Spire Fylde Coast Hospital is operated by Spire Healthcare Ltd. The hospital has 26 single rooms and 11day care beds which are provided in two single sex bays.

Facilities include three operating theatres, 10 consulting rooms, physiotherapy treatment rooms, medical imaging services and outpatient and diagnostic facilities.

Outpatient clinics are also provided from a small clinic in Lytham, approximately 20 minutes away. Facilities for plain x-ray diagnostic tests are also available in this clinic.

The hospital provides surgery and outpatients and diagnostic imaging services. We inspected surgical services only on this inspection.

We inspected this service using our focused inspection methodology. We carried out an unannounced inspection on 2 December 2017. A focused inspection is targeted to look at specific concerns rather than gathering a holistic view across a service. The reason for this inspection was to follow up concerns which had been shared with the Care Quality Commission anonymously. These concerns were about areas of practice which are in the safe domain therefore this was the only domain inspected at this time.

We asked the question is the service safe. We did not inspect if the service was effective, caring, responsive or well-led on this inspection. Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate. However, for this inspection we did not rate the safe domain as the inspection was focused and evidence was collected against specific key lines of enquiry.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We did not rate this service but noted the following areas that required improvement:

• The record for controlled drugs was not accurately completed in theatre three.

• Not all theatre records were fully completed.

• The World Health Organisation surgical safety checklists were not fully completed for all patients.

• Documented evidence for the verification of the qualification and competence of the surgical first assistant was not available on site.

• The necessary employment checks were not completed and documented for all staff working in the theatres.

• On the ward we saw some boxes containing controlled drugs had one end removed. This meant the expiry dates were not on the boxes or some strips of medicines. Therefore there was no assurance these medicines were within their expiry date.

• A log of all staff who had worked as a surgical first assistant was kept. This included doctors who accompanied a consultant and assisted them in this capacity. Not all the information required in this log was recorded as present. For one staff member there was no record of a disclosure and barring service check. For two there was no record of indemnity insurance and two were not signed as required on the record.

We also noted the following areas of good practice:

• Staff knew how to report incidents and received feedback and learning when incidents had occurred.

• Safety performance was monitored and the information used to improve services.

• All areas of the hospital we visited were clean and tidy.

• Emergency equipment was in place and checks recorded.

• Patient records on the wards were fully completed.

• Processes were in place and followed to identify a patient whose condition was deteriorating. This included escalation for medical review.

• There were sufficient numbers of suitably qualified staff on the wards and in theatres to care for the patients.

• There was a process in place to provide appropriate medical cover for patients over a 24 hour period.

• We observed two of these staff members appropriately completing the duties of a surgical first assistant and not working outside that remit

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 one requirement notices. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Spire Fylde Coast Hospital is operated by Spire Healthcare Ltd. The hospital has 26 single rooms and 11 day care beds which are provided in two single sex bays. Facilities include three operating theatres, 10 consulting rooms, physiotherapy treatment rooms, medical imaging services and outpatient and diagnostic facilities. Outpatient clinics are also provided from a small clinic in Lytham, approximately 20 minutes away. Facilities for plain x-ray diagnostic tests are also available in this clinic.

The hospital provides surgery and outpatients and diagnostic imaging services. We inspected both of these services. The services for children and young people had been reviewed by the provider and were suspended at the time of this inspection.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 and 7 September 2016, along with an unannounced visit to the hospital on 15 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.

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.

We rated this hospital as requires improvement overall. This was because:

• At the time of our inspection there were insufficient numbers of staff deployed in theatre in accordance with the association of perioperative practitioners (AFPP) guidelines. Action was being taken to improve this.

• Staff were not adhering to the controlled drugs regulations 2001 when controlled drugs were being administered.

• Hospital staff were not consistently implementing the World Health Organisation (WHO) surgical safety checklist for the administration of joint injections, to ensure safety checks were completed.

• Staff at the hospital were not fully implementing the controls to mitigate the risk to patients who were identified as at an increased risk of bleeding.

• Competency assessments had not been fully completed and documented appropriately for staff undertaking the role of the surgical first assistant

• Risks and areas of poor compliance were not always correctly identified or dealt with in a timely way.

• Medicines were not consistently stored within the recommended temperature range and any variation in this was not always acted upon appropriately.

• Compliance rates with some specific key training areas was low.

• One department had not reported clinical and non-clinical incidents on the electronic system to ensure improvements could be made when needed.

• Department of Health standards were not being met in respect of the provision of hand wash basins within patient areas.

• There was no equipment checklist for theatre to ensure equipment was checked appropriately prior to surgery being undertaken.

• Control of substances hazardous to health (COSHH) legislation was not consistently followed when storing flammable liquids.

• Theatre access was not restricted, therefore there was a potential that unauthorised persons were able to enter unsupervised.

• Consultant signatures were not consistently timed and dated in all patient records.

• The ‘sign out’ phase of the World Health Organisation (WHO) surgical safety checklist was not always being completed following surgical procedures.

• Staff we spoke with were unaware of any policy or standard operating procedure to provide guidance on appropriate staffing levels. Additionally, there was no escalation guidance for staff to ensure it was clear when a manager should be contacted during out of hours.

• Compliance with fasting guidance prior to surgery was not consistent.

• There was a low level of compliance in completion of annual staff appraisals to ensure their performance was reviewed and improvements made where needed.

• There was a lack of clarity in the records we reviewed if the two week ‘cool off’ period was adhered to for patients undergoing cosmetic surgery.

• The hospital had not adapted facilities to support people living with dementia.

• The monitoring of governance processes was not robust.

• A new corporate risk register had been recently introduced in the hospital and staff were not yet familiar with the management of the documentation.

However:

• In the outpatients department there were sufficient numbers of nursing and support staff to meet patients’ needs and we observed effective multidisciplinary working by competent staff

• We saw that care and treatment was provided in a kind, compassionate way. Staff treated all patients with dignity and respect during their time at the hospital.

• We found suitable medical cover at all times from a resident medical officer and on-call consultants and noted arrangements for consultants to provide cover for absent colleagues.

• There was an effective system for managing complaints and concerns.

• There was an open culture with staff able to raise concerns or issues.

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 six requirement notices that affected both surgery and outpatients and diagnostic services.

Ellen Armistead

Deputy Chief Inspector of Hospitals