Spire London East Hospital

Spire London East Hospital is operated by Spire Healthcare Group plc. The hospital has 27 inpatient beds and 16 day case rooms called ‘pods’. Facilities include four operating theatres, an endoscopy suite, a three-bed level one extended recovery unit, pharmacy and x-ray, outpatient and diagnostic facilities.

The hospital provides surgery and outpatients, physiotherapy, diagnostics and imaging services. It also provides some limited outpatients medical appointments for adults, children and young people. We inspected the surgery, outpatients and diagnostic imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 5-7 November 2019. This was an announced visit.

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.

Where our findings on outpatients apply to other services, we do not repeat the information but cross-refer to the outpatients service level.

Services we rate

Our rating of this hospital/service improved. We rated it as Good overall.

• The hospital 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.
• The hospital infection risks well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• We observed the clinical and reception areas were clean and tidy. The service used stickers and cleaning schedules to identify when areas had been last cleaned.
• The hospital had a dedicated infection prevention and control (IPC) lead that monitored compliance with IPC practices, supported by link practitioners in theatres, wards and paediatrics. The IPC Lead nurse managed the annual audit of infection prevention and control practices across surgical wards and theatres, which was used to inform an annual IPC report.
• We observed good hand hygiene practices in place across surgical wards. All staff (including non-clinical) received training in Aseptic non-touch technique (ANTT) for prevention of the spread of infection.
• Since the last inspection the hospital has reviewed practice in this area and improved the processes in line with best practice. This included new decontamination equipment and refurbishment of the endoscopy areas, which reduced the risk of contamination, ensuring there was a sterile processing technician team available throughout the endoscopy list.
• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well.
• In surgery, staff completed and updated risk assessments for each patient and took action to remove or minimise risks. Staff identified and quickly acted upon patients at risk of deterioration. Staff used the national early warning scores (NEWS 2) system to assess and monitor risk of deterioration in patients.
• Patient risk was discussed each day in the morning huddles and twice daily nursing handovers. The morning huddle provided an overview of activity (including any alterations to theatre lists) and key risks each day, and included attendance from surgery staff, as well as the heads of department. Notes from each morning huddle were typed up and shared with staff by email.
• In surgery, the hospital used the World Health Organisation (WHO) Surgical Safety Checklist to minimise the risk of incidents during surgery. We observed multiple examples of the WHO checklist in use on inspections. In all cases they followed a standardised, accurate approach that were well led and had good staff engagement.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
• The service used systems and processes to safely prescribe, administer, record and store medicines.
• The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
• The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.
• The service had enough nursing 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 staffing levels and skill mix, and gave agency staff a full induction.
• There was sufficient access to medical staffing on the ward, and out of hours consultant support if needed

• Staff assessed patients’ needs and planned and delivered patient care in line with evidence-based, guidance, standards and best practice.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
• In surgery, staff made sure patients had support with nutrition and hydration to meet their needs. Any patients that had specific dietary needs would be identified at pre-assessment for surgery, and catering staff could then prepare accordingly.
• In surgery, 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 pain relief to ease pain. The hospital had a senior lead nurse with responsibility for pain management care for surgery patients.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service had been accredited under relevant clinical accreditation schemes.
• 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.
• The service had a practice development lead nurse (PDN) in post with responsibility for monitoring mandatory training, ensuring staff competencies, and supporting staff development. The PDN ran regular training sessions for ward staff, often in collaboration with consultants on specific topics. Staff told us they were positive about the support and involvement of the PDN.
• Staff of different disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• The hospital had policies in place for the process to obtain informed consent, and for the management of patients under MCA and DoLS.
• At the time of the last inspection, we found some consent forms were unsigned so could not clearly show confirmation of consent. On this inspection we found staff clearly recorded consent to surgery to treatment in the patients’ records as necessary.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• During the inspection we saw staff on the surgery ward treating patients with dignity, kindness, compassion, courtesy, and respect. Staff explained their roles and any care they delivered to patients during their interactions. Care that we observed was patient centred.
• Patients and family members spoke very positively about the care they received, and how they were treated by the staff on the wards
• Parents could accompany their child to the anaesthetics area before the patient proceeded to theatres. This was meant to alleviate some of the anxiety prior to surgery for both the child and their family.
• Staff understood the impact that patients' care, treatment and condition had on wellbeing. Staff stressed the importance of treating patients as individuals and this was reflected in the interactions we observed.
• Surgery wards had access to a patient concierge, who could provide patient centred and individual support as needed. Staff were able to provide numerous examples of input from the patient concierge that improved the experience of patients using the service.
• Staff provided reassurance and support for patients throughout their care. Staff demonstrated a calm and reassuring attitude to put patients at ease. We observed staff taking time to explain their treatment to patients and asking them if they had any questions about their care. The hospital also had dignity champions appointed across the hospital to provide enhanced person-centred care.
• Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
• Family members of patients were positive about the care the patients received and stated that staff members were professional and welcoming.

• 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 planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
• Surgery wards provided food that catered to dietary requirements and cultural preferences. Patients told us they were happy with the quality of the food that they received.
• Staff were aware of how to access translation if patients or families were unable to communicate in English.
• People could access the service when they needed it and received the right care promptly. The service admitted, treated and discharged patients in line with national standards.
• In surgery, the recovery area had a designated recovery bed for young people, so that they were segregated from older patients. The paediatric recovery space had been decorated to accommodate young patients.
• In surgery, there were adequate discharge arrangements in place with patients provided with contact details of who should be contacted should any problems occur. Patients stated that they would contact the ward if they had any concerns, and some patients who had done so stated they received a quick reply from their consultants.
• 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.

• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
• Staff we spoke with stated that the senior leadership team was visible on the wards and were approachable to all staff, operating an “open door” policy. Staff we spoke with told us that there was a no blame culture, and that they felt valued and respected.
• The Hospital had a clear vision and strategic goals, which was aligned to the national corporate clinical strategy. The paediatric services delivered at the hospital had also introduced strategic goals for their service, which were currently in development.
• Staff were proud of the work they carried out. Staff stated they enjoyed working at the service and were enthusiastic about the care and services they provided for patients.
• There was a robust corporate governance framework in place which oversaw service delivery and quality of care.
• The hospital had a regular patient experience committee which discussed feedback from patient and how to improve the patient journey. The hospital also had input from patient ambassadors, who were patients that had used the service in the past and now provided feedback and advice to hospital leadership.
• The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

However:

• The hospital did not have a dedicated dietitian, input from a provider level dietician was available to provide advice and support if needed.
• In surgery, there had been two ‘never events’ reported at the hospital from June 2018 to July 2019, both relating to incorrect site surgery. Never events are serious incidents that are entirely preventable as guidance, or safety recommendations providing strong systemic protective barriers, are available at a national level, and should have been implemented by all healthcare providers. The service had taken appropriate action to address the issues highlighted by these events.

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

Nigel Acheson

Deputy Chief Inspector of Hospitals (London)