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Spire Hull & East Riding Hospital Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 15 November 2018

Inspection areas

Safe

Good

Updated 15 November 2018

We rated safe as good because:

  • Mandatory training rates across all services exceeded compliance targets.
  • The hospital had appropriate policies to support staff to safeguard adults and children and young people and all safeguarding incidents at the hospital were reported through the electronic incident reporting system.
  • We found that all areas of the hospital were visibly clean and tidy. Infection prevention control processes had improved. The hospital had a director of infection prevention and control (DIPC) with an appropriate post graduate accredited qualification. There was an infection prevention & control (IPC) lead and an IPC committee responsible for ensuring that the hospital complied with effective IPC requirements.
  • The hospital had improved the ward environment and waiting areas to make them more child-friendly.
  • The hospital followed clear admission criteria to ensure they were able to provide safe care and treatment. This included a registered children’s nurse with responsibility and accountability for the whole of the child’s pathway.
  • The diagnostic imaging department has implemented the world health organisation (WHO) safety checklist since the previous inspection.
  • Results of World Health Organisation (WHO) surgical safety checklist ‘five steps to safer surgery’ audits showed 95% compliance for the surgical service.
  • Staffing levels, across all services were planned to ensure there was sufficient numbers of appropriately trained staff to safely care for patients.
  • Incident reporting processes and methods for shared learning were robust.

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

  • Some safety checks and log books for equipment, for example the difficult-intubation equipment trolley were not completed appropriately.
  • Prescription charts were not always completed in full.
  • Work to mitigate some environmental and security risks had not yet been fully completed, for example ligature risks and secure access in the children’s ward area and the suitability of waiting areas for older children.

Effective

Good

Updated 15 November 2018

Are services effective?

We rated effective as good because:

  • Care pathways were based on clinical guidelines from established and recognised bodies (for example National Institute for Health and Care Excellence).
  • The hospital had introduced a separate clinical scorecard to monitor the effectiveness of care and treatment for children and young people.
  • The hospital had a clinical audit programme and clear approach to policy management. The hospital completed national and local audits and discussed these at relevant governance meetings.
  • Patients confirmed their dietary requirements were managed well and that they were given clear information about fasting prior to surgery.
  • Pain scores were checked with patients and documented by staff and appropriate pain relief provided.
  • The hospital used a range of tools to monitor and benchmark performance against targets, other hospitals and providers; data reported to the National Joint Registry showed ‘as expected’ patient reported outcomes for both hip and knee replacements.
  • Local audits showed 100% of cancer patients had evidence of multi-disciplinary team discussion recorded within their notes.
  • Records showed that staff had up to date appraisals and their registration had been validated. All staff caring for children and young people were required to have completed paediatric competencies and have up to date training in safeguarding level three and life support, appropriate to their role.
  • The daily safety huddle for all heads of departments was led by the hospital director and involved department leads from all areas.
  • We saw effective multidisciplinary working between staff of all grades at the hospital.
  • The hospital had negotiated a health promotion commissioning for quality and innovation (CQUIN) with the local clinical commissioning group (CCG) to monitor smoking and alcohol consumption.
  • The hospital had signed up to the ‘You’re Welcome’ accreditation scheme for services for children and young people.
  • Staff demonstrated knowledge and understanding of the Mental Capacity Act and consent.

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

  • Action plans following audits were often documented as single actions without detailing any subsequent actions or cooperation by other departments or disciplines.

Caring

Good

Updated 15 November 2018

Are services caring?

We rated caring as good because:

  • The hospital was proactive in seeking patients’ views and their experience of care and treatment and they were given time to ask questions and to make sure they understood what was to happen.
  • ‘Friends and Family test’ (FFT) audits of patient feedback showed 98% of patients would recommend the hospital to a friend or relative.
  • Staff were passionate about providing the best possible service and experience for their patients. During the inspection we observed patients were treated with care, compassion, and respect by all staff, greeted professionally on their entrance to the hospital and directed to the relevant service.
  • The hospitals lead nurse for children and young people demonstrated compassionate leadership and a clear understanding of the emotional needs of vulnerable young people and their families.
  • Staff took practical steps to minimise anxiety of children and young people and prepare them for procedures, parents/carers could stay overnight where required, children (and parents) were able to wear their own clothes in theatre.
  • Patient led assessments of the care environment (PLACE) showed that privacy, dignity and well-being was scored at 85%.
  • There was an established volunteer programme in place.
  • Patients told us treatment had been explained and their questions were answered fully by both nursing and consultant staff. Patients also said, ‘it was a really good experience using services at the hospital and that all staff were always polite and helpful.’

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

  • The FFT response rates at the hospital were low and we did not hear of any plans to address and improve this.

Responsive

Good

Updated 15 November 2018

We rated responsive as good because:

  • Service planning was responsive to the needs of local people and supported delivery of services offered by local NHS trusts. There was a wide range of services offered and they were available to NHS, self-funding and insured patients.
  • The service was planned to ensure a qualified children’s nurse was able to support children and young people from booking to discharge.
  • Patients were referred to the surgeon of their choice where possible and seen by that consultant throughout their treatment ensuring continuity.
  • The staff worked hard to meet people’s individual needs and to improve access and flow. The hospital had introduced a ‘one stop’ assessment process for patients prior to surgery.
  • Staff could access interpreters and translation services when necessary.
  • Open visiting times were promoted, and parents and carers were able to stay overnight with children where required.
  • There was personalised, patient-centred care provided for patients living with a dementia and the hospital had dementia link nurses in place.
  • The hospital had reconfigured regular outpatient clinics to better meet the needs of children with learning difficulties and changed outpatient waiting areas to make them more child-friendly and cancellations were rare.
  • We saw ‘You said, we did’ displays throughout the hospital which demonstrated learning from feedback and complaints and the changes made in response.
  • There was an average inpatient length of stay of 1.9 days.
  • The reduction of avoidable cancellations was a priority for the hospital and processes and systems within the pre-operative assessment team were under review.
  • The service took complaints seriously and responded in a timely manner. There were examples where improvements had been made because of complaints. Complaints were managed and overseen by the hospital director and clinical complaints specifically overseen by matron.

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

  • There were still high numbers of adult patients affected by cancelled and rearranged clinics.
  • The hospital consent policy was unclear as it stated that it is not appropriate to use children under the age of 16 years and preferably not under 18 years to interpret for family members who do not speak English. Family members should not be used as interpreters for any clinical matter. In addition, the policy did not include local arrangements for accessing interpreters including for British sign language (BSL). However, we saw information about translation services displayed and this clearly stated family members should not be used. The senior team told us that the concern about the policy would be raised with the corporate team as this was a national policy.
  • Staff recognised that information could not readily be made available in different languages or formats if required.

Well-led

Good

Updated 15 November 2018

We rated well-led as good because:

  • The hospital had a clear management structure in place with clear lines of responsibility and accountability.
  • The services had managers with the right skills and abilities to run a service providing high-quality sustainable care.
  • Staff spoke highly of their immediate line managers and the hospital leadership team and felt they were listened to and engaged in the organisation. Staff of all grades told us the senior management team were extremely supportive, visible and approachable.
  • Staff of all grades spoke positively about the culture within the hospital and told us they were passionate about their roles and the hospital.
  • Professional relationships between all staff promoted the values of the hospital and staff said they felt valued and worked well together;
  • The hospital had a robust clinical strategy action plan in place.
  • Although, there is no requirement for independent healthcare hospitals to have a freedom to speak up guardian (F2SUG), the hospital had appointed a member of staff to this role.
  • We found that governance processes had improved and were more robust. The governance of the children’s and young people’s service was now clearly defined and linked to the governance processes for the whole hospital. A children and young peoples (CYP) clinical score card system had been introduced to support structured monitoring of quality, performance and patient outcomes.
  • The service took patient feedback seriously and had a desire to learn and improve.
  • Staff had been involved in developing a vision for their own areas of work.
  • Minutes of the MAC meeting were detailed and included comprehensive governance information.

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

  • The hospital acknowledged that there was limited evidence that actions to mitigate risks, following serious incidents, were completed effectively.
  • The minutes of clinical governance did not show evidence of analysis, challenge or assurance.
  • The risk registers needed further improvement to ensure there are no long-standing risks and that all risks have evidence of actions to mitigate the risk.
  • It was unclear whether the CYP service was sufficiently represented at senior level to influence and support strategic developments across the hospital involving children and young people.
  • While arrangements were in place, the formal agreement for the transfer of sick children to the NHS was out of date.
Checks on specific services

Medical care (including older people’s care)

Not sufficient evidence to rate

Updated 15 November 2018

Medical 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.

We did not have enough robust and proportionate evidence to rate medical care due to the small nature of the service and the limited activity taking place at the time of our inspection.

Services for children & young people

Good

Updated 15 November 2018

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

Since our last inspection the hospital had improved the services for children and young people including the environment and the governance and reporting systems to monitor outcomes.

Diagnostic imaging

Good

Updated 15 November 2018

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

Since our last inspection the diagnostic imaging service had improved services including moving from mobile units to an onsite purpose-built unit.

Outpatients

Good

Updated 15 November 2018

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

Since our last inspection the hospital had improved the outpatient facilities including opening a fully equipped physiotherapy department on the Lowfield’s site.

Surgery

Good

Updated 15 November 2018

Surgery was the main activity at the service. Where our findings also apply to other activities, we do not repeat the information but cross-refer to the surgery section of the report.

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

Since our last inspection the hospital had improved the services for surgical patients and strengthened the overall governance systems.