14,15,16 September 2016
During an inspection looking at part of the service
Spire Hesslewood Clinic is operated by Classic Hospitals Limited as a satellite to Spire Hull and East Riding and is governed by the same management structure. Staff worked across both sites. Facilities at the clinic included two operating theatres for minor procedure day cases, outpatient and diagnostic facilities.
We inspected this clinic as part of our independent hospital inspection programme. The inspection was conducted using the Care Quality Commission’s comprehensive inspection methodology. It was a routine planned inspection. We inspected the following three core services at the hospital: surgery, children and young people and outpatient and diagnostic imaging. We carried out the inspection on the 14, 15, 16 September 2015.
Overall we rated surgical services and outpatient and diagnostic imaging services as good. We rated safe and well-led for children and young people’s services, we inspected but did not rate effectiveness, caring or responsiveness because we did not have sufficient evidence and because of the small size of the services.
Are services safe at this clinic ?
The clinic was visibly clean but there were gaps in assessing and auditing of infection prevention and control procedures, specifically observational hand hygiene audits. Staff were aware of the duty of candour. Incidents were reported. Staff received mandatory training in the safeguarding of vulnerable adults and children and the nursing and medical staff we spoke to were aware of their responsibilities and of appropriate safeguarding pathways to use to protect vulnerable adults and children. Mandatory training was in place for all employed staff with some areas below expected compliance levels. For the medical staff mandatory training records were not always completed or checked with substantive employers; there were only three out of 10 which we checked that had training evidence logged. The hospital undertook the ‘five steps to safer surgery’ checks. The required pregnancy test records for a specific dermatology treatment were not well-maintained, which meant there was a risk that patients may have been inappropriately prescribed medication when they were pregnant. There was no standard operating procedure (SOP) for pregnancy tests, and audits of pregnancy tests were not performed.
Are services effective at this clinic ?
Patients mostly were cared for in accordance with evidence based guidelines. Policies were mostly developed nationally. On a local level when a new organisational policy was received, it was reviewed by the Medical Advisory Committee (MAC) and a gap analysis undertaken, information relevant to the site was added in; nothing was allowed to be removed from the policies. Clinical indicators were monitored and compared across the company through the publication of a quarterly clinical scorecard. Consultants working at the clinic were utilised under practising privileges (authority granted to a physician or dentist by a hospital governing board to provide patient care in the hospital); these, with appraisals, were reviewed every year by the senior management team.
Are services caring at this clinic ?
Patients were cared for in a positive and compassionate way. Patients and relatives we spoke to all gave positive examples of caring. We observed positive interaction of staff with patients and staff appeared genuine, supportive and kind. There were high (scores above 85%) for the Friends and Family Test, however the response rate fluctuated from high levels (above 61%) to low levels (less than 30%). Patients felt they were involved with information and decisions taken about them.
Are services responsive at this clinic ?
Spire had responded to demand and opened the Hesslewood Clinic in 2015 to initially provide outpatient services and also dermatology day surgery for NHS and private patients. No patients waited longer than 18 weeks for treatment. Theatre utilisation was growing as new services were being developed on site or transferred from Spire Hull and East Riding hospital. Patients’ individual needs were met. There was a complaints policy and process in place.
Are services well led at this clinic ?
There was a vision and strategy in place for Spire across the two sites. However there was a lack of vision and strategy for the smaller core services and staff could not articulate verbally what the vision might be. Whilst there were governance structures in place for the provider and locally across the two sites these were not robustly implemented; there was a high element of trust and a low assurance culture. There was a shared governance structure, with a clinical governance committee, across both the Spire Hull and East Riding hospital and the Hesslewood clinic. This committee fed directly into the medical advisory committee (MAC). It also had direct links into the senior management team and hospital and national group governance arrangements. The monitoring system to ensure the doctors’ safety to practice within the clinic was not robust at the time of the inspection, especially with regard to monitoring mandatory training and some disclosure and barring checks. The organisation had a governance structure with reasonable attendance at meetings. Staff described leadership and culture across the sites in a positive manner. The management team actively engaged in proactive recruitment and retention of staff including recent staff incentive packages.
However, there were also areas of poor practice where the provider must make improvements. Importantly, the clinic must:
- Take action to ensure that the appropriate checks and records as per HR policies are in place and recorded for the doctors working at the hospital including Disclosure and Barring Service (DBS) checks, mandatory training and appraisals.
In addition there were a number of areas where the provider should take action and these are listed at the end of the report.