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Inspection Summary


Overall summary & rating

Good

Updated 8 December 2015

Spire Little Aston Hospital, part of Spire Healthcare, offers comprehensive private hospital treatments, procedures, tests and scans to patients from Sutton Coldfield and surrounding areas. The hospital offers a range of surgical procedures, cancer care, rapid access to assessment and investigation and a physiotherapy service. The hospital did not provide children’s in patient or day case surgery

Patients are admitted for elective surgery, attend as a day case or for outpatient care. There are no emergency admissions.

Services are available to people who held private insurance or to those paying for one-off private treatment. Fixed prices, agreed in advance, are available. The hospital also offers services to NHS patients on behalf of the NHS through local contractual agreements and 39% of its activity was NHS funded care.

 Facilities include an Inpatient ward with 24 private rooms with ensuite facilities, a   Day Care Ward with 8 private rooms with ensuite facilities, a two bedded High Dependency Unit, a Chemotherapy Suite consisting of a 4 chair day care room and two private rooms with ensuite facilities and a Endoscopy Suite consisting of a 4 bay recovery area. There are 3 theatres all with laminar flow, 2 minor procedure theatres and an Endoscopy procedure.

Prior to the CQC on-site inspection, the CQC considered a range of quality indicators captured through our monitoring processes. In addition, we sought the views of a range partners and stakeholders. A key element of this comprised the focus groups with healthcare professionals and feedback from the public.

The inspection team make an evidence based judgment on five domains to ascertain if services were:

• Safe

• Effective

• Caring

• Responsive

• Well-led.

Our key findings were as follows:

Spire Little Aston Hospital was selected for a comprehensive inspection as part of the independent healthcare inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

The inspection team included CQC inspectors, doctors, nurses, experts by experience and senior managers with experience of working in the Independent Healthcare sector. The inspection took place on 22 July 2015, with an unannounced visit on 5 August 2015.

The inspection team looked at the following core services: Surgery, High Dependency unit, outpatient and diagnostic imaging services.

Inspection areas

Safe

Good

Updated 8 December 2015

  • There was an open culture and learning environment for reporting incidents. The staff reported incidents using an electronic reporting system. Outcomes and learning from incidents were cascaded to staff.An increase in reported incidents was believed to be due to an improvement in culture within the hospital. Staff were aware of the duty of candour and a robust Duty of Candour Policy was in place.

  • We were not assured the World Health Organisation (WHO) surgical safety checklist was being used consistently. Monthly figures did not demonstrate that the WHO checklist was being completed fully. Information sent to us in post inspection in September 2015 suggested a significant improvement month on month.

  • There was no for Interventional Radiology in operation at the hospital during our inspection. This is a recommendation from the Royal College of Radiologists. The checklist

  • Staff were aware of their responsibility to safeguard adults and children and the action to take if there was a concern and both training courses in 2014 were well attended.

  • The hospital had a resident medical officer (RMO) who provided cover on an on call basis for the hospital 24 hours a day. The RMOs worked for seven days and then had seven days off and were supplied by an agency.

  • There was sufficient staff to meet people’s needs across outpatients and diagnostic and surgery. A recruitment campaign was underway to meet vacancies within ward and theatre areas and many staff worked overtime and as part of a bank to ensure safe staffing levels. Agency staff usage was RAG rated red on the hospital clinical score card and Spire Little Aston was one of the highest agency users in the Spire group.

  • There were good infection control surveillance procedures to identify and manage infections. However, hand hygiene procedures for infection prevention and control needed to be improved in OPD. We saw the hospital identified that from 1 April 2014 to 31 March 2015 there had been no cases of MRSA, C. difficile, E. coli or MSSA infections. There were three post-operative wound infections during this time frame. Investigations into the causes had been carried out with action plans implemented.

  • Medicines were stored and managed in safe way and the pharmacy department had good governance systems to monitor new drugs, off licence drugs, safety and drug alerts and incidents. There was a medicines reconciliation service on admission and audits on prescribing on the wards. Local medicines policies were up to date and the medication error rate was low.

  • Mandatory training attendance figures showed at the end of June 2015 48% of staff had completed their mandatory e-learning / training which was the expected training compliance for half way through the year.

Effective

Good

Updated 8 December 2015

  • Local policies and care pathways to treat patients followed national guidance. Governance and research for the introduction of new technologies had been followed.

  • We saw that the hospital had systems in place to provide care and treatment in line with best practice guidelines such as National Institute for Health and Care Excellence (NICE)

  • There was some participation with National audits, however majority of benchmarking clinical practice was measured and compared across the 39 Spire Healthcare Hospitals. A clinical scorecard was updated monthly and performance and quality was monitored and measured using a RAG rated system which fed up to the central governance team. Any area rated red was escalated automatically and a remedial action plan was required to address concerns.

  • Patients had appropriate pain relief and their nutrition and hydration needs were well managed. They were offered a choice of meals and alternative meals could be provided if required and special diets were catered for.

  • Staff understood their responsibilities in relation to gaining consent.

Caring

Good

Updated 8 December 2015

  • Staff were caring and compassionate and treated patients with dignity and respect. Staff in the OPD went ‘the extra mile’ to ensure patients received their care and treatment and carers well fully supported.

  • Patients were positive about services and told us they felt well-cared for and were involved in their care plans and were able to make informed decisions and choices.

  • The hospital had recorded high for the NHS equivalent Friends and Family Tests scores for both privately funded and NHS funded patients who had responded to the survey, from April 2015 to June 2015 the hospital scored 99 %. Patients reported excellent, professional and caring staff and good information about their care and treatment.

  • The needs of patients living with dementia or who had a learning disability were identified at pre-assessment and were supported by staff throughout their stay.

Responsive

Good

Updated 8 December 2015

  • Patient operations and procedures were rarely cancelled. The hospital undertook NHS funded care. There was no differentiation between NHS or private patients, although theatre staff told us that if cancellations were required this would more likely be for NHS patients.

  • Patients were positive about the information they received to help them in making decisions. Written information was available to support verbal information, however this was only available in standard English text.We were told by the hospital information could be translated in advance into other languages on request by the contracted translation service.

  • Appraisal rates for both surgery and OPD and diagnostic services staff during 2013-2014 were 98%.

Well-led

Good

Updated 8 December 2015

  • During the inspection we reviewed the 15 recommendations made by Verita, who is anindependent consultancy who carry out reviews and investigations of complex, sensitive issues to regulated organisations.The Verita review was commissioned by Spire Healthcare and was completed in March 2014. The aim of the review was to understand the circumstances that enabled a former breast care surgeon to practice as they did At Sire Parkway and Little Aston Hospitals, which led to the consultant’s ultimate dismissal in 2013 and the recall of more than 600 patients at Spire Parkway Hospital.The consultant had practicing privileges at both hospital sites but Spire Little Aston Hospital to a much lesser extent. The report looked specifically at governance arrangements within both hospitals. We saw evidence to demonstrate that the majority of recommendations made by Verita had been implemented at Spire Little Aston Hospital. Corporate Spire had adopted a further eight actions across the Spire hospital network to improve governance and monitoring arrangements. We were assured all eight had been completed at Spire Little Aston.

  • The hospital’s vision and values were well embedded across hospital services and staff were aware how this aligned to the Spire Corporate vision and strategy, which was to be recognised as a world class healthcare business.
  • There were consultants from each speciality represented at the hospital’s medical advisory committee (MAC). There were regular meetings held with the hospital management team and there was liaison with other consultants via email, meeting, minutes and newsletters.

  • Governance arrangements were in place for teams and departments to discuss complaints, incidents and audits, share lessons learned and minimise clinical risks. However, the senior management team were working through a backlog of consultant biennial reviews which had not been carried out in a timely manner. 16% had been completed (49/300) at the time of the inspection. Post inspection, 30 September 2015, this figure had increased to 90%, with rationale and action plans for the outstanding 10%.

  • The Hospital risk register did not include all risks across services. For example there was no reference made to the challenge related to the consultant biennial review backlog and the absence of the theatre WHO checklist had not been included as an identified risk.

  • Staff were positive about the hospital as a place of work. There was a supportive and open culture and staff felt that ward and department managers were approachable as were the hospital management team. The hospital was described and felt like a “friendly” place to work. The culture in the theatre department was said to be improving following previous concerns about management arrangements.

  • The senior management team used innovative ways to communicate with staff to glean feedback to improve services for patients and improve staff’s working environment. This included employees’ forum, team talks and a staff newsletter, a “reward drop-in session” and tea with the hospital director.

  • The hospital actively monitored social media for any content involving them so that they could investigate any issues raised and respond appropriately.

Professor Sir Mike Richards

Chief Inspector of Hospitals. 

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 8 December 2015

The outpatient and diagnostic service department at Spire Little Aston was rated good overall. Incident reporting was well in-bedded and staff were aware of their responsibility towards Duty of Candour. Record management was well managed through outpatients and diagnostic services, however, Infection control practices in the OPD needed to be improved. Staffing levels met the needs of patients’ and an ongoing recruitment drive was in place to fill vacancies.  Patient’s nutrition and hydration needs were met and patient’s pain levels were monitored and managed well. Clinical practice across all areas was underpinned by National guidelines and imaging regulations were followed appropriately. There was a collaborative approach to care and treatment with evidence of strong MDT working across OPD and diagnostic services. Staff were supported to attend mandatory training and attendance at Safeguarding and Mental Capacity Act training was good.  Facilities in the outpatients was under review to replace the reception desk, there was no dedicated administration or rest room for nurses in outpatients to use and inadequate car parking for patients and staff. Staff were caring and compassionate and treated patients with dignity and respect. Staff supported people with complex needs such as those with learning disabilities or people living with dementia appropriately. We saw numerous examples of how OPD staff went above and beyond to ensure patients received their care and treatment by often overcoming obstacles. Governance arrangements were effective to review risks and included, monitoring the performance of consultants, in areas such as lateness for clinics, unauthorised removal of medical records and clinic overruns.  However there was no WHO safety check list for interventional radiology in operation. This had been introduced by the time we carried out an unannounced visit on 5 August 2015. The culture was open and transparent and staff said their departments were well led. Staff reported that the managers ensured they felt respected, valued, and engaged.  The OPD and diagnostic service were proactive in obtaining feedback from patients and staff at regular intervals to improve care and treatment within the department.

Surgery

Good

Updated 8 December 2015

We rated Surgical services at Spire Little Aston Hospital as good overall. However, we saw World Health Organisation (WHO) surgical safety checklist was not used consistently and monthly figures did not demonstrate that the WHO checklist was being completed fully. Evidence received three months after the inspection demonstrated significant improvement. Services followed procedures to provide safe care and incident reporting and dissemination of lessons learned was well in-bedded throughout. All staff were aware of the Duty of Candour and the complaints process was robust. Patient’s nutrition and hydration needs were met and patient’s pain levels were monitored and managed effectively. Some national audits were carried out together with local audits supported by action plans and regular review dates to measure progress to improve patient outcomes. Cases of unplanned returns to theatre, readmissions to hospital and transfers of patients to other hospitals were all ‘similar to expected’ compared to the other independent acute hospitals we hold this type of data for. The nursing handover required more structure as it did not include all details relevant to patients care and treatment. During the unannounced visit on 5 August 2015 we saw improvements had been made to the nursing handover. A staff induction programme was in place for new clinicians and consultants and staff competencies were assessed and signed off as competent within a timely manner. We were not assured there were robust on call arrangements for consultants. There were appropriate systems in place to respond to deteriorating patients and medicines were managed safely. Staff supported people with complex needs such as those with learning disabilities or people living with dementia appropriately. Staff were kind and caring, and treated patients and relatives with dignity and respect. Staff were supported with internal and external training and appraisal figures were good for staff across the hospital. The governance structure was in place with regular reviews of consultant’s practising privileges. However, the newly appointed senior management team had inherited a backlog of consultant biennial reviews with only 16% completed at the time of the inspection. Post inspection 30 September 2015 we saw this had increased to 90%. The hospital risk register did not include all risks across surgery services. Staff described local and senior managers as nurturing, excellent role models, with an ‘open door’ policy.We rated Surgical services at Spire Little Aston Hospital as good overall. However, we saw World Health Organisation (WHO) surgical safety checklist was not used consistently and monthly figures did not demonstrate that the WHO checklist was being completed fully. Evidence received three months after the inspection demonstrated significant improvement. Services followed procedures to provide safe care and incident reporting and dissemination of lessons learned was well in-bedded throughout. All staff were aware of the Duty of Candour and the complaints process was robust. Patient’s nutrition and hydration needs were met and patient’s pain levels were monitored and managed effectively. Some national audits were carried out together with local audits supported by action plans and regular review dates to measure progress to improve patient outcomes. Cases of unplanned returns to theatre, readmissions to hospital and transfers of patients to other hospitals were all ‘similar to expected’ compared to the other independent acute hospitals we hold this type of data for. The nursing handover required more structure as it did not include all details relevant to patients care and treatment. During the unannounced visit on 5 August 2015 we saw improvements had been made to the nursing handover. A staff induction programme was in place for new clinicians and consultants and staff competencies were assessed and signed off as competent within a timely manner. We were not assured there were robust on call arrangements for consultants. There were appropriate systems in place to respond to deteriorating patients and medicines were managed safely. Staff supported people with complex needs such as those with learning disabilities or people living with dementia appropriately. Staff were kind and caring, and treated patients and relatives with dignity and respect. Staff were supported with internal and external training and appraisal figures were good for staff across the hospital. The governance structure was in place with regular reviews of consultant’s practising privileges. However, the newly appointed senior management team had inherited a backlog of consultant biennial reviews with only 16% completed at the time of the inspection. Post inspection 30 September 2015 we saw this had increased to 90%. The hospital risk register did not include all risks across surgery services. Staff described local and senior managers as nurturing, excellent role models, with an ‘open door’ policy.