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Spire Washington Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 8 May 2020

Spire Washington Hospital is operated by Spire Healthcare Limited. The hospital had 47 beds, however the hospital provided information stating there were currently 36 beds operational.

The hospital provides a range of inpatient and outpatient elective services. We inspected surgery, termination of pregnancy, outpatients and diagnostic imaging.

We carried out the unannounced visit to the hospital on 4 and 5 December 2019 and inspected the diagnostic imaging service on the 7 February 2020.

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 overall.

  • 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. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well.

  • Staff identified and acted upon patients at risk of deterioration. The service had enough staff with the right qualifications, skills, training and experience. Managers regularly reviewed and adjusted staffing levels.

  • The service used systems and processes to safely prescribe, administer, record and store medicines. The service 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.

  • The service provided care and treatment based on national guidance and evidence-based practice. 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. Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

  • 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. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

  • 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.

  • Leaders understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.

  • 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.

  • Leaders and staff actively and openly engaged with patients, staff, and local organisations to plan and manage services. All staff were committed to continually learning and improving services.

However, we also found the following issues that the service provider needs to improve:

  • Staff did not always keep detailed records of patients’ care and treatment in the outpatient department.

  • We observed some inconsistencies in executing the WHO checklist which was not implemented consistently across each operating theatre.

  • Recruitment and retention of orthopaedic scrub staff for theatres required some development to alleviate shortages.

  • Some items of equipment were overdue for service which did not comply with documentation.

  • Staff used personal protective equipment with one exception we observed following which immediate action was taken to remedy practice.

  • Some key positions were filled on an interim basis and the hospital identified recruitment to key leadership roles in clinical areas as an area for development.

  • Consultation appointments were available on only one weekday in the termination of pregnancy service.

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

Ann Ford

Deputy Chief Inspector of Hospitals (North Region)

Inspection areas

Safe

Good

Updated 8 May 2020

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

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. The service controlled infection-risk well. Staff assessed risks to patients, acted on them and kept good care records.

  • Staff complied with best practice regarding cleanliness and infection control, and the environment was appropriate for the service. Risks were assessed and managed appropriately.

  • The service used a nationally recognised tool to identify deteriorating patients and escalated them appropriately.

  • Detailed records of patients’ care and treatment were clear, up-to-date and easily available to all staff providing care. The service had systems in place to identify and manage adults and children at risk of abuse.

  • Systems were in place for reporting, monitoring and learning from incidents. The service contributed to the NHS Safety Thermometer to support monitoring of patient harm incidents and promote harm-free care.

  • The service had sufficient medical and nursing staff to keep patients safe.

  • The design of the operating theatres and the maintenance of equipment was fit for purpose and in line with national guidance. The theatre department was very clean and organised. Equipment available within theatres was appropriate.

  • Medicines were stored and managed safely and prescribing documents were prepared in line with the provider’s policy.

  • The service managed safety incidents well and learned lessons from them.

However, we found the following areas that the service provider needed to improve:

  • We observed some inconsistencies in executing the WHO checklist which was not implemented consistently across each operating theatre.

  • Recruitment and retention of orthopaedic scrub staff for theatres required some development to alleviate shortages.

  • Some items of equipment were overdue for service which did not comply with documentation.

  • Staff used personal protective equipment with one exception we observed following which immediate action was taken to remedy practice.

  • Staff did not always keep detailed records of patients’ care and treatment in the outpatient department.

Effective

Good

Updated 8 May 2020

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

  • The hospital consistently achieved positive patient outcomes including low rates of surgical site infection and positive patient reported outcome measure results. The hospital held a number of national accreditations which demonstrated the hospital met national quality markers.
  • Managers monitored the effectiveness of the service and made sure staff were competent.
  • Pain relief was prescribed pre and post-procedure, and women’s pain levels were assessed following both medical and surgical terminations. Staff were competent in general nursing practice, and additional, informal training in caring for women undergoing termination of pregnancy was provided by appropriate consultant staff. Informed consent was obtained in all cases, and staff understood their responsibilities under the Mental Capacity Act 2005.
  • Staff supported patients to make informed decisions about their care and treatment and followed national guidance to gain patients’ consent.
  • Staff followed up-to-date policies to plan and deliver high quality care and treatment according to best practice and national guidance. Care pathways were used for all patients undergoing surgical procedures.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. The patient’s pain score was assessed following guidelines.
  • Adequate nutrition and hydration standards were maintained in the theatres and ward areas. Staff followed national guidelines to make sure patients fasting before surgery were not without food for long periods.
  • The hospital held effective multidisciplinary meetings to support effective care for patients and staff worked across health care disciplines and with other agencies when required.
  • The service helped to promote healthy lifestyles for patients. Staff assessed each patient’s health when admitted and provided support for individual needs to promote healthy living.
  • Key services were available seven days a week to support timely patient care.
  • Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients. Managers supported staff, including consultant staff, with their development through six monthly or annual appraisals of their work performance.
  • A clinical audit programme was in place which supported the hospital’s management of its policies.

Caring

Good

Updated 8 May 2020

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

  • The hospital promoted privacy and dignity for patients and the provider’s value statement was ‘Caring is our passion’.
  • Staff were compassionate, discreet and responsive when caring for patients. Staff took time to interact with patients and those close to them in a respectful and considerate way.
  • Staff understood and respected the personal, cultural, social and religious needs of patients and how they may relate to care needs.
  • Staff talked with patients, families and carers in a way they could understand, using communication aids where needed. Staff gave informative explanations to the patient and continued to keep them informed.
  • Staff gave patients and those close to them help, emotional support and advice when they needed it.
  • Each patient we spoke with (with one exception) was very positive about their experience of the hospital and their care and treatment.
  • There were no women attending clinics or theatres for this service during our inspection. We were therefore unable to observe the way patients were treated by staff. However, staff described to us how they treated women with compassion, kindness, dignity, and respect. They told us how they explained the different methods of termination and options available to women attending the service. Should a woman need time to make a decision, staff told us how they would support her.
  • Post-termination counselling was offered to all women using the service.

However, we found the following area that the service provider needed to improve:

  • One patient had been disturbed by the noise of staff in the theatre area.

Responsive

Good

Updated 8 May 2020

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 including primary healthcare 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.
  • Special arrangements were made for bariatric patients requiring surgery including holding a multidisciplinary meeting prior to surgery.
  • The service supported patients living with dementia by making suitable arrangements for their stay in hospital.
  • Patients were not discharged on the day of their surgery if they lived alone and their circumstances were checked at the pre-operative stage so that overnight accommodation was pre-arranged.
  • 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.
  • One-stop clinics were used to reduce the need for patients to attend on several occasions.
  • The service worked to ensure patients accessed services they needed promptly. Managers and staff worked to ensure patients did not stay in hospital longer than necessary and to keep the number of cancelled operations to a minimum.
  • Discharge planning started as early as possible. Discharge planning was discussed at the patient’s pre-assessment meeting. Patients requiring assistance from other services at discharge were identified at pre-assessment.
  • The service was responsive to the needs of women. Pre and post-procedure checks and tests were carried out at the hospital, and waiting times were consistently within guidelines set by the Department of Health and Social Care. Interpreting and counselling services were available to all women using the service, and information and advice were available to women at all stages of their episode of care. Foetal remains were disposed of sensitively, and choice was available.
  • 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.

However:

  • Consultation appointments were available on only one weekday.

Well-led

Good

Updated 8 May 2020

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

  • The hospital had a stable leadership structure with an experienced hospital director and registered manager and a leadership team of 12 senior managers and managers. Consultant staff we spoke with told us their engagement with the hospital leadership team was positive.

  • Leaders ran services well, using reliable information systems, and supported staff to develop their skills. Staff felt respected, supported, and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. All staff were committed to improving services continually.

  • There was strong leadership of the services. Quality care and patient experience were regarded as the responsibilities of all staff members, and staff felt proud of the service they provided. Clinical governance and risks were managed well. Staff felt supported to carry out their roles and were confident to raise concerns with managers.

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

  • Staff were consistently positive about the culture they experienced in the hospital. Staff felt well supported and morale was high. A robust procedure was in place for challenging consultant behaviours and performance. Any staff issues were dealt with supportively.

  • The service had in place clear and well-established governance structures and leaders operated effective governance processes. An established clinical governance team was in place with robust arrangements for clinical governance. The service managed risks proactively and used systems to manage performance effectively.

  • Staff had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.

  • The hospital could demonstrate high levels of patient and staff satisfaction. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

  • The hospital was committed to continually learning and improving services. It’s staff had an understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However, we found the following area that the service provider needed to improve:

  • Some key positions were filled on an interim basis and the hospital identified recruitment to key leadership roles in clinical areas as an area for development.

Checks on specific services

Surgery

Good

Updated 8 May 2020

Summary of service

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.

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

The service used a nationally recognised tool to identify deteriorating patients and escalated them appropriately.

Detailed records of patients’ care and treatment were clear, up-to-date and easily available to all staff providing care. The service had systems in place to identify and manage adults and children at risk of abuse.

Systems were in place for reporting, monitoring and learning from incidents. The service contributed to the NHS Safety Thermometer to support monitoring of patient harm incidents and promote harm-free care.

The hospital consistently achieved positive patient outcomes including low rates of surgical site infection and positive patient reported outcome measure results. The hospital held a number of national accreditations which demonstrated the hospital met national quality markers.

Staff supported patients to make informed decisions about their care and treatment and followed national guidance to gain patients’ consent.

The hospital promoted privacy and dignity for patients and the provider’s value statement was ‘Caring is our passion’.

Staff were compassionate, discreet and responsive when caring for patients. Staff took time to interact with patients and those close to them in a respectful and considerate way.

The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.

Special arrangements were made for bariatric patients requiring surgery including holding a multidisciplinary meeting prior to surgery.

The service supported patients living with dementia by making suitable arrangements for their stay in hospital.

Patients were not discharged on the day of their surgery if they lived alone and their circumstances were checked at the pre-operative stage so that overnight accommodation was pre-arranged.

The hospital had a stable leadership structure with an experienced hospital director and registered manager and a leadership team of 12 senior managers and managers. Consultant staff we spoke with told us their engagement with the hospital leadership team was positive.

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

Staff were consistently positive about the culture they experienced in the hospital. Staff felt well supported and morale was high. A robust procedure was in place for challenging consultant behaviours and performance. Any staff issues were dealt with supportively.

The service had in place clear and well-established governance structures and leaders operated effective governance processes. An established clinical governance team was in place with robust arrangements for clinical governance. The service managed risks proactively and used systems to manage performance effectively.

Termination of pregnancy

Good

Updated 8 May 2020

Spire Washington provides medical termination of pregnancy up to 16 weeks gestation and surgical termination of pregnancy up to 19 weeks gestation.

The service provides a vasectomy service.

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

We rated safe as good, because 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.

Training was up-to-date. Staff were aware of their responsibilities is respect of safeguarding. Staff complied with best practice regarding cleanliness and infection control, and the environment was appropriate for the service. Risks were assessed and managed appropriately. Nursing and medical staff numbers were sufficient and appropriate to meet the needs of patients in their care. Medicines were stored and prescribed safely. Medical records were comprehensive and clear. There was a process for reporting incidents, staff understood when and how to use it, and there was a process for cascading lessons learned and actions to be taken to front-line staff.

We rated effective as good, because 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.

There were processes for implementing and monitoring the use of evidence-based guidelines and standards to meet patients’ care needs. Patient outcomes were monitored. Pain relief was prescribed pre and post-procedure, and women’s pain levels were assessed following both medical and surgical terminations. Staff were competent in general nursing practice, and additional, informal training in caring for women undergoing termination of pregnancy was provided by appropriate consultant staff. Informed consent was obtained in all cases, and staff understood their responsibilities under the Mental Capacity Act 2005

We had insufficient evidence to rate ‘caring’ within this service.

It was evident that staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their procedure. They provided emotional support to patients, families and carers.

There were no women attending clinics or theatres for this service during our inspection. We were therefore unable to observe the way patients were treated by staff. However, staff described to us how they treated women with compassion, kindness, dignity, and respect. They told us how they explained the different methods of termination and options available to women attending the service. Should a woman need time to make a decision, staff told us how they would support her.

Post-termination counselling was offered to all women using the service.

We rated responsive as good, because 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. Women did not have to wait too long for treatment.

The service was responsive to the needs of women. Pre and post-procedure checks and tests were carried out at the hospital, and waiting times were consistently within guidelines set by the Department of Health and Social Care. Interpreting and counselling services were available to all women using the service, and information and advice were available to women at all stages of their episode of care. Foetal remains were disposed of sensitively, and choice was available. There were appropriate systems for managing complaints should they arise.

Leaders ran services well, using reliable information systems, and supported staff to develop their skills. Staff felt respected, supported, and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. All staff were committed to improving services continually.

There was strong leadership of the service. Quality care and patient experience were regarded as the responsibilities of all staff members, and staff felt proud of the service they provided. Clinical governance and risks were managed well. Staff felt supported to carry out their roles and were confident to raise concerns with managers.

Diagnostic imaging

Good

Updated 8 May 2020

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

We do not rate effective for diagnostic imaging.

The service provided mandatory training in key skills to all staff and made sure everyone completed it.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well.

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.

Leaders understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.

Outpatients

Good

Updated 8 May 2020

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

We do not rate effective for outpatients.

The service provided mandatory training in key skills to all staff and made sure everyone completed it.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well.

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.

Leaders understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.