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Inspection Summary


Overall summary & rating

Good

Updated 26 November 2019

Spire Southampton hospital is operated by Spire Healthcare Limited. The hospital has 67 beds which includes seven critical care beds. Facilities include six operating theatres, a seven-bed critical care unit, a six ‘podded’ oncology unit, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery, medical care, critical care, services for children and young people, diagnostic imaging and outpatients services.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 16 and 17 July 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 hospital stayed the same. We rated it as Good.

We found areas of good practice across all services:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • The hospital controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. Most staff managed medicines well. The service managed safety incidents well and learned lessons from them.

  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it.

  • Most 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. Key services were available seven days a week.

  • Staff treated patients with compassion and kindness, and most 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. 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.

  • Most of the hospital services engaged well with patients to plan and manage services and all staff were committed to improving services continually.

We found areas of outstanding practice in services for children and young people:

  • The service was proactive in developing resources which had been adapted by the provider and shared across the hospital group: for example, the fasting instruction cards. The latest innovation had been the ‘app’ to help children and young people prepare for their hospital stay. One member of the children and young people’s staff team had been supported and encouraged to implement the 15 Steps process.

We found areas of outstanding practice in Surgery:

  • The hospitals bariatric Tier three weight management service won a UK Association for the Study of Obesity best practice award in 2018.

However, we found areas of practice that required improvement in critical care

  • Nursing staff in the critical care unit did not always follow the local safety standards or pathways for invasive procedures.

  • There was lack of strong leadership of the critical care service to provide assurance the service was managing risks and delivering evidence based care and treatment.

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 one requirement notices that affected critical care services. Details are at the end of the report.

Name of signatory

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and south)

Inspection areas

Safe

Requires improvement

Updated 26 November 2019

Are services safe?

Our rating of safe stayed the same. We rated it as Requires improvement because:

  • On the inpatient wards, staff did not fully understand new systems and processes for completion of venous thromboembolism risk assessments and completion of ward controlled drug registers.

  • In surgery there was a risk of injury to staff from the uneven flooring in the autoclave area and the flooring .

  • The flooring in communal areas of inpatient wards and some clinical areas posed a risk to effective cleaning of those areas

  • In the critical care service, there was a high dependence on the use of agency nurses which was above the national recommended rate for critical care units. There was a lack of assurance that agency staff working in the critical unit had completed an induction to the area they were working in.

  • The critical care unit did not ensure infection risk was consistently well controlled. There was a risk that equipment that was not clean would be used in the care and treatment of patients. There was lack of assurance that the facilities and systems to care for patients with suspected communicable diseases were effective.

  • Records in the critical care unit did not evidence consultants reviewed patients twice a day.
  • in the diagnostic imaging service much of the imaging equipment was over ten years old. This increased the risk of equipment breakdown and poor image quality.

However,

  • The service 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.
  • Except for some areas in surgical services, the hospital controlled infection risk well. The service used systems to identify and prevent surgical site infections. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • Except for the uneven flooring in the autoclave area, the design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration
  • Patient records were clear, stored securely and easily available to all staff providing care.
  • The service mostly managed patient safety incidents well. Staff recognised and reported incidents and near misses. 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 had enough medical 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 and adjusted staffing levels and skill mix, and gave locum staff a full induction.
  • The service did not always have enough of its own substantive nursing and support staff. They relied on agency and bank nurses; however, all staff had the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

Effective

Good

Updated 26 November 2019

Are services effective?

Our rating of effective stayed the same. We rated it as Good because:

  • Medical, surgery, children and young people, outpatients and diagnostic imaging services provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service adjusted for patients’ religious, cultural and other needs. Staff followed national guidelines to make sure patients fasting before surgery were not without food for long periods.
  • 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 additional pain relief to ease pain.
  • Medical, surgery, children and young people, outpatients and diagnostic imaging services monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • 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.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff gave patients practical support and advice to lead healthier lives.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

However,

  • Nursing staff in the critical care unit did not always follow the local safety standards or pathways for invasive procedures.
  • Other than for cardiac surgery, the leaders of the critical care unit did not use available information to  benchmark their performance and patient outcomes against similar critical care units.

Caring

Good

Updated 26 November 2019

Are services caring?

Our rating of caring stayed the same. We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

However,

  • In the critical care unit staff did not always ensure bedside curtains were fully closed before providing care and treatment to patients.

Responsive

Good

Updated 26 November 2019

Are services responsive?

Our rating of responsive stayed the same. We rated it as Good because:

  • 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.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
  • 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 included patients in the investigation of their complaint.

However,

  • Access to the children’s spinal surgery services was temporarily suspended, due to lack of registered nurse children (RN Child).

Well-led

Good

Updated 26 November 2019

Are services well-led?

Our rating of well-led stayed the same. We rated it as Good because:

  • Most leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced.

    • The service had a vision for what it wanted to achieve and a strategy to turn it into action. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy.

    • Staff felt respected, supported and valued, promoted equality and diversity in daily work and had an open culture where patients, their families and staff could raise concerns without fear.

    • Most leaders operated effective governance processes and most staff at all levels were clear about their roles and accountabilities. Staff had regular opportunities to meet, discuss and learn from the performance of the service.

    • Most leaders and teams used systems to manage performance and risk. Risk registers were maintained with most of them reflecting most of the risks staff shared with us. They had plans to cope with unexpected events.

    • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were secure. Data or notifications were consistently submitted to external organisations as required.

    • Leaders and staff actively and openly collaborated with partner organisations to help improve services for patients.

    • All staff were committed to continually learning and improving services.

However,

  • There was lack of strong leadership of the critical care service.
  • There was lack of a governance structure to support monitoring and evidence of the critical care service performance.
  • Processes to manage risks in the critical care service did not identify all risks expressed by staff and identified on inspection.
  • There was no formal  feedback processes to gain the views of patients to help improve the critical care service.
Checks on specific services

Medical care (including older people’s care)

Good

Updated 26 November 2019

Medical services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

The service provided elective endoscopy, interventional cardiology procedures and oncology services.

We rated this service as good because it was safe, effective, caring, responsive and well led.

Services for children & young people

Good

Updated 26 November 2019

Children and young people’s services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring and responsive and well led.

Critical care

Requires improvement

Updated 26 November 2019

Critical care services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

The hospital has a seven bedded critical care unit providing mainly level two with some level three care. The three level three beds are predominantly used for patients after cardiothoracic surgery. The four level two care beds for post-operative care are used for spinal and general surgery patients. In addition, there is one isolation room.

We rated this service as requires improvement because safe, effective and leadership required improvement. Caring and responsive were good.

Surgery

Good

Updated 26 November 2019

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

Staffing was managed jointly with medical care.

We rated this service as good because it was safe, effective, caring and well-led.

Diagnostic imaging

Good

Updated 26 November 2019

Diagnostic imaging services were a small proportion of hospital activity.

The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section. 

We rated this service as good. The service was caring, responsive and well led. However, improvement was needed in the safe domain. We did not rate effective.

Outpatients

Good

Updated 26 November 2019

Outpatients were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, caring, responsive and well led. We did not rate effective.