We found that the provider had systems in place to ensure that before patients received any care or treatment they were asked for their consent and that the provider acted in accordance with their wishes.

Information was provided to staff about the procedures to follow if there were any concerns that people were at risk of abuse and patients told us they felt safe in the hospital. We saw records to support that staff had received appropriate safeguarding training and were knowledgeable about the correct procedures to follow if they had concerns.

We reviewed the policies and procedures to ensure that there were robust systems in place to manage the obtaining, storing, prescribing, dispensing, administration, monitoring and disposal of medicines. Patients told us that they understood what medication they were being given and one person told us "They always tell me what I am taking and what it is for."

We looked at records related to the employment of staff and clinical practitioners that worked at the hospital. The provider was able to provide evidence that staff were appropriately qualified and competent to carry out their roles and meet the needs of patients using the service. We found that the provider had undertaken appropriate checks on staff and ensured that references and documentation were in place as required under Schedule 3 of the Health and Social Care Act 2008.

The hospital had a clear clinical governance structure in place with established committees and lines of reporting and responsibility embedded into practice. We found effective systems to regularly assess, capture and record the quality of service that people received. The provider had processes to record, manage and learn from incidents and complaints.

The Montefiore Hospital is operated by the Spire Healthcare plc

. .

The hospital provides a full range of diagnostic, outpatient and surgical services. Facilities included 8 consulting rooms, 3 operating theatres, all with laminar flow, and an endoscopy suite. There are 20 inpatient rooms, all with en-suite facilities, a day care ward, and a 3 bed extended recovery unit. The hospital also had a dedicated chemotherapy facility with 8-day treatment cubicles. A range of diagnostic services were provided which included MRI, CT, X-ray, fluoroscopy, digital mammography and ultrasound. Sterile services and pathology are provided on-site.

The main specialties provided at the hospital are orthopaedics, general surgery, GI and colorectal endoscopy, ENT, gynaecology, pain management and urology.

We inspected this service using our comprehensive inspection methodology. We carried out announced inspection on 23, 24 and 25 January 2017 along with an unannounced visit to the hospital on 4 February 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 service 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 report

Services we rate

We rated this hospital as Outstandind overall.

We have rated Surgery as Outstanding.

• Staff proactively reported, investigated and learned from serious incidents.
• There was an open and transparent approach to handling complaints which took account of the Duty of Candour regulations. Complaints and feedback were used to improve the service.
• Patients had their pain needs met by competent staff in a timely manner.
• Medical records demonstrated patient involvement in their care.
• Records also demonstrated valid consent was obtained.
• The care in the surgical department had a multidisciplinary focus.
• Staff were aware of their roles in protecting vulnerable adults from abuse.
• Patients’ views about the service was regularly sought. This feedback was used to improve services.

We have rated the care in medicine as good.

• There were processes to report and learn from incidents.
• Patients were cared for by appropriately trained staff who were competent to meet the patients individual care needs.
• Care and treatment reflected national guidance and best practice guidance.
• There were suitable quality assurance processes to measure patient outcomes.
• Patients were involved in planning their care and received a service that took account of their individual preferences.
• Risks were identified and managed to minimise the risk of harm to patients and others.

We have rated the care in outpatients and diagnostic imaging as good.

• Staff reported safety incidents which were appropriately investigated and used to improve the service.
• The environment was visibly clean and fit for purpose.
• All equipment used was well maintained.
• Medicines and prescriptions were handled, stored and prescribed in line with national guidance.

Professor Edward Baker

Deputy Chief Inspector of Hospitals