We looked at the results of the patient feedback collected by the hospital in October 2013 to which 183 had responded. 94.3% of respondents said that their proposed course of treatment was always clearly explained to them by consultants and 97.3% of people said their questions were completely answered by nurses when they asked them. We spoke with over 13 people using the service. They told us that "I cannot praise the nursing staff here highly enough. They are sensitive and helpful without being intrusive". Another said that staff were "lovely" and another described them as "very helpful and kindly".

People underwent appropriate assessments on admission to ensure that their needs could be met and any risks mitigated whilst in hospital. Staff had been trained in what to do in a medical emergency. There was appropriate medical emergency drugs and equipment available. 97.5% of respondents to the patient satisfaction survey rated their overall care as "excellent" or "very good" and 99.4% of respondents said they were likely or extremely likely to recommend the hospital to others.

On the day of the inspection all areas of the hospital that we visited appeared clean and well maintained. In the patient satisfaction survey all respondents rated the cleanliness of the hospital positively with the majority of people rating it as "excellent".

There were enough qualified, skilled and experienced staff to meet people’s needs. Accurate medical records were kept securely.

Before undergoing treatment or procedures people using the service received explanations of what was involved and the risks and benefits. They were asked to sign their consent to treatment and care and the service undertook monthly audits to check this.

Appropriate risk assessments and medical checks were undertaken for people using the service before, during and after treatment and procedures. People using the service described it as "first class" and "absolutely outstanding". All staff had been trained in how to manage medical emergencies and there was medical equipment and drugs available for such situations.

On the day of the inspection the hospital appeared clean and tidy. People using the service described it as "spotless" and "very clean". There were appropriate facilities and procedures for the decontamination of instruments and the cleaning of clinical areas. Regular checks were made to ensure that infection control procedures were being followed.

Prospective staff underwent a suitable recruitment procedure before they started work. Appropriate checks were also made, including with the Criminal Records Bureau and on staff professional registration.

People using the service told us that they would be comfortable raising any concerns that they had. There was a complaints policy and procedure in place at the hospital. Details were provided of recent complaints that had been received and how they had been responded to.

People who use the service told us they were able to make decisions about their treatment and how they were looked after. They said the care and treatment at the hospital was “very person orientated” and that staff were respectful towards them. They said that they were provided with a high standard of care and that their treatment had been fully explained to them, and they praised the professionalism and dedication of staff.

The Lister Hospital is operated by HCA International Ltd. The hospital employs over 500 consultants and nursing staff and has 61 beds. Facilities include four operating theatres, a six bedded level 3 critical care unit and an endoscopy suite.

The hospital provides surgery, medical care, critical care, and outpatients and diagnostic imaging. All services at this hospital were inspected during our visit.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 28 February – 2 March 2017.

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

Services we rate

We rated this hospital as ‘outstanding’ overall because:

• Patients were treated with compassion and their privacy and dignity were maintained. Patient feedback forms were positive, as were comments we received from patients themselves.

• The needs of individuals were taken into account when planning care and treatment. Patients could access care when they needed it. There was a choice and flexibility around appointments and most procedures were elective.

• The hospital was managed by a team who had the confidence of both patients and their teams. Staff felt motivated and supported by the management team. The vision and strategy of the service was embedded and staff spoke very highly of their management team.

• There were adequate systems to keep people safe and learn from incidents. Learning from incidents that occurred in other departments was shared across the service.

• The environment at the hospital was visibly clean and well maintained. There were appropriate measures in place to ensure the spread of infection was prevented.

• There were systems in place to ensure safe storage, use and administration of medicines.

• There were sufficient nursing and medical staff to ensure patient safety was maintained at all times.

• Care was planned and delivered in line with current evidence-based guidance, standards and best practice. Patient outcomes were collected and monitored to improve care.

• We observed evidence of collaborative working and positive relationships across all departments within the hospital.

• There were effective governance structures in place.

We found areas of ‘outstanding’ practice in surgery services and critical care services:

• Within surgery, we found that staff went above and beyond their duty to accommodate patients’ individual needs in different ways.

• We found a culture of friendly professionalism, support and respect at all levels throughout the surgical division.

• In critical care, staff demonstrated a consistent approach to providing highly individualised care that contributed to emotional wellbeing and a positive recovery. This included facilitating family visits at mealtimes, and learning Arabic to communicate effectively with patients and their families. Individual examples included ordering fresh flowers to decorate a patient’s hair ready for discharge, and inviting a relative to eat lunch with staff each week.

• A consultant intensivist led a critical care post-discharge support programme (PDSP), that was based on a holistic model of care. This meant the service provided support for improved physical health and wellbeing, as well as for psychological health. The PDSP had an international scope. Patients who were discharged to countries outside of the UK had access to this by video link.

However, we also found the following issues that the service needs to improve:

• The hospital should ensure that the quality of documentation of consultants is monitored and any issues are addressed.

• Not all staff had access to the same system for documentation.

• Not all staff had completed their mandatory training, and in many cases the hospital target of 85% was not met.

• Not all complaints in the medical service were responded to within the 20 day timeframe.

• We found high vacancy rates for inpatient and theatre staff and high turnover rates of inpatient nurses.

• In radiology, we found that that prescription pads were not stored securely and there was no system in place to log usage of prescription pads.

• The safeguarding children's policy was out of date as it had not been reviewed in June 2016.

• The outpatients department did not have a separate waiting area for children. 

Following this inspection, we told the provider that they should make some 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