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Inspection Summary


Overall summary & rating

Good

Updated 12 September 2018

Spire Wellesley Hospital is operated by Spire Healthcare Limited Spire Wellesley Hospital offers comprehensive private hospital care to patients from Southend-on-Sea and the rest of Essex. This includes patients with private medical insurance, those who self-pay and patients referred through NHS contracts. . Facilities include three operating theatres, a stand-alone endoscopy suite and X-ray, outpatient and diagnostic facilities.The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. At our previous inspection of the hospital, 16 & 17 May 2016 we inspected surgery, medicine, outpatients including diagnostic imaging and services for children and young people. We rated surgery, medicine and outpatients as good and services for children and young people as inadequate. This inspection was to follow up on the specific concerns we found in children and young people’s services. The hospital suspended all surgical procedures for children and young people following our last inspection. The hospital reinstated a full service for children and young people in August 2017.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection on 19 June 2018.

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. Services for children made up a small proportion of activity at the hospital from August 2017 to May 2018, 81 surgical procedures were conducted on children and young people.

Services we rate

We rated this service as good overall.

  • There were risk assessments and procedures in place to safeguard children and young people from abuse. The service had robust incident reporting systems and there was evidence of learning from incidents.
  • There were measures to monitor and manage children and young people including signs of deteriorating health. We found systems in place that reflected national, professional guidance and legislation to keep people safe.
  • Staffing was planned and continually monitored in accordance with the needs of the service.

  • Care and treatment was planned and delivered with current evidence based guidance and standards with a holistic approach to care. Relevant audits were used to assess compliance with best practice.
  • Staff were qualified and had the relevant skills for their role and were encouraged to undertake specialist training in their field of expertise. We saw that staff had received an annual appraisal and were supported in the revalidation process.
  • We saw that children and young people received care from a range of staff and services, which worked in collaboration to achieve the best outcomes for their patients.
  • Children and their families reported that staff were kind and compassionate when tending to their needs. Staff consistently included their patients and families in the care delivery and promoted their dignity.
  • The emotional needs of the patients were embedded in the care provided. Parents were able to accompany their child to theatre and be present in recovery to give extra emotional support.
  • The services were flexible to meet the needs of children and their families with processes in place to ensure continuity of care. Children had timely access to appointments and procedures, which were arranged at a convenient time for children and their parents.
  • The needs of individual children were taken into account when planning and delivering services. Staff had found innovative ways to use equipment as distraction to reduce anxiety.
  • The hospital had a robust complaints procedure. We found that there had been no complaints about the service for children and young people from June 2017 to May 2018.

  • There was strong leadership from the hospital director and department managers. The leadership team drove continuous improvement through actively seeking feedback from staff and service users.
  • The hospital had a strategy to improve services for children and young people and the set objectives were being met.
  • There was a clear governance structure and this demonstrated a proactive approach to managing risk and quality improvement of services.
  • Staff were committed and cared about the services they provided and were supported by their managers. There were mechanisms in place to maintain staff and service user engagement. We saw that the hospital worked in close collaboration with the local NHS trust.

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

  • The service should make provision for a children’s waiting area in the outpatients department, however the hospital had plans to develop a children’s waiting area during planned refurbishment work.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 12 September 2018

We rated safe as good because:

  • Staff providing care to children had completed appropriate safeguarding training.
  • There were risk assessments and procedures in place to safeguard children and young people from abuse.
  • There were systems and processes in place to safely care for children and young people including recognising signs of deteriorating health.
  • We found systems in place that reflected national, professional guidance and legislation to keep people safe.
  • Staffing was planned and continually monitored in accordance with the needs of the service.
  • The service had a robust incident reporting system and there was evidence of learning from incidents.

Effective

Good

Updated 12 September 2018

We rated effective as good because:

  • Care for children and young people was planned and delivered in line with evidence-based guidance, standards, best practice and legislation.
  • Comprehensive child assessments were completed accurately and monitored throughout their admission.
  • Staff were qualified and had the skills required for their roles. They were supported by their managers to deliver effective care and had received an annual appraisal.
  • Children and young people received care from a range of staff and services, which worked in collaboration to achieve the best outcomes for their patients.

Caring

Good

Updated 12 September 2018

We rated caring as good because:

  • Children and their families were truly respected and treated as individuals and were empowered as partners in their care.
  • Feedback from children and their parents was consistently positive praising them for going the extra mile and the care they received exceeded their expectations,
  • Children and their parents were at the heart of the visible strong patient centred approach to care. Children and their parents were partners in decision-making. Staff valued the strong professional relationships built with children and their families.
  • Staff recognised and respected the totality of the needs of children and their parents. They always took into account their personal, cultural and social needs.
  • Staff highly valued children’s emotional and social needs, which were demonstrated at all times.
  • Parents were encouraged to accompany children to theatre and be present in recovery to give extra emotional support.

Responsive

Good

Updated 12 September 2018

  • The services were flexible to meet the needs of children and their families with processes in place to ensure continuity of care.
  • The needs and preferences of individual children were central to planning and delivering services.
  • The service had a proactive approach to understanding the needs of children and their families and delivered care to meet their needs.
  • The service used innovative approaches to provide care tailored to the individual needs of children and young people including children with mild learning disabilities and extra communication needs.
  • Children could access appointments and procedures, which were arranged at a convenient time for children and their parents.
  • The hospital had a robust complaints procedure. We found that there had been no complaints about the service for children and young people within the last 12 months.

However:

  • The hospital did not have a separate children’s waiting area in the outpatients department, this formed part of the hospital’s planned refurbishments.

Well-led

Good

Updated 12 September 2018

We rated well-led as good because:

  • The hospital had a strategy to improve services for children and young people and the set objectives were being met.
  • The service had proactive approach to governance and performance management arrangements.
  • Leaders had an inspiring shared purpose. The service lead was inspirational and motivated staff to succeed.
  • The leadership team actively sought feedback from staff and service users to continuously drive improvements. Staff were committed and cared about the services they provided and spoke highly of the culture; they felt proud of the organisation.
  • Rigorous and constructive challenge from service users and the public was welcomed and seen as a vital way of holding the service to account,
  • The service worked in close collaboration with the local NHS trust.
  • The leadership drives continuous improvement and staff were accountable for delivering change. Leaders celebrated the innovations within the service.
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 19 December 2016

Outpatient and diagnostic imaging services at Spire Wellesley Hospital were rated as good overall. We inspected, but did not rate, effective.

Areas of good practice included effective processes to ensure equipment was checked, serviced and ready for use and radiology and pathology reports and results were available to appropriate staff via secure electronic systems.

Data provided showed that 100% of outpatient and diagnostic staff and completed their annual appraisal for 2015

Patients were seen and treated within national guidance timeframes and were very happy with the level of care they received.

We saw that staff interactions with patients were polite, friendly, and helpful and the hospital was mindful of the needs of patients from various religions and backgrounds and translation services were available.

“You said, we did” notices were displayed in patient waiting areas, showing changes made as a result of complaints received.

However:

The procedures for monitoring medication fridge temperatures were not adhered to.

Patient records were not always fully complete or legible. The hospital did not hold a copy or summary of consultants’ records held off site however this was accessible on request.

Incident reporting was minimal within the diagnostic imaging department.

Incident information was provided to heads of department regularly but this data was across the hospital and not specific to individual departments.

There was a lack of oversight in relation to the management and development of hospital policies.

Medical care (including older people’s care)

Good

Updated 19 December 2016

We rated the medical care service as good across all five domains: safe, effective, caring, responsive, and well-led.

Nursing staff knew how to report and escalate concerns and incidents. Identified lessons were shared back to staff. Nursing and medical staff were aware of their responsibilities under duty of candour.

Infection control practices were in place and the environment was visibly clean. Staff adhered to ‘bare below the elbow’ policy and good practices of hand washing and sanitation.

All equipment and medicines were stored correctly in line with the Nursing & Midwifery Council (NMC) standards for medicines management guidelines. Staffing was adequate and specialist knowledge provided by four oncology specialist nurses. They had sufficient training and were proactive in their professional development.

Oncology services were effective and provided a 24-hour advice line. Staff used the UK Oncology Nursing Society (UKONS) triage tool, allowing them to work to safe and clear guidelines. Staff were innovative and used internal audits to improve patient records and communication with other departments. Pain relief was well managed and patients’ nutrition and hydration needs were met.

Nursing staff provided compassionate and caring support. Additional support was available via a Macmillan counsellor and palliative care consultant when required. Patients were involved in their care and could attend coffee mornings or drop in sessions to provide feedback on the service, ask advice or discuss concerns.

The service was responsive to patients’ needs. Patients had no concerns regarding waiting times and could pick an appointment that suited them. Staff were aware of the vision and values of the service. Staff felt that the senior management were approachable and supportive. The department engaged with patients and actively sought feedback.

However:

Some medical records used were inconsistent, leading to confusion and potential risk of medication mistakes.

Staff had completed training in Mental Capacity Act and Deprivation of Liberty Safeguards, However, there was limited need to reflect this in practice and staff were unable to explain the practical application of Deprivation of Liberty Safeguards. This was escalated as a concern and staff were provided additional training.

Surgery

Good

Updated 19 December 2016

We rated surgical services as good overall. Safe, effective, caring and responsive were rated as good with well led rated as requires improvement.

Nursing documentation was complete and nursing assessments and monitoring of patients was appropriate. National Early Warning Scores (NEWS) were used to identify and respond to a deteriorating patient. The hospital was within Spire target for surgical site infections (SSI) for knee operations and had no SSI’s for hip operations during 2015.

There was an effective process in place for the servicing of equipment and all equipment checked was within its required service date.

Pain assessments were regularly undertaken and patients’ pain control was monitored and responded to efficiently. The latest Patient Reported Outcome Measures (PROMs) data was positive.

Staff provided compassionate, kind and dignified care. Patients felt involved in the decision-making processes around their care needs. The latest Friends and Family Test (FFT) results for NHS patients showed that throughout 2015, the hospital scored 99% to 100%. The hospital’s patient wide survey also showed that consistently over 99% of patients would recommend the hospital to friends and family.

Patients had timely access to assessments, diagnosis and urgent treatment and staff knowledge around additional support required by patients with a learning difficulty was good. The hospital had facilities to allow relatives to stay with patients to provide additional support if needed. The hospital met its target of 71% in 2015 for the way patients were prepared for discharge, scoring 75%.

The hospital had a vision and strategy in place and staff were positive about the local leadership.

However:

Storage and security of patients’ records, both electronic and paper based, was lacking. We raised this issue with senior hospital managers who responded and took immediate action.

Some orthopaedic surgeons did not follow infection control guidance within theatre.

Staff knowledge of safeguarding procedures, Mental Capacity Act 2005 (MCA), mental capacity assessments, and Deprivation of Liberty Safeguards was limited. We received inconsistent responses from nursing staff regarding the care needs of patients living with dementia

The annual average compliance score with pre-operative fasting guidelines had increased to 60% in the first 3 months of 2016. However this meant that some patients were at risk of having fasted for a prolonged period.

Not all senior staff were familiar with the contents of the risk register and the storage of several versions led to some confusion.

Root cause analysis (RCAs) and subsequent actions plans were not always completed in detail. Root causes were not always identified which meant potential additional actions were missed.

Services for children & young people

Good

Updated 12 September 2018

Children and young people’s services were a small proportion of hospital activity. We rated this service as good because it was safe, effective, responsive, caring and well-led.