CT and 3T MRI scanner; and onsite pharmacy and pathology. The hospital has three operating theatres that are in use six days a week; with usual daily allocations of two to three sessions between 08:00 and 21:00.The Care Quality Commission (CQC) carried out a comprehensive inspection on 09 and 10 June 2015 and undertook an unannounced inspection on 15 June 2015.

We inspected this hospital as part of our independent hospital inspection programme, using the Care Quality Commission’s new inspection methodology.Spire Gatwick Park Hospital provides adult elective surgery, outpatients and diagnostic imaging, services to children and young people and endoscopy.For the purpose of the comprehensive inspection, we undertook an on-site review of surgery, children and young person’s services and outpatient services and have included our findings of the small volume of medical care, and end of life care from within these core services. The hospital does not provide maternity or termination of pregnancy services.

Overall, we judged the hospital to require improvement. This is because we identified concerns in relation to safety, and issues affecting the effectiveness of care.

Our key findings were as follows:Overall Service Leadership

  • Staff told us they were supported by visible, accessible and approachable managers.

  • There were systems of governance to ensure any issues affecting safety and quality of care were identified and managed.

  • The hospital did not maintain complete and comprehensive records as required by the relevant regulations due to consultants taking their own outpatient clinic notes away with them.

Cleanliness and infection control

  • The hospital was meeting government guidance in relation to infection control, and care was delivered in a clean environment.

  • Floor coverings in some areas did not meet government guidance and presented a potential risk of infection.

Staffing Levels

  • There were adequate numbers of appropriately skilled and experienced staff to meet patients' needs.

  • Children and young people were cared for by registered sick children's nurses and consultants treating children had their competency verified.

Outcomes for patients

  • Hospital policies, care and treatment were in line with guidance from the National Institute for Health and Care Excellence (NICE), the Department of Health and learned societies.

  • There was insufficient data collected to allow adequate monitoring of the treatment outcomes of children and young people and for patients having cosmetic surgery.

Nutrition and hydration

  • Patients had access to appropriate food and drink in sufficient quantities.

  • However, patients were starved for longer than recommended before surgery.

Actions we have told the provider they must take:

  • Review its arrangements for the retention of outpatient records at the hospital.

Actions we have told the provider they should take:

  • Ensure all staff have access to the electronic incident reporting system and know how to use it.

  • Sustain new systems introduced after our initial visit that ensure medicines are stored at temperatures that maintain them in optimum condition.

  • Ensure all staff are up to date with mandatory training, including Basic Life Support.

  • Carry out an appropriate risk assessment for the cleaning of carpets, and ensure that replacement plans comply with Department of Health HTM Health Building Note 00-09: 'Infection control in the built environment'.

  • Review the arrangements for maintaining records in an easily usable condition.

  • Review its arrangements for pre-operative starving of patients.

  • Review the arrangements for the provision of 'as needed' pain relief for patients.

  • Ensure that all elements of the World Health Organisation Surgical Safety Checklist are consistently completed and that compliance is audited.

  • Consider how it can differentiate between the feedback from children and young people from that of other patients.

  • Consider how it measures and monitors the outcomes of treatment for children and young people.

  • Identify what mandatory skills staff require in order to effectively care for children and young people.

  • Review its policies, procedures and literature to ensure that the definition of children is consistent.

  • Ensure consultants holding electronic patient records are registered with the Information Commissioner’s Office.

Inspection areas

Safe

Requires improvement

Updated 4 January 2016

The safety of services required improvement.

Not all staff were able to report safety incidents easily and medicines were not always stored at appropriate temperatures although the provider took action to rectify this. We saw a number of floor surfaces that were inappropriate for a clinical environment. The World Health Organisation's Surgical Checklist was not consistently adhered to. Outpatient records were not retained by the hospital, which meant that there were no comprehensive patient records that were accessible by all staff. We found some weaknesses in the way that patients were assessed before surgery. However, we found care was delivered by adequate numbers of appropriately trained staff in clean, hygienic surroundings. We saw evidence of learning and implementing changes to practice following the analysis of safety incidents.

Effective

Requires improvement

Updated 4 January 2016

The effectiveness of services required improvement. Patients were being starved and restricted from fluids for periods which were longer than required, which could impact their wellbeing and the outcome of surgery. The management of 'as needed' pain relief for day case patients required review. There was a lack of systems in place to obtain data and monitor their outcomes of care for children and young people. However, we saw evidence that NICE guidelines and other national guidance were used in practice.

Caring

Good

Updated 4 January 2016

The service provided was caring. Patients received compassionate care in an environment that afforded them sufficient privacy and dignity, and were supported throughout their care and treatment. Patients advised us that they received compassionate care from friendly and approachable staff, this corresponded with our observations.

Responsive

Good

Updated 4 January 2016

Services were responsive to patients' needs and they experienced treatment which was delivered in a timely way and took into account their individual requirements. Outpatient clinics were provided in daytime, evenings and at weekends so patients were able to access appointments at their convenience. There were clear systems in place for receiving, investigating and learning from complaints.

Well-led

Good

Updated 4 January 2016

Services were well-led. Overall, there were robust governance arrangements. Staff described receiving strong leadership, with senior management being visible and accessible to staff. There was evidence of an open culture, and staff were very positive about their work and were aware of the provider's strategy and values. There were systems in place for gathering patient feedback, however these were adult orientated and did not differentiate between adult and children’s services.

Checks on specific services

Services for children & young people

Updated 19 December 2017

At our 2015 inspection, services for children and young people was rated as requires improvement because local policies, procedures and guidelines were inconsistent in their definition of a child. There was limited data collected to measure the outcomes of care for children and young people and feedback systems were adult orientated. There was no designated, child-friendly area for treating

children. Not all staff caring for children had specific

training to do so. However, children were cared for

by registered sick children's nurses who had access

to appropriate equipment. Consultants treating

children had their competency verified. The majority

of staff had received training in safeguarding

children.

At this inspection, we found all of these actions had been met. Policies and literature had been updated and all definitions of infants, children and young people were consistent and accurate. Management had focused on improving staff paediatric competencies. Facilities for children at the hospital had improved since the 2015 inspection.

Outpatients and diagnostic imaging

Updated 19 December 2017

At our 2015 inspection, outpatient and diagnostic services were rated as good overall. We saw patients received compassionate care in accordance with national guidance from a range of clinical staff and therapists. Waiting times were minimal and clinics ran at weekends and evenings to allow patients to be seen at a time convenient to them. Diagnostic equipment, including that using ionising radiation, was properly calibrated, used and maintained. However, there were inadequate arrangements to ensure that consultant outpatient notes were retained to ensure a comprehensive patient record was available to all staff that needed to access it. There was inappropriate floor coverings for this environment, which presented potential infection risks.

At this inspection, we found the hospital had developed an on-site records department that ensured a comprehensive patient record was available for three months. After this period, records were sent to an archiving facility where they could be retrieved within 24 hours when required. This meant the service was no longer in breach of regulation with regard to records. The outpatients department was included in the first stage of hospital refurbishment; therefore, at the time of this inspection, flooring within outpatients was appropriate.         

Surgery

Updated 19 December 2017

At our 2015 inspection, surgical services required improvement because floor coverings were not appropriate for a hospital environment. Not all staff knew how to report safety incidents. The amount of time patients were starved before surgery was often too long and ‘as needed’ pain relief was not effectively monitored. We found some weaknesses in the way some patients were assessed before surgery, as staff were not consistently following the World Health Organisation ‘five steps to safer surgery’ guidance. However, we found that patients were treated in a compassionate and timely way by adequate numbers of appropriately trained staff to meet their needs. The hospital environment was clean and equipment was well maintained.

At this inspection, we found there were still areas of the hospital that were carpeted and surgical clinical areas were a priority for refurbishment with work already underway. There was effective cleaning and auditing of these areas. All staff knew their responsibilities in reporting incidents and knew how to use the online reporting system. Incidents were regularly discussed at team meetings. Patient starve times were closely monitored and within national guidelines. ‘As needed’ pain relief was monitored and regularly checked to ensure effectiveness.