Fordcombe Hospital

Updated 17 November 2016

Spire Tunbridge Wells Hospital is run by Spire Healthcare Limited, which is part of Spire Healthcare PLC. It is a 40 bedded acute hospital situated in the rural area of Kent located within five miles of Royal Tunbridge Wells and on the boundaries of West Sussex. Spire Tunbridge Wells provides hospital services to predominately insured and self-pay private patients along with patients funded by the NHS under the Standard Acute Contract and local contract

Spire Tunbridge Wells Hospital opened in 1991, originally as an independent hospital changing ownership to Goldsborough, then Bupa and then in 2007 a private equity company called Cinven purchased a number of BUPA Hospitals of which Spire Tunbridge Wells Hospital was one and Spire Healthcare was established. Spire Healthcare became a public limited company in 2014.

The organisation offers a range of services and facilities including two operating theatres, a sterile services department, a dedicated endoscopy suite, and a diagnostic and imaging department with a MRI and CT scanner. There are outpatient and physiotherapy departments providing services six days week. There is a hot lab on site which comes under the umbrella of Spire Alexandra Hospital which is a MHRA & UKAS accredited Pathology laboratory.

Main specialties treated are: orthopaedics; general surgery, breast surgery; gynaecology; ENT; ophthalmology; urology; gastroenterology; cosmetic; dental; vascular; general medicine.

Between April 2015 to March 2016, there were 2,881 visits to the operating theatre, with the most commonly performed procedures being: phacoemulsification of lens with implant and shoulder surgery.

Spire Tunbridge Wells Hospital was selected for a comprehensive inspection using our new methodology. We carried out an announced inspection of Spire Tunbridge Wells Hospital between the 26 and 27 July 2016. We also carried out an unannounced inspection of the hospital on 08 August 2016

The inspection team inspected the following core services:

• Surgery

• Outpatients and diagnostic imaging

• Medicine

Adrian Connolly the Hospital Director is the Registered Manager and has been in post for 7 years.

Updated 17 November 2016

Our key findings were as follows:

• The overall leadership was good. The senior management team were visible, had good oversight of governance and continually strove for improvement. They rewarded good performance by the staff and fostered a culture of transparency and openness. This was also reflected in local leadership at departmental level.

• The cleanliness of the hospital was good and this was reflected in their infection control policies, processes and infection rates.

• Staffing levels were well monitored and provided a high standard of care despite challenges in recruitment. Staff turnover was low and was mainly due to staff progressing to more senior roles.

• Mortality rates were low

• The hospital took a lot of care in monitoring nutrition and hydration levels. It was evident that the care taken to ensure that patients who had a diminished appetite, due to being unwell, were provided with alternatives to ensure that nutrition was good to facilitate their recovery.

• Spire Healthcare is finalising with NHS England its approach to report Workforce Equality Standard (WRES) data. The hospital was able to provide local information to demonstrate it reviews the ethnicity of its workforce.

We saw several areas of outstanding practice including:

• The hospital had systems and processes in place that supported staff in providing a good service.

• The catering department met both patients and staff individual requirements, and visited with patients daily.

• The leadership from the senior management team was described as approachable, available and visible.

• Patients and their families were cared for by kind and compassionate staff who went out of their way to support them.

• Two-hourly patient “quality rounds” on the ward, led by the nurse-in-charge.

• Regular scenario-based training to ensure staff responded appropriately to emergency situations was undertaken.

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

The provider should:

• Ensure that if a patient declines a chaperone this is recorded in the patient’s notes for inpatients, in line with hospital policy.

• Consider making the layout of some rooms on the ward more accessible for wheelchair users.

• Consider providing training to ward staff to help them better meet the needs of physically disabled patients.

• Consider using observational hand hygiene audits to monitor hand washing.

• Ensure dedicated hand hygiene sinks in patient bedrooms are included when carrying out refurbishment in accordance with the Department of Health’s Health Building Note 00-09.

• The hospital should progress Joint Advisory Group (JAG) accreditation for endoscopy services.

Updated 17 November 2016

We rated each of the key questions, Safe, Effective, Caring, Responsive and Well-led as good.  Overall, we rated medical care services as good because:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents that were fully investigated. There was evidence of shared learning from incidents to prevent recurrences.

• There was sufficient emergency resuscitation equipment available and evidence of assurances that this was safe and fit for purpose.

• The hospital planned, implemented and reviewed staffing levels to keep people safe at all times and responded to any staff shortages quickly and effectively.

• We saw that patient care was provided in line with current evidence-based guidance, standards, best practice and legislation. This was monitored to ensure consistency of practice.

• Staff received meaningful and timely supervision and appraisal. We saw evidence of an appropriate approach for supporting and managing staff when their performance was poor.

• The hospital routinely collected and monitored information about people’s care and treatment, and their outcomes. These were benchmarked against other independent hospitals and within the Spire Healthcare network. The hospital used this information to improve patient care.

• Overall, feedback from people who used the service and those close to them was positive about the way staff treated people.

• The service had links with other services to help patients living with cancer and those close to them cope emotionally with their care and treatment.

• Waiting times, delays and cancellations were minimal and the service managed these appropriately and kept patients well informed.

• The hospital coordinated the care and treatment it provided with other services and other providers, and had made positive improvements to make the service more accessible for patients living with dementia.

• There were high levels of staff satisfaction across all staff groups. Staff were proud of the organisation as a place to work and spoke highly of the culture.

• There were robust governance arrangements. Governance and performance management arrangements were proactively reviewed and reflected best practice. The vision and values of the hospital were well embedded amongst staff and leaders drove continuous improvement.

However:

• The service did not always meet the needs of wheelchair users, in terms of ease of access on the ward.

• There were no dedicated hand hygiene sinks in patient bedrooms. This meant staff had to wash their hands in the sinks in patients’ en suite bathrooms contrary to the Department of Health’s Health Building Note 00-09.

•           The hospital did not have Joint Advisory Group (JAG) accreditation for endoscopy services.

Updated 17 November 2016

We rated each of the key questions, Safe, Effective, Caring, Responsive and Well-led as good. Overall, we rated outpatients and diagnostic services as good because:

• There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training specific for their roles. Staff had appropriate safeguarding awareness and people were protected from abuse.

• Staff followed cleanliness and infection control procedures. Potential infection risks were anticipated and appropriate responses implemented and measured.

• Patients’ treatment and care was delivered in accordance with their individual needs. Patients told us they felt involved in decisions about their care and they were treated with dignity and respect.

• People were always made aware of waiting times and meals were offered to those delayed or in clinic over meal times.

• People’s concerns and complaints were listened and responded to and feedback was used to improve the quality of care.

• Medicines were stored safely and checks on emergency resuscitation equipment were performed routinely. Incidents and adverse events were reported and investigated through robust quality and clinical governance systems. Lessons arising from these events were learned and improvements had been made when needed.

• The leadership, governance and culture within the departments were strong. Staff were supported by their managers and were actively encouraged to contribute to the development of the services.

Updated 17 November 2016

• We rated each of the key questions, Safe, Effective, Caring, Responsive and Well-led as good.Overall, we rated surgery as good because:

• Patients were protected from the risk of abuse and avoidable harm. Staff knew how to escalate key risks that could affect patient safety, such as safeguarding from abuse. They took steps to prevent abuse from occurring, responded appropriately to any signs of abuse and worked effectively with others to implement protection plans.

• Levels of staffing including medical, nursing, therapy and support staff were safe and met patients’ needs. The hospital was visibly clean and there were appropriate systems in place to prevent and control healthcare associated infections. Medicines were managed safely. Staff completed mandatory training with good compliance rates.

• The consent process for patients was well structured and staff demonstrated a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

• During the inspection, we observed staff respond compassionately when people needed help and support to meet their basic personal needs. People’s privacy and confidentiality was respected at all times. Patients’ feedback through interviews and comments cards was entirely positive. Patients praised all aspects of the service with comments such as ‘level of care has been fantastic’, ‘friendly’, ‘and excellent’, and ‘nothing is too much trouble’.

• The hospital monitored patient outcomes to provide assurance of the effectiveness of the service. Patients were well cared for on the ward and in theatres. Patients received care and treatment in line with national guidelines such as National Institute for Health and Clinical Excellence (NICE) and the Royal Colleges. The rate of unplanned readmissions and unplanned patient transfers to other hospitals was within expected levels when compared to national averages and other independent hospitals. Pain control was well managed. There was evidence of excellent multidisciplinary working and out-of-hours services were provided when needed.

• Complaints about the service were investigated and lessons learnt were shared with staff. There was a clear governance structure in place with committees such as clinical governance, infection control, heads of department and risk management feeding into the medical advisory committee (MAC) and hospital senior management team (SMT).

• There was clear and visible leadership provided by senior management and within the departments. Staff spoke highly of their managers, who told us they were visible and approachable, and told us the senior management team had an ‘open door’ approach, and visited departments daily. Staff told us they felt ‘proud’ to work at the hospital, and there was good team spirit and atmosphere, and staff felt a part of a ‘big family’.

• However we found:

• There were a lack of dedicated washbasins in patient bedrooms; this is not in accordance with Department of Health’s Health Building Note 00-09: infection control in the built environment. The hospital was aware of this and we saw the installation of washbasins was included in their proposed programme of works due to start in January 2017.

• There were no observational hand hygiene audits to monitor hand washing.

• All written information, including pre-appointment information, leaflets and signage was in English only. However, Staff had access to a translation service. Information gathered at the referral stage identified patients who would need the assistance of the interpretation service and translators were booked when the appointment was made.