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Archived: Spire Manchester Hospital Requires improvement

Reports


Inspection carried out on 13 to 14 September 2016

During a routine inspection

Spire Manchester Hospital is operated by Spire Healthcare Plc. and originally opened in June 1981 as Bupa Manchester. The hospital was renamed in 2007 when the hospital arm of Bupa was sold to Spire Healthcare. The Spire Manchester Hospital treats both NHS funded patients and patients who wish to pay for their own treatment.

The Hospital is located in Whalley Range, Manchester and it has 49 patient bedrooms, four theatres (two of which are laminar flow), a separate endoscopy room and a CE (European conformity) accredited Sterile Services department.

There are imaging facilities on site, which include a 16 slice computed tomography (CT) scanner, 1.5T Magnetic resonance imaging (MRI) scanner, a Fluoroscopy room, ultrasound and mammography. There is also a physiotherapy department, a complete patient gym with rehabilitation equipment, including an anti-gravity treadmill. The outpatient department has 18 consulting rooms in the main hospital, minor treatment rooms and two specially adapted consulting areas for bariatric patients. The hospital is also an International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) accredited weight loss centre.

Specialities undertaken at the hospital include: Cardiology and Chest medicine, Cosmetic Surgery, Dermatology, ENT, Endocrinology, Gastroenterology, General Medicine, General Surgery, Gynaecology, Neurology, Ophthalmology, Oral and Maxillofacial surgery, Orthopaedics, Paediatric Medicine and Surgery, Pain Management, Plastic/Cosmetic Surgery, Psychiatry, Rheumatology, Urology and Weight Loss Surgery. The hospital also has a satellite clinic in Hale, with four consulting rooms and a minor treatment room.

Chris Chadwick became registered manager in November 2012 and the accountable officer for controlled drugs for the Spire Manchester Hospital is Dawn Davies.

The majority of the consultants are from local NHS trust and have all been given practice and privilege rights at the hospital. The hospitals main activity comes from general surgical procedures and outpatient diagnostics imaging services. The hospital reported 6,470 inpatient and day case episodes of care in the reporting period (April 2015 to March 2016); of these 33% were NHS funded and 67% were funded privately. The hospital operates Monday to Saturday, also offering evening appointments.

We inspected the hospital as part of our routine comprehensive inspection programme for independent healthcare services. We carried out an announced inspection visit on 13 and 14 September 2016 and an unannounced inspection on 26 September 2016.

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.

Spire Manchester Hospital has previously been inspected by the Care Quality Commission on 22 May 2014. The Care Quality Commission inspected against five core standards and found the hospital to be compliant.

Spire Manchester Hospital is operated by Spire Healthcare Limited, Spire Manchester Hospital is registered to provide the following regulated activities:

  • Diagnostic and screening.
  • Surgical procedures.
  • Treatment of disease, disorder or injury.

We inspected the core services of Surgery, Services for Children and Young People and the Outpatients and Diagnostics service.

We rated this hospital/service as requires Improvement overall. Our key findings were as follows:

  • Equipment was maintained and appropriately checked, but in some areas was not always visibly clean.
  • In theatres, there were inconsistencies in the recording of the administration and destruction of controlled drugs in all of the controlled drug registers we reviewed.
  • We found there were numerous missing signatures and times for administration of controlled drugs were not, or not accurately, recorded. Failures to record the amount of the medication administered or destroyed, indicated that these medications were unaccounted for.
  • Medications, including controlled drugs, were observed being drawn up prior to the operation and prior to the patient arriving in the anaesthetic room.
  • Staffing levels were sufficient to meet patients’ needs and staff assessed and responded to patient risks in theatres and the outpatients and imaging department. However, care and treatment was not always provided by suitably trained, competent staff. For example nurses caring for children did not have the appropriate paediatric competencies.
  • Patients did not always receive care and treatment according to national guidelines such as National Institute for Health and Care Excellence (NICE) and the Royal Colleges. Surgery services participated in national audits.
  • There were governance structures in place, which included a risk register. We saw that not all risks had been identified and actions were not always taken to mitigate the risks in a number of areas that included controlled drugs in theatres.

However 

  • The hospital had systems in place for reporting risk and safeguarding patients from abuse.
  • Medical equipment was checked and maintained by an independent company. We saw records to confirm that electrical equipment had been tested across all areas.
  • There was sufficient capacity in the ward and theatres, so patients could be seen promptly and receive the right level of care before and after surgery.
  • Patients were given information about how to make a complaint. Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.
  • Staff treated patients with dignity and respect and patients were kept involved in their care. Patients and their relatives we spoke with told us they were supported by staff. We observed staff deliver care in a caring, compassionate and supportive way.
  • All staff were dedicated to delivering good, compassionate care and were motivated to work at the hospital.
  • Patient records were stored securely at the hospital and access was limited to those individuals who needed to use them. This ensured that patient confidentiality was maintained at all times.
  • Patients had a choice of appointments available to them through the ‘Choose and Book’ service. This meant that patients were able to attend appointments at a time best suited to their needs.
  • Robust systems were in place to ensure that consultants holding practising privileges were valid to practice. We saw there were procedures in place to ensure all consultant requests to practice were reviewed by the Medical Advisory Committee (MAC).
  • Staff that worked at the hospital felt appreciated and valued, they discussed with us the different ways Spire recognised staff for their hard work.

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 a requirement notice that affected surgical services and children and young people services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)

Inspection carried out on 22 May 2013

During a routine inspection

Our expert by experience spoke with nine people who used the service along with some of their relatives who were present on the day. They all told us they were very happy with the care they had received. Everyone we spoke with felt staff had been attentive to their needs and had responded quickly when they required assistance. Comments included: “I am really pleased, I am not worried and everyone seems really nice and helpful”, “Here they listen, they understand and so I go ‘phew’ no stress. My baby is calm, I am calm” and “They gave us information for a local hotel so we knew we would be close to here…they are very, very good, very kind”.

We found people were asked to sign a consent form before receiving any treatment. Admission assessments were completed and care pathways were in place to ensure people received safe and appropriate treatment.

Medicines were dispensed, stored and administered in line with best practice requirements.

We looked at staff files and found the provider carried out a range of pre-employment checks to ensure people were suitable to work at the hospital.

We saw that the provider had a system in place to review and respond to any complaints they received. Complaints were monitored so that the provider could learn from mistakes and improve the service.

Inspection carried out on 15 May 2012

During a routine inspection

We spoke to seven people using the service, who were staying on the inpatient ward at the time of our visit. Everyone we spoke to gave us very positive feedback about the quality of their care overall. People were happy with the amount of information they had been given about their surgery and said the ward staff kept them informed and respected their choices. People said their admission date had not been changed by the hospital and they were happy with how their surgery had gone. Everyone we spoke with was happy with the quality of their care on the ward. People said they got enough pain relief and the nursing staff were very friendly and helpful. Everyone was happy with the quality and variety of the food. People said they felt safe on the ward and staff treated them with dignity and respect. Everyone we spoke with was complimentary about their surgeon and the staff on the ward. People felt that all the staff were well trained and competent. Only one of the people we spoke with had raised any concerns with the provider during their admission. They were completely happy with how the provider had responded to their concerns.

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