We visited all areas of the hospital which provided care and treatment to patients. This included the wards and out-patient departments.

Patients we spoke with told us staff treated them respectfully, promoted their dignity and involved them in decisions regarding their care and treatment. One patient told us, “I’ve had two operations here. Each time, the surgeon explained the treatment and advised reconstruction. The surgeon was amazing and went through the different options and what the results were likely to be for each.”

Patient's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

One patient told us, “Staff are fantastic, really attentive and very thorough. They do regular checks on you, at one point I was being checked every 30 minutes. I’ve nothing negative to say at all. I can’t praise them enough.”

The hospital had enough qualified, skilled and experienced staff to meet patient's needs. Staff told us they had enough to meet patients' needs. One member of staff said, “It’s good to be able to give patients what they need. I wouldn’t mind being a patient here. I am that confident we deliver good care here.”

We found that care and treatment was planned and delivered in a way that was intended to ensure patient's safety and welfare.

The hospital had effective systems in place to reduce the risk of infection and followed appropriate guidance. One patient said, “It is immaculate here; I have no concerns about the cleanliness at all.”

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients who used the service and others.

We spoke with patients, their relatives and staff and reviewed case notes. All of the patients we spoke with were positive about their care and about their experience at the hospital. One person said, “When I ask for help staff respond quickly.” Other people told us they were, “Happy with the care they had received,” “No problems with the care and support provided and “The staff have been very good to me.” "The service is excellent", "I have had no reason to complain" and "The hospital is perfect."

Patients told us they were either dealt with promptly or if they had to wait; they were told the reasons for the delay, such as waiting for an x-ray. They told us they were satisfied with the care and treatment they had received once they had been admitted to the ward. All praised the staff and told us how helpful they were. One person said they had received “Good care by nurses.” Other people told us, “I received the help I needed it. I have no complaints at all.”

People were cared for in a clean, well maintained building. People were supported by suitably qualified and experienced staff. People were provided with information that would assist them if they needed to raise concerns or make a complaint.

We spoke with one patient who was generally positive about their experience and complimented both the services and staff at the hospital.

The patients said:

“The staff are very nice, they treat me with respect and seem to know what they are doing.”

Spire Leeds Hospital is operated by Spire Healthcare Limited. The hospital has 88 inpatient beds. Facilities include eight operating theatres, an eight-bedded level two critical care unit, a chemotherapy unit, outpatients’ departments, an eight-bedded children’s ward and diagnostic and imaging facilities.

The hospital provides surgery, including cosmetic surgery, medical care including chemotherapy, high dependency care for adults, services for children and young people, and outpatients and diagnostic imaging. We inspected all these services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection from 10 to 12 January 2017, along with an unannounced visit to the hospital on 24 January 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. See surgery section for main findings.

We rated this hospital as good overall.

We found good practice in relation to surgery, medicine, critical care, children and young people and outpatients and diagnostics:

• There were sufficient qualified, experienced and skilled staff to meet people’s needs in most areas. The service managed staffing effectively. Staff teams and services worked well together to deliver good quality care.
• The hospital had systems and processes in place to protect people from avoidable harm. There were systems for incident reporting. Staff knew how to use these and learning was shared to prevent reoccurrence.
• We found care and treatment supported good patient outcomes and was based on the best available evidence. There were clear pathways of care and staff were able to recognise and respond to warning signs of deteriorating health.
• The service met national indicators for referral to treatment (RRT) waiting times. The service worked closely with local commissioners and NHS providers to meet the needs of the local population. The service considered the individual needs of people in some areas, including those living with dementia and those with learning disabilities.
• Senior managers were visible, approachable and promoted a fair culture. Staff felt listened to and said the hospital was a great place to work. There was a clear vision and strategy. Staff were fully engaged with changes in the hospital and patients were encouraged to suggest improvements.

There were governance systems in place to ensure oversight of quality, performance and management of risks.

• Radiology services were able to access electronic images held by other healthcare providers without any delays and reducing the need for re-imaging.

We found areas of outstanding practice in relation to caring:

• All staff demonstrated a very caring approach to their patients. We saw all patients were treated with dignity and respect and feedback from patients was consistently positive. The approach to care was patient-centred and all staff demonstrated a high level of commitment to ensuring patients had a positive experience. We heard of numerous examples where staff had gone the extra mile to ensure patients had a positive experience.

• We saw staff in endoscopy had sourced special theatre shorts for patients undergoing endoscopies and colonoscopies to maintain patients’ dignity as much as possible.

We found areas of outstanding practice in relation to responsiveness and well-led in medicine:

• Partnership working ensured patients could access counselling, holistic therapist, cosmetic services, palliative and pain services as well as hospice care to meet all of their individual care needs.

There were areas where the provider should make some improvements, to help the service improve. These were:

• The provider should ensure the safer steps for surgery, which includes the WHO checklist, is consistently adhered to.

• The provider should ensure the senior management team and the medical advisory committee take note of actions and matters from other groups, such as the paediatric steering group, within the hospital.
• The provider should ensure there is a robust process for document control for documents produced at the hospital.
• The provider should ensure that appropriately trained staff undertake incident investigations.
• The provider should ensure audits or checks of the National Early Warning System (NEWS) include correctly calculated scores.

• The provider should review the process for recording and sharing learning from near miss incidents.
• The provider should continue to implement measures to improve fasting times for patients.
• The provider should risk assess situations where one registered children’s nurse is caring for children on the ward.
• The provider should review the chaperone policy and the admission and discharge policy in relation to children to ensure the requirements are clear for chaperones and age of children admitted.
• The provider should monitor did not attend (DNA) rates and have a robust system for recording and following up children who did not attend appointments.

• The provider should ensure that all records are completed in line with hospital and professional standards including the provision of care plans for patients identified at high risk of falls or developing pressure ulcers.
• The provider should review their local audit programme in the outpatient’s department.

Ellen Armistead

Deputy Chief Inspector of Hospitals