Archived: Spire Dunedin Hospital

Updated 3 October 2016

Spire Dunedin hospital was opened in 1918, initially as a surgical nursing home and became part of Spire Healthcare in 2008.

The main hospital is located at 16 Bath Road with outpatient clinics across the road at 13 and 22 Bath Road. The hospital has 24 inpatient beds and 15 day care beds.

The following services are outsourced to other providers including:

• Human Tissue Supplies - NHS Blood and Transport
• Pathology Services - Frimley Health NHS Foundation Trust/North Bristol NHS Trust
• Provision of Resident Medical Officers - NES Holdings (UK) Limited
• Specialist Blood Services - NHS Blood and Transport.

We inspected the hospital as part of our planned inspection programme. This was a comprehensive inspection and we looked at the four core services provided by the hospital: medicine, surgery and outpatient and diagnostic imaging.

The registered manager at the time of inspection was Miss Margaret Da Costa and they were registered with the Care Quality Commission on 26 June 2013.

The nominated individual from Classic Hospitals Limited at the time of the inspection was Jean Jacques De Gorter.

Updated 3 October 2016

Spire Dunedin Hospital, located in Reading, is one of 38 private Spire hospitals in the UK.

The hospital provides a range of medical, surgical and diagnostic services. The onsite facilities include two laminar flow theatres, a minor procedure room, a pain management suite, an oncology unit, an endoscopy room, 15 consulting rooms, 24 inpatient beds and 15 day case beds. The hospital offers physiotherapy treatment as an inpatient and outpatient service and has four treatment areas and a small gym for this service. Radiology services including CT and MRI scanning, digital mammography and ultrasound are provided onsite.

Services offered include general surgery, orthopaedics, cosmetic surgery, ophthalmology, general medicine, oncology, endoscopy and diagnostic imaging. Most patients are self-funded or use private medical insurance. Some services are available to NHS patients through the NHS choose and book service.

There were no surgical procedures carried out on children under the age of 16 years old at this hospital in 2015.

We inspected the hospital as part of our planned inspection programme, visiting 13-14 April 2016 followed by an unannounced visit 22 April 2016. This was a comprehensive inspection and we looked at the three core services provided by the hospital: medicine, surgery, and outpatients and diagnostic imaging.

Spire Dunedin Hospital was selected for a comprehensive inspection as part of our routine inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

The hospital was rated as good overall and good for safe, effective, caring, responsive and well led services.

Our key findings were as follows:

Are services safe at this hospital?

By safe, we mean people are protected from abuse and avoidable harm.

• Patients were protected from the risk of abuse and avoidable harm across medical, surgical services and outpatient and diagnostic imaging services.

• Staff reported incidents and openness about safety was encouraged. Incidents were monitored and reviewed. We saw examples of changes in practice that occurred as a result of learning from incidents. Staff we spoke with understood Duty of Candour legislation however, following a serious incident of avoidable patient harm legislation was not fully followed.

• Staffing (nursing and medical) was sufficient to provide good care and treatment across all areas. All areas inspected were visibly clean and tidy. Hospital infection prevention and control practices were followed and these were regularly monitored, to reduce the risk of spread of infections.

• Staff routinely assessed and monitored risks to patients. There were appropriate transfer arrangements to transfer patients to a local NHS hospital if required.
• Staff followed comprehensive risk assessments from the initial pre-assessment clinic through to discharge, however the preoperative assessment service was currently stretched due to lack of staff. Major cases were being prioritised but this meant that some patients may not be preoperatively risk assessed prior to admission.
• Medication management across the hospital was variable. There were good systems for storage and checking. However we found medication omission codes were inconsistent on the charts.

Are services effective at this hospital?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence..

• Care and treatment took account of best practice and evidence base guidelines across the services. However the medicine reconciliation process, (the checking of patients’ pre-admission medication against a GP’s or other record) which was considered best practice, was not completed consistently.
• The service was taking action to be able to meet current evidence based guidance. A business plan has been produced to drive towards achieving Joint Advisory guidance (JAG) accreditation in gastrointestinal endoscopy.
• Oncology patient outcomes were monitored at cancer multi-disciplinary (MDT) meetings and staff worked well within teams and across different services to plan and deliver patients’ care and treatment in a coordinated way.
• The hospital routinely collected and monitored information about patients’ surgical outcomes for comparative analysis against the Spire corporate dashboard and national performance audits.
• The hospital had a process for checking competency and granting and reviewing practising privileges for consultants. The medical advisory committee (MAC) reviewed patient outcomes and the renewal of practising privileges of individual consultants. It also reviewed policies and guidance and advised on effective care and treatments.
• Staff were supported in their role through appraisals. All staff were appraised or had appraisals booked with their managers. Staff were encouraged to participate in training and development to support them to deliver good quality care.
• Staff were competent and sufficiently skilled to deliver effective care and treatment. This hospital provided core training for staff in Mental Capacity Act, 2005, and Deprivation of Liberty Safeguards.

Are services caring at this hospital?

By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.

• Feedback from patients about their care and treatment was consistently positive.
• Staff treated patients with kindness and compassion. Staff treated patients courteously and respectfully, and patients’ privacy and dignity were maintained.
• Patients told us they had sufficient information about their treatment and were involved in decisions about their care. Results of the latest patient survey showed a high level of patient satisfaction with the hospital scoring over 95%.
• Staff supported patients emotionally with their care and treatment as needed.

Are services responsive at this hospital?

By responsive, we mean that services are organised so they meet people’s needs.

• The hospital met national waiting times for endoscopy patients to wait no longer than 18 weeks for treatment after referral.
• The needs of different people were taken into account when planning and delivering services. The provider planned and delivered services in a way that met the needs of the local population. The service reflected the importance of flexibility and choice.
• Staff took account of individual patient’s spiritual, religious and emotional needs when delivering care and treatment. Suitable adjustments were made to meet individual needs. For example adjustments had been made to support a patient living with dementia.
• The hospital dealt promptly with complaints or concerns. There was evidence that the hospital used learning from complaints to improve the quality of care.
• There was patient information on specific procedures, conditions and hospital charges. This was routinely in  English, but could be provided  in other languages or formats, such as braille if required. There was good access to translation services for patients that required it.
• The preoperative assessment service was currently stretched due to lack of staff. Recent recruitment had taken place. Whilst the hospital was waiting for the new members of staff to commence employment major cases were being prioritised but this meant that some patients could not be preoperatively assessed prior to admission, this at times resulted in patients operations being cancelled.

Are services well led at this hospital?

By well led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovations and promotes an open and fair culture.

• There was a clear statement of goals and a local strategy with a strong focus on patient care and improvement across the hospital. This aligned with the corporate vision and mission for excellence and highest quality patient care. Most of the staff were clear about the vision and strategy for their services, driven by quality and safety
• There were risk, quality and governance structures, managed at departmental, hospital and corporate levels, and systems to share information and learning. However the hospital was in the process of transferring from one system to another and arrangements for risk management and governance were not always clear with duplicated risk registers held locally and hospital wide. Action plans to mitigate risks did not always have timescales or dates for review.
• All staff spoke highly of their senior management team, stating that they provided a visible and strong leadership within the hospital. There was an open and supportive learning culture. Most staff across the services described being proud of working for the hospital because they were well supported and respected by visible and accessible managers, with good communication structures.
• Consultants we spoke with were positive about senior members of the hospital and described good working relationships
• Patients were encouraged to leave feedback about their experience by the use of a patient satisfaction questionnaire and for NHS patients by the Friends and Family Test. During 2015 the hospital reported consistently high levels (over 85%) of patients would recommend the hospital to their friends and families.

We saw areas of outstanding practice including

• The rapid access spinal pain clinic offered patients an appointment within a week of referral which included diagnosis, expert advice and a treatment plan.

However, there were also areas of where the provider should ensure:

• Systems are in place to review, update and monitor actions against known risks recorded on the risk register.
• Audits are undertaken into antibiotic prescribing.
• Risks are assessed, recorded and mitigated against consistently.
• Consistent medicines reconciliation across surgical and medical services.
• Staff are trained and follow guidelines to recognise female genital mutilation (FGM)
• All staff are familiar with the medication chart in use for their area.
• Ensure all staff are aware of the assessment tool in the outpatient’s and diagnostic department in order to help identify a patient whose condition might deteriorate.
• Patients have chaperones available to provide support in all clinics as needed.
• Audits are developed in outpatient departments to include did not attend (DNA) and patient group directives (PGD).
• All medication fridges in the outpatient’s departments are locked.
• Duty of Candour is applied in line with requirements.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 3 October 2016

Overall, we found medical care at this hospital was good.

Endoscopy, oncology and the ward and were visibly clean and there were good infection prevention and control practices. Patient risks were assessed, reviewed and appropriately monitored during their stay. Staff were supported in their role and were aware of the hospital’s safeguarding process and were clear about their responsibilities. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

However, the hospital did not have audit processes in place to assure safe antibiotic prescribing. Intravenous medications were sometimes prescribed in the wrong place on medication charts which could potentially put patient’s safety at risk.

Medical staff obtained informed consent from patients prior to endoscopy procedures and chemotherapy.

The service was taking action to be able to meet current evidence based guidance. A business plan has been produced to drive towards achieving Joint Advisory guidance (JAG) accreditation in gastrointestinal endoscopy

During the inspection, we saw that staff were caring, compassionate and sensitive to the needs of patients. Patients commented positively about the care provided from all of the endoscopy, oncology, and ward staff. Patients felt well informed and involved in their procedures and care.

The service met national waiting times for endoscopy which meant patients would wait no longer than 18 weeks for treatment after referral. Care and treatment was coordinated with other providers. The needs of different people were taken into account when planning and delivering services.

There were risk, quality and governance structures, managed at departmental, hospital and corporate levels, and systems to share information and learning. The hospital was in the process of transferring from one system to another and there were duplicated risk registers held locally and hospital wide. However the arrangements for risk management and governance were not always clear.

Staff across the service described being proud of working for the hospital because they were well supported and respected by visible and accessible managers, with good communication structures

Updated 3 October 2016

Overall, this service was rated as good. We found outpatients and diagnostic imaging good for the key questions of safe, caring, responsive and well-led. We did not rate effective as we do not currently collate sufficient evidence to enable a rating.

Patients were positive and complimentary about the care they received from staff, access to appointments and the efficiency of the service as a whole. Staff were encouraged to report incidents and the learning was shared to improve services. In diagnostic imaging, staff were confident in reporting Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) incidents and followed their internal procedures to report to the radiation protection team and the Care Quality Commission as required.

There were appropriate systems in place to keep patients safe. Staff were aware of their responsibilities to raise concerns and report incidents and near misses. There were clearly embedded systems and processes to keep patients and staff safe and safeguarded from abuse. Staff received up-to-date training in all aspects of health and safety.

Patients care and treatment was planned and delivered in line with current evidence based guidance, best practice and legislation. There was evidence of local and national audits, including clinical audits in diagnostic and imaging service and reviews were undertaken at regular intervals. Staff were qualified and had the appropriate skills to carry out their roles effectively, and in line with best practice. Staff were supported to deliver effective care and treatment, through ongoing training and appraisal.

We observed that staff were caring, kind, compassionate, and treated patients with dignity and respect at all times when providing care and support. Patients and their relatives’ feedback were positive.

Staff managed, and scheduled, clinics appropriately. Services were planned and delivered in a way which met the needs of the local population. Waiting times, delays, and cancellations were minimal and managed appropriately. There was openness and transparency in how complaints were dealt with.

There was a clear statement of vision and values, which was driven by quality and safety. Staff knew and understood the vision, values and the service’s goals. 

Updated 3 October 2016

Overall we found surgical services provided good care and treatment to patients.

All areas of the service we visited were visibly clean, systems had been implemented to ensure nurses, medical, and domestic staff adhered to infection control policies and procedures. On the ward, we observed all staff were bare below the elbows. Care and treatment took account of current legislation and nationally recognised evidence-based guidance. Policies and guidelines were developed organisationally and locally to reflect national guidance.

Patients had a comprehensive assessment of their needs and access to a variety of methods for pain relief. Feedback from patients about their care and treatment was consistently positive. We observed that patients were treated with kindness, compassion and dignity throughout our visit. Patients’ privacy and confidentiality was respected at all times. Patients told us they felt informed about their treatment and had been included in decisions about their care.

Staff across the service described a ‘family’ culture and felt well supported by visible and accessible managers.

There were risk, quality and governance structures, managed at departmental, hospital and corporate levels, and systems to share information and learning. The hospital was in the process of transferring from one system to another and there were duplicated risk registers held locally and hospital wide. However the arrangements for risk management and governance were not always clear.

Staff followed comprehensive risk assessments from the initial pre-assessment clinic through to discharge, however the preoperative assessment service was stretched due to lack of staff. Major cases were being prioritised but this meant that some patients may not be preoperatively assessed prior to admission.

Ward staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

Medication management across the hospital was variable with good systems for storage and checking. However we found medication omission codes were inconsistent on the charts, and inconsistent medicine reconciliation. Some medication errors were not escalated appropriately to serious incident level. However, we saw all the incidents had been investigated action plans developed and learning shared to prevent the risk of recurrence.