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Spire Little Aston Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 18 November 2019

Spire Little Aston Hospital is operated by Spire Healthcare Limited. The hospital has a 24 bedded surgical ward and a separate two bedded extended recovery unit, an eight bedded day case unit and a chemotherapy suite with four chairs and two private rooms. Facilities include one endoscopy theatre and three laminar flow operating theatres and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, outpatient services for children and young people, and outpatients and diagnostic imaging. We inspected surgery, medicine and outpatients.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection from 11-12 June 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 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 service level.

Services we rate

Our rating of this service stayed the same. We rated it as Good overall.

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

  • Staff provided good 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. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

  • The service planned care to meet the needs of local people, 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.

  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work.Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

    However:

    Outpatients:

  • The audio consulting room in outpatients was very small and cramped. It would not easily accommodate a patient using a wheel chair safely together with one other person beside the consultant.

  • The outpatient service did not have in place an audit programme of patient records to assure continued good quality of records and records management.

  • Front line outpatient staff were not active in encouraging patients and visitors to cleanse their hands.

  • The hospitals policy for its Cognitive Impairment Adult Framework was incomplete and did not include ‘the outpatient phase’ as indicated was intended by the contents page.

  • There were insufficient patient toilets for outpatient services demand and some degree of privacy was compromised by their location.

Endoscopy:

  • There was an inconsistent approach to decontamination and hand hygiene within the endoscopy unit.

  • Two sharps boxes were not assembled correctly.

Chemotherapy Suite:

  • Room 63 in the chemotherapy suite needed updating to be fully compliant with HBN 00/10- part A (flooring).

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

Heidi Smoult

Deputy Chief Inspector of Hospitals



Inspection areas

Safe

Good

Updated 18 November 2019

Our rating of safe stayed the same. We rated it as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.

  • The service used systems and processes to safely prescribe, administer, record and store medicines.

  • The service mainly controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. However, the endoscopy service needs to ensure a consistent approach to decontamination processes and hand hygiene.

However,

  • Two sharps boxes were not assembled correctly within the endoscopy unit.

  • Room 63 in the chemotherapy suite needed updating to be fully in line with latest HBN 00/10- part A (flooring) guidance.

  • The audio consulting room in outpatients was very small and cramped. It would not easily accommodate a patient using a wheel chair safely together with one other person beside the consultant.

  • The outpatient service did not have in place an audit programme of patient records to assure continued good quality of records and records management.

  • Front line outpatient staff were not active in encouraging patients and visitors to cleanse their hands.

Effective

Good

Updated 18 November 2019

Our rating of effective stayed the same. We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patient’s subject to the Mental Health Act 1983.

  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

However:

  • The hospitals policy for its Cognitive Impairment Adult Framework was incomplete and did not include ‘the outpatient phase’ as indicated was intended by the contents page.

Caring

Good

Updated 18 November 2019

Our rating of caring stayed the same. We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 18 November 2019

Our rating of responsive stayed the same. We rated it as Good because:

  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.

  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

However:

  • There were insufficient numbers of patient toilets for outpatient services compared with demand and some degree of privacy was compromised by their location.

Well-led

Good

Updated 18 November 2019

Our rating of well-led stayed the same. We rated it as Good because:

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

Checks on specific services

Surgery

Good

Updated 18 November 2019

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.

Staffing was managed jointly with medical care.

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

Medical care (including older people’s care)

Good

Updated 18 November 2019

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.

Outpatients

Good

Updated 18 November 2019

Out–patient activity accounted for the majority of the activity at the hospital, a very small proportion of this was for children and young people. There were also a range of diagnostic imaging services and a physiotherapy service.

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