Spire Harpenden Hospital

Updated 9 January 2017

Spire Harpenden is a private hospital in Harpenden, Hertfordshire. It has 79 registered beds including four extended recovery beds. The hospital was opened in 1983 and, is purpose built over two floors. During this period the hospital has seen a number of changes, including a major development and expansion in 2014.

The registered manager has been in post for over five years.

The hospital provides inpatient services to adults and outpatient services to both adults and children. The outpatient department comprises of 22 consulting rooms. The hospital offers imaging and physiotherapy services in addition to a pharmacy department providing services for both inpatients and outpatients. All outpatient services are situated on the ground floor of the building.

The inpatient services are situated on the ground and first floors. There are four wards and an extended recovery unit which comprise of 58 inpatient beds, which have ensuite facilities and 21 day case beds.

The operating facilities include five theatres and an endoscopy suite. Four of the five theatres have laminar flow and two offer integrated laparoscopic services.

The hospital undertakes a range of surgical procedures and treats adults. The hospital suspended its inpatient and day case surgical service for children and young people in January 2016 following a review of paediatric services.

The hospital is managed by Spire Healthcare and is part of a network of over 35 hospitals. The hospital provides care for private patients who are either covered by their insurance companies or are self-funding. Patients funded by the NHS, mostly through the NHS referral system can also be treated at Spire Harpenden Hospital.

Updated 9 January 2017

We carried out an announced inspection visit on 12 and 13 April 2016 and an unannounced inspection on 25 April 2016.

Our key findings were as follows:

Overall the hospital was rated as good.

Are services safe at this hospital?

• There was access to appropriate equipment to provide safe care and treatment.
• The environment was visibly clean and there were systems in place to maintain the safety of equipment used across clinical areas. However in surgery we found that ‘I am clean’ stickers were not always dated.
• Staff were encouraged to report incidents and were aware of the duty of candour regulation. There was evidence of learning from incidents and complaints and effective processes were in place to reduce risk.
• Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice.
• Systems were in place for the prescribing, storage and administration of medications.
• Staffing levels were appropriate to the needs of the clinical areas and flexed according to the demands of the service, ensuring flexibility to meet patient demands.
• There were clear escalation processes in place, which included escalating to the resident medical officer (RMO) and the patient’s consultants.
• Safeguarding systems were in place and staff knew how to respond to safeguarding concerns. However, not all staff had been trained to the right level.

Are services effective at this hospital?

• Care and treatment was delivered in line with evidence based-guidance.
• Policies were accessible, current and reflected professional guidelines. The hospital monitored adherence to policies with the use of local audits.
• Patient outcomes were audited in surgery; however we found that they were not always formally captured in medical care.
• Pain was well-managed and pain management was audited.
• Patients’ nutritional status was assessed.
• An induction programme was provided to all new staff.
• There was a process in place for checking professional registration.
• The Medical Advisory Committee (MAC) ensured consultants were competent to practice and practising privileges were reviewed annually.
• Consultants were on call for 24 hours a day and seven days a week for their inpatients and day case patients. There was an RMO providing medical cover for patients and clinical support to staff.
• There were arrangements to ensure staff were able to access all necessary information to provide effective care.
• Staff were aware of their role with to regards to the Mental Capacity Act and Deprivation of Liberty and had received training.
• Multi-disciplinary teams worked well together to provide effective care. Multi-disciplinary team working included hospital staff, local acute trusts, clinical commissioning groups and general practitioners.
• Staff had received an up to date appraisal and identified individual training needs. Staff had the right qualifications, skills, knowledge and experience to do their job.

Are services caring at this hospital?

• Patients were treated with dignity and respect. Their preferences were taken into account with treatment planning and they were given the time and information required to make informed decisions about their care.
• Feedback from patients and those close to them was positive about the way staff cared for them and the treatment they had received.
• The Friends and Family Test response rates across services were better than the national average. The percentage of patients that would recommend the hospital to family and friends varied between services.
• Staff recognised the need to provide patients and their families with emotional support and the hospital had a list of multi-faith contact details should patients require these.

Are services responsive at this hospital?

• Services were planned and delivered in a way that met the needs of the local population. The importance of flexibility, choice and continuity of care was reflected in the services.
• Services included other organisations and general practitioners in planning patient care to ensure a holistic approach.
• Appointments were scheduled according to the patient’s condition and could be arranged as telephone appointments if preferred.
• Appropriate facilities were provided to meet the needs of patients requiring wheelchair access and hearing loop. Interpreters were available to support patients if necessary.
• Patients could access the service at times to suit them.
• The services had protocols and procedures in place to manage patients with complex needs, including those living with a learning disability and dementia.
• Staff had awareness and had attended training in caring for patients living with dementia.
• Information on complaints or how to raise a concern was available for patients. Complaints and concerns were always taken seriously and responded to in a timely manner. There was evidence of actions taken to address issues raised in complaints and staff were informed of changes required in response to complaints.
• Patients received and had access to appropriate written information about their condition and treatment.
• There were no toys or books available in the waiting areas specifically for children when they attended outpatients, physiotherapy or diagnostics appointments.

Are services well led at this hospital?

• The hospital had a vision and a set of values. The hospital also had a clear governance structure and a clinical governance committee that met monthly to discuss a range of hospital issues.
• There were defined routes for cascading information to hospital staff.
• The hospital had a robust risk register.
• Senior management staff at the hospital were visible, supportive and approachable.
• Staff were generally proud to work at the hospital and said they felt supported and valued.
• Clinical leads had a shared purpose and motivated staff to deliver services and succeed.
• Services were being actively progressed through the development of Joint Advisory Group (JAG) accredited endoscopy department and planning palliative care services within chemotherapy.

We saw an area of outstanding practice including:

• Oncology services offered a high standard of personalised care for a variety of patients. This included bespoke appointments, support out of hours and access to specialists. Treatment options were inclusive of new medications and not limited by clinical commissioning. Patients experience was individualised and supportive of their decision-making.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Staff who have responsibility for potentially assessing, planning, intervening and evaluating children’s care, must be trained to level three in safeguarding.

In addition the provider should:

• Although there were clinical hand basins in utility areas, there were no clinical hand basins in patients’ rooms. Therefore staff were using these patient sinks at the point of care when it was necessary to wash their hands. Clinical sinks should be available at point of care.
• The floor coving in patient bedrooms and bathrooms was not compliant with infection control guidelines.
• Medicine cupboards in theatres were being left unlocked for convenience when theatres were in use.
• Medication was found to have been prepared in advance and stored in an unlocked fridge.
• When changes were made to theatre lists, the lists were reprinted and the wards informed of the changes. However, the lists were not reprinted on different coloured paper, which is not best practice. This meant that there was an opportunity for errors to occur if there had been multiple changes in list orders. By the time of our unannounced visit, work was underway to rectify this.
• Medical representatives visiting theatre did not have their identification routinely checked, as they and the companies they represented, were well known to the theatre staff.
• Patient outcomes in oncology were not formally captured.
• Consider the effective management processes required for out of hour endoscopy emergencies.
• Although there was some participation in national audits, this was not comprehensive, particularly in medical care and the hospital should consider formally collecting patient outcomes and participate in national audit programmes to enable benchmarking against national standards.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 9 January 2017

Overall, we rated the service as good for safe, effective and outstanding for caring responsive and well led. We found that:

Both endoscopy and chemotherapy services had a small established team that flexed working days and staffing numbers to meet the demands of the service and ensure patients’ treatments were provided according to their condition and any demands on their work/life balance.

The clinical environment was suitable to the demands of the service, with Macmillan accreditation in place on Heartwood ward, and Joint Advisory Group Gastroenterology Society accreditation being applied for in the endoscopy unit.

There were robust processes in place to maintain equipment and facilities and nursing staff were aware of their responsibilities to ensure patient safety. There was evidence of learning from incidents and complaints and effective processes in place to reduce risk.

The hospital used paper records, which were held locally and were readily accessible for patient attendances at the hospital. Patient records were found to be comprehensive and inclusive of specialist advice, notifications to general practitioners and evidence of multidisciplinary discussions. Heartwood ward had participated in an organisational pilot in electronic records and this was planned to be rolled out nationally following a successful trial period.

Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice. Staff had information they needed before providing care and treatment. Staff were able to access additional support and advice from clinical leads.

Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice. Staff felt supported to deliver care and treatment to an appropriate standard, including having relevant training and appraisal. Consent was obtained before care and treatment was given.

During the inspection, we saw and were told by patients, that the staff were kind, caring and compassionate at every stage of their treatment. Patients we spoke with during our inspection were positive about the way they were treated and felt able to gain support at any time. The oncology team provided a 24-hour advice line for all patients to assist with any concerns with symptoms or treatment.

There were systems to ensure that services were able to meet individual needs, for example, appropriate decorations for those with visual impairment. There were also systems to record concerns and complaints raised within the department, review these and take action to improve patients’ experience.

Staff were familiar with the organisational vision and values and felt part of the team as a whole. Nursing staff told us that they felt supported by their immediate line managers and that the senior management team were visible within the departments.

There were effective systems for identifying and managing the risks at the team, hospital and organisational levels. Teams were benchmarked against organisational hospitals.

Regular governance meetings were held and staff were updated and involved in the outcomes of these meetings. There was a strong culture of team working across the areas we visited.

Updated 9 January 2017

Overall, we rated the outpatients and diagnostics service as good for safe, caring, responsive and well-led; effective was inspected but not rated. We found that:

Safety concerns were identified and addressed. Staff were clear with regards to the process to report incidents. Staff were fully aware of the Duty of Candour regulation.

There were good infection control procedures in place and the areas were generally visibly clean and well organised. However, we found some areas did not comply with the Health Building Notes for flooring and sinks in a clinical area.

Records were accessible and completed accurately.

Staffing levels were appropriate for the service provision with minimal vacancies. Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice.

Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice.

Consent was obtained before care and treatment was given.

Safeguarding systems were in place and staff knew how to respond to safeguarding concerns. However staff employed by the hospital, who were responsible for assessing children’s care in outpatients, did not all have the correct level of safeguarding training. Staff had received Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) training.

There were systems to ensure that services were able to meet individual patient needs, for example, for patients living with dementia.

Services were planned and delivered in a way that met the needs of the local population. The importance of flexibility, choice and continuity of care was reflected in the services. Patients could access the right care at the right time.

The imaging department planned and delivered care and treatment in line with current evidence-based guidance, standards and best practice. Staff had the right qualifications, skills, knowledge and experience to do their job.

The learning needs of staff were understood. Staff were supported to participate in training and development.

Multi-disciplinary teams worked well together to provide effective care.

Referrals to treatment times were in line with the national average and appointments could be made easily and quickly if required.

Patients were positive about the way staff treated them in all outpatients and diagnostic areas. They were involved in decisions around their care and treatment and found leaflets informative regarding any potential surgery. Patients were informed about relevant fees for their consultation before they attended their appointment.

Complaint information or how to raise a concern was available for patients. Complaints and concerns were always taken seriously and responded to in a timely manner.

Staff had knowledge regarding the vision for the hospital. There was good staff satisfaction. Staff felt supported and valued. There was a strong culture of team working across the areas we visited.

Updated 9 January 2017

Overall, we rated the surgical services as good for caring, effective, responsive and well-led. Safety required improvement. We found that:

There was appropriate equipment to provide safe care and treatment. Incidents were reported and dealt with appropriately and themes and outcomes were communicated to staff. Action was taken to ensure harm free care.

Children aged 16 years and above were cared for, however not all staff were trained to level 3 in safeguarding.

Patient areas were visibly clean, tidy and appropriately equipped. Patients were assessed, treated and cared for in line with professional guidance. There were effective arrangements in place to monitor and manage pain.

Patient surgical outcomes were monitored and reviewed through formal national and local audit. Patients’ nutritional status was assessed and nutritional needs were met. There was sufficient competent medical and nursing staff on duty to meet the needs of patients.

Patients were treated with dignity and respect. Nursing, medical and other healthcare professionals were caring and patients were positive about their care. Patients were given appropriate written information on what to expect from their care and treatment. Staff were able to recognise the needs of patients and relatives and gave emotional support.

The booking system offered some flexibility to patients. There was appropriate discharge planning. Complaints were acknowledged, investigated, and responded to in a timely manner. Information about the hospitals complaints procedure was available for patients and their relatives.

The hospital had a clear governance structure. Information was cascaded to all staff. The service reviewed and acted on feedback about the quality of care received. There was strong leadership and staff felt valued.