Spire Leeds Hospital

Spire Leeds Hospital is operated by Spire Healthcare Ltd. The hospital has 88 inpatient and day case beds. Facilities include four operating theatres, one endoscopy suite, one angiography suite, a chemotherapy unit, physiotherapy services, outpatients’ departments, and diagnostic and imaging facilities. There is an eight-bedded level two critical care unit, an eight-bedded children’s ward, a 10-bedded ambulatory care unit, six oncology day case chairs, and 56 inpatient and day case beds spread across two adult wards.

The hospital provides surgery - including cosmetic surgery, medical care - including chemotherapy, high dependency care for adults, services for children and young people, and outpatients and diagnostic imaging services.

We inspected this service using our focused inspection methodology. We carried out an unannounced responsive inspection on 11 December 2018. We focused on specific services which were highlighted as concerns to CQC from staff and members of the public, and we inspected surgery and services for children and young people. As concerns spanned multiple inspection domains, we looked at all key questions and asked if surgery and children’s and young people’s services were safe, effective, caring, responsive, 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. As this was a focused inspection, new ratings were only awarded for the key questions that were inspected. The overall rating for surgery changed from good to requires improvement. The overall rating for and children’s and young people’s services changed from good to requires improvement. We amalgamated these ratings with ratings from our routine 2017 inspection of medical care, outpatients and diagnostic imaging, and critical care services. Our rating of this hospital went down. The rating for the hospital changed from good to requires improvement overall.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospital was surgery. Where our findings about surgery services (for example, management arrangements) also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Services we rate

Our rating of this hospital went down. The rating for the hospital changed from good to Requires improvement overall.

We found the following areas of concern in surgery and children and young people’s services:

• Key leaders in the service did not have the right skills and abilities to run a service providing high-quality sustainable care. Opportunities to prevent or minimise harm were missed.

• Safety was not always a high priority, and the application of safety systems and processes required improvement. Levels of harm were inconsistently recorded against incident records. Investigation reports were of variable quality, and the completion and sign-off of action plans was inconsistent.

• The application of governance arrangements and systems was not adequate. The hospital could not reliably determine how many serious incidents had occurred, and had not always notified CQC of serious incidents, or had not done so in a timely manner. At the time of inspection, the hospital had been without a governance lead for several months. We saw the frequency of key committees was not always in line with their terms of reference. There was little evidence senior leaders had worked to systematically improve service quality and safeguard good standards of care. Risk registers were not adequately managed and did not reflect key risks facing the service.

• Senior leaders had not supported or promoted a culture of appropriately identifying, reporting, categorising, and learning from incidents. When concerns were raised, or things went wrong, the approach to reviewing and investigating causes was often insufficient or too slow. There was little evidence of learning from events or action taken to improve safety in key committee and group meeting minutes we reviewed.

• Senior leaders had failed to meet their duty of candour obligations consistently well. The culture was not one of fairness, openness, transparency, honesty, challenge and candour. Senior leaders were reactive and defensive. When something went wrong, people were not always told in an open and honest way or in a timely manner.

• The culture, policies and procedures had not provided adequate support for staff to raise concerns and have these adequately addressed at hospital level. From November 2017 to October 2018, CQC received five whistleblowing enquiries; and an internal whistleblowing investigation by Spire Healthcare (corporate) had been undertaken with respect to children’s and young people’s services.

• The service had not sufficiently applied the systems available to identify risks and implement plans to eliminate or reduce them. Risks to patient safety had not been monitored or mitigated over time consistently well.We found senior managers had failed to sufficiently address fasting time compliance. Recent improvements had been made in venous thromboembolism (VTE) prophylaxis, daily and pre-discharge medical review of patients, and medical record keeping compliance; but deficiencies with compliance were observed throughout most of 2018. Where action plans had been implemented, we often found these were not sufficiently robust.

• The hospital had systems to manage information. However, the information that was used to monitor performance or to make decisions was not always accurate, valid, reliable, or timely. We saw that clinical audit measures were not always collated or presented to committees and groups in a timely fashion; and we observed data inaccuracies between key hospital and service reports.

• The service level agreement (SLA) for the transfer of critically ill children had expired in February 2018 and had not been renewed as of January 2019.

• Staff did not always follow best practice when prescribing, giving, recording and storing medicines.

• There was limited evidence of discussions about learning from concerns and complaints in key committee and group meeting minutes we reviewed.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals