• Hospital
  • Independent hospital

Spire Southampton Hospital

Overall: Good read more about inspection ratings

Chalybeate Close, Southampton, Hampshire, SO16 6UY (023) 8077 5544

Provided and run by:
Spire Healthcare Limited

All Inspections

08 July 2021

During a routine inspection

Our rating of this location stayed the same. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care to patients. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of the communities it served, took account of patients’ individual needs, and made it easy for people to give feedback. People accessed the service when they needed it and did not have to wait too long.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

16 to 17 July 2019

During a routine inspection

Spire Southampton hospital is operated by Spire Healthcare Limited. The hospital has 67 beds which includes seven critical care beds. Facilities include six operating theatres, a seven-bed critical care unit, a six ‘podded’ oncology unit, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery, medical care, critical care, services for children and young people, diagnostic imaging and outpatients services.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 16 and 17 July 2019. 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.

The main service provided by this hospital was surgery. Where our findings on surgery – 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 stayed the same. We rated it as Good.

We found areas of good practice across all services:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • The hospital controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. Most staff managed medicines well. The service managed safety incidents well and learned lessons from them.

  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it.

  • Most managers monitored the effectiveness of the service and made sure staff were competent.

  • Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.

  • Staff treated patients with compassion and kindness, and most respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

  • The service planned care to meet the needs of local people, took account of patients’ individual needs. People could access the service when they needed it and did not have to wait too long for treatment.

  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.

  • Most of the hospital services engaged well with patients to plan and manage services and all staff were committed to improving services continually.

We found areas of outstanding practice in services for children and young people:

  • The service was proactive in developing resources which had been adapted by the provider and shared across the hospital group: for example, the fasting instruction cards. The latest innovation had been the ‘app’ to help children and young people prepare for their hospital stay. One member of the children and young people’s staff team had been supported and encouraged to implement the 15 Steps process.

We found areas of outstanding practice in Surgery:

  • The hospitals bariatric Tier three weight management service won a UK Association for the Study of Obesity best practice award in 2018.

However, we found areas of practice that required improvement in critical care

  • Nursing staff in the critical care unit did not always follow the local safety standards or pathways for invasive procedures.

  • There was lack of strong leadership of the critical care service to provide assurance the service was managing risks and delivering evidence based care and treatment.

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 one requirement notices that affected critical care services. Details are at the end of the report.

Name of signatory

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and south)

23 April 2019

During an inspection looking at part of the service

Spire Southampton Hospital is operated by Spire Healthcare Limited. The hospital was registered with the Care Quality Commission in 2010. The hospital offers outpatient, diagnostic imaging, inpatient medical and surgical care for adults, children and young people. The hospital also provides more complex care including specialist cardiac and spinal surgery, which is supported by an on-site critical care unit. Services are available for insured and self-funding patients, as well as working in partnership with local NHS trusts to provide NHS funded care.

The hospital has 60 inpatient rooms, a six-bedded children’s suite, nine day care bays and seven critical care beds. There are four laminar flow theatres, an endoscopy suite and cardiac catheter suite. The outpatient department consists of 16 consulting rooms, two treatment rooms and a minor procedure theatre. The hospital hosts a computerised tomography (CT) room, magnetic resonance imaging (MRI) suite, x-ray room, digital mammography and a fluoroscopy suite.

The Spire Southampton Hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. This inspection was solely focussed on the diagnostic imaging core service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 23 April 2019.

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.

Services we rate

Whilst we have the legal authority to rate diagnostic imaging services, we have opted not to rate the service as a result of this inspection. This is due to there being a legacy rating for the wider outpatient and diagnostic imaging service. Because this was an unannounced inspection which focussed on one core service only, we have not inspected the outpatient core-service, and so legacy ratings remain in force.

Our key findings were:

  • Governance processes surrounding the maintenance of personal protective equipment was not effective.
  • Staff did not consistently follow provider and local level safety rules associated with the use and exposure of ionising radiation (X-rays).
  • The service could not demonstrate they consistently provided care and treatment based on national guidance and evidence of its effectiveness.
  • Managers did not routinely monitor the effectiveness of care and treatment and therefore could not use the findings to improve them. The lack of local level data meant it was not possible for the service to compare local results with those of other services to learn from them.
  • Managers at all levels in the service did not have the right skills and abilities to run a service providing high-quality sustainable care.
  • The service did not have a local vision for what it wanted to achieve.
  • Morale was reported to be low with limited mutual respect shown between front-line staff and their managers. There did not exist a positive culture which should have supported and valued staff, creating a sense of common purpose based on shared values.
  • The service failed to systematically improve service quality and safeguard high standards of care due to a lack of a culture which encouraged excellent clinical care to flourish.
  • The service had poor systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

However,

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse however the local policy was in need of updating to reflect recent updates to safeguarding concerns.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
  • Emergency equipment was available and regularly checked.
  • Staff recognised incidents and reported them appropriately and managers investigated incidents and shared lessons learned with the whole team and the wider service. There was evidence of audits being completed to ensure that identified actions have been followed by relevant staff.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the service policy and procedures when a patient could not give consent.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The service planned and provided services in a way that met the needs of local people.
  • The service took account of patients’ individual needs.
  • Staff could not describe a departmental vision or strategy. The provider subsequently reported that individual specialties were not required to have a local strategy, often due to the size of locations; it was acknowledged that each location had a hospital wide vision and strategy. Staff could describe the vision for the hospital. They also described the wider values of Spire Healthcare.
  • People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Following this inspection, we told the provider that it must take some actions. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South)

18 to 19 October 2016 & unannounced visit 1 November 2016

During a routine inspection

We inspected the following core services:

  • Medicine

  • Surgery

  • Critical care

  • Children and young people

  • Outpatients and diagnostic screening.

We undertook an announced inspection 18 and 19 October 2016, with an unannounced visit on 1 November 2016. We visited all departments, theatres and wards at different times of the day and evenings.

We reviewed a wide range of documents and data we requested from the provider. These included policies, minutes of meetings, staff records and results of surveys and audits. We placed comment boxes at the hospital prior to the inspection, which enabled staff and patients to provide us with their views. We received ninety three comments from patients and relatives, of which 96% contained positive comments.

We spoke with 56 staff including; registered nurses, health care assistants, reception staff, medical staff, operating department practitioners, and senior managers. We spoke with 19 patients and relatives. We also received ninety three tell us about your care’ comment cards which patients had completed prior to our inspection. During our inspection, we reviewed 33 sets of patient records.

There were no special reviews or investigations of the hospital ongoing by the CQC at any time during the 12 months before this inspection. The hospital had last been inspected in October 2014 and we found areas needing improvement. We found breaches of four regulations. These were regulations relating to cleanliness and infection control, safety and suitability of premises, supporting staff with training and assessment and ensuring there were enough suitably trained staff when treating children. We reviewed improvements in these areas specifically.

There were 326 consultant surgeons and anaesthetists who worked at the hospital under practising privileges across anaesthetics, orthopaedic surgery, plastic surgery, ophthalmology, gastroenterology, rheumatology and oncology.

The hospital employed seven resident medical officers (RMO), who worked on a ‘one in five’ 24 hour shift pattern Monday to Friday and one in five weekend rota.

There were 124 contracted staff which equated to 106 full time equivalent (FTE) nurses and operating department practitioners and 27 contracted healthcare assistants which equated to 23 FTEs. The accountable officer for controlled drugs (CDs) was the registered manager.

Activity (July 2015 to June 2016)

  • In the reporting period July 2015 to June 2016 there were 10,842 inpatient and day case episodes of care recorded at the hospital; of these 28% were NHS-funded and 72% other funded.

  • There were 8,554 visits to theatre in the reporting period July 2015 to June 2016.

  • 45% of all NHS-funded patients and 58% of all other funded patients stayed overnight at the hospital during the same reporting period.

  • There were 70,740 outpatient total attendances in the reporting period; of these 82% were other funded and 18% were NHS-funded.

    Track record on safety (July 2015 to June 2016)

  • 1 Never event in surgery

  • 1157 clinical incidents – higher rate than in other independent acute hospitals: 1 serious injury (patient fall); 15 deaths of which 9 were unexpected

  • 0 incidence of hospital acquired Methicillin-resistant Staphylococcus aureus (MRSA),

  • 0 incidence of hospital acquired Methicillin-sensitive staphylococcus aureus (MSSA)

  • 1 incidence of hospital acquired Clostridium difficile (c.diff)

  • 1 incidence of hospital acquired E-Coli

  • 10 complaints received by CQC

Services accredited by a national body:

  • Macmillan Quality Environmental Mark

  • Pathology ISO accreditation

  • Sterile Services Department CE accreditation with SGS Yardsley

  • VTE Exemplar Status.

Services provided at the hospital under service level agreement:

  • Critical Care transfer agreement

  • Multidisciplinary Team for oncology

  • Gynaecology CNS

  • Sterile Services

22 & 23 October and 3 November 2014

During a routine inspection

Spire Southampton Hospital, part of Spire Healthcare, offers comprehensive private hospital treatments, procedures, tests and scans to patients from Hampshire, Dorset, Wiltshire, the Isle of Wight, the south coast of England and the Channel Islands.

The hospital offers a range of surgical procedures, cancer care, rapid access to assessment and investigation and a physiotherapy service for women's heath and pain management. Acupuncture, massage and hydrotherapy was also available.  Patients are admitted for elective surgery, day case or outpatient care.  There are no emergency admissions. Patients requiring an emergency admission are usually triaged through the high dependency unit (HDU) before a decision is taken to manage their care in HDU or if they are safe to move to a ward.

Facilities included 78 beds, of these 59 are en-suite patient bedrooms, 12 beds in day care, and seven in the intensive the care unit and high dependency unit.  There are five theatres, outpatient facilities, a cancer care suite (The Chalybeate Suite) and the Perform Centre for physiotherapy and pre-assessment.

Services were available to people who held private insurance  or to those paying for one-off private treatment. Fixed prices, agreed in advance, were available. The hospital also offered services to NHS patients on behalf of the NHS through local contractual agreements and 30% of its activity was NHS funded care  

Spire Southampton Hospital was selected for a comprehensive inspection as part of the first wave of independent  healthcare inspections. The inspection was conducted using the care quality commissions new inspection methodology.

The team of 20 included CQC inspectors and analysts, doctors, nurses, experts by experience and senior  managers. The inspection took place on 22 and 23 October 2014, with unannounced visit on 3 November 2014. 

The inspection team looked at the following core services: Medical care, surgery, critical care, services for children and young people, outpatient and diagnostic imaging services.   

Our key findings were as follows:

Are services safe?

  • There was an open culture and learning environment for reporting incidents.  The staff reported incidents using an electronic reporting system.  Outcomes and learning from incidents was cascaded to staff. The numbers of serious incidents in the hospital compared to patient and bed numbers was low (better than expected).  However, the timeliness of investigations following incidents  needed to improve in some areas, for example, theatres.
  • There were good infection control surveillance procedures to identify and manage infections.  However, procedures for infection prevention and control were not always followed, and the and fabric of the building and the design of some areas increased the risk of cross infection.
  • Patients, other than those receiving critical care, were cared for in single rooms with ensuite facilities.  The critical care unit was adjacent to and open to the operating department theatre. The Critical Care Unit was built prior to the present building guidance. This meant the bed spaces and facilities did not meet current guidance. The space was smaller than expected but this did not have an adverse impact on patient outcomes.  Some daily equipment checks had not been done on the critical care unit.
  • The hospital building was 30 years old and some areas required updating.  The outpatients department was undergoing renovation to increase the number of consulting rooms and improve facilities.  There was not enough storage space and equipment was in corridors.  We observed that this was kept as tidy as possible. 
  • Most medicines were stored and managed in safe way. However, there was limited space in the critical care unit and the storage of intravenous infusion fluids did not reflect best practice.  The expiry date for liquid medicines was not being appropriately recorded, and intravenous fluids not recommended for use in children were stored on the paediatric resuscitation trolley.  
  • The pharmacy department had good governance systems to monitor new drugs, off licence drugs, safety and drug alerts and incidents. There was a medicines reconciliation service on admission and audits on prescribing on the wards.  Local medicines policies were up to date and the medication error rate was low (0.28%, between January to March 2014).  There reporting of near misses was improving but the pharmacy department needed more time to verify medicines. The pharmacy department had limited capacity in terms of staffing levels, and stock control arrangements were limiting the amount of time available to provide a clinical service. 
  • A single patient record was used by all professionals. These were mainly complete but consultant and nursing staff signatures and dated entries required improvement. The documentation for cardiac patients was incomplete and there was not an appropriate care pathway plan for neuro-surgical patients on the critical care unit. Outpatient records belonged to consultants and were not always consolidated with the hospital’s inpatient records.  The hospital was working to improve this. 
  • The early warning score was used to identify and monitor patients whose condition might deteriorate, but there was not an age appropriate paediatric early warning score and this needed to be addressed
  • Staff were aware of their responsibility to safeguard adults and children and the action to take if there was a concern. However, not all staff had completed appropriate training.  This had been identified as an area for action and there was on-going training. 
  • Staff had been working flexibly to ensure that safe staffing levels were maintained while a recruitment campaign was underway.  To manage costs appropriately, staffing was matched to activity.  Many staff worked overtime and as part of a bank to cover vacancies or for example, if theatre lists overran; agency staff were not used.  Recruitment was on-going in the hospital but staff in all areas expressed some concern about the need to quickly improve recruitment processes as working long hours was becoming difficult.
  • Staffing levels in pre-assessment meant that not all patients could be reviewed prior to admission and, staffing levels in the recovery area of the operating department did not always meet national guidelines.
  • The children's service was small and was staffed in line with national guidance for surgical, medical and theatre staff and for nurses on duty for the number of children.  The service was not in line with national guidance, however, when only one registered paediatric nurse was on the day care unit and children were inpatients, and there needed to be a paediatric nurse on call. There were paediatric link nurses on the wards but some nursing staff did not feel they had the appropriate training to care for children.  Staff training for the care of older children was being developed. 
  • Consultants were required to be available within 30 minutes when they had patients in the hospital and this on call procedure was adhered to. Intensivists were on call to support patients in the critical care unit.  There was a resident medical officer (RMO) in the hospital at all times.  In case of an unexpected emergency, the hospital had a resuscitation team consisting of the RMO, a critical care nurse, a senior nurse and an operating department practitioner.  Staff in the operating theatre and a general anaesthetist were also on call.  

Are services effective?

  • Local policies and care pathways to treat patients followed national guidance.  Research and the introduction of and new technologies were introduced formally and through appropriate governance arrangements.  The policies and procedures in the critical care unit were out of date but these were being reviewed to ensure they were in line with current guidance.
  • The hospital did not have an end of life care pathway but appropriate steps were taken for patients, for example, palliative care patients who had requested admission.  There were good procedures for when someone died, particularly in terms of responding to the needs of the family, spiritual needs and undertaking procedures for a coroner’s inquest.
  • Patient's had appropriate pain relief but the critical care unit needed to develop pain assessments tools for all patients to ensure patient's pain relief was adequate. 
  • Patients had appropriate nutrition and hydration. They were offered a choice of meals and alternative meals could be provided if required and special diets were catered for.  For those patients unable to take food orally  there was guidance for patients to receive nutrition though tube feeds or through an infusion. A dietician was available to offer support and guidance
  • The hospital reported mortality rates were lower than national average for cardiac surgery, although audit needed to improve to demonstrate compliance with standards overall and patient outcomes.
  • There was good multi-disciplinary team working to coordinate care for patients. 
  • Services were supported by dedicated staff: For example, the weight loss service was supported by a dietician and a specialist nurse. The cancer service had a specialist breast care nurse and there was a cosmetic surgery nurse to support patients undergoing cosmetic procedures.
  • Staff had annual appraisals which was linked to personal development plans.  The completion of mandatory training did not meet hospital targets in 2013, but the hospital was on track this year (2014).  However, the completion of other specialist training and staff supervision needed to improve. The competency assessments and reviews for staff on the critical care unit had not been maintained and this was identified as an area for action.  The majority (92.3%) of core staff had immediate life support training for adults but more staff overall needed to do basic and immediate life support training for adults and children. 
  • Staff did not have an understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguards.  For example, staff did not recognise that sedation and the use of bed rails in the critical care unit were considered types of restraint. This had been identified as an area for action.

 Are services caring?

  • Staff were caring and compassionate and treated patients with dignity and respect.  Patients were  positive about services and told us they felt well-cared for.
  • Patients told us they were involved in their care plans and were able to make informed decisions and choices
  • The hospital had recorded high Friends and Family Tests scores for both privately funded and NHS funded patients who had responded to the survey. 
  • We received 22 comment cards from patients that were overwhelmingly positive about their experience of care and treatment.  Patients reported excellent, professional and caring staff and good information about their care and treatment.  Only one patient commented about the need for more support when having flat bed rest.
  • The patient led assessment of the care environment (PLACE) conducted in June 2014 was positive. Although no comparative scores were provided, there were no actions identified for the hospital's environment and facilities, cleanliness, food, and privacy, dignity and well-being. 

 Are services responsive?

  • Patient operations and procedures were rarely cancelled.
  • The hospital undertakes 30% NHS funded care. There was no differentiation between NHS or private patients, although theatre staff noted that if cancellations were required this would more likely be for NHS patients.
  • The majority of MRI and CT scans were not being reported within 48 hours.
  • The hospital did not have dedicated facilities for children. When children were treated there was a paediatric nurse and the toys, and appropriate bed linen, were made available in the adult outpatient and inpatient areas”
  • Children with a learning disability would be supported by a play specialist at pre-admission. There was no specialist support for adults with a learning disability, and staff had not received any dementia awareness training. The management team were actively addressing the concern about dementia awareness and an e-learning training package had been launched.
  • Patients were positive about the information they received to help them in making decisions. Written information was available to support verbal information, however this was only available in standard English text.  There were some information leaflets about children's procedures but these had not been specifically written for children to understand.
  • The hospital had received 88 complaints (1 April to 31 August 2014) and 52% were responded to within the hospital's target timescale of 20 days.  Patients were informed and kept up to date if their complaints took longer, and this was in line with the hospital's policy.  The hospital had not identified any themes in their analysis of complaints, but the number was increasing from previous years and showed higher levels involving clinical care from nurses and doctors. Complaints were taken seriously and investigated with the outcomes shared with the person making the complaint. The majority of complaints had been upheld and patients were reimbursed or compensated appropriately. The learning from complaints was cascaded to staff.  

 Are services well led?

  • There were consultants from each speciality who represented their speciality at the hospital’s medical advisory committee (MAC).    There were regular meetings held with the hospital management team and there was liaison with other consultants via email, minutes, and meetings where necessary. 
  • There were heads of departments, and ward and department managers.  There were medical leads for each service speciality represented on the hospital MAC.  
  • Team and department meetings were used to discuss service and governance issues, such as complaints, incidents and audits. However, governance arrangements in the critical care unit and in the paediatric service needed to improve.
  • Staff were positive about the hospital as a place of work. There was a supportive and open culture and staff felt that ward and department managers were approachable as were the hospital management team. The hospital was described and felt like a “friendly” place to work. The culture in the theatre department was said to be improving following previous concerns about management arrangements.
  • Patient surveys and consultant surveys were conducted and these overall described a good or excellent service.  Action was being taken on areas identified for improvement. 
  • Some nursing staff had specific subject matter lead roles for the hospitals, such as infection prevention and control and venous thromboembolism.  Some were working towards gaining national recognition for the service through national “exemplar status”  award schemes.  
  • Staff had been involved in the design and development of services such as the Perform Centre and Chalybeate Suite.

  Was the hospital well led?

  • The hospital's vision and strategy was that of Spire Healthcare group.  Its Compassion in Practice strategy was launched in 2012  and identified key organisational actions, values and behaviours (including the Spire Behaviours)  to support staff to deliver compassionate and high quality care, and improve patients outcomes and well-being. 
  • There were six strategic objectives as part of its clinical strategy: clinical reliability, clinical safety, compliance, patient empowerment, clinical effectiveness and staff empowerment.  These were monitored quarterly through a clinical dashboard and defined targets. Hospitals that did not meet these targets were required to demonstrate what actions were being taken to improve. 
  • Spire Healthcare produced the quality account as a company and the quality targets this year were to improve on the Friends and Family Test results, increase the number of telephone post-operative consultations, and embed the Compassion in Practice strategy.
  • Spire Healthcare inspected the hospital as part of its quality assessment programme. The quality assessment report in February 2014 was positive overall.  There were areas to improve in medicines management, governance of consultant staff and staff training and development. The hospital had demonstrated some, but not complete progress towards these areas of action. The report in (May 2014) commended the hospital's strong incident reporting culture.
  • In Spire Southampton Hospital, the Hospital Director and Matron were well thought of by staff.  Staff reported that they highly visible and took action in response to issues identified and staff concerns.  Staff were aware of the ‘Spire Behaviours’ guidelines.
  • The hospital granted practising privileges to doctors who wished to practice and be employed by the hospital.  The process included pre-employment checks, induction, training and monitoring of appraisal. The information held by the hospital was not up to date, or was missing.  For example on Disclosure and Barring Scheme (DBS) re-checking, Hepatitis B screening, medical indemnity insurance and the approved practice profile of procedures that a consultant could undertake.   Approximately 13% of consultants could not demonstrate up to date medical indemnity cover and some had been out of date for several years.  There was evidence that these were being followed up, and evidence of suspension of practising privileges but action needed to be more timely.  
  • The hospital undertook a review  of consultants annual appraisals and at the same time reviewed the information they held in relation to the consultants practice. This included review of complaints, incidents, adverse incidents and events and patient outcomes.  The hospital asked consultants to provide a copy of their annual NHS appraisal, and had copies from 93% of consultants.  There were arrangements to ensure that information on a consultant's private practice was included in their appraisal. The matron/ head of clinical services read all appraisals and followed up where  information was incomplete or absent.
  • The hospital director and matron met with medical director of the local NHS trust quarterly and the deputy director monthly.  Information was shared, for example on clinical practice and incidents.  This was in line with national guidance for doctors and responsible officers (the medical director) on The Role of the Responsible Officer, Department of Health, 2013. There was a joint post with the local NHS trust of associate medical director for patient safety.
  • There was a clinical committee structure to oversee and monitor the hospital’s services.  This included the monitoring arrangements for consultants under the MAC.  
  • Governance arrangements needed to improve overall.  Some were effective and the hospital was focused on improvement. There was an open culture and learning environment for incident reporting; the hospital used the clinical dashboard and action was taken when targets were not met, for example, temperature checks had improved in theatre and a risk assessment introduced for falls prevention.  Adherence to hospital policies, procedures and care pathways was monitored. The hospital had weekly clinical effectiveness meeting to identify and manage risks.  Known risks had been identified as areas for action.
  • Some  governance arrangements, however, needed to improve. There needed to be better assurance processes and escalation of priorities. Assurance processes, for example, to review practising privileges or to ensure changes following audits were embedded. There were quality governance reports that were comprehensive but were not timely.  The most recent report in October 2014, was for the period 1 January to 31 March 2014, and priorities were not analysed and defined so as to effectively be shared across all committees and staff groups.  Risks that were identified were appropriately managed but the focus of the risk register was on non–clinical risks and clinical risks were not highlighted and formally reviewed in the same way. 
  • The hospital held meetings with patients where there had been moderate or severe harm following procedures. These meetings were documented and patients received information and details of action and/or necessary compensation.   A corporate policy on Duty of Candour was being developed in readiness for the new legislation in April 2015. 
  • There were quarterly staff forum meetings that the hospital and matron held. The attendance target was for 80% of staff to attend.  Most staff were positive about these meetings and felt comfortable discussing issues and raising concerns. Some staff in lower pay grades, such as administration and clerical staff, cleaners and porters felt less engaged and identified that they needed different opportunities to be listened to and raise concerns. 
  • Innovation and ideas from staff were actively encouraged.  We identified examples where staff were involved in service changes and developments and their achievements were recognised through awards.
  • There was also a staff recognition award program. Staff could nominate other staff for awards. This peer recognition process was well received by staff.
  • Patients were surveyed and asked about services, but other than this there was limited evidence of public engagement.   The hospital website included information about its services and staff, and was clear about fees and methods of payment.  
  • Efficiency targets set by Spire Healthcare included reducing the length of stay, over-night conversion rates, non-clinical cancellations, and re-admission rates and minimizing hospital acquired infection and the use of agency staff.  The hospital recognised the need to have good working relationships with NHS commissioning groups and to have links with health and social care services, for example for effective discharge planning, if efficiency targets were to be met.  Agency staff were not used and staff were rostered to work to meet demand and costs were being reduced in administration.  The hospital was clear that clinical quality was the priority. There had not, however, been any quality impact assessments on the overall, approaches to meeting efficiency targets on patient care.

 We saw areas of outstanding practice: 

  • The Chalybeate Suite for patients receiving chemotherapy and palliative care, was designed by nursing staff and patients. The environment was private, calm and relaxing.   The unit had received a Macmillan Quality Environmental Mark which indicates that the unit meets national standards to provide a welcoming private and comfortable environment for people with cancer to support and improve their wellbeing.  
  • The hospital director and matron/head of clinical services met regularly with the Medical Director of the local NHS trust to share information on consultant's clinical practice, performance and services.  The hospital had a joint post with the local NHS trust of associate medical director for governance and patient safety.

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

Importantly, the provider must ensure that:

  • Procedures for infection prevention and control are followed.
  • The environment is in line with recommend guidance to reduce the risk of cross infection.  Particular attention needs to be placed on the fabric of the building, and keeping dirty and clean equipment for cleaning and sterilisation processes separate.
  • Single use gowns are used appropriately.
  • Access and security arrangements are effective and  reduce risks to staff and patients.
  • Medicines are managed appropriately, so that liquid medicines are stored and labelled correctly and there is adequate storage for intravenous infusions, dialysis and irrigation solutions in the critical care unit. Intravenous fluids not recommended for use in children are not stored on the paediatric resuscitation trolley.
  • Cleaning fluids covered by the Control of Substances Hazardous to Health (COSHH) regulations, 2002 are stored securely. 
  • All equipment in the critical care unit is checked daily where this is required.
  • Staffing levels improve in theatre recovery to meet national guidance and improve to ensure appropriate pre-assessment prior to admission.
  • Nurse on call arrangements for children in the day care unit are in accordance with national guidance.
  • An age appropriate paediatric early warning score system, to identify children whose condition might deteriorate, is introduced in line with current national guidance.
  • Staff working in the critical care unit have their competencies reassessed on an annual basis.
  • All staff have appropriate safeguarding training and staff who have regular contact with children should complete safeguarding children training at a level suitable to their role.
  • Staff attend basic and immediate life support training according to hospital targets.
  • Nursing staff have appropriate training to care for medical patients and children.
  • Staff must have an understanding, and follow guidance, to ensure they adhere to the Mental Capacity Act 2005 and deprivation of liberty safeguards.  
  • Imaging reporting times meet service standards of within 48 hours.
  • Appropriate information for consultant's practising privileges are reviewed and kept up to date, and there is evidence that suspension is timely, where required.

In addition the provider should ensure that:

  • Improve the timeliness of investigation following an incident in areas where this remains outstanding.
  • Recruitment continues to alleviate the pressure of long working hours on staff.
  • Information is available in a format other than English and that information is available that is specific for children and young people.  
  • Clinical staff have an understanding of the needs of people living with dementia and those with a learning disability.
  • Care plans are appropriately completed for cardiac patients in critical care and there is appropriate documentation for patients on a neurosurgical pathway.
  • The capacity within pharmacy is reviewed to ensure more time is spent on providing a clinical pharmacy service.
  • A policy on Duty of Candour is implemented with respect to forthcoming legislation.
  • There are better systems to audit and monitor compliance with guidelines and patient outcomes
  • Quality impact assessments are undertaken for actions taken to meet efficiency targets, and the annual operating plan.

Professor Sir Mike Richards

Chief Inspector of Hospitals

21 November 2013

During a routine inspection

We spoke with eight patients in three different outpatient areas of the hospital. We also spoke with staff and two relatives along with the management team responsible for clinical services, human resources and complaints.

Staff were seen to be courteous when patients' approached the outpatients reception desk. One patient said 'the reception staff are very good, they don't keep you waiting long', 'they always acknowledge you when you come to the desk'. Everyone we spoke with gave us positive feedback about the quality of their care overall. Patients were happy with the amount of information they had been given about their surgery or medical condition and said staff kept them informed and respected their choices.

People experienced care, treatment and support that met their needs and protected their rights. Patients health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

Patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had effective recruitment and selection processes, and appropriate checks were undertaken before staff began work.

People felt that all the staff were well trained and that they were able to raise any concerns or complaints with the customer services.

20 December 2012

During a routine inspection

We spoke with three patients on one of the inpatient wards. Everyone we spoke with gave us positive feedback about the quality of their care overall. Patients were happy with the amount of information they had been given about their surgery and said the ward staff kept them informed and respected their choices. People said they received enough pain relief and the nursing staff were very friendly and helpful. Everyone we spoke with was complimentary about their surgeon. People felt that all the staff were well trained and that they were able to raise any concerns with the customer services.

We found patients were treated with dignity and respect. They were able to make decisions and were supported to express their opinions. Before people received any care or treatment they were asked for their consent and their wishes / opinions respected. The care pathway records for surgical patients showed people were involved in discussions with their consultant surgeon and anaesthetist. People experienced care, treatment and support that met their needs and protected their rights with the provider responding appropriately to any allegation of abuse. There were systems in place to ensure the cleanliness of the hospital premises and protect people from infection. The staff received appropriate training to meet the wide range of patient needs. The provider had an effective system to regularly assess and monitor the quality of service that people received.