Spire Cheshire Hospital

Updated 17 May 2017

Spire Cheshire Hospital is a private hospital located in Warrington, Cheshire. It is operated by Spire Healthcare Ltd., which is the second largest provider of private healthcare in the United Kingdom. The hospital opened in 1988 and primarily serves the communities of the Cheshire, Merseyside and Manchester but also accepts patient referrals from outside this area.

The registered manager designate is Verlie Brazel who had been in post since 5 November 2013. The provider’s nominated individual for this service is Jean Jacques De Gorter. The controlled Drug Accountable Officer was Verlie Brazel.

The hospital has one ward and is registered to provide the following regulated activities:

• Diagnostic and screening procedures

• Surgical procedures

• Treatment of disease, disorder, or injury

We previously inspected this service in 2013 under the previous methodology and found the service to be compliant.

We carried out the announced part of the inspection on 18th and 19th October 2016, along with an unannounced visit to the hospital on 28th October 2016.

Updated 17 May 2017

Spire Cheshire Hospital is operated by Spire Healthcare plc. The hospital has 50 beds which could be occupied by inpatients or day-case patients. Facilities on site included three operating theatres, a five bedded recovery unit, a two bedded Extended Recovery Unit (ERU), an Endoscopy unit and X-ray, computerised tomography (CT) scanner, a magnetic resonance imaging (MRI) scanner, outpatient and diagnostic facilities. The hospital provides surgery, and outpatients and diagnostic imaging for adults, children and young people from birth to aged 17 years. We inspected surgery and outpatients and diagnostic imaging but looked at the care provided to children and young people within each core service.

We inspected this service as part of our national programme to inspect and rate all independent hospitals, using our comprehensive inspection methodology. We carried out the announced part of the inspection on 18th and 19th October 2016, along with an unannounced visit to the hospital on 28th October 2016. We rated both core services and the hospital overall as ‘Outstanding’.

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.

We rated this hospital as ‘Outstanding’ overall because:

• There were effective and comprehensive systems in place to monitor, highlight and learn from incidents, to help to keep patients safe and to minimise the risk to patients. All staff were knowledgeable and engaged with the process to learn from incidents, the process was robust, effective and integrated into working practices.
• The environment across the hospital was visibly clean and well maintained, there were efficient infection control and prevention measures in place and the hospital had low levels of healthcare related infections.
• Effective systems and monitoring were in place for the administration, usage and storage of medicines, controlled drugs and pharmacy items.
• There were appropriate numbers of skilled, experienced and qualified staff (including doctors, nurses and allied health professionals) to meet patients’ need. Arrangements were in place to ensure staff undertook annual mandatory training and had annual performance appraisal and reviews.
• The service actively ensured the nutritional and hydration needs of the patients were met. The hospitality services provided an extensive choice of quality nutritional options tailor made to meet patients’ needs and preferences. The services went the extra mile to ensure patients’ needs were met and patients were exceptionally pleased with the service and the way this was delivered.
• Care and treatment was aligned to national evidence based guidance and best practice. The hospital continually reviewed their service delivery against national policies and ensured they were consistent with the required standards.
• Patient outcomes were positive and exceeded benchmarks for similar services. The hospital measured their performance against a number of measures and used this information to identify how they could improve.
• Staff were aware of and adhered to legal requirements for obtaining consent.
• The individual needs of patients were recognised and accommodated including those in vulnerable circumstances such as those living with dementia, mental health concerns and learning disabilities. The needs of carers were also considered and planned for within the holistic assessment process.
• Care and treatment was accessible and flexible and patient choice was respected.
• The patients were cared for with kindness and compassion, their privacy and dignity were maintained at all times and staff were attentive and responsive to their holistic needs.
• The hospital championed a proactive approach to raising standards and seeking improvements, they engaged with the public, community groups and staff to solicit ideas and canvass opinion, responding to feedback and individual needs by acting upon areas highlighted and implementing initiatives to promote satisfaction and increase their responsiveness.
• The hospital was managed by a visible, competent and enthusiastic team who placed patient care as central to their success. The team inspired and motivated staff and promoted a collective ethos of patient care and improving standards. Staff were committed and motivated and demonstrated ambition to achieve high standards, which led to a professional, efficient and caring service.
• Quality measurement and improvement was assisted by effective and well organised management and governance structures at a local level. Managers were not only aware of the risks and challenges they needed to address, but were dynamic in identifying areas for improvement and actively implementing quality advances.

In surgery, we found the service ‘outstanding’ overall. This was because;

• Staff had adopted a flexible approach to working during times of high demand, with staff working together with a strong team ethos.
• There was a tangible and positive person centred ethos, staff respected the holistic needs of the patients and were extremely motivated and proud to deliver care that was of high quality and effective. There were positive and respectful rapport between those using the service and those providing it. Staff did all in their power to deliver a caring and responsive service to all patients.
• The hospital had built a new endoscopy suite in response to the needs of patients, this improved both the availability of services and the environment in which they were delivered.
• Patients were offered flexibility in their access to treatment, in response to local demand, operating theatres provided surgery services to patients seven days a week. Patients could choose an appointment to suit their personal circumstances.
• Theatre lists were planned around patient’s needs, for example, patients with dementia or a learning disability could be placed on the beginning of the theatre list to reduce the amount of time they needed to spend at the hospital thus reducing any anxiety.
• The hospital had consistently good referral to treatment times for NHS patients, on average from July 2015 to June 2016, 95% of patients were treated within 18 weeks of being referred for treatment.
• Anticipatory discharge planning took place at the pre-operative assessment stage to ensure there were no impediments in meeting the needs of patients with complex needs.

In outpatients and diagnostics we found the service ‘outstanding’ overall. This was because;

• The hospital consistently exceeded performance targets around referral to treatment times for National Health Service (NHS) patients. Appointments were flexible and the needs of NHS patients were accommodated.
• Private patients and self-paying patients could often secure appointments within a few days and were provided with flexibility and options to suit their individual needs.
• No patients waited longer than six weeks for Magnetic Resonance imaging (MRI), Computerised Tomography (CT) or ultrasound scanning. The average time it took to report the result of diagnostic imaging was 1.7days.
• All patients received comprehensive instructions and information with their appointment letters and we observed information packs containing additional useful information.
• The environment was pleasant, suitable and appropriate, waiting areas had sufficient seating available with access to toilets, baby changing facilities and refreshments. Newspapers and free car parking were available.
• The individual needs of patients were accommodated and staff went out of their way to ensure that they understood and accommodated patients’ differing requirements.
• Staff were aware of the hospitals’ values of delivering high quality clinical care supported by a customer focused service model and felt connected to the wider Spire network through management feedback and the sharing of information and good practice.
• Managers, clinical leads, matron and the hospital director were visible and approachable. They inspired a cohesive, collaborative and focused workforce with a shared sense of purpose. Staff felt motivated, happy and proud of their work and their achievements. Staff received positive feedback and recognition for their work.
• There was a systematic, logical and comprehensive approach to departmental, clinical and hospital governance. There were joined up committee meetings which worked together to monitor, identify and respond to risks, incidents and key issues. Quality and performance were monitored through the Clinical Scorecard and Key Performance Indicators.
• Radiation Safety Committee meetings were held annually to ensure that clinical radiation procedures and supporting activities in the hospital were undertaken in compliance with ionising and non-ionising radiation legislation.
• The views of patients were actively sought within outpatients and diagnostic imaging using the NHS Friends and Family Test, patient satisfaction surveys and patient feedback initiatives. A child friendly feedback form was also available. A patient engagement forum had been launched to obtain feedback from past patients to improve the patient journey for future service users.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 17 May 2017

All of the clinical areas we visited were visibly clean and tidy and completed cleaning checklists were observed.

Policies and procedures for the prevention and control of infection were in place and staff adhered to “bare below the elbow” guidelines. Hand gel was readily available in all clinical areas and we observed staff using it.

Maintenance contracts were in place to ensure specialist equipment was serviced regularly and faults repaired and we saw evidence of quality assurance for diagnostic equipment.

Outpatients and diagnostic imaging staff met the hospital target for compliance with mandatory training.

Care and treatment was delivered in line with evidence-based practice and patient pathways were in place for a wide range of treatments.

An audit programme was in progress assessing compliance in relation to a number of activities including the World Health Organisation (WHO) checklist, patient care pathways and hand hygiene.

A planning meeting was held weekly and attended by senior representatives from each hospital department. This ensured appropriate staffing levels and allowed identification and forward planning for patients with additional requirements such as children, vulnerable adults or those with complex care needs.

Staff valued the ability to give patients time in all interactions and patients we spoke with confirmed how much they appreciated this.

The NHS Friends and Family Test, which assesses whether patients would recommend a service to their friends and family showed that between April 2016 and June 2016 over 99% of NHS patients would recommend the hospital.

Patients had a choice of appointment date and time and clinics were held in the evenings and at weekends for the convenience of patients.

Between July 2015 and June 2016 the hospital consistently exceeded the target of 92% of National Health Service (NHS) patients on incomplete pathways waiting 18 weeks or less from time of referral.

Staff told us they felt supported by their local managers and that managers, clinical leads, matron and the hospital director were visible and approachable.

Clinical governance committee meetings took place quarterly to discuss risks, incidents and key issues and quality and performance were monitored through the Clinical Scorecard and Key Performance Indicators.

A patient engagement forum had been launched to obtain feedback from past patients to improve the patient journey for future service users.

Updated 17 May 2017

Improvements and learning took place through the review of reported incidents. We saw improvements made to the decontamination of endoscopy equipment and longer oxygen tubing was attached to all oxygen points following reported incidents. Infection control procedures kept patients safe from healthcare acquired infection, we observed equipment cleaned after use by patients, and good hand hygiene throughout the theatre and inpatient areas.

There had been no cases of Methicillin-resistant Staphylococcus aureus (MRSA) Methicillin-sensitive Staphylococcus aureus (MSSA) or Clostridium difficile, for the period July 2015 to June 2016.

Emergency equipment was readily available and safety checks were completed.

Mandatory training was well attended by theatre and inpatient staff and consistently met the hospital target for compliance.

Care and treatment was planned and delivered in line with current evidence-based guidance, standards, and best practise legislation. Adherence to evidence-based practice was monitored as part of the annual audit plan to ensure a consistent approach to care using clinical scorecard and key performance indicators.

Patients were monitored to detect any deterioration in their condition and systems were in place to escalate any concerns in a timely manner. We saw action had been taken when a patient had deteriorated the day before our inspection. The Registered Medical Officer reviewed the patient and called the consultant who was on site within 30 minutes and the patient review had been documented within 45 minutes of the consultant being initially contacted. There were service level agreements in place should a patient require transfer to a NHS acute hospital.

Appropriate staffing levels were reviewed at the weekly planning meeting and patients with additional requirements such as children, vulnerable adults or those with complex care needs were highlighted and included in the planning. There had been no unfilled shifts from April 2016 to June 2016.

There was a strong visible person-centred culture within the theatre and inpatient departments. Staff were motivated to offer care that was kind and compassionate. We observed this at the time of our inspection in the way that staff spoke with patients and their carers and feedback that patients gave us at the time of our inspection.

The hospital had introduced the role of a Patient Services Manager who visited patients daily to ensure they were satisfied with services they were receiving. Nine patients we asked told us they had been visited by the Patient Services Manager.

Friends and Family test results for the period August 2015 to August 2016 identified that for 11 months 98-100% (with one month recorded as 96%) of patients would recommend the services they received at the hospital to friends and family if they required the same service. A patient engagement forum had been launched to obtain feedback from past patients to improve the patient journey for future service users.

Theatre lists were planned around patient’s needs, for example, patients with dementia or a learning disability could be placed on the beginning of the theatre list to reduce the amount of time they needed to spend at the hospital thus reducing any anxiety.

The hospital had consistently achieved 91-100% for patients being seen within 18 weeks of referral for the 12 month period from July 2015 to July 2016.

Staff felt supported by their local managers, clinical leads, the matron and the hospital director and were comfortable to raise any concerns

Governance  was well managed through a variety of meetings held at senior manager and team level. Managers and staff were aware of risks and actions were in place to mitigate risks. Quality and performance were monitored through the clinical scorecard and key performance Indicators.