Archived: Spire Manchester Hospital

Updated 22 March 2017

Spire Manchester Hospital is operated by Spire Healthcare Plc. and originally opened in June 1981 as Bupa Manchester. The hospital was renamed in 2007 when the hospital arm of Bupa was sold to Spire Healthcare. The Spire Manchester Hospital treats both NHS funded patients and patients who wish to pay for their own treatment.

The Hospital is located in Whalley Range, Manchester and it has 49 patient bedrooms, four theatres (two of which are laminar flow), a separate endoscopy room and a CE (European conformity) accredited Sterile Services department.

Chris Chadwick became registered manager in November 2012 and the accountable officer for controlled drugs for the Spire Manchester Hospital is Dawn Davies.

Specialities undertaken at the hospital include: Cardiology and Chest medicine, Cosmetic Surgery, Dermatology, ENT, Endocrinology, Gastroenterology, General Medicine, General Surgery, Gynaecology, Neurology, Ophthalmology, Oral and Maxillofacial surgery, Orthopaedics, Paediatric Medicine and Surgery, Pain Management, Plastic/Cosmetic Surgery, Psychiatry, Rheumatology, Urology and Weight Loss Surgery. The hospital also has a satellite clinic in Hale, with four consulting rooms and a minor treatment room.

Updated 22 March 2017

Spire Manchester Hospital is operated by Spire Healthcare Plc. and originally opened in June 1981 as Bupa Manchester. The hospital was renamed in 2007 when the hospital arm of Bupa was sold to Spire Healthcare. The Spire Manchester Hospital treats both NHS funded patients and patients who wish to pay for their own treatment.

The Hospital is located in Whalley Range, Manchester and it has 49 patient bedrooms, four theatres (two of which are laminar flow), a separate endoscopy room and a CE (European conformity) accredited Sterile Services department.

There are imaging facilities on site, which include a 16 slice computed tomography (CT) scanner, 1.5T Magnetic resonance imaging (MRI) scanner, a Fluoroscopy room, ultrasound and mammography. There is also a physiotherapy department, a complete patient gym with rehabilitation equipment, including an anti-gravity treadmill. The outpatient department has 18 consulting rooms in the main hospital, minor treatment rooms and two specially adapted consulting areas for bariatric patients. The hospital is also an International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) accredited weight loss centre.

Specialities undertaken at the hospital include: Cardiology and Chest medicine, Cosmetic Surgery, Dermatology, ENT, Endocrinology, Gastroenterology, General Medicine, General Surgery, Gynaecology, Neurology, Ophthalmology, Oral and Maxillofacial surgery, Orthopaedics, Paediatric Medicine and Surgery, Pain Management, Plastic/Cosmetic Surgery, Psychiatry, Rheumatology, Urology and Weight Loss Surgery. The hospital also has a satellite clinic in Hale, with four consulting rooms and a minor treatment room.

Chris Chadwick became registered manager in November 2012 and the accountable officer for controlled drugs for the Spire Manchester Hospital is Dawn Davies.

The majority of the consultants are from local NHS trust and have all been given practice and privilege rights at the hospital. The hospitals main activity comes from general surgical procedures and outpatient diagnostics imaging services. The hospital reported 6,470 inpatient and day case episodes of care in the reporting period (April 2015 to March 2016); of these 33% were NHS funded and 67% were funded privately. The hospital operates Monday to Saturday, also offering evening appointments.

We inspected the hospital as part of our routine comprehensive inspection programme for independent healthcare services. We carried out an announced inspection visit on 13 and 14 September 2016 and an unannounced inspection on 26 September 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.

Spire Manchester Hospital has previously been inspected by the Care Quality Commission on 22 May 2014. The Care Quality Commission inspected against five core standards and found the hospital to be compliant.

Spire Manchester Hospital is operated by Spire Healthcare Limited, Spire Manchester Hospital is registered to provide the following regulated activities:

• Diagnostic and screening.
• Surgical procedures.
• Treatment of disease, disorder or injury.

We inspected the core services of Surgery, Services for Children and Young People and the Outpatients and Diagnostics service.

We rated this hospital/service as requires Improvement overall. Our key findings were as follows:

• Equipment was maintained and appropriately checked, but in some areas was not always visibly clean.
• In theatres, there were inconsistencies in the recording of the administration and destruction of controlled drugs in all of the controlled drug registers we reviewed.
• We found there were numerous missing signatures and times for administration of controlled drugs were not, or not accurately, recorded. Failures to record the amount of the medication administered or destroyed, indicated that these medications were unaccounted for.
• Medications, including controlled drugs, were observed being drawn up prior to the operation and prior to the patient arriving in the anaesthetic room.
• Staffing levels were sufficient to meet patients’ needs and staff assessed and responded to patient risks in theatres and the outpatients and imaging department. However, care and treatment was not always provided by suitably trained, competent staff. For example nurses caring for children did not have the appropriate paediatric competencies.
• Patients did not always receive care and treatment according to national guidelines such as National Institute for Health and Care Excellence (NICE) and the Royal Colleges. Surgery services participated in national audits.
• There were governance structures in place, which included a risk register. We saw that not all risks had been identified and actions were not always taken to mitigate the risks in a number of areas that included controlled drugs in theatres.

However 

• The hospital had systems in place for reporting risk and safeguarding patients from abuse.
• Medical equipment was checked and maintained by an independent company. We saw records to confirm that electrical equipment had been tested across all areas.
• There was sufficient capacity in the ward and theatres, so patients could be seen promptly and receive the right level of care before and after surgery.
• Patients were given information about how to make a complaint. Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.
• 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.
• All staff were dedicated to delivering good, compassionate care and were motivated to work at the hospital.
• Patient records were stored securely at the hospital and access was limited to those individuals who needed to use them. This ensured that patient confidentiality was maintained at all times.
• Patients had a choice of appointments available to them through the ‘Choose and Book’ service. This meant that patients were able to attend appointments at a time best suited to their needs.
• Robust systems were in place to ensure that consultants holding practising 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).
• Staff that worked at the hospital felt appreciated and valued, they discussed with us the different ways Spire recognised staff for their hard work.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with a requirement notice that affected surgical services and children and young people services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)

Updated 22 March 2017

We gave the services for children and young people at Spire Manchester Hospital an overall rating of requires Improvement. This was because:

• When incidents required more detailed investigation, which applied to 2/21 of the incidents that had occurred from September 2015 – August 2016, there was variability in the quality of the investigations. One case was appropriately investigated but the other did not identify all the issues that required addressing to ensure learning and prevention of further incidents.
• Nurse staffing did not fully meet national guidance. We found there was only one children’s nurse on duty when children were taken to theatre, meaning that paediatric patients were left with adults’ nurses who did not have the appropriate paediatric competencies.
• Not all theatre staff were trained in accordance with standards outlined in national guidance; 56.5% of theatre staff were not up to date with paediatric competencies and 33.3% of staff recovering children post-operatively had not completed their advanced paediatric life support (APLS) training.
• Paediatric records completion was not consistently in accordance with best practice. Audits had recently been introduced in the hospital, but action plans to address findings from audits were not embedded at the time of our inspection. The service measured some patient outcomes using the paediatric scorecard, which had been recently introduced at the hospital. However, there was no standard dataset across Spire hospitals for effective benchmarking within the Spire group. The service told us this was being developed corporately, but no implementation date was provided. There were no child-friendly consulting rooms and limited provision for children in outpatients, for example toys and seating. In one of two pre-assessment clinics that were being undertaken, the patients were seen for their observations from the children’s playroom for inpatients.
• Children waited alongside adults for their outpatient appointments and were nursed on adult wards.

• Risks that affected the paediatric service were not all recorded on the provider’s risk register.
• Whilst a gap analysis had gone some way to assist the provider in achieving its strategy, the analysis undertaken was not comprehensive and omitted immediate risks to patients’ safety.

However,

• Systems and processes were in place to safeguard children and young people.
• Duty of candour, a regulatory duty that relates to openness and transparency, was understood and correctly applied by staff.
• Policies and procedures were in place that were in accordance with best practice and national guidance. For example staff applied the “Child day-case/overnight stay care pathways” for children and young people undergoing elective surgery.
• The services available to children and young people were planned according to service demand. The hospital offered good access for children and young peoples’ routine operations. Outpatient clinics were available in the evening, as well as during the day.
• Parents spoke very highly of the caring and compassionate nature of staff. Children and young people were involved in their care and were aware of their treatment options.
• We found that consultants holding practising privileges for children had been assessed as holding the relevant skills and experience.

Updated 22 March 2017

We rated outpatients and diagnostic imaging good overall. This was because:

• There were systems in place for reporting risk and safeguarding patients from abuse. Staff were aware of how to report incidents that took place in the departments and we saw evidence of incidents being investigated and learning being shared within the team.
• From observations we saw that equipment was maintained, appropriately checked and visibly clean. Medical equipment was checked and maintained by an independent company.
• Clinical areas and waiting rooms were all visibly clean and tidy. Patient records were stored securely and were only accessible by those authorised to do so. This ensured that patient confidentiality was maintained at all times.
• The departments used evidence based guidance to inform their practice.
• Patients and their relatives we spoke with told us they were supported by staff that were caring, empathetic and helpful to their needs. Patients were positive about how they were treated by staff. Staff maintained patient privacy and dignity across the departments and provided emotional support to patients.
• Patients were kept well informed about the treatment they were receiving in the hospital.
• Services were planned and delivered to meet the needs of patients. The hospital offered a wide range of services, which were planned and delivered in a way which met the needs of local people. Patients told us there was good access to appointments and flexibility to attend appointments at times that suited their needs.
• All staff told us that managers of the service were available and supportive. Staff were positive about the culture within their departments and said the senior management team were visible and approachable.

However,

• The hospital did not hold a full medical record for insured and self-paying patients using the outpatient department. Although it did have a process for requesting all records needed.

• Not every non-emergency patient having a CT scan involving an iodinated contrast agent had their kidney function tested prior to their scan, which is a recommendation of Royal College of Radiologist guidelines.
• On one occasion during the inspection we found patients standing in the waiting area as there were not enough seats in the outpatient department waiting area to always accommodate all of the patients waiting for appointments.

Updated 22 March 2017

We rated surgery as requires improvement in the safe and well-led domains, although effectiveness, caring and responsive was good.

• Staff assessed and responded to patient risks and used recognised assessments. However the surgical safety checklist was not always fully completed.
• Staff did not always cleanse their hands after touching patient surroundings. Equipment stored on corridors in theatres, such as trolleys, was dusty, whilst this equipment was labelled with an ‘“I am clean” sign. Oxygen cylinders had been stored outside and dirt from the base of the cylinders had been transferred onto patient trolleys.
• Incidents in relation to recording controlled drugs and omissions or errors were under reported in theatres. There were widespread omissions and poor recording of controlled drugs in record books in theatre. Staff reported that there was consultant resistance to complete the controlled drug registers. We found no evidence of actions taken to address this prior to the inspection; action was only taken when the inspection team raised concerns. This issue had not been raised at the medical advisory committee.
• Medications, including controlled drugs, were observed being drawn up prior to the operation and prior to the patient arriving in the anaesthetic room and this practice was confirmed by theatre staff; we observed an anaesthetist drawing up controlled drugs and documenting this in the controlled drugs register prior to the patient’s arrival in the anaesthetic room. However, when the order of the theatre list was changed, the entries in the controlled drugs register were crossed through and the name of the patient amended.
• Audits to monitor patient safety did not always detail what actions were required to improve patient care and safety
• The most recent audit of the surgical safety checklist showed 88% compliance with documentation and 73% compliance on the observational audit. The outcome of the audit did not identify appropriate actions or sufficient measures to address the shortfall in compliance. There had been no previous audit of compliance with this checklist.
• We reviewed nine sets of records and saw that in all cases, documentation was incomplete and not in line with best practice for record keeping. In theatre records staff were identified by their first name only and there was no clear record of which staff member had undertaken what role during surgery.
• There was no locally agreed policy or risk assessment in place to support the use of scrub staff carrying out a dual role in theatre.
• Not all risks on the risk register had action due dates or details of who was responsible for completing the actions identified for wards and theatre departments. This meant that there was a risk of ineffective monitoring of actions taken to reduce risk.

However,

• There were systems in place to keep people safe and staff were aware of how to ensure patients were safeguarded from abuse.
• Staff were kind, caring and compassionate and high numbers of patients would recommend the hospital to their friends and family.
• Patients had access to treatment in a timely way. Staff recognised and understood the importance of individual patients’ needs.
• Staff responded to patient risk appropriately. Early warning scores and risk assessments were completed and escalated in line with guidance. Clear systems were in place to manage the care of deteriorating patients. Staff had access to resident medical officers and consultants, 24 hours a day.
• Patients received care from sufficient numbers of well-trained staff. There were sufficient numbers of suitably qualified staff to care for patients and they worked well as part of a team.
• Nursing staffing levels met the needs of patients. There was adequate access to a resident medical officer and access to consultant surgeons, physicians or intensivists if required.
• Systems were in place to ensure the competence and compliance of consultants operating under practising privileges. .
• Care and treatment was delivered in line with national guidance and best practice. Hospital policies and pathways reflected evidence based care and treatment.
• The hospital participated in a number of national audits of patient outcomes including patient reported outcome measures.
• Staff were supported to develop their skills through additional training. All clinical staff in surgical services had completed an annual appraisal.
• There were systems in place to support vulnerable patients. Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.
• The Medical Advisory Committee (MAC) provided clinical scrutiny in relation to evidence based care and treatment. If consultants wanted to introduce new treatment methods or procedures, the evidence and guidelines for these procedures were reviewed by the MAC and approved if this was appropriate. Minutes we reviewed showed that the MAC refused permission to carry out procedures where there was insufficient evidence to support the use of the procedures.
• There was a positive, open and honest culture. Staff described leaders as approachable and they were happy to work at the hospital. Staff and the public were involved in developments and service improvement initiatives.
• The hospital’s vision and values had been cascaded across the surgical services and staff had an understanding of what these involved. There was clearly visible leadership within the services.