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Spire Methley Park Hospital Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 29 March 2017

Spire Methley Park Hospital is operated by Spire Healthcare Limited. The hospital has 24 inpatient beds including three operating theatres, outpatient department, diagnostic and imaging facilities. At the time of inspection, the hospital was undergoing building work and the number of beds had temporarily been reduced to 16.

The hospital provides surgery and outpatients and diagnostic imaging. We inspected surgery, outpatient department, diagnostic and imaging facilities. The hospital had stopped providing services for children and young people (below the age of 18) prior to our inspection to enable a full review of services in line with latest national guidelines.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 1 and 2 November 2016, along with an unannounced visit to the hospital on 17 November 2016.

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 core service. See surgery section for main findings.

We rated this hospital as good overall.

We found good practice in relation to surgery, diagnostics and outpatient care:

  • There were sufficient qualified, skilled and experienced staff to meet people’s needs. The service managed staffing effectively. Staff teams and services worked together effectively to deliver good care.

  • The hospital had good systems and processes in place to protect people from abuse and avoidable harm. There were systems in place for incident reporting, staff knew how to use them and learning was shared to prevent recurrence.

  • We found patient care, treatment and support achieved good outcomes and helped patients to maintain their quality of life, based on the best available evidence. There were clear pathways of care and staff were able to recognise and respond to warning signs of deteriorating health.

  • All staff showed a caring approach to their patients. We saw patients treated with dignity and respect and feedback from patients was positive.

  • The provider met national indicators for referral to treatment (RTT) waiting times. The service took account of the different individual needs of people using the service, including those living with dementia and learning disabilities.

  • Staff had worked closely with the local Healthwatch; they had done environment checks and assessed the hospital for dementia and learning disability friendliness. They had worked closely together to design a dementia friendly room as part of the new building work.

  • Leaders were visible, promoted an open and fair culture. Staff felt listened to and said the hospital was a good place to work. There was a clear vision and strategy and effective governance systems in place to ensure that quality, performance and risks were managed.

There were no breaches of regulations. However, there were areas where the provider should make some improvements, even though a regulation had not been breached, to help the service improve. These were:

  • The provider should implement plans to ensure there is appropriate pharmacy provision at the hospital.

  • The provider should continue to review and revise the risk register to reflect the specific risks for Spire Methley Park Hospital.

  • The provider should consider installing clinical hand wash basins and hard flooring in patient bedrooms as part of the refurbishment programme.

  • The provider should continue to raise staff awareness regarding safeguarding including domestic abuse.

  •  The provider should review the audit programme within the outpatient department.

Ellen Armistead

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 29 March 2017

We rated safe as good because:

  • The hospital had good systems and processes in place to protect people from abuse and avoidable harm.

  • There were systems in place for incident reporting, staff knew how to use them and learning was sharedto prevent recurrence.

  • The hospital had invoked duty of candour on one occasion between July 2015 and June 2016. Practice had been changed following this incident even though no direct failing was identified.

  • The hospital measured, monitored and analysed patient harm and harm free care. NHS safety thermometer data was collected and showed 100% harm free care between July 2015 and July 2016.

  • All the actions from the most recent legionella risk assessment and water hygiene audit been completed. The site engineer had recently undertaken legionella refresher training.

  • There were sufficient qualified, skilled and experienced staff to meet people’s needs.

  • There were clear pathways of care and staff were able to recognise and respond to warning signs of deteriorating health.

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

  • At the time of the inspection, the hospital did not have a dedicated pharmacist; pharmacy provision was supplied, through a service level agreement, by a local Spire hospital. A robust action plan was in place and the pharmacy superintendent for Spire hospitals was providing support. Recruitment to vacant posts was in progress.

  • Some clinical areas had carpets on the floor, although risk assessments were in place for these. The patient rooms did not contain clinical hand basins for hand washing. These were due to be addressed during the refurbishments.

Effective

Good

Updated 29 March 2017

We rated effective as good because:

  • Policies and guidelines were up to date, based on national guidance and staff were able to access them on the intranet.

  • There was evidence of audit at local and national level, with action plans produced in response to the results.

  • Staff were competent and had the skills and knowledge to deliver effective care and treatment. Staff teams and services worked together effectively to deliver good care.

  • We found patient care, treatment and support achieved good outcomes and helped patients to maintain their quality of life, based on the best available evidence.

Caring

Good

Updated 29 March 2017

We rated caring as good because:

  • All staff showed a caring approach to their patients. We saw patients treated with dignity and respect.

  • Feedback from patients was positive. Patient satisfaction survey results showed that 98% of patients would recommend the hospital.

  • Patients and their families were informed and involved in their care and treatment choices available to them .

  • Staff supported patients and their families to cope emotionally with their care and treatment.

Responsive

Good

Updated 29 March 2017

We rated responsive as good because:

  • Services were organised so that they met the needs of the people using them.

  • People could access care and treatment in a timely way.

  • Outpatient clinics, radiology and physiotherapy services were planned flexibly over six days, including early mornings, late evenings and Saturdays. This meant patients could attend their appointments without needing to take time off work.

  • The provider met national targets for referral to treatment (RTT) waiting times

  • The service took account of the different individual needs of people using the service, including those living with dementia and learning disabilities. Staff had worked closely with the local Healthwatch; they had done environment checks and assessed the hospital for dementia and learning disability friendliness. They had worked closely together to design a dementia friendly room as part of the new building work.

  • The service acted on complaints and concerns in a timely way and used the information to improve the quality of care.

Well-led

Good

Updated 29 March 2017

We rated well-led as good because:

  • There was a clear vision and strategy and staff were aware of them.

  • There were governance systems in place to ensure that quality, performance and risks were managed and information could be cascaded between senior management and clinical staff.

  • Leaders were visible and staff spoke positively about them. Staff felt listened to and said the hospital was a good place to work.

  • The leadership and management encouraged learning and innovation, and promoted an open and fair culture.

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

  • The risk register was a general risk register which was In the process of being reviewed and revised to reflect the specific risks for Spire Methley Park Hospital.
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 29 March 2017

We rated this service as good because it was safe, caring, responsive to people’s needs and well-led. We did not rate the effectiveness of the service.

Surgery

Good

Updated 29 March 2017

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 to people’s needs and well-led.