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Spire Leeds Hospital Requires improvement

Reports


Inspection carried out on 11 December 2018

During an inspection to make sure that the improvements required had been made

Spire Leeds Hospital is operated by Spire Healthcare Ltd. The hospital has 88 inpatient and day case beds. Facilities include four operating theatres, one endoscopy suite, one angiography suite, a chemotherapy unit, physiotherapy services, outpatients’ departments, and diagnostic and imaging facilities. There is an eight-bedded level two critical care unit, an eight-bedded children’s ward, a 10-bedded ambulatory care unit, six oncology day case chairs, and 56 inpatient and day case beds spread across two adult wards.

The hospital provides surgery - including cosmetic surgery, medical care - including chemotherapy, high dependency care for adults, services for children and young people, and outpatients and diagnostic imaging services.

We inspected this service using our focused inspection methodology. We carried out an unannounced responsive inspection on 11 December 2018. We focused on specific services which were highlighted as concerns to CQC from staff and members of the public, and we inspected surgery and services for children and young people. As concerns spanned multiple inspection domains, we looked at all key questions and asked if surgery and children’s and young people’s services were safe, effective, caring, responsive, 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. As this was a focused inspection, new ratings were only awarded for the key questions that were inspected. The overall rating for surgery changed from good to requires improvement. The overall rating for and children’s and young people’s services changed from good to requires improvement. We amalgamated these ratings with ratings from our routine 2017 inspection of medical care, outpatients and diagnostic imaging, and critical care services. Our rating of this hospital went down. The rating for the hospital changed from good to requires improvement overall.

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 about surgery services (for example, management arrangements) also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Services we rate

Our rating of this hospital went down. The rating for the hospital changed from good to Requires improvement overall.

We found the following areas of concern in surgery and children and young people’s services:

  • Key leaders in the service did not have the right skills and abilities to run a service providing high-quality sustainable care. Opportunities to prevent or minimise harm were missed.

  • Safety was not always a high priority, and the application of safety systems and processes required improvement. Levels of harm were inconsistently recorded against incident records. Investigation reports were of variable quality, and the completion and sign-off of action plans was inconsistent.

  • The application of governance arrangements and systems was not adequate. The hospital could not reliably determine how many serious incidents had occurred, and had not always notified CQC of serious incidents, or had not done so in a timely manner. At the time of inspection, the hospital had been without a governance lead for several months. We saw the frequency of key committees was not always in line with their terms of reference. There was little evidence senior leaders had worked to systematically improve service quality and safeguard good standards of care. Risk registers were not adequately managed and did not reflect key risks facing the service.

  • Senior leaders had not supported or promoted a culture of appropriately identifying, reporting, categorising, and learning from incidents. When concerns were raised, or things went wrong, the approach to reviewing and investigating causes was often insufficient or too slow. There was little evidence of learning from events or action taken to improve safety in key committee and group meeting minutes we reviewed.

  • Senior leaders had failed to meet their duty of candour obligations consistently well. The culture was not one of fairness, openness, transparency, honesty, challenge and candour. Senior leaders were reactive and defensive. When something went wrong, people were not always told in an open and honest way or in a timely manner.

  • The culture, policies and procedures had not provided adequate support for staff to raise concerns and have these adequately addressed at hospital level. From November 2017 to October 2018, CQC received five whistleblowing enquiries; and an internal whistleblowing investigation by Spire Healthcare (corporate) had been undertaken with respect to children’s and young people’s services.

  • The service had not sufficiently applied the systems available to identify risks and implement plans to eliminate or reduce them. Risks to patient safety had not been monitored or mitigated over time consistently well.We found senior managers had failed to sufficiently address fasting time compliance. Recent improvements had been made in venous thromboembolism (VTE) prophylaxis, daily and pre-discharge medical review of patients, and medical record keeping compliance; but deficiencies with compliance were observed throughout most of 2018. Where action plans had been implemented, we often found these were not sufficiently robust.

  • The hospital had systems to manage information. However, the information that was used to monitor performance or to make decisions was not always accurate, valid, reliable, or timely. We saw that clinical audit measures were not always collated or presented to committees and groups in a timely fashion; and we observed data inaccuracies between key hospital and service reports.

  • The service level agreement (SLA) for the transfer of critically ill children had expired in February 2018 and had not been renewed as of January 2019.

  • Staff did not always follow best practice when prescribing, giving, recording and storing medicines.

  • There was limited evidence of discussions about learning from concerns and complaints in key committee and group meeting minutes we reviewed.

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. We also issued the provider with three requirement notices. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals

Inspection carried out on 10 January to 12 January 2017 and 24 January 2017

During a routine inspection

Spire Leeds Hospital is operated by Spire Healthcare Limited. The hospital has 88 inpatient beds. Facilities include eight operating theatres, an eight-bedded level two critical care unit, a chemotherapy unit, outpatients’ departments, an eight-bedded children’s ward and diagnostic and imaging facilities.

The hospital provides surgery, including cosmetic surgery, medical care including chemotherapy, high dependency care for adults, services for children and young people, and outpatients and diagnostic imaging. We inspected all these services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection from 10 to 12 January 2017, along with an unannounced visit to the hospital on 24 January 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. See surgery section for main findings.

We rated this hospital as good overall.

We found good practice in relation to surgery, medicine, critical care, children and young people and outpatients and diagnostics:

  • There were sufficient qualified, experienced and skilled staff to meet people’s needs in most areas. The service managed staffing effectively. Staff teams and services worked well together to deliver good quality care.
  • The hospital had systems and processes in place to protect people from avoidable harm. There were systems for incident reporting. Staff knew how to use these and learning was shared to prevent reoccurrence.
  • We found care and treatment supported good patient outcomes and was based on the best available evidence. There were clear pathways of care and staff were able to recognise and respond to warning signs of deteriorating health.
  • The service met national indicators for referral to treatment (RRT) waiting times. The service worked closely with local commissioners and NHS providers to meet the needs of the local population. The service considered the individual needs of people in some areas, including those living with dementia and those with learning disabilities.
  • Senior managers were visible, approachable and promoted a fair culture. Staff felt listened to and said the hospital was a great place to work. There was a clear vision and strategy. Staff were fully engaged with changes in the hospital and patients were encouraged to suggest improvements.

There were governance systems in place to ensure oversight of quality, performance and management of risks.

  • Radiology services were able to access electronic images held by other healthcare providers without any delays and reducing the need for re-imaging.

We found areas of outstanding practice in relation to caring:

  • All staff demonstrated a very caring approach to their patients. We saw all patients were treated with dignity and respect and feedback from patients was consistently positive. The approach to care was patient-centred and all staff demonstrated a high level of commitment to ensuring patients had a positive experience. We heard of numerous examples where staff had gone the extra mile to ensure patients had a positive experience.

  • We saw staff in endoscopy had sourced special theatre shorts for patients undergoing endoscopies and colonoscopies to maintain patients’ dignity as much as possible.

We found areas of outstanding practice in relation to responsiveness and well-led in medicine:

  • Partnership working ensured patients could access counselling, holistic therapist, cosmetic services, palliative and pain services as well as hospice care to meet all of their individual care needs.

There were areas where the provider should make some improvements, to help the service improve. These were:

  • The provider should ensure the safer steps for surgery, which includes the WHO checklist, is consistently adhered to.

  • The provider should ensure the senior management team and the medical advisory committee take note of actions and matters from other groups, such as the paediatric steering group, within the hospital.
  • The provider should ensure there is a robust process for document control for documents produced at the hospital.
  • The provider should ensure that appropriately trained staff undertake incident investigations.
  • The provider should ensure audits or checks of the National Early Warning System (NEWS) include correctly calculated scores.

  • The provider should review the process for recording and sharing learning from near miss incidents.
  • The provider should continue to implement measures to improve fasting times for patients.
  • The provider should risk assess situations where one registered children’s nurse is caring for children on the ward.
  • The provider should review the chaperone policy and the admission and discharge policy in relation to children to ensure the requirements are clear for chaperones and age of children admitted.
  • The provider should monitor did not attend (DNA) rates and have a robust system for recording and following up children who did not attend appointments.

  • The provider should ensure that all records are completed in line with hospital and professional standards including the provision of care plans for patients identified at high risk of falls or developing pressure ulcers.
  • The provider should review their local audit programme in the outpatient’s department.

Ellen Armistead

Deputy Chief Inspector of Hospitals

Inspection carried out on 17 December 2013

During a routine inspection

We visited all areas of the hospital which provided care and treatment to patients. This included the wards and out-patient departments.

Patients we spoke with told us staff treated them respectfully, promoted their dignity and involved them in decisions regarding their care and treatment. One patient told us, �I�ve had two operations here. Each time, the surgeon explained the treatment and advised reconstruction. The surgeon was amazing and went through the different options and what the results were likely to be for each.�

Patient's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

One patient told us, �Staff are fantastic, really attentive and very thorough. They do regular checks on you, at one point I was being checked every 30 minutes. I�ve nothing negative to say at all. I can�t praise them enough.�

The hospital had enough qualified, skilled and experienced staff to meet patient's needs. Staff told us they had enough to meet patients' needs. One member of staff said, �It�s good to be able to give patients what they need. I wouldn�t mind being a patient here. I am that confident we deliver good care here.�

We found that care and treatment was planned and delivered in a way that was intended to ensure patient's safety and welfare.

The hospital had effective systems in place to reduce the risk of infection and followed appropriate guidance. One patient said, �It is immaculate here; I have no concerns about the cleanliness at all.�

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients who used the service and others.

Inspection carried out on 12 December 2012

During a routine inspection

We spoke with patients, their relatives and staff and reviewed case notes. All of the patients we spoke with were positive about their care and about their experience at the hospital. One person said, �When I ask for help staff respond quickly.� Other people told us they were, �Happy with the care they had received,� �No problems with the care and support provided and �The staff have been very good to me.� "The service is excellent", "I have had no reason to complain" and "The hospital is perfect."

Patients told us they were either dealt with promptly or if they had to wait; they were told the reasons for the delay, such as waiting for an x-ray. They told us they were satisfied with the care and treatment they had received once they had been admitted to the ward. All praised the staff and told us how helpful they were. One person said they had received �Good care by nurses.� Other people told us, �I received the help I needed it. I have no complaints at all.�

People were cared for in a clean, well maintained building. People were supported by suitably qualified and experienced staff. People were provided with information that would assist them if they needed to raise concerns or make a complaint.

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