Spire Cheshire Hospital

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