We carried out an announced, comprehensive inspection visit on 17 and 18 August 2016 and an unannounced inspection on 26 August 2016.
Overall we rated the hospital required improvement, although surgical services were good.
Are services safe at this hospital/service?
Incidents were reported and dealt with appropriately and outcomes with learning were cascaded to staff. However, the tool used for undertaking root cause analysis, was not fit for purpose. Some root cause analysis were not completed thoroughly. The ward and theatres were visibly clean and well equipped. Fluid balance charts were not always completed. Nursing and surgical staffing was suitable for patients’ needs and staff had undergone appropriate training, in adult care, but not for the care of children and young people. A resident medical officer was present 24 hours a day, seven days a week, to provide medical care. Consultants were on call 24 hours a day for their patients. The lead for safeguarding was the matron, who had undergone level 3 training. However, other staff dealing with children and young people did not have the required level of safeguarding training. Some staff were aware of how to escalate safeguarding concerns outside the hospital.
Are services effective at this hospital/service?
The endoscopy suite was Joint Advisory Group on gastrointestinal endoscopy (JAG) accredited. Policies and practice were evidence based and followed national guidance. Pain levels were assessed and managed appropriately. Patients’ nutrition needs were met following surgery and the service was improving in its performance in fasting patients prior to surgery. Arrangements were in place to ensure that consultants were competent to perform surgical procedures. There were arrangements in place to obtain medications out of hours. Not all staff had a clear understanding of mental capacity and how to assess a patient’s capacity to consent to treatment.
Are services caring at this hospital/service?
Patients were treated with compassion, with their dignity and respect upheld. Patients felt well cared for and would recommend the service to others. Staff respected patient confidentiality. Patients understood their care and treatment and had opportunities to ask questions. Staff had access to contact details for religious leaders, to help meet patients’ spiritual needs.
Are services responsive at this hospital/service?
Flexible appointments and surgery times were available to patients. When operations had to be cancelled, they were always rescheduled within 28 days. All patients aged over 75 years were screened for dementia. Any patients identified as living with dementia followed a dementia care pathway. Staff had an awareness of dementia and had received training in this. The hospital had hearing loops and access to interpreters for patients for whom English was not their first language. Catering staff were aware of religious and cultural preferences for food and catered for these accordingly. There was evidence of changes to practice as a result of patient complaints and feedback.
Are services well led at this hospital/service?
The hospital had a clear governance structure and framework, which was driven by their corporate body, Spire Healthcare Ltd. Audit results were discussed at governance meetings, with findings cascaded to staff through team meetings and via email. There was no oversight of risk with regards to children and young people. The risk register contained mostly corporate risks and there were no dates when the risk was added or target dates for completion. A business plan had been developed, although this lacked strategic direction and was not supported by clear objectives and milestones. Leaders were visible and approachable, with the hospital director and matron visiting the ward and theatres daily. Staff felt respected and valued and described the staff within the service as ‘like family’.
Our key findings were as follows:
- The hospital was clean and well equipped
- Staffing levels were appropriate; staff were registered with the appropriate professional body and were well trained.
- The lead infection prevention and control nurse did not have a specialised infection prevention and control qualification.
- There was an effective practising privileges procedure in place, supported by the Medical Advisory Committee (MAC,) which ensured that surgeons were fit to practise.
- Children under the age of 18 years were treated at the hospital. Numbers were very low and the hospital did not have the infrastructure to effectively support this service. Therefore it was withdrawn shortly after our inspection.
- Patients and relatives said that staff were kind and took time to explain things to them.
- There was excellent multidisciplinary team working, this included care to patients with cancer.
- There were processes in place to ensure that patients were safe, however, the hospital’s risk register was not reflective of some of the key risks.
However, there were also areas of where the provider needs to make improvements.
Importantly, the provider should:
- Comply with Healthcare associated infection (HCAI): operational guidance and standards, (July 2012,) Health Building Note (HBN) 00-10 Part A: Flooring and HBN 00-10, in all clinical areas.
- The flooring and coving in patient bedrooms should be considered for refurbishment as part of a plan, to ensure compliance with current infection control guidelines.
- Review the requirement for clinical hand wash basins in patients’ bedrooms.
- Ensure the infection prevention and control lead has a specialised infection prevention and control qualification to enhance their knowledge.
- All NEWS charts should have clear evidence of regular observations, according to the patient’s condition and the type of surgery undertaken.
- Ensure there is a nursing presence in the ‘Garden Suite’ so that patients who may be deteriorating can be identified quickly.
- Clinical staff should have a system of formal clinical supervision.
- Review the Spire tool used for root cause analysis and ensure all root cause analysis are completed thoroughly and in a consistent manner.
- All staff should have a clear understanding of mental capacity and how to assess a patient’s ability to consent to treatment.
- Ensure the risk register is updated to include the date the risk was identified, why the risk has been included, the date of review, appropriate controls to mitigate the risk.
- The hospital should continue working towards improving its performance in discharging patients before 11am as part of Spire’s clinical scorecard.
- Staff should be confident in making safeguarding referrals outside of the organisation.
- A hearing loop should be available in the main outpatient area.
Professor Sir Mike Richards
Chief Inspector of Hospitals