Spire Bristol Hospital

Updated 23 June 2022

Spire Bristol Hospital is a large independent acute hospital part of the Spire Healthcare Limited group. The service provides care for patients in the South West of England.

The hospital provides surgical, outpatients and diagnostic services, critical care and services for children and young people.

The hospital has a registered manager, Mr Phillip Curran, who has been the registered manager since March 2020. The service is registered to provide the following regulated activities:

• Services in slimming clinics
• Family planning services
• Treatment of disease, disorder or injury
• Surgical procedures
• Diagnostic and screening procedures
• Management of supply of blood and blood derived products

The service was last inspected in September 2016 and was rated good overall with good in all five key questions.

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 service.

Updated 23 June 2022

Our rating of this location stayed the same. We rated it as good because:

• Our rating of critical stayed the same. We rated it as good.
• Our rating of children and young people’s services stayed the same. We rated it as good.
• We rated outpatients as good.
• We rated diagnostics as good.

However:

• Our rating of surgery went down from good to requires improvement.

Updated 23 June 2022

Our rating of this service stayed the same. We rated it as good overall because:

• The service was responsive to children and young people’s individual needs. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities.
• Staff treated children and young people with compassion and kindness and respected their privacy and dignity.

However:

• There were not separate waiting areas for children and adults in line with best practice at the time of inspection. While the service had single-use activity packs available for young children, the service had not taken steps to ensure the environment and atmosphere was as young people friendly as possible. Before the COVID-19 pandemic the service had child-friendly chairs and a play area available in outpatients. These had been removed for infection control reasons and had not been re-instated at the time of the inspection.
• While staff assessed most risks to children and young people, venous thromboembolism (VTE) assessments were not always completed in line in line best practice for post-pubertal children or children over 40kg.
• The service was unable to demonstrate monitoring and improvement of patient clinical outcomes. While managers monitored the short-term outcomes of surgery for children and young people, Managers did not have processes to monitor the longer-term clinical effectiveness of care.
• The service did not have a process for recording of consent in relation to refusal of blood products at the time of the inspection.

We rated this service as good overall as although effective was requires improvement, safe, responsive, and well-led were rated good. We did not have sufficient evidence to rate caring at this inspection as, although we spoke with staff about the care they provided to children and young people, we were unable to speak with children and their families during this inspection due to low levels of activity.

Children and young people’s services are a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

During the inspection we spoke with two staff - the children’s service lead a paediatric nurse. There were no other children and young people’s services staff on site at the time of inspection. We reviewed five records. We were unable to speak with any children and young people during the inspection due to low activity levels at the hospital. We requested but were not provided with contact details of children and young people and their families to contact and discuss their care.

Updated 23 June 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service mostly controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided effective care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients and had access to the information they needed. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Documentation of care and treatment patients received in the critical care unit was not clear and easy to find.
• Documentation of care and treatment patients received in the critical care unit was not clear and easy to find. Boxes were stored on the floor in the storeroom. Documentation of care and treatment patients received in the critical care unit was not clear and easy to find. Staff knew about incidents, but learning was not always shared effectively with staff in team meetings.
• Staff knew about incidents, but learning was not always identified and shared effectively with staff.
• The hospital did not always monitor the effectiveness of care and treatment for some procedures in a manner that enabled benchmarking patient outcomes with other and similar services.

The critical care unit provided enhanced care to patients admitted for elective surgery who require a period in critical care immediately after their operation. The service also provided an outreach service to inpatient wards in the hospital.

The critical care unit had two designated critical care beds with the option to use a further bed space in the adjacent post anaesthetic care unit. There had been 224 admissions to the critical care unit in the 12 months prior to our inspection.

We last inspected the critical care unit in 2016 when it was rated as ‘good’ across all five domains. We found some progress on the service improvement recommendations we highlighted in our last report but there was still more work to do.

Critical care was a small proportion of hospital activity. The main service was surgical services. Where arrangements were the same, we have reported findings in the surgery section.

We carried out a site visit on 17 February 2022 and followed this up with additional interviews the week commencing 28 February 2022.

We spoke with nine staff and nine patients. We reviewed two patient records and looked at policies and procedures relevant to the critical care unit.

Updated 23 June 2022

We have not previously rated diagnostic imaging as a single service. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand diagnostic processes. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services.

However:

• Changes in the senior team and a reliance on agency staff led to some inconsistencies in understanding and application of policies and audits.
• Leaders ran services well using reliable information systems although this was not always shared with, and understood by, all staff.

Between February 2021 and January 2022, the service carried out 21,552 scans.

The diagnostic imaging service provides nine modalities: computerised tomography (CT), magnetic resonance imaging (MRI), X-Ray, mammography, fluoroscopy, ultrasound, echocardiography, and interventional radiology. The service provides diagnostic imaging to patients referred privately, through their insurance, and from the NHS. The department provides imaging support to surgical inpatients.

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 main service.

Updated 23 June 2022

We have not previously rated outpatients as a single service. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Outpatients services were delivered from a dedicated department with 27 consulting rooms and two treatment rooms. The service included a specialist ophthalmology service and worked with the diagnostic imaging service to provide a breast clinic. A wide range of clinical specialties were available, including gynaecology, orthopaedics, and dermatology. Services were led by consultants, nurses, and healthcare assistants.

A dedicated physiotherapist outpatient team provides care across 10 key specialties, including sports therapy, musculoskeletal therapy, and isokinetic rehabilitation. A physiotherapy gym was located on site.

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 service.

Updated 23 June 2022

Our rating of this service went down. We rated it as requires improvement because:

• There was little evidence of the service monitoring they used the findings to make improvements and achieved good outcomes for patients. There was very minimal evidence of improvements by benchmarking with other similar services. We could not identify where the outcomes for patients were measured, monitored, assessed, or improved.
• Key recruitment documents regarding some senior staff were not available as required by Schedule 3 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Although key services were available out of hours not all staff understood how to access them.

However:

• The service had enough appropriately trained staff to care for patients and keep them safe. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept accurate care records. The service managed safety incidents well and learned lessons from them.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• People could access the service when they needed it and did not have to wait too long for treatment.

We rated this service as requires improvement overall because although safe, caring, and responsive were rated good, effective and well led were rated as requires improvement.