Overall summary

Spire Thames Valley Hospital is operated by Spire Healthcare Limited. It opened in the 1960s initially as a nursing home, and its’ ownership has changed a number of times over the years.

The hospital treats patients from Buckinghamshire, Berkshire and Middlesex. Spire Thames Valley is a two storey Hospital with 37 beds providing inpatient and day case care and a 2 bed High Dependency Unit.

In 2015 the hospital developed its sterile services department. Current facilities include 8 consulting rooms, 2 minor procedures treatment rooms, audiology room, physio gym and treatment room, 2 laminar flow theatres and 1 endoscopy unit, an in-house theatre sterile services department and 3 wards. Diagnostic imaging facilities include a digital mammography, ultrasound and x-ray. 2 days per week, a mobile MRI service is on site.

Specialities at the hospital include: Bariatric (Obesity) surgery, Oncology, Breast surgery, Oral surgery, Cardiology, Orthopaedic surgery, Colorectal (bowel) surgery, Paediatric surgery (age 3 and above), Age 0-3 OPD Consultation only, Cosmetic surgery, Dermatology, Physiotherapy, Dietetics, Plastic & reconstructive surgery, Ear, Nose & Throat (ENT), Psychology, Endocrinology, Renal medicine, Fertility, Respiratory medicine, Foot & ankle surgery, Gastroenterology, General surgery, Hand & wrist surgery, Urology, Immunology & allergy testing, Vascular surgery, X-ray/MRI/Mammography, Gynaecology, Cardiac Stress Echo’s, Fertility.

The Spire Healthcare Limited provides surgery, including highly-specialist, complex, gender-reassignment surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery and services for children and young people within the surgical section of the overall report.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14 and 15 November 2016, with an unannounced visit on 28 November 2016.

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, governance or medical staffing – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

Services we rate

We rated this hospital as Good overall.

• We found a good incident reporting culture, staff were trained how to report and there was a willingness to learn from mistakes.

• Equipment was maintained and appropriately checked.

• The hospital had systems in place for reporting abuse and safeguarding patients.

• Staffing levels were sufficient to meet patient needs, and skill mix was planned and reviewed to ensure that patients were safe.

• Medicines were stored safely and checks on emergency resuscitation equipment were performed routinely.

• Staff treated patients with dignity and respect and patients were kept involved in their care. Patients and their relatives we spoke with told us they were supported by staff. We observed staff deliver care in a caring, compassionate and supportive way.

• The hospital had a national programme of clinical audits in place.

• There were robust systems to ensure that consultants holding practicing privileges were valid to practice. We saw there were procedures in place to ensure all consultant requests to practice were reviewed by the Medical Advisory Committee (MAC).

• Managers were engaged with staff in realising the hospital’s ambition of working together to provide excellent care in a highly-saturated local health economy.

• There was an open culture and staff were empowered to make changes and improvements.

However, we found areas of practice that require improvement in both surgery and medicine:

• There was a concern regarding a lack of robust cleanliness and infection control practices within theatres and endoscopy.

• Our inspection of the theatre suite found that some parts including ceilings in the operating theatres were not visibly clean and there were cracked tiles in both scrub rooms which did not allow for effective cleaning.

• Our inspection of the endoscope decontamination room found that the washers and floors were marked following leaks from the washers. The decontamination room was cluttered and we were not assured the room could be cleaned effectively.

• Hand washing facilities in the decontamination room were not accessible to staff due to large items of portable equipment being stored within the room.

• Recording of surgical first assistant competency within theatre was inconsistent.

• The use of the WHO Checklist process was carried out safely, but certain aspects such as team and patient interaction were not fully completed with the patient fully involved.

• The outpatient departments had not completed audits on WHO checklist audits, patient medical notes, waiting times and consent.

• Governance of risk within endoscopy was not sufficiently robust. The hospital had identified risks concerning the flow of decontaminated endoscopes but these had not been addressed or mitigated.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals