Archived: Spire Hesslewood Clinic

Updated 16 May 2016

In 2014 the parent company Classic Hospitals Limited acquired Spire Hesslewood Clinic, which is located approximately one and a half miles south of Spire Hull and East Riding Hospital and is operated as a satellite to Spire Hull and East Riding, under the same management structure.

After a six month commissioning period, Spire Hesslewood Clinic began caring for patients from February 2015 on a ‘walk in, walk out’ basis. There are two minor procedures theatres and outpatient consulting rooms at the clinic, which offer dermatology, botox, chronic migraine, dietetics, podiatry, orthotics, rheumatology and outpatient ophthalmology services. These services had previously been offered at Spire Hull and East Riding Hospital. Staff are ‘flexed’ across the two sites, which also share the same Medical Advisory Committee, Senior Management Team, a single medical records storage site, policies and procedures. The two sites also have a combined data collection process and clinical dashboard, meaning that data is not available at a site level for Spire Hesslewood Clinic. The two sites are registered separately with CQC.

The clinic primarily serves the communities of the East Riding of Yorkshire and Hull. It also accepts patient referrals outside of this catchment area.

There were no special reviews or investigations of the clinic ongoing by the CQC at any time during 2014/15. The clinic had not been inspected previously. We inspected this hospital as part of our independent hospital inspection programme. The inspection was conducted using the Care Quality Commission’s new comprehensive inspection methodology. It was a routine planned inspection. For this inspection, the team inspected the following three core services at Spire Hesslewood clinic:

• Children and young people

• Outpatient and diagnostic imaging

In August 2015 the longstanding manager of five years was deregistered due to a promotion within the company. At the time of the inspection a new manager was in place and was registered with CQC in September 2015.

Updated 16 May 2016

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.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 16 May 2016

Due to the small size of the service we did not have sufficient, robust information to fully rate the service.

The environment was visibly clean and personal protective equipment was available. However, the service was not carrying out hand hygiene observation audits. Equipment was well maintained and there had been no incidents reported which involved children and young people. There were no separate areas to wait or clinic time for children and young people. However, all patients were seen in private consulting rooms.

Nurse staffing for children and young people was predominantly two part time contracted children’s nurses who worked across both sites, and bank staff. Mandatory training was up to date for employed staff, this enabled staff to carry out their roles effectively and safely, training included awareness of safeguarding procedures and child protection. However, some consultants may have been treating children without having received the appropriate level 3 safeguarding training. Employed staff caring for children and young people had their competencies checked and received professional development, including an annual appraisal.

Procedures were in place for assessing and responding to patient risk, including risk assessment of rooms where child assessments took place. For routine outpatient appointments, there were no separate clinics for children and young people. 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.

We spoke with two parents and one young person following our visit; they all told us the care received was supportive and the staff were kind, caring and friendly.

Senior nursing staff were unable to tell us about the vision and strategy for the children’s service. Spire Hull and East Riding hospital and Hesslewood clinic did not carry out any specific audits relating to the services or patient outcomes for children and young people. Governance, risk management and quality measurement within the service were not well developed and there was no evidence of continuous quality improvement. Feedback from staff about the culture within the service, teamwork, staff support and morale was positive.

Updated 16 May 2016

Incidents were reported and investigated, risk assessments were up to date, and protective measures were in place. Staff were well trained and adhered to policies and procedures. There were enough staff within the department to deliver care safely. The outpatient department offered flexible appointment systems. Clinical staff worked to evidence based guidance and participated in observational research.

Patients were treated with kindness and compassion and staff were courteous and respectful. Patients felt that confidentiality was excellent and spoke very highly of the service provided by the pain clinic. Patients could be seen quickly for urgent appointments, clinics were rarely cancelled and waiting times were well within targets.

Staff and managers had a vision for the future of their services and staff felt empowered to express their opinions or concerns. Patients were given opportunities to provide feedback about their experiences of the services provided.

Updated 16 May 2016

We rated surgical services at Spire Hesslewood clinic as good overall because:

We saw appropriate staffing levels at the Hesslewood clinic. We observed good compliance with the ‘five steps to safer surgery’ procedures and the related World Health organisation audit. The clinic was visibly clean. Patient safety was monitored and incidents were reported via a centralised computer based system,

Patients were cared for in a positive and compassionate way. Internal organisational patient surveys we reviewed showed positive responses around care received, discharge information, and privacy and dignity.

Spire had recognised the growth in demand for services and had begun caring for patients from February 2015 on a ‘walk in, walk out’ basis, after a six month commissioning period. Patients’ individual needs were met.

Staff received mandatory training however, compliance rates in a number of areas were below the expected level of approximately 67% for the end of August 2015 especially in resuscitation training with below 50% attendance on life support courses. Medical personnel records we reviewed had variable levels of compliance with the HR policies. Mandatory training records and certification for medical staff from substantive employers were not always documented as checked and a full set of references were not always available.

There were minimal IPC audits carried out, policy implementation and policy into practice audits did not occur, and observational hand hygiene compliance or technique data audits were not performed. There had been no serious incidents reported since the clinic opened. Personnel records we reviewed had variable levels of compliance with the HR policies. DBS checks were not consistently recorded or reviewed regularly and a full set of references were not always recorded.

There was a vision in place for the development of the clinic.