Spire Hesslewood Clinic is operated by Spire Healthcare Limited. The clinic primarily serves the communities of the East Riding of Yorkshire and Hull. It also accepts patient referrals outside of this catchment area.

Spire Healthcare Limited acquired Spire Hesslewood Clinic in 2014. 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 theatres, where minor procedures were performed under local anaesthesia and outpatient consulting rooms at the clinic, which offered dermatology, Botox, chronic migraine, dietetics, podiatry, orthotics, rheumatology and outpatient ophthalmology services. The clinic operates as a satellite to the main site, Spire Hull and East Riding Hospital. The hospital is located approximately one and a half miles north of the clinic. The clinic is under the same management structure. 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 was not available at a site-specific level for Spire Hesslewood Clinic.

Services were provided to children and adults of all ages (0 to 75+) and were offered to NHS, insured and privately funded patients. The service had six consulting rooms at the Hesslewood clinic.

We inspected this service using our comprehensive inspection methodology. The inspection was unannounced (staff did not know we were coming) and took place from 18 to 20 September 2018.

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 service stayed the same. We rated it as good overall.

• Staffing was managed safely across all services. We found there were enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs. The clinic was visibly clean and well maintained. Incidents were reported and the quality of root cause analysis (RCA) investigations was more robust. Mandatory training compliance was at or above trajectory including safeguarding of vulnerable adults and children.
• Patients, including children and young people were cared for effectively using evidence based best practice guidance. Policies were mostly developed nationally. Staff across the services had received an up to date appraisal and had the right knowledge and skills to care for patients. Consent to care and treatment was obtained appropriately. There were clinical performance indicators which were monitored and compared across the company through a clinical scorecard. We saw effective multidisciplinary working between staff of all grades. All staff caring for children and young people were required to have completed paediatric competencies and have up to date training in safeguarding level three and life support, appropriate to their role.
• Patients were cared for in a kind, caring and compassionate way. Patients and relatives, we spoke gave consistent feedback without exception. We observed positive interaction of staff with patients. We found that the services received positive feedback for the Friends and Family Test. Staff told us they took practical steps to maintain privacy and dignity and to minimise anxiety of children and young people. Staff we spoke with demonstrated a sensitive and supportive attitude to children and young people, parents and carers. Private consulting rooms were available
• The services were planned and managed to meet demand. In the twelve months from August 2017 to July 2018

  referral to treatment (RTT) data for July 2017 to August 2018 showed that 100% of patients commenced treatment within 18 weeks. This meant the clinic had consistently exceeded the standard of 90%. There was personalised, patient-centred care provided for patients living with a learning disability and dementia. There were dementia link nurses in place. Complaints were managed and overseen by the hospital director and clinical complaints specifically overseen by matron. The reduction of avoidable cancellations was a priority and processes and systems within the pre-operative assessment team were under review. Registered children’s nurses worked at both Hesslewood clinic and the main Spire Hull and East Riding hospital site as required to support children and young people attending outpatient appointments and procedures at Hesslewood, as required. Staff told us appointments and admissions were planned flexibly to meet children and young people’s needs. The service had received no complaints from families of children and young people relating to Hesslewood clinic.

• The clinic had a clear management structure in place with clear lines of responsibility and accountability. The manager had the right skills and abilities to run a service providing high-quality sustainable care. Staff of all grades told us leaders and the senior management team were extremely supportive, visible and approachable. Staff of all grades spoke positively about the culture and told us they were passionate about their roles and the organisation. Professional relationships between all staff promoted the clinic values and staff said they felt valued and worked well together. There was a robust clinical strategy action plan in place. Although, there is no requirement for independent healthcare providers to have a freedom to speak up guardian (F2SUG), a member of staff had been appointed to this role. We found that governance processes had improved and were more robust. Minutes of the MAC meeting were detailed and included comprehensive governance information. Consultants were utilised under practising privileges and these, with appraisals were reviewed every year by the senior management team. The governance of the children’s and young people’s service was now clearly defined and linked to the governance processes for the whole service. A children and young peoples (CYP) clinical score card system had been introduced to support structured monitoring of quality, performance and patient outcomes. There was a positive culture across all staff involved in the delivery of children and young people’s services. All staff spoke highly of the support they received from the children and young person’s lead nurse. The CYP service had identified its risks and had taken action to mitigate them. The service lead had developed links with the local safeguarding networks and visited the regional transfer team.

However, we also found the following issues that need to improve:

• There was no separate waiting area for children, toys and activities provided were located on the main route into the clinic. Action plans following audits were often documented as single actions without detailing any subsequent actions or cooperation by other departments or disciplines. Whilst policies and guidelines were evidence based we found out of date paper versions of policies and protocols held in a reference file in the clinic area. There were up to date versions on the staff computer server. The friends and family test (FFT) feedback was positive however response rates were low. There were high numbers patients affected by cancelled and rearranged clinics. We did not see a comments book or other ways for children and families to give feedback on the service at the Hesslewood clinic. It was unclear whether the CYP service was sufficiently represented at senior level to influence and support strategic developments involving children and young people. The planned children and young people’s service staff steering group was still in development.

Following this inspection, we told the clinic it should make some improvements, even though a regulation had not been breached, to help the service improve.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)