Spire Little Aston Hospital, part of Spire Healthcare, offers comprehensive private hospital treatments, procedures, tests and scans to patients from Sutton Coldfield and surrounding areas. The hospital offers a range of surgical procedures, cancer care, rapid access to assessment and investigation and a physiotherapy service. The hospital did not provide children’s in patient or day case surgery

Patients are admitted for elective surgery, attend as a day case or for outpatient care. There are no emergency admissions.

Services are available to people who held private insurance or to those paying for one-off private treatment. Fixed prices, agreed in advance, are available. The hospital also offers services to NHS patients on behalf of the NHS through local contractual agreements and 39% of its activity was NHS funded care.

 Facilities include an Inpatient ward with 24 private rooms with ensuite facilities, a   Day Care Ward with 8 private rooms with ensuite facilities, a two bedded High Dependency Unit, a Chemotherapy Suite consisting of a 4 chair day care room and two private rooms with ensuite facilities and a Endoscopy Suite consisting of a 4 bay recovery area. There are 3 theatres all with laminar flow, 2 minor procedure theatres and an Endoscopy procedure.

Prior to the CQC on-site inspection, the CQC considered a range of quality indicators captured through our monitoring processes. In addition, we sought the views of a range partners and stakeholders. A key element of this comprised the focus groups with healthcare professionals and feedback from the public.

The inspection team make an evidence based judgment on five domains to ascertain if services were:

• Safe

• Effective

• Caring

• Responsive

• Well-led.

Our key findings were as follows:

Spire Little Aston Hospital was selected for a comprehensive inspection as part of the independent healthcare inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

The inspection team included CQC inspectors, doctors, nurses, experts by experience and senior managers with experience of working in the Independent Healthcare sector. The inspection took place on 22 July 2015, with an unannounced visit on 5 August 2015.

The inspection team looked at the following core services: Surgery, High Dependency unit, outpatient and diagnostic imaging services.

We visited Spire Little Aston Hospital to look at the progress since the last inspection when non-compliance was identified in five outcomes. The inspection was unannounced which meant that the manager and staff did not know we were visiting.

We met and spoke with the hospital director and matron, the acting theatre manager, the deputy theatre manager, seven staff and one anaesthetist.

We looked at records relating to the previous non-compliance, which were overall much improved. We observed the preparation for a theatre list and sat in on the theatre list team brief.

We saw that not all medical staff complied with the ‘no jewellery’ policy. However, we saw that theatre staff appropriately challenged medical staff to follow the protocol for pre list team briefing. Staff told us that they felt supported to do this by the acting theatre manager.

We saw that theatre etiquette and practice had improved; although we are concerned about the continuity of staff support with further planned changes to the theatre structure. The improvements made so far will continue to be monitored by CQC to ensure that they are sustained.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We visited Spire Little Aston on Tuesday, 12 March 2013. We did not tell them that we were going to visit. We met with the matron, acting theatre manager, theatre co-ordinator, risk and clinical governance manager and seven staff who worked in the theatre department. We conducted this visit as concerns had been raised with us regarding the theatre department.

We observed some theatre practices that did not maintain people's privacy and dignity. Other practises compromised the safety of people, due to risk of spread of infection or not completing relevant checks. We discussed these issues with the acting theatre manager and the matron.

We looked at records to see if staff were supported in their role. We could not find sufficient evidence to demonstrate that this was the case. Staff reported that they worked excessive hours, received no appraisal and were reluctant to raise concerns as they feared repercussions. We could not find any evidence to demonstrate that some staff had been assessed as competent to perform their role. Staff told us that they did not feel competent to complete all tasks required of them.

We were told that there was no information regarding agency staff working in the department.

We visited Spire Little Aston as anonymous concerns had been raised. We met with the newly appointed theatre manager, theatre co-ordinator, matron and other staff who worked at the hospital. We saw that some of the anonymous issues raised had already been identified and acted upon by the service. Other issues were in the process of being addressed and some were unfounded. We spoke with people who had recently undergone a surgical procedure to find out their views of the service provided at Spire and they told us, "The staff are brilliant"; "The care is good". We visited the theatre department and spoke with staff and observed some of the theatre safety checks.

We saw paperwork which demonstrated that all treatment options were discussed. People were given sufficient information to enable them to make a decision about their care. We saw that written consent was obtained before any treatment was completed.

A pharmacist inspector visited to look at the safe management of medicines including controlled drugs (CDs). We spoke with a pharmacist and a pharmacy technician about the support given to clinical wards and theatre departments. We found that CDs were handled and managed safely within theatres. However some theatre Operating Department Practice staff had not received training in order to manage all aspects of CDs. We were told that this training was planned to take place shortly.