People told us what it was like to be treated at the hospital. They told us that they were involved in the deciding on the care and treatment they received. One person told us, "The staff listened to what I said." We saw that staff interacted very well with people and they were treated with dignity and respect. We found that people had opportunities to express their views.

We saw that there was a good assessment process in place, including a pre-admission assessment. Detailed records were kept about people's care and treatment needs. People told us they were satisfied with the care and treatment and one person said, "I would come back again to this place, if needed."

We found the environment to be suitably clean and tidy and there were systems in place, such as cleaning schedules and disposal of clinical waste to promote the safety of people who used the services. Infection control audits were completed. Staff were required to attend an annual infection control training and the provider had a lead nurse who was responsible for maintaining the infection control standards. One person commented, "Their hygiene is good."

There were effective recruitment processes and employment checks were made on all members of staff.

People were encouraged to provide feedback and shared their concerns with the provider. We saw that complaints were managed in line with the complaints procedure.

People told us they were happy with their care and felt safe and well looked after. People told us they had asked to go to Spire Roding. One person told us this was the second time they had been to the hospital and would be happy to use the hospital again if necessary. Staff were observed to be courteous and respectful of peoples privacy. Patients needs were identified and risk assessed prior to their admission to ensure care was planned and delivered to ensure their safety and meet their individual requirements.

The facilities were clean and well maintained. People were able to tell us about their discharge plans and that these had been organised with them before admission to hospital.Information about their hospital say and treatment was available. One person told us "I knew what to expect but I didn't really want to know too much detail,I was just pleased to come in to get operation over and done with".

People who use the service told us that they were happy with the care and treatment that they received. All the people we spoke to told us that they had chosen to go to Spire Roding for their treatment. Some had received treatment at the hospital on previous occasions and said they were happy to have further treatment there. Comments included: “This was the third time that I have been here and I made the choice to use this hospital again.” “After the operation they explained what they had done and they went over everything again later when I was fully awake.” “Everyone has been wonderful and I have been well looked after.” “I am happy with the care and do not have any suggestions for improvement.“

People told us that they had been given clear information about the treatment that they would receive and that they had been involved in decisions about their care. One person who was due to be discharged told us that he had a follow-up appointment and medication. He also said that he had been given a 24-hour telephone number to call if he had any concerns. Comments included: “I had good information regarding my treatment and an explanation of the reasons why it was needed.” “I had explanations about what they were going to do and I signed a consent form. I understood what they were going to do.”

Spire Roding Hospital is operated by Spire Healthcare Group plc. The hospital has 27 inpatient beds and 16 day case rooms called ‘pods’. Facilities include four operating theatres, an endoscopy suite, a three-bed level one extended recovery unit, pharmacy and x-ray, outpatient and diagnostic facilities.

The hospital provides surgery and outpatients, physiotherapy, diagnostics and imaging services. It also provides some limited outpatients medical appointments for adults, children and young people. We inspected both surgery and outpatients diagnostics and imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 16-17 November 2016. This was an announced visit.

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.

We rated this hospital as requires improvement overall. Our key findings were as follows:

We rated safe as requires improvement because:

• The surgery service used the WHO Surgical Safety checklist; however despite this, there were a number of serious incidents and a high number of reported incidents in the service.
• Cleanliness within the outpatients and imaging department did not always meet national or local standards.
• We found four private prescriptions in the imaging department which staff were unable to account for. This was investigated by the hospital.

However,

• There were low surgical site infection rates across surgical specialities.
• Staff knew how to report concerns and most staff felt that they received good and timely feedback about reported incidents.
• Staff were able to describe how to follow safeguarding procedures correctly.

We rated effective as good because:

• There were good patient outcomes across surgical specialities. The service performed well in national clinical audits.
• There were short length of stay and low readmission rates.
• Patients had access to effective and timely pain relief.
• Multidisciplinary working (MDT) was encouraged. There was good multidisciplinary team working between doctors, nurses and allied health professionals.
• The surgery service had direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medicine.

However,

• Some consent forms were unsigned so could not clearly show confirmation of consent.

We rated caring as good because:

• Patients spoke highly of the care they received at the hospital, and felt fully involved in decisions made about their care and treatment. Patients told us staff were friendly, helpful, and professional.
• Care was delivered in line with relevant national guidelines.

We rated responsive as requires improvement because:

• There were concerns about waiting times during clinics and late theatre start times because of consultant delays or consultants not attending.
• Complaints and actions arising from complaints were discussed in governance meetings. Staff also had a good understanding of how they would handle a complaint they received. However, there was no risk assessment or action plans for some of the complaints which is deemed good practise.

However:

• Patients had access to effective and timely pain relief.
• The admission guidance, exclusion criteria, and discharge processes were clear and well documented.
• The service had a dementia strategy in place that adhered to the Royal College of Nursing guidelines.

We rated well led as requires improvement because:

• The hospital’s risk management documentation did not provide adequate assurance of actions taken to mitigate or rectify concerns. However, new governance arrangements, such as committees and reporting structures were being embedded into practice.

• There was a vision and strategy in place for the surgery service, but many of the non-management staff we spoke with were not aware of future plans or strategic vision for the service.

• Risk management processes did not provide sufficient assurance that risks and issues were addressed in a timely and appropriate way.

• Some consultant doctors felt there was limited communication and engagement between the hospital leadership and the consultant body.

However,

• The senior management team were visible within the hospital and encouraged an open and transparent culture. Staff told us there was a positive organisational culture and they enjoyed working at the hospital, and felt valued.

• New governance arrangements, such as committees and reporting structures were being embedded into practice.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with [number] requirement notices that affected both surgery and outpatients diagnostics and imaging. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals