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Spire Fylde Coast Hospital Requires improvement

The provider of this service changed - see old profile

We are carrying out a review of quality at Spire Fylde Coast Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 30 May 2017

Spire Fylde Coast Hospital is operated by Spire Healthcare Ltd. The hospital has 26 single rooms and 11 day care beds which are provided in two single sex bays. Facilities include three operating theatres, 10 consulting rooms, physiotherapy treatment rooms, medical imaging services and outpatient and diagnostic facilities. Outpatient clinics are also provided from a small clinic in Lytham, approximately 20 minutes away. Facilities for plain x-ray diagnostic tests are also available in this clinic.

The hospital provides surgery and outpatients and diagnostic imaging services. We inspected both of these services. The services for children and young people had been reviewed by the provider and were suspended at the time of this inspection.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 and 7 September 2016, along with an unannounced visit to the hospital on 15 September 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.

We rated this hospital as requires improvement overall. This was because:

  • At the time of our inspection there were insufficient numbers of staff deployed in theatre in accordance with the association of perioperative practitioners (AFPP) guidelines. Action was being taken to improve this.

  • Staff were not adhering to the controlled drugs regulations 2001 when controlled drugs were being administered.

  • Hospital staff were not consistently implementing the World Health Organisation (WHO) surgical safety checklist for the administration of joint injections, to ensure safety checks were completed.

  • Staff at the hospital were not fully implementing the controls to mitigate the risk to patients who were identified as at an increased risk of bleeding.

  • Competency assessments had not been fully completed and documented appropriately for staff undertaking the role of the surgical first assistant

  • Risks and areas of poor compliance were not always correctly identified or dealt with in a timely way.

  • Medicines were not consistently stored within the recommended temperature range and any variation in this was not always acted upon appropriately.

  • Compliance rates with some specific key training areas was low.

  • One department had not reported clinical and non-clinical incidents on the electronic system to ensure improvements could be made when needed.

  • Department of Health standards were not being met in respect of the provision of hand wash basins within patient areas.

  • There was no equipment checklist for theatre to ensure equipment was checked appropriately prior to surgery being undertaken.

  • Control of substances hazardous to health (COSHH) legislation was not consistently followed when storing flammable liquids.

  • Theatre access was not restricted, therefore there was a potential that unauthorised persons were able to enter unsupervised.

  • Consultant signatures were not consistently timed and dated in all patient records.

  • The ‘sign out’ phase of the World Health Organisation (WHO) surgical safety checklist was not always being completed following surgical procedures.

  • Staff we spoke with were unaware of any policy or standard operating procedure to provide guidance on appropriate staffing levels. Additionally, there was no escalation guidance for staff to ensure it was clear when a manager should be contacted during out of hours.

  • Compliance with fasting guidance prior to surgery was not consistent.

  • There was a low level of compliance in completion of annual staff appraisals to ensure their performance was reviewed and improvements made where needed.

  • There was a lack of clarity in the records we reviewed if the two week ‘cool off’ period was adhered to for patients undergoing cosmetic surgery.

  • The hospital had not adapted facilities to support people living with dementia.

  • The monitoring of governance processes was not robust.

  • A new corporate risk register had been recently introduced in the hospital and staff were not yet familiar with the management of the documentation.

However:

  • In the outpatients department there were sufficient numbers of nursing and support staff to meet patients’ needs and we observed effective multidisciplinary working by competent staff

  • We saw that care and treatment was provided in a kind, compassionate way. Staff treated all patients with dignity and respect during their time at the hospital.

  • We found suitable medical cover at all times from a resident medical officer and on-call consultants and noted arrangements for consultants to provide cover for absent colleagues.

  • There was an effective system for managing complaints and concerns.

  • There was an open culture with staff able to raise concerns or issues.

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 six requirement notices that affected both surgery and outpatients and diagnostic services.

Ellen Armistead

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 30 May 2017

We rated safe as requires improvement because:

  • We found the decontamination department were using paper incident reporting forms rather than the electronic incident reporting system. These had not been raised with the theatre management team.
  • On the ward area, there was only one hand basin in the patient bedrooms.
  • Theatres were accessed by double doors which were unsecured. This meant that members of the public could gain access unsupervised. Following the inspection we were provided with assurance that improvements were being made.
  • Equipment did not always have up to date stickers which highlighted when they were due for service. This meant that it was unclear to staff if they were safe for use.
  • We found flammable substances stacked against the wall instead of being stored in the designated flammable liquid cupboard. This provided a risk to both staff and patients in that current legislation was not being adhered to.
  • Controlled drugs were not being managed in accordance with the controlled drugs regulations 2001.
  • The service did not have a fridge for storing blood at the time of inspection. This had broken down in April 2016 and had not yet been fixed.
  • The management had identified a risk to patients that blood was not readily available for use in an emergency situation. A risk assessment had been completed and included a number of controls to mitigate this. However, we found that these controls were not being followed consistently.
  • We found that, between July 2016 and the time of inspection, the member of staff completing the surgical first assistant (SFA) role was in replacement of one of the scrub nurses. This meant that the theatre team was continuously one scrub practitioner short of the Association for Perioperative Practitioners (AFPP) guidelines when an SFA was required.
  • Two members of the management team we spoke with were unable to provide any escalation guidelines for nursing staff to follow which determined when a manager should be called.
  • The temperature of the room where medicines were stored within the outpatients department was noted to be frequently above the recommended maximum temperature of 25 degrees centigrade.
  • There was personal identifiable information within an unlocked cupboard in the physiology exercise room, which was potentially accessible to the general public.
  • Staff in all areas were not compliant with the hospital target for mandatory training including both safeguarding adults and children training, with the worst compliance being in diagnostic imaging with only 30% of staff being compliant in safeguarding children training.

However:

  • There were systems for the reporting and investigation of safety incidents that were well understood by most staff. Staff could demonstrate their understanding of the duty of candour and provide examples of its implementation.
  • We found suitable medical cover at all times from a resident medical officer and on-call consultants and noted arrangements for consultants to provide cover for absent colleagues.
  • There were sufficient numbers of nursing and support staff on the inpatient ward and outpatient areas to meet patients’ needs.

Effective

Requires improvement

Updated 30 May 2017

We rated effective as requires improvement because:

  • We found that the efficiency of pain medication had not been documented within all patient records.
  • Staff were not following Spire guidelines with nutrition and hydration, particularly in terms of compliance with patients being nil by mouth two hours prior to surgery.
  • The hospital did not use a nationally recognised tool to collect patient satisfaction information with breast augmentation and blepharoplasty operations. This meant there was limited oversight of the quality of cosmetic surgery that had been undertaken.
  • There was no evidence that staff who completed the role of the surgical first assistance had completed an assessment of their competence.
  • Only 20% of theatre staff were up to date with their annual appraisal, which meant there had been limited opportunity for staff to have their performance reviewed.
  • Communication between the theatre and ward teams was not always effective.
  • When a patient was discharged, an electronic discharge form was sent to the patient’s GP. However, information about implants was not sent as part of this, which was against national guidance.
  • The records that we reviewed lacked clarity of whether the two week ‘cool off period’ was being adhered to when we reviewed the case notes of patients who had undergone cosmetic surgery
  • No staff appraisals had been completed for staff working in the outpatient departments during the current appraisal year (January 2016 to December 2016).

However:

  • The hospital used care pathways that had been designed by Spire and were followed when delivering care and treatment to patients. A care pathway was in place for all treatments provided.
  • The hospital’s outcomes for primary knee replacements and primary hip replacements were similar to outcomes reported by similar services nationally.

Caring

Good

Updated 30 May 2017

We rated caring as good because:

  • We saw that care and treatment was provided in a kind, compassionate way. Staff treated all patients with dignity and respect during their time at the hospital.
  • Patient led assessments of the care environment (PLACE) showed that 93% of patients thought that their privacy and dignity had been maintained during their time at the hospital.
  • The hospital took part in the NHS Friends and Family test for all patients who were NHS funded. This showed that between October 2015 and March 2016, monthly averages, for patients who would recommend the service, varied between 95% and 100%. However, response rates during these periods had been low, ranging from 11% to 34%.

Responsive

Good

Updated 30 May 2017

We rated responsive as good because:

  • The hospital had access to translation services and interpreters if required. The needs of the patient and family were assessed during the initial assessment and a translator or an interpreter was booked if needed.
  • There was access to psychological services that were provided by another hospital if required.
  • The hospital had adapted some facilities to accommodate bariatric patients who were undergoing treatment. This included a modified wheelchair and the inpatient ward had access to two bariatric beds if needed.
  • The hospital had a policy for managing complaints and concerns. Staff that we spoke with were able to tell us about the complaints process and that if a complaint or concern was raised, it was escalated to the department manager.

  • The provider met the target of 92% of patients beginning treatment within 18 weeks of referral for each month in the reporting period (April 2015 to March 2016).
  • The provider met the target of 95% of non-admitted patients beginning treatment within 18 weeks of referral for each month in the reporting period before the targets were abolished (April 2015 to May 2015). Above 95% of patients began treatment within 18 weeks of referral throughout the rest of the reporting period (June 2015 to March 2016).
  • The hospital had no patients waiting longer than six weeks for Magnetic Resonance Imaging (MRI), Computerised Tomography (CT) or non-obstetric ultrasound during the reporting period (April 2015 to March 2016).

However:

  • The hospital was unable to provide shower facilities in some rooms as modernisation of some facilities on the ward was still in progress.
  • The hospital had not made any formal adjustments to the facilities that met the needs of patients living with dementia. The service had recently provided dementia training to staff as part of the e-learning course that was available.

Well-led

Requires improvement

Updated 30 May 2017

We rated well-led as requires improvement because:

  • The hospital did not have any clear policies or guidelines determining staffing levels on the inpatient ward or in theatre. However, in theatre, staffing levels did not meet the guidelines set by the Association for Perioperative Practitioners (AFPP).
  • There had been no audit process undertaken to provide assurance of compliance with actions implemented as a result of a never event.
  • There were some areas of risk that had not been dealt with appropriately or in a timely way. Controls that had been put in place to reduce this risk had not always been followed and the senior management team were unaware that this was the case.
  • The clinical governance team were not always aware of incidents that had occurred. This meant that the management team were unaware of some incidents and they were not investigated to ensure improvements could be made.
  • Staff turnover had been consistently high between the period April 2015 and March 2016, which was a significant increase from the period of April 2014 to March 2015.
  • The rate of sickness for outpatient nurses was varied when compared to the average of other independent acute hospitals we hold this type of data for during the reporting period (April 2015 to March 2016). The rate was particularly higher than the average in January 2016 to March 2016.

However:

  • Spire had an overall vision and strategy. The values highlighted in this statement were caring, succeeding, driving excellence, doing the right thing, delivering on promises and keeping it simple.
  • The hospital had set its own objectives based on these values. These included delivering high quality care, enhancing relationships with partners to promote services to the local population and improving the hospital’s survey scores.
  • The management team had also developed a strategy for each individual department which included theatres and the ward area. Staff were aware of the strategy for their area.
  • The hospital used departmental risk assessments to highlight and manage areas of risk. Significant risks were escalated to the hospital risk register.
  • Incidents and complaints were investigated by the appropriate members of staff and oversight of this process was provided by the clinical governance coordinator. Outcomes and learning from incidents and complaints was disseminated to staff through team meetings or by email.
Checks on specific services

Outpatients and diagnostic imaging

Requires improvement

Updated 30 May 2017

We rated this service as ‘requires improvement’. This was because;

  • There were systems for keeping people safe, including the reporting and investigation of safety incidents.
  • We found suitable nursing and medical cover at all times to meet the needs of patients.
  • There were sufficient numbers of nursing and support staff to meet patients’ needs and we observed effective multidisciplinary working by competent staff.
  • We saw that care and treatment was provided in a kind, compassionate way. Staff treated all patients with dignity and respect during their time at the hospital.
  • There were arrangements to ensure that the individual needs of patients were met, for example, interpreters could be booked for patients and the hospital was wheelchair accessible.
  • There were clearly defined and visible local leadership roles and managers provided visible leadership and motivation to their teams. There was appropriate management of quality and governance at a local level.

However:

  • Mandatory training rates, including safeguarding adults and children were below those expected by the organisation.
  • The temperature of the room where medicines were stored within the outpatients department was noted to be frequently above the recommended maximum temperature of 25 degrees centigrade.
  • There was personal identifiable information within an unlocked cupboard in the physiology exercise room, which was potentially accessible to the general public.

Surgery

Requires improvement

Updated 30 May 2017

We rated this service as ‘requires improvement’. This was because;

  • We found that, between July 2016 and the time of inspection, the member of staff completing the surgical first assistant (SFA) role was in replacement of one of the scrub nurses. This meant that the theatre team was continuously one scrub practitioner short of the Association for Perioperative Practitioners (AFPP) guidelines when an SFA was required.
  • There were no clear escalation guidelines for nursing staff to follow which determined when a manager should be called.
  • Only 20% of theatre staff were up to date with their annual appraisal, which meant there had been limited opportunity for staff to have their performance reviewed.
  • There were some areas of risk that had not been dealt with appropriately or in a timely way. Controls that had been put in place to reduce this risk had not always been followed and the senior management team were unaware that this was the case.

However,

  • The hospital used care pathways that had been designed by Spire and were followed when delivering care and treatment to patients. A care pathway was in place for all treatments provided.
  • Spire had an overall vision and strategy. The values highlighted in this statement were caring, succeeding, driving excellence, doing the right thing, delivering on promises and keeping it simple.