Spire Parkway Hospital is operated by Spire Healthcare. The hospital has 59 beds. Facilities include five operating theatres, a recovery unit, two in-patient wards, a day care unit, a specialist cancer centre, endoscopy and ambulatory care unit. The hospital provides surgery, oncology services, services for children and young people, and outpatients and diagnostic imaging.

We carried out an inspection of the hospital on 26 November 2018. We announced the inspection because we needed to make sure staff and patients would be available to speak with us when we visited. We inspected the surgical service using our focused inspection methodology. The inspection was prompted by concerns we received about surgery staff being bullied and an unsafe theatre environment. We did not find any evidence to support these concerns. We did not inspect any other core services. Although surgery was provided to children and young people under sixteen years old we did not look at this aspect of the service.

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.

Services we rate

Our rating of this core service improved. We rated it as Good overall. Although we re-rated the surgery core service, our overall aggregated for the service has not changed.

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• Staff understood how to protect patients from abuse.

• The service controlled infection risk well.

• The service had suitable premises and equipment and looked after them well.

• Staff completed and updated risk assessments for each patient.

• The service had enough staff including nursing and medical with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment.

• The service followed best practice when prescribing, giving, recording and storing medicines.

• The service managed patient safety incidents well.

• The service used safety monitoring results well.

• The service provided care and treatment based on national guidance and evidence of its effectiveness.

• Staff gave patients enough food and drink to meet their needs and improve their health.

• Staff assessed and monitored patients regularly to see if they were in pain.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them.

• The service made sure staff were competent for their roles.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

• The service offered seven-day services to ensure surgery patients would receive consistent care and outcomes.

• People were provided with information which enabled them to make informed decisions about their life style choices and how they could improve the quality of their lives and outcomes.

• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the service policy and procedures when a patient could not give consent.

• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

• Staff cared for patients with compassion.

• Staff provided emotional support to patients to minimise their distress.

• Staff involved patients and those close to them in decisions about their care and treatment.

• The service planned and provided services in a way that met the needs of local people.

• The service took account of patients’ individual needs.

• People could access the service when they needed it.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.

• The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff, patients, and local community groups.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.

• The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

• The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

We found areas of outstanding practice in surgery:

• Staff identified innovate ways to providing integrated person-centred pathways of care for people with learning disabilities and those living with dementia to manage their anxieties at all stages of their treatment. This included providing care in environments where people felt safe, identifying how to make their admission to the hospital as reassuring as possible and providing continuous care and support from staff and people they were familiar with and trusted.

However, the service should:

Seek to improve the response rate to the family and friends test (a measure of patient satisfaction).

Professor Sir Mike Richards

Chief Inspector of Hospitals

Spire Parkway Hospital, part of Spire Healthcare, offers private hospital treatments, procedures, tests and scans to patients from Solihull and surrounding areas. The hospital offers a range of surgical procedures, cancer care, rapid access to assessment and investigation and a physiotherapy service. Paediatric services are offered to children aged three and over.

Patients are admitted for elective surgery, day case or outpatient care. There are no urgent admissions.

Facilities included 42 beds each with ensuite facilities, including two double rooms, 8 beds in day care, and four in the high dependency unit. There are four theatres, outpatient facilities, and plans are underway for a refurbishment of the cancer care suite. Cancer care was being delivered in temporary accommodation. The hospital also offered services to NHS patients on behalf of the NHS through local contractual agreements and 24% of its activity was NHS funded care.

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 is 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 are:

• Safe

• Effective

• Caring

• Responsive

• Well-led.

Our key findings were as follows:

Spire Parkway Hospital was selected for a comprehensive inspection as part of a first wave of independent healthcare inspections. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

The inspection team included CQC inspectors, doctors, nurses, expert by experience and senior managers with experience of working in the Independent Healthcare sector. The inspection took place on 21 July 2015, with an unannounced visit on 1 August 2015. The inspection team looked at the following core services: surgery, high dependency unit (HDU) services for children and young people, outpatient and diagnostic imaging services.

We saw an area of outstanding practice:

• Installation of a new MRI scanner which has a wider bore, more comfortable for patients, with the added capability of treating uterine fibroids with MR guided Focused Ultrasound Surgery (MRgFUS), only two of its kind nationally.

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

Importantly, the provider must:

• Ensure the hospital maintains complete sets of patient records on site and ensures patient confidentiality is maintained at all times.

• Ensure robust governance arrangements are in place to ensure consultants adhere to the hospital’s directives when risks had been identified and action required to monitor and mitigate risks.

• In addition the provider should:

• Ensure all medications and managed as per Spire Medications Policy.

• Improve incident reporting across all areas of the hospital including pharmacy.

• Improve mandatory training attendance for all staff including MCA and DoLS.

• Ensure clinical audits include findings, actions and demonstrate patient outcomes so care improvements can be measured clearly.

• Ensure the Lone Working Policy applies to all staff working at the hospital and includes staff working out of hours.