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Spire Little Aston Hospital Good

Reports


Inspection carried out on 11-12 June 2019

During a routine inspection

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 carried out on 22 July 2015

During a routine inspection

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.

During a check to make sure that the improvements required had been made

We have continued to receive relevant notifications. This demonstrated that staff were now aware of the procedure to follow for notification of incidents in relation to regulation 18 of the Health and Social Care Act 2008.

Inspection carried out on 30 October 2013

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

We visited Spire Little Aston Hospital to look at the progress since the last inspection when non-compliance was identified in five outcomes. The inspection was unannounced which meant that the manager and staff did not know we were visiting.

We met and spoke with the hospital director and matron, the acting theatre manager, the deputy theatre manager, seven staff and one anaesthetist.

We looked at records relating to the previous non-compliance, which were overall much improved. We observed the preparation for a theatre list and sat in on the theatre list team brief.

We saw that not all medical staff complied with the �no jewellery� policy. However, we saw that theatre staff appropriately challenged medical staff to follow the protocol for pre list team briefing. Staff told us that they felt supported to do this by the acting theatre manager.

We saw that theatre etiquette and practice had improved; although we are concerned about the continuity of staff support with further planned changes to the theatre structure. The improvements made so far will continue to be monitored by CQC to ensure that they are sustained.

Inspection carried out on 12 March 2013

During an inspection in response to concerns

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We visited Spire Little Aston on Tuesday, 12 March 2013. We did not tell them that we were going to visit. We met with the matron, acting theatre manager, theatre co-ordinator, risk and clinical governance manager and seven staff who worked in the theatre department. We conducted this visit as concerns had been raised with us regarding the theatre department.

We observed some theatre practices that did not maintain people's privacy and dignity. Other practises compromised the safety of people, due to risk of spread of infection or not completing relevant checks. We discussed these issues with the acting theatre manager and the matron.

We looked at records to see if staff were supported in their role. We could not find sufficient evidence to demonstrate that this was the case. Staff reported that they worked excessive hours, received no appraisal and were reluctant to raise concerns as they feared repercussions. We could not find any evidence to demonstrate that some staff had been assessed as competent to perform their role. Staff told us that they did not feel competent to complete all tasks required of them.

We were told that there was no information regarding agency staff working in the department.

Inspection carried out on 15, 31 October and 13 November 2012

During a routine inspection

We visited Spire Little Aston as anonymous concerns had been raised. We met with the newly appointed theatre manager, theatre co-ordinator, matron and other staff who worked at the hospital. We saw that some of the anonymous issues raised had already been identified and acted upon by the service. Other issues were in the process of being addressed and some were unfounded. We spoke with people who had recently undergone a surgical procedure to find out their views of the service provided at Spire and they told us, "The staff are brilliant"; "The care is good". We visited the theatre department and spoke with staff and observed some of the theatre safety checks.

We saw paperwork which demonstrated that all treatment options were discussed. People were given sufficient information to enable them to make a decision about their care. We saw that written consent was obtained before any treatment was completed.

A pharmacist inspector visited to look at the safe management of medicines including controlled drugs (CDs). We spoke with a pharmacist and a pharmacy technician about the support given to clinical wards and theatre departments. We found that CDs were handled and managed safely within theatres. However some theatre Operating Department Practice staff had not received training in order to manage all aspects of CDs. We were told that this training was planned to take place shortly.

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