We spoke with seven people using the service on the day of our inspection visit. Everyone was satisfied with the service. People were treated with respect and they were involved in decisions about their care. Risks and benefits of treatment were explained to people “in no uncertain terms.” People were confident they would be able to comment or complain about the service. One person had complained and told us, “They don’t make it difficult to complain. They approached me for information.”

People’s needs were assessed and the service was delivered to meet those needs. People’s safety and welfare was protected because there were effective systems for assessing and managing risks. People felt safe using the service because the provider had effective systems for protecting people from the risk of abuse.

The people we spoke with told us staff were excellent. They said this was true, “Especially on reception.” and one person said, “The night I went into HDU (high dependency unit) – they’re just exceptional.” One person said, “Everybody seems to be a friendly happy team. From ward sister down to whoever’s bringing you your juice or your food.” We saw that staff received training and professional development. They were supported to do their jobs.

Records were generally stored securely and staff were able to locate records promptly when they needed them.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Patients told us they were satisfied with the care, treatment and support they received.

Spire Leicester Hospital is run by Spire Healthcare Limited. The hospital is located in Oadby which is a residential area south of Leicester.

Healthcare is provided by the hospital to patients with private medical insurance, those who self-pay and through NHS contracts.

The service is registered to provide inpatient care to 54 patients at any time. Hospital facilities include a 30-bed inpatient ward, 14 bed day ward, five chemotherapy pods and five chemotherapy beds. Theatre provision includes: three theatres with laminar flow, a cardiac catheter laboratory and a minor procedures suite. From April 2014 to March 2015 there were 6,518 visits to theatre.

This was the first comprehensive inspection of Spire Leicester Hospital. We carried out an announced inspection of Spire Leicester Hospital between the 11 and 12 August 2015. Following this inspection an unannounced inspection took place on the 17 August 2015 between 12 and 3pm. The purpose of the unannounced inspection was to look at how the hospital operated at peak times and to follow-up on some additional information from the announced inspection.

The inspection team inspected the following core services:

• Surgery
• Medicine
• Outpatients and Diagnostic Imaging
• Children and Young People
• Termination of Pregnancy.

The hospital provided a health screening service which was not inspected as part of our inspection.

We rated Spire Leicester Hospital as ‘Good’ overall but the outpatients and diagnostic imaging service required improvement.

Our key findings were as follows:

Are services safe at this hospital

• There were information gaps in some children's and young people’s records. We reviewed 16 sets of records; four records did not have completed fluid charts and five records had no risk assessment.
• We found gaps in some of the patient records we reviewed. We were told that some consultants used their own notes rather than Spire medical records in which to record the patient’s outpatient consultation and not all those notes were retained within the Spire medical record.
• Medical notes were not always easy to read although the provider informed us notes were sometimes typed and staff could contact medical staff for an explanation if necessary.
• The Spire Leicester Hospital weekly compliance report dated the 7 and 11 August 2015 showed shortfalls in the receipt of medical staff information on medical indemnity, disclosure and barring checks and General Medical Council registration expiry dates. The provider acknowledged that further work was required to ensure all consultants provided evidence of all the required documentation. A senior manager informed us of the actions in place to achieve compliance and mitigate risk. By 20 August 2015, 312 consultants had provided all the required documentation. The suspension of practising privileges for 34 consultants took place until all documentation was submitted to the hospital. Since 20 August 2015, the provider confirmed that compliance has remained at 100% at all times in relation to the collection of this information and that all medical staff were fully insured during the CQC inspection, despite shortfalls having been observed in the collection of this data.
• Patients were protected from abuse and avoidable harm. Patients felt safe and staff had the skills, knowledge and tools to identify risks and knew how to escalate these if needed. Processes were in place to mitigate risks.
• Incidents were investigated, actions taken and learning disseminated throughout the hospital.
• All patient areas were visibly clean, infection prevention and control processes were in place and equipment had been checked regularly. Medicines were stored and administered safely.
• Staffing was managed effectively to ensure patients received good care with access to medical care obtained in a timely manner. Staff were well trained and records were kept securely.

Are services effective at this hospital

• The Spire Leicester Hospital weekly compliance report dated the 7 and 11 August 2015 showed shortfalls in the receipt of medical staff information on whole practice appraisals and biennial review dates.
• The provider acknowledged that further work was required to ensure all consultants provided evidence of all the required documentation. We spoke with a senior manager who informed us of the actions in place to achieve compliance and mitigate risk. By 20 August 2015, 312 consultants had provided all the required documentation. The suspension of practising privileges for 34 consultants took place until all documentation was submitted to the hospital. Since 20 August 2015, the provider confirmed that compliance has remained at 100% at all times in relation to the collection of this information and that all medical staff were fully insured during the CQC inspection, despite shortfalls having been observed in the collection of this data.
• No audits or monitoring of children’s and young people’s outcomes had taken place since this service had been set up in 2013. There was no audit system for ensuring that medical notes were fully completed within the children’s and young people’s service.
• Patient’s pain was well managed.
• Staff helped patients if they needed support to eat and drink and they had access to drinks.
• Evidence based care and treatment was delivered to adult patients, which followed national guidance.

Are services caring at this hospital

• Patients we spoke with confirmed that staff were kind, considerate and treated them with dignity and respect.
• We observed staff being attentive and caring to patients during the inspection.
• Patient experience was reported on through local patient surveys and the NHS Friends and Family Test (FFT). The FFT score for June 2015 was 99%.

Are services responsive at this hospital

• Delays, cancellations and attendance rates had not always been monitored in an effective way. Data was collected but not audited or actioned further to prevent or reduce these events in future.
• Waiting times in the outpatient department were not always monitored effectively.
• Signage in all areas was small and only in English which could have proved a challenge for those with poor sight or whose first language was not English.
• Planned admissions and multidisciplinary meetings took place to ensure effective admission, treatment and discharge planning. Processes were in place for transfers to other hospital if a patient required a higher level of care.
• The hospital had a complaints policy and procedure in place and patients were given information about how to raise any concerns or make a complaint.

Are services well led at this hospital

• The leadership, governance and culture at the hospital promoted the delivery of high quality person-centred care. Members of the management team were well respected amongst both staff and patients.
• Staff felt valued and were positive about their roles.
• There was a shared vision throughout the hospital and safe patient care was paramount.
• Patient feedback was a valued tool and the hospital strived to improve following any negative comments from patients or relatives.

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

Importantly, the provider must:

• Ensure that an accurate, complete and contemporaneous record is securely maintained in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided. There was no audit system for ensuring that medical notes were fully completed within the children’s and young people’s service.
• Ensure arrangements are put in place to monitor outpatient appointment cancellations and delays.

In addition the provider should:

• Ensure paediatric and adult drug boxes for resuscitation are not of a similar colour to aid quick identification in an emergency.
• Ensure appropriate interpreting services following best practice are always available for those whose first language is not English.

• Ensure auditing samples for compliance with the five steps to safer surgery checklists are more representative of the number of patients undergoing surgical procedures.
• Ensure that there is an effective system in place for contacting a radiologist urgently.
• Ensure that the minor operations room has a plan in place for ensuring patient safety and that treatment can be provided rapidly without delay.

• Ensure that the privacy and dignity of patients using the imaging department is maintained.

• Ensure that all staff working with oncology patients in the chemotherapy unit are aware of the gold standards framework.
• Ensure practice is reviewed around the use of the malnutrition universal screening tool.
• Ensure a protocol for children with learning difficulties is developed.
• Ensure that staffing and workforce development plans are developed in parallel with the paediatric strategy.
• Ensure the areas where children are cared for are appropriate for the needs of the child.

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Professor Sir Mike Richards

Chief Inspector of Hospitals