Spire Gatwick Park Hospital is operated by Spire Healthcare Limited. Spire Gatwick Park Hospital was initially a joint venture between an airline, local consultants and GPs.

The hospital opened in 1984 and has subsequently been extended several times. Facilities include:

• Two outpatient areas, plus Bupa Health Assessment centre

• Two ward areas with 29 single rooms

• Two bedded emergency recovery unit

• Sixteen bedded day care unit, plus five single rooms

• Three operating theatres, two with laminar flow

• Endoscopy suite

• On site sterile services department

• Inpatient and outpatient physiotherapy

• Radiology department, which includes 3T MRI, 64-slice CT & digital mammography

• On site pathology laboratory

• On site pharmacy

The hospital provides surgery, services for children and young people and outpatients and diagnostic imaging.

We visited this hospital in June 2015 as part of our national programme to inspect and rate all independent healthcare providers.

We rated the hospital as ‘requires improvement’ overall and found improvements were required to minimise risks and promote safety. We rated surgery and services for children and young people as requires improvement and although we rated outpatients as good, we found improvements were required in the retention of outpatient records.

At the previous inspection, we told the hospital it must:

• Ensure that medicines were stored at temperatures that maintain them in optimum condition.

• Review its arrangements for the retention of outpatient records at the hospital to ensure that a complete record for each patient attending the hospital as outpatients was maintained.

These were regulatory breaches.

We told the hospital it should:

• Ensure all staff had access to the electronic incident reporting system and know how to use it.

• Ensure all staff were up to date with mandatory training, including basic life support.

• Carry out an appropriate risk assessment for the cleaning of carpets, and ensure that replacement plans comply with Department of Health HTM Health Building Note 00-09: 'Infection control in the built environment'.

• Review the arrangements for maintaining records in an easily usable condition.

• Ensure consultants holding electronic patient records were registered with the Information Commissioner’s Office.

• Review its arrangements for pre-operative starving of patients to meet current guidance.

• Review the arrangements for the provision of 'as needed' pain relief for day case patients.

• Ensure that all elements of the World Health Organisation Surgical Safety Checklist were consistently completed and that compliance was audited.

• Consider how it could differentiate the feedback from children and young people from that of other patients.

• Consider how it measured and monitored the outcomes of treatment for children and young people

• Identify the skills staff require to effectively care for children and young people.

• Review its policies, procedures and literature to ensure that the definition of children was consistent.

This report is solely focused on the above regulation breaches and ‘should do’ actions from the 2015 inspection, in order to assess whether the hospital was meeting required standards as detailed in their action plan.

We carried out the announced part of the inspection on 8 August 2017 and found the provider was meeting all standards set out in their requirement notice and were compliant with all ‘must do’ regulatory actions and the majority of ‘should do’ actions. We found a number of clinical areas had been refurbished since our previous inspection and the new areas had had carpets replaced in line with latest best practice. However, carpets were still present in areas where the was a risk of blood or body fluid spillage, which was not in line with best practice. There was an ongoing refurbishment plan in place to replace all remaining carpets by summer 2018. Remaining carpets had been risk assessed and there was evidence of robust cleaning in place.

As this was a focused inspection, we did not re-rate the provider.

We will continue to monitor the performance of this service and inspect it again, as part of our ongoing programme.

Alan Thorne

Head of Hospital Inspections

Patients spoke positively about the care and treatment they received. One patient said "The staff are excellent. The Consultant has been brilliant". Another patient said "The staff have kept me informed throughout my whole stay. The staff act in a professional manner and there always seem to be enough staff working".

We found that patients' care needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan.

There were sufficient numbers of suitably qualified, skilled and experienced staff to meet patients' needs.

We found that patients were surveyed about the care they received. This meant the Provider was seeking the views of people to help improve the quality of the service they provided.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

We met and talked with six people staying at the hospital. They were all positive about the care they were receiving and half told us they had stayed at the hospital before. One person told us "I can't fault the nurses.They are very professional but also friendly and will stop to chat." Another person told us "I have been looked after very well." This was supported by our own observations that the staff were polite, professional and respectful in their dealings with people. The care records we looked at were well completed and indicated a careful attention to the safety and welfare of patients.

The provider had effective staff recruitment and vetting procedures in place. There was an open culture and the staff we spoke to enjoyed working for the provider.

We found that overall the premises provided good standards of general cleanliness and comfort and were being appropriately maintained.

The provider had an effective complaints system which was overseen by senior managers and which sought to resolve complaints speedily.

People were very pleased with the care and treatment they received. Waiting times were short. Staggered arrival times meant that time spent in the hospital waiting to be seen was also short. Patients understood the procedures that were being carried out on them. They said the staff were caring and attentive, the food was good and the hospital was clean.

Gatwick Park Hospital is run by Spire Healthcare Limited which is a part of Spire Healthcare Group Plc. An acute hospital with 55 beds, Spire Gatwick Park Hospital provides private hospital services to self-funding and insured patients and NHS patients referred under the Standard NHS Acute Contract, predominantly from the Surrey and Sussex area.

The organisation offers a range of services and facilities including: two bed HDU (Level 1 enhanced care); a dedicated endoscopy unit; a dedicated day care unit; an in-house ISO accredited sterile services department; a 64-slice CT and 3T MRI scanner; and onsite pharmacy and pathology. The hospital has three operating theatres that are in use six days a week; with usual daily allocations of two to three sessions between 08:00 and 21:00.The Care Quality Commission (CQC) carried out a comprehensive inspection on 09 and 10 June 2015 and undertook an unannounced inspection on 15 June 2015.

We inspected this hospital as part of our independent hospital inspection programme, using the Care Quality Commission’s new inspection methodology.Spire Gatwick Park Hospital provides adult elective surgery, outpatients and diagnostic imaging, services to children and young people and endoscopy.For the purpose of the comprehensive inspection, we undertook an on-site review of surgery, children and young person’s services and outpatient services and have included our findings of the small volume of medical care, and end of life care from within these core services. The hospital does not provide maternity or termination of pregnancy services.

Overall, we judged the hospital to require improvement. This is because we identified concerns in relation to safety, and issues affecting the effectiveness of care.

Our key findings were as follows:Overall Service Leadership

• Staff told us they were supported by visible, accessible and approachable managers.

• There were systems of governance to ensure any issues affecting safety and quality of care were identified and managed.

• The hospital did not maintain complete and comprehensive records as required by the relevant regulations due to consultants taking their own outpatient clinic notes away with them.

Cleanliness and infection control

• The hospital was meeting government guidance in relation to infection control, and care was delivered in a clean environment.

• Floor coverings in some areas did not meet government guidance and presented a potential risk of infection.

Staffing Levels

• There were adequate numbers of appropriately skilled and experienced staff to meet patients' needs.

• Children and young people were cared for by registered sick children's nurses and consultants treating children had their competency verified.

Outcomes for patients

• Hospital policies, care and treatment were in line with guidance from the National Institute for Health and Care Excellence (NICE), the Department of Health and learned societies.

• There was insufficient data collected to allow adequate monitoring of the treatment outcomes of children and young people and for patients having cosmetic surgery.

Nutrition and hydration

• Patients had access to appropriate food and drink in sufficient quantities.

• However, patients were starved for longer than recommended before surgery.

Actions we have told the provider they must take:

• Review its arrangements for the retention of outpatient records at the hospital.

Actions we have told the provider they should take:

• Ensure all staff have access to the electronic incident reporting system and know how to use it.

• Sustain new systems introduced after our initial visit that ensure medicines are stored at temperatures that maintain them in optimum condition.

• Ensure all staff are up to date with mandatory training, including Basic Life Support.

• Carry out an appropriate risk assessment for the cleaning of carpets, and ensure that replacement plans comply with Department of Health HTM Health Building Note 00-09: 'Infection control in the built environment'.

• Review the arrangements for maintaining records in an easily usable condition.

• Review its arrangements for pre-operative starving of patients.

• Review the arrangements for the provision of 'as needed' pain relief for patients.

• Ensure that all elements of the World Health Organisation Surgical Safety Checklist are consistently completed and that compliance is audited.

• Consider how it can differentiate between the feedback from children and young people from that of other patients.

• Consider how it measures and monitors the outcomes of treatment for children and young people.

• Identify what mandatory skills staff require in order to effectively care for children and young people.

• Review its policies, procedures and literature to ensure that the definition of children is consistent.

• Ensure consultants holding electronic patient records are registered with the Information Commissioner’s Office.

Professor Sir Mike Richards

Chief Inspector of Hospitals