Spire Elland Hospital is located between Halifax and Huddersfield, was purpose-built by United Medical Enterprises and opened in July 1985. The hospital became part of the BUPA portfolio in 1989 and in 1998 had additional outpatient, physiotherapy and office accommodation built. The hospital was sold to Classic Hospitals Ltd in 2005 and subsequently taken over by Spire Healthcare in 2008. In 2015, Spire Healthcare extended theatre capacity at the hospital by building an additional operating theatre.

There are three theatres, 43 bed spaces (comprising 35 single en-suite rooms, two Extended Recovery Unit beds and six day-case spaces) and 10 consulting rooms. Physiotherapy is provided in three private treatment rooms or within the purpose-built gym. There are facilities for digital plain film x-ray, ultrasound and digital mammography with MRI and CT scanning provided by a Spire Healthcare owned mobile service. An accredited sterile service department is located on site for the decontamination of theatre instrumentation. The hospital works predominantly with consultants from the local NHS hospitals of Calderdale, Huddersfield, Dewsbury and Bradford.

Longlands Consulting Rooms are located nine miles away adjacent to Dewsbury District Hospital with three general consulting rooms and a treatment room providing outpatient services only. This includes physiotherapy clinics provided by the Elland Hospital team.

We rated Spire Elland Hospital including Longlands Consulting Rooms as good overall. We rated the service as good for safe, caring and responsive and well-led, and outstanding for effective.

Are services safe at this hospital/service

We rated safe as good:

There was a strong culture of being open with patients and staff were aware of how to raise incidents and gave examples of learning. We saw evidence of effective root cause analysis, application of Duty of Candour and of learning cascaded from hospital committees to team meetings. There had been no never events at the hospital. The hospital used a modified Safer Nursing Care Tool (SNCT) to monitor staffing levels on a weekly basis at a capacity meeting led by the Matron. Staffing levels, clinical safety issues and patient flow were reviewed at a daily hospital-wide morning meeting that included all department heads. The areas we inspected had a sufficient number of trained nursing staff with the appropriate skill mix to meet patients’ needs. There were two safeguarding leads in place with Level 3 safeguarding training and all staff were required to achieve Level 2 child safeguarding training and Level 2 adult safeguarding training. Shared information at handover was clear, with discussion around individual patient’s needs and risks and the plan for their hospital admission and discharge. Two resident medical officers (RMO) alternately provided medical cover 24 hours per day over a one-week period each and had received appropriate induction training from the hospital. Almost all of the consultant surgeons and physicians were employed by NHS organisations and had practising privileges at Spire Elland Hospital. The arrangements for anaesthetic and surgeon cover out of hours were detailed in the Consultant Handbook and staff we spoke with described the procedure for on-call arrangements for anaesthesia or surgeon consultants out of hours. However, we found that there were issues with the medicines being stored within the right temperature in theatre and the outpatients department and cleaning agent tablets were not held in secure storage at Longlands Consulting Rooms. The tablets were relocated to secure storage at the time of the inspection. Oxygen masks and ambu bags on the resuscitation trollies in outpatients did not have expiry dates; this was a known problem and had been reported by staff

Are services effective at this hospital/service

We rated effective as outstanding:

There was evidence care and treatment was based on current guidance, standards and best practice. Opportunities to participate in benchmarking and accreditation were actively pursued including Joint Advisory Group for GI endoscopy accreditation for endoscopy services. Patient reported outcome measures (PROMs) April 2014 to March 2015, showed NHS funded knee replacement outcome measures were significantly higher than the national average. The hospital was working towards best practice to reduce the risk of dehydration before surgery, by ward and theatre staff using a joint approach to minimise fasting times. There was a holistic approach to planning people’s discharge, which was done at the earliest possible stage. Staff appraisals were on trajectory for completion for all staff by the end of the year and staff were encouraged to develop their skills. Systems to manage and share information that was needed to deliver effective care were fully integrated and provided real-time information across teams and services. There was evidence of effective multidisciplinary working taking place. The rate of unplanned readmissions and unplanned patient transfers to other hospitals was within expected levels when compared to other independent hospitals.

Are services caring at this hospital/service

We rated caring as good.

Feedback from patients during inspection was universally positive about the caring attitude and efficiency of the service. Comment cards received during the inspection all contained positive statements about the standard of care, support and attitude of the staff. Examples of comments included: “I was very impressed by the kindness and helpfulness shown to me.” “They have got me back on my feet after years of pain, this place is fantastic.” “My treatment today was prompt, friendly and very caring.” The hospital collected friends and family test (FFT) survey data for measuring patient experience and satisfaction: 99% of patients said they would recommend the services. Scores for being treated with dignity and respect were 100% and 99% for having privacy when discussing their condition. All staff that we met during inspection were approachable and friendly. Patients we spoke with said that they were listened to and time was taken to ensure that they understood their care, treatment and condition. They also felt able to approach staff if they felt they needed any aspect of support. There was access to specialist nursing advice services through individual consultants, for example, breast care advice services provided by a specialist nurse to support the one-stop breast clinic.

Are services responsive at this hospital/service

We rated responsive as good.

There were effective arrangements in place for planning and booking of surgical activity including waiting list initiatives through contractual agreements with the clinical commissioning group. Patients admitted to Spire Elland Hospital were assessed for admission suitability by their consultant and by using a risk stratification system in line with local and national guidelines. This meant the majority of patients treated at the hospital were considered “low risk.” Adults in vulnerable circumstances, such as patients with learning disabilities and those living with dementia were supported by open visiting arrangements for carers if required. Management had recently introduced dementia awareness champion roles and there was an initiative in progress to make the environment more dementia friendly. Staff held a daily hospital-wide meeting to discuss staffing levels, safety issues as well as patient flow in the hospital. Ward nursing staff and the nurse manager reviewed clinical activity in handovers and throughout the shift to assess capacity and patient safety. The hospital achieved better than the overall referral to treatment indicator of 90% of patients admitted for treatment from a waiting list within 18 weeks for the reporting period. It also achieved better than the indicator of 92% of incomplete admitted patients beginning treatment within 18 weeks of referral in the reporting period. Arrangements were in place with the local NHS trust to receive unplanned transfers for further care. Complaints were responded to in a timely manner and staff were familiar with the process. There was evidence that assurance was obtained of actions arising from complaints being completed.

Are services well led at this hospital/service

We rated well-led at this service as good.

A clear vision, mission and values were on display and accessible to staff. Staff talked about how the values (such as ‘caring is our passion’, ‘doing the right thing’ and ‘driving excellence’) were demonstrated in the way they delivered their service. The hospital had a defined governance structure in place to ensure performance, quality and clinical risk was monitored. Non-clinical risks and health and safety issues were monitored at the Health and Safety, Quality and Risk Committee, which reported to the senior management team and the hospital director. We found that the current risk register template did not record the date a risk was added to the register therefore it would not be possible to know how long the risk had been monitored. However, risk management processes and the risk register template had been reviewed at corporate level, the revised template was new and in the process of being introduced at the time of inspection. Managers were aware of their organisational and service level risks and the actions in place to mitigate the risks. Staff were well engaged across the hospital and reported an open and transparent culture. They felt they were able to raise concerns. There was strong local leadership of the hospital from the hospital director, which was effectively supported by the chair of the Medical Advisory Committee, Matron and the heads of departments.

Our key findings were as follows:

• The hospital had infection prevention and control policies and an infection prevention and control lead supported by departmental representatives. Quarterly infection prevention and control committee meetings were held. There were links to the infection prevention and control team and microbiology at a local NHS trust and we noted discussion of any infection control issues in minutes of meetings. There were low rates of wound infection and no cases of Methicillin-Resistant Staphylococcus Aureus bacteraemia (MRSA), Methicillin-Sensitive Staphylococcus Aureus (MSSA) bacteraemia or Clostridium difficile infections at the hospital between April 2015 and June 2016.
• The hospital used a modified safer staffing nursing dependency and skill mix tool as a guide to assist staff to assess required staffing levels. The matron led a weekly capacity meeting to anticipate staffing needs for the following week and staffing levels were monitored on a daily basis to meet patients’ needs. The areas we inspected had a sufficient number of trained nursing staff with the appropriate skill mix to meet patients’ needs. Use of agency was low. There were formal on-call arrangements for theatre staff to cover out of hours, should an unplanned return to theatre be required. Shared information at handover was clear, with discussion around individual patient’s needs and risks.
• All departments, patient areas and equipment were visibly clean. Antibacterial gel dispensers were available throughout the departments. We observed staff complying with bare below the elbows policy, correct handwashing technique and use of hand gels in most of the areas we visited. Hand hygiene audit standards were monitored across the hospital and these were met. Cleaning audits included room cleanliness in all areas, management of disposable curtains and carpet cleaning. Patient Led Assessments of the Care Environment (PLACE) audits were conducted annually. These assessments apply to hospitals, hospices and day centres that provide NHS funded care. The 2016 assessment rated the hospital as 100% for cleanliness (national average 98%).
• Patients had a nutritional assessment at pre-assessment or on admission to identify and address any nutritional needs. Staff we spoke with were knowledgeable around the need for accurate fluid balance and hydration in post-operative patients and the fluid balance charts we reviewed were completed appropriately. Fasting times were the focus of a detailed audit and action plan for better compliance and patient recovery. Theatre and ward staff were working together to help reduce the fasting times and keep patients hydrated. We saw this in practice and the information was recorded in the patient’s records. A variety of hot and cold food was available. There was good choice for patients including vegetarian, gluten-free, lighter options and multi-cultural food choices.

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

The hospital should:

• Manage hazardous materials in line with current legislation and guidance.

Professor Sir Mike Richards

Chief Inspector of Hospitals