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Spire Nottingham Hospital Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 1 June 2018

Spire Nottingham Hospital is operated by Spire Healthcare Limited. The hospital opened on 29 April 2017. It is a new purpose built independent healthcare hospital in Nottingham, Nottinghamshire. Spire Nottingham Hospital is situated south of Nottingham city centre; it opened almost two years after work started on the project. A full project team including engineering, pharmacy, pathology, IT, logistics, purchasing, recruitment and training supported the Senior Management Team in getting the hospital ready for opening. A majority of the consultants who have practising privileges at the hospital are from the local NHS hospital trust. The hospital’s main specialties are orthopaedics, spinal surgery, urology, gynaecology, general surgery, plastic surgery, ophthalmology, ENT, oral surgery, gastroenterology and breast surgery. Spire Nottingham Hospital is the only hospital in the region with a hybrid theatre.

The hospital primarily serves the communities of the Nottinghamshire, Lincoln and North Leicestershire areas. It also accepts patient referrals from outside these areas.

Services are provided to NHS patients, and self-funded patients who may be insured or who self-pay to cover the costs of their treatment.

The hospital currently provides services to adults only. It stopped providing children’s and young people’s services in October 2017.It offers outpatient, day case and inpatient services for a range of specialities including orthopaedics, ophthalmology, gynaecology, urology, ear, cosmetic and general surgery. Additional services offered on an outpatient basis include rheumatology, dermatology and cardiology. These services are supported by on-site physiotherapy and diagnostic imaging departments.

The hospital has been registered with the CQC to carry out the following regulated activities since April 2017:

  • Surgical Procedures

  • Treatment of disease, disorder or injury

  • Diagnostic and screening services

  • Services in slimming clinics

  • Family Planning Services

The hospital has had a registered manager and a designated controlled drugs accountable officer (CDAO) in post since registration in April 2017. Spire Healthcare Limited has a nominated individual.

This was the hospital’s first inspection since opening. There were no special reviews or investigations of the hospital ongoing by the CQC at any time during the nine months since opening.

Inspection areas

Safe

Good

Updated 1 June 2018

We rated safe as good because:

  • There was an open incident reporting culture within the hospital, and an embedded process for staff to learn from incidents. All staff demonstrated an understanding of the duty of candour and the principles behind this.

  • The hospital monitored safety through a clinical scorecard with 47 clinical indicators. The scorecard was used for benchmarking against other Spire hospitals and to identify areas for improvement.

  • Staff were knowledgeable about safeguarding processes and what constitutes abuse.

  • There were processes in place to manage a deteriorating patient and staff spoke confidently on steps they would take to manage a patient. Staff used a national early warning scoring system to aid identification of a deteriorating patient.

  • There were sufficient numbers of staff with the necessary skills, experience and qualifications to meet patients’ needs. They were supported by a programme of mandatory training in key safety areas. There were simulation exercises that kept staff skills current.

  • Equipment was serviced and visibly clean and processes were in place to ensure all items were well maintained.

  • The environment was fit for purpose and visibly clean and tidy. We observed good levels of infection prevention and control practice throughout the department.

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

  • Documentation was not always completed in line with professional standards.

Effective

Good

Updated 1 June 2018

We rated effective as good because:

  • Policies, procedures and guidelines were up to date and based on National Institute for Health and Care Excellence (NICE) guidelines, relevant regulations and legislation.

  • Quality improvements were made as a result of audits and the hospital benchmarked its performance against other Spire hospitals.

  • Patients received appropriate pain control and food and drink that met their needs and preferences.

  • Staff worked collaboratively as part of a multi-professional team to meet patients’ needs. There were systems that demonstrated staff were competent to undertake their jobs and to develop their skills or to manage under-performance.

  • There was effective multidisciplinary team working throughout the department and with other departments in the hospital.

  • Staff had regular development meetings with their department manager, and were encouraged to develop their roles further. Information provided by the hospital showed 100% of staff had been appraised.

  • Staff could access information they needed to provide care and treatment in a timely manner.

  • The physiotherapy department had started to collate patient outcome data. This information was used locally to develop and improve treatment plans for patients.

  • Staff demonstrated an effective knowledge of the consent process and we observed staff gaining consent in accordance with local policy and professional standards.

Caring

Good

Updated 1 June 2018

We rated caring as good because:

  • Patients were always treated with dignity, respect and compassion. This was reflected in the feedback received from patients who told us staff were very caring.

  • Patients received information in a way which they understood and felt involved in their care. Patients were always given the opportunity to ask staff questions, and patients felt comfortable doing so.

  • Feedback from patients and relatives was consistently extremely positive, and patients told us they would recommend the department to their friends and family.

  • Staff provided patients and those close to them with emotional support; all staff were sympathetic to anxious or distressed patients.

Responsive

Outstanding

Updated 1 June 2018

We rated responsive as outstanding because:

  • Hospital managers had worked with the local community and local commissioning groups to plan and deliver services to meet the needs of local people.

  • There was a proactive approach to meeting the individual needs of patients. Staff in the outpatient department had worked hard to ensure the needs of patients living with dementia were taken into consideration.

  • Staff on the ward had put together a dementia box. Relatives or carers could stay overnight to reduce anxiety for patients living with dementia.

  • There were one-stop clinics available for some specialities including breast care and basal cell carcinoma to minimise the number of attendances to the department. Staff were looking to provide more one-stop clinics in other specialities.

  • Staff were encouraged to resolve complaints and concerns locally, which was reflected in the low numbers of formal complaints made against the service.

  • Patient complaints and concerns were managed according to the hospital policy. Complainants were kept informed of the progress and could discuss their complaint face to face if they wished.

  • Complaints were investigated thoroughly, analysed for trends and themes. We saw learning identified and shared to improve service quality.

  • The diagnostic imaging department ensured a quick turn around on the reporting of procedures. Time taken for reporting was between two and three days.

  • Services were planned and delivered in a way that met the needs of the local population. On the day appointments could be provided for patients with the required referral paperwork, as well as a range of appointment times for those who worked during the week.

  • Patients could access services easily; appointments were flexible and waiting times short. Appointments and procedures occurred on time and patients were kept informed of next steps throughout the care pathway.

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Well-led

Outstanding

Updated 1 June 2018

We rated well-led as outstanding because:

  • The hospital had a clear vision and strategy which was realistic and was reflected through team and individual staff member objectives.

  • Staff understood the vision and strategy and their role in contributing towards it.

  • There was a clear governance structure, which all members of staff were aware of and involved in. There was evidence of information escalated from local level governance meetings and information cascaded from top-level governance meetings.

  • Staff were extremely positive about their local leaders and felt they were supported and appreciated. This positivity also extended to the executive level of leadership, who were extremely visible and approachable.

  • The morale amongst the departments was very high and staff felt proud to work within their departments and as part of the hospital.

  • Departments had their own risk registers, which fed into the hospital risk register. Managers had clear visibility of their own risks and were knowledgeable about the mitigating actions taken.

  • A reward and recognition scheme was in place for staff, staff could also be nominated for the annual Spire Healthcare award scheme.

  • Staff from the outpatient and diagnostic imaging had received all three ‘inspiring people’ awards, which have so far been awarded by the hospital.

  • Staff felt well informed and involved in the development of the departments, and within the development of the hospital.

  • Up to date policies and procedures were in place to support staff in the delivery of safe and effective care.

  • Robust procedures were in place for the granting of practising privileges to consultants.

  • There was a culture of openness and honesty supported by a whistle blowing policy and freedom to speak up guardian.

  • The hospital prioritised engagement with staff, patients and the public. Comments and suggestions were taken seriously and we saw evidence of resulting changes.

  • Managers were open to innovative ideas and constantly strived for quality improvement. Plans were in place to increase patient numbers and ensure sustainability.

  • Information was used to improve quality, we saw many examples of where this had taken place.

Checks on specific services

Outpatients and diagnostic imaging

Outstanding

Updated 1 June 2018

We rated this service as outstanding because people were protected from avoidable harm and abuse and there were systems for reporting and learning from safety incidents.

Patients received care and treatment that was based on current national guidelines from staff who were competent to do their jobs.

Patients were valued as individuals and their dignity was truly respected. Feedback from patients was unfailingly positive.

Patients could access care and treatment in a timely way and there was flexibility around timing of appointments. The individual needs of patients were recognised and arrangements made to meet them.

The leadership was robust and visible, with a focus on providing a safe service that met the needs of the patients.

There were robust governance arrangements that gave adequate assurance and which drove improvement. Staff demonstrated the organisation's values through their work.

Surgery

Outstanding

Updated 1 June 2018

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 outstanding because patients were protected from abuse and avoidable harm and received care and treatment that reflected best practice guidance from competent staff.

Patients were treated as partners in their care, and valued as individuals which protected their dignity and privacy.

Patients’ feedback was overwhelmingly positive. Services were tailored to individual needs and there was flexibility to ensure patients’ choices and preferences were respected.

The management team were focused on the delivery of safe and effective care, and there were robust governance arrangements used to drive service improvement.

All staff showed an appreciation of the hospital’s values and this was demonstrated in their daily work.