Quality and Standards

Quality and Standards

St Anthony's Hospital is committed to sound policies and practices that support its effective operation. We consistently plan to meet the requirements of our patients, their visitors, consultants, our volunteers and our staff. Through a well-trained, effective and motivated workforce we aim to take the hospital forward within a culture of continuous improvement and an environment that maintains the principles underpinning both corporate and clinical governance.

Our 10 key quality statements are set out here:-

  1. The needs of patients are put first at all times.
  2. The service is responsive to the needs of patients, their visitors and consultants.
  3. A caring, honest and professional attitude is maintained.
  4. Feedback from patients, visitors, consultants and staff is encouraged and viewed as an opportunity to improve.
  5. The hospital and grounds are safe, clean and tidy and pleasing to the eye.
  6. The confidentiality of information concerning both patients and staff is constantly observed.
  7. Communication with patients, visitors, consultants and staff is effective.
  8. Staff are treated fairly and encouraged to maximise their full potential.
  9. Staff understand the nature of the business and their role within it.
  10. The best use is made of resources and wastage minimised.

Standards

The Care Quality Commission

The Care Quality Commission was set up under the Health and Social Care (Community Health & Standards) Act 2003 to promote improvement in the quality of health and healthcare.

In April 2004, the Care Quality Commission took over responsibility from the National Care Standards Commission for regulating and inspecting the independent healthcare sector.

In England, the Care Quality Commission are responsible for assessing and reporting on the performance of both NHS and independent healthcare organisations, to ensure that they are providing a high standard of care. They also aim to encourage providers to continually improve their services and the way they work.

From the 1st April 2009, a new body "the Care Quality Commission" will absorb the role of the Care Quality Commission.

St Anthony's Hospital has been inspected against the National Minimum Standards regulations since their inception in 2002. An archive of the ealthcare Commission Inspection reports can be found on the Care Quality Commission's website.

The Hospital's last inspection report can be found here:-

2006/2007 – St Anthony's Hospital submitted its self assessment documentation to the Care Quality Commission who acknowledged that an inspection during the period 1 April 2006 to 31 March 2007 was not required*.

From April 2007, the rules on the frequency of inspection in the independent healthcare sector changed, from annual inspection, to more targeted, appropriate and risk based assessments and inspections. For hospitals that can demonstrate that they comply with the independent healthcare national minimum standards, this could mean that inspections are only carried out every five years.

2007/2008 – St Anthony's Hospital submitted its self-assessment documentation to the Care Quality Commission who acknowledged that an inspection during the period 1 April 2007 to 31 March 2008 was not required*.

* The Care Quality Commission reviews a range of information, including the last inspection report (2005/2006), the Hospital's self-assessment and other information they receive from and about the hospital. From this information they did not identify any risks to suggest that St Anthony's Hospital was not meeting the National Minimum Standards, consequently there was no need for the hospital to be further checked through an inspection.

Investors in People (IIP)

St Anthony's Hospital has been a recognised Investor in People since 1994. The Hospital regards its staff as its greatest asset and takes pride in its targeted training programmes and high rates of staff retention. The Hospital is required to be inspected against prescribed IIP standards once every three years in order to maintain its IIP status. It last underwent and passed inspection in October 2007. The report's executive summary stated that

St Anthony's hospital is a successful and happy organisation where the care of patients and staff are a top priority… St Anthony's has a personal approach to staff, an ethos of caring and delivers the highest standard of care to patients."

Clinical Pathology Accreditation (CPA)

St Anthony's Hospital has achieved and maintains Clinical Pathology Accreditation. This scheme provides assurance that the pathology service provided is of high quality and meets defined standards of practice. The Hospital was last inspected in July 2007.

Environmental Health

The Hospital receives periodic visits from the local Environmental Health Inspectors. Assessing the Hospital Hotel Services standards of cleanliness and working practice the Hospital gains an additional assurance that its standards are high and remain so.

In 2007, the Hospital received a Five Star hygiene rating following an unannounced visit by the Senior Environmental Health Officer for the London Borough of Sutton. In effect, this award, that is part of the Food Standards Agency initiative "Scores on the Doors" confirms that the Hospital has achieved very high standards of food safety management and is fully compliant with food safety legislation


Performance

Performance Indicators

Constituting part of the Care Quality Commission's risk-based approach to inspection, a series of high-level indicators including numbers of surgical of site infections, unplanned readmissions and unplanned returns to theatre have been developed to help monitor the performance of providers in the independent healthcare sector. These indicators are one of the factors taken into account when a provider's performance against the national minimum standards is assessed and the frequency of inspections is planned. The Hospital submits a quarterly return of data to the Care Quality Commission in compliance with its mandatory responsibilities.

Audit

The evaluation of practice against agreed standards is integral element in the programme for clinical governance at St Anthony's Hospital. Projects are predominantly undertaken by staff to explore either areas of concern or interest. All projects fundamentally aim to support staff in achieving and maintaining the high standards of care delivered to our patients. Highlighting areas for improvement and providing reassurance that high standards of practice are maintained, the pursuit of audit and monitoring activity is afforded a high degree of importance at St Anthony's. Up to 40 bespoke projects are either on-going or planned each year and a small team of dedicated personnel provide the necessary support.

The Hospital keeps abreast of guidance issued by the relevant professional bodies and the National Institute for Health and Clinical Excellence and is actively involved in the national clinical audits that are co-ordinated via the NHS and the projects directed by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).


Infection Control and Prevention

At St Anthony's hospital, the prevention and control of infection is considered to be a very high priority. The hospital employs a full time qualified infection control nurse who is supported by a consultant microbiologist and a team of Bio-medical scientists. There is a fully accredited microbiology laboratory located in the main hospital, which allows results to be processed and accessed promptly. Cleanliness is a very important factor to both the staff and the patients and high importance is placed on maintaining excellent standards of cleanliness in all areas.

These are just some of the measures, which keep our rates of cross infection so low:

  • All patient rooms are single and en-suite, which lends itself to effective prevention and control of infection.
  • Each ward has a team of dedicated housekeepers who take pride in the standards of cleanliness for their area. They are regularly trained in infection control procedures and policies.
  • Yearly training on aspects of good infection control practice is mandatory for all staff as is a comprehensive induction programme for new staff.
  • Alcohol gel is readily available in all clinical areas and by every patient bedside, which allows easy and visible hand decontamination.
  • At risk patients are screened for MRSA before admission to enable treatment before admission.

There is also a high 'nurse to patient' ratio allowing time for quality care.

Surgical Site Infections

Surveillance for the incidence of surgical site infections is ongoing and robust at St Anthony's. All categories of surgery are included in the in-house surveillance with a total incidence of infection of 0.8% in the last quarter October – December 2007. All hip and knee replacement operations and blood infections (bacteraemia) are included in surveillance, which is reported to the Health Care Commission

SSI = Surgical Site Infection identified in hip and knee replacement surgery during patient in patient episode according to NINN’s criteria
Dates Overall SSIs as % of patient episodes
July – Sept '06 0%
Oct – Dec '06 0%
Jan – March '07 0%
April – June '07 1.63%
July – Sept '07 1.49%
Oct – Dec '07 0%

On their last inspection, the Health Care Commission highly praised the standard of cleanliness and the commitment to infection control at St Anthony's. They stated,

"One area of particular note was infection control which is managed enthusiastically and effectively"

We believe that infection control is everybody's business and are committed to maintaining these high standards. If you have any questions regarding infection prevention and control at St Anthony's, please contact the infection control sister Debbie Calver on 020 8337 6691 ext. 4163.

MRSA

What is MRSA?

MRSA stands for Methicillin resistant Staphylococcus Aureus. It is a bacteria (germ) that has become resistant to many of the commonly used antibiotics; Methicillin is one of those antibiotics.

What is Staphylococcus Aureus?

This is a common form of bacteria, which lives quite happily on the skin of about 30% of the population without causing problems or infections. This is called colonisation. Staphylococcus aureus, like many other germs can cause infections ranging from minor infections such as skin boils to more serious infections such as septicaemia (blood poisoning) This is more likely in those who are already unwell, have lowered immunity and wounds.

Why is MRSA a problem?

We have known about MRSA since the 1960's but it is now becoming more of a problem in hospitals and is widespread in the community. If MRSA causes an infection then less commonly used antibiotics may need to be used which often take longer to work. These antibiotics are usually given intravenously (by injection) which often means the patient has to stay in hospital for their treatment.

How is MRSA spread?

It is usually spread by person-to-person contact mainly by the hands. This is why hand hygiene by everyone is so important. MRSA is also found in dusty environments. MRSA may be acquired both in hospital and the community.

What are we doing about it at St Anthony's?

At St Anthony's we take infection control very seriously and work continuously to reduce the risk of cross infection from MRSA and all other infections. St Anthony's does not discriminate against patients who are known to be MRSA carriers but if they need to be admitted then we have strict source isolation procedures to negate the risk of cross infection.

  • For more information on MRSA you can visit the Health Protection Agency website on www.hpa.org.uk.
  • Alternatively you can call Debbie Calver our infection control nurse at St Anthony's on 020 8337 6691.

Clostridium Difficile (C-Diff) - What is it?

Clostridium Difficile is a major cause of antibiotic related diarrhoea in healthcare. It mostly affects elderly people and those with underlying conditions. It is a bacteria which is spore forming which allows it to survive well in the environment. It lives happily in the gut of about 35% of babies and 5% of healthy adults without causing harm or infections. It is normally kept in check by healthy bacteria in the gut. It usually only causes an infection when the healthy (good) bacteria are killed off by antibiotics. This allows the Clostridium difficile bacteria to multiply and irritate the lining of the gut causing diarrhoea. When an infection occurs this causes diarrhoea ranging from very mild to very severe. In very rare and extreme cases the gut may perforate. The diarrhoea is often smelly, watery or bloody. The patient may suffer abdominal cramps and a raised temperature.

Who is at risk?

Mostly the elderly with serious underlying conditions, patients who have been on broad spectrum antibiotics, particularly those treated for chest infections. Clostridium difficile may be acquired both in hospital and the community as well as nursing homes. Fit healthy people are not at risk.

How is it spread?

Mostly by cross infection from another patient. Either by direct contact with the diarrhoea or patient or via the health care workers hands or contaminated equipment.

Can it be treated?

Yes by specific antibiotics.

Prevention & Control

  • Good hand washing with soap and water is imperative as the clostridium difficile spores are resistant to alcohol gel.
  • All rooms at St Anthony's are single and en-suite which allows affected patients to be source isolated and all patients have their own bathroom facilities.
  • Clostridium difficile is resistant to many cleaning agents but chlorine is the most effective agent to clean and kill the spores. All cleaning staff are dedicated to their own area and have training in decontaminating and thoroughly cleaning equipment and the environment to a high standard and effectively.
  • Careful use of antibiotics is encouraged at St Anthony's and on call advice from a consultant microbiologist is available to all our consultants and resident doctors.

What is type 027 and why is it a problem?

There are over 100 different types of Clostridium difficile. Until recently, type 027 was rare in the UK and it was first identified in 1999. In 2004-2005 there were outbreaks in Stoke Mandeville and Exeter hospitals and more recently at Maidstone and Kent hospital. This type appears to produce more toxins and causes more severe infection which can spread rapidly between patients.

For more information on Clostridium difficile, you can visit the Health Protection Agency website on www.hpa.org.uk.

Alternatively you can call Debbie Calver our infection control nurse at St Anthony's on 020 8337 6691 on ext. 4163.


Patient Satisfaction

St Anthony's Hospital has pursued the active canvassing of patient feedback for over 10 years.

The staff at St Anthony's welcome the comments and views of the users of its services. A structured survey questionnaire seeks the views of patients against in excess of 55 criteria covering aspects such as the professionalism and communication of our staff to the taste and choice of food. All comments are discussed and reviewed at the monthly senior management meeting.

We aim to achieve the highest standards in the services we provide and regard the feedback from our patients and their visitors as vital in this achievement.

Between 2007 and 2010:-

  • Over 5,500 responses recommended St Anthony's Hospital. This represented over 99% of survey returns.
  • 95% of patient responses regarded the services they experienced as either Excellent or Good.
  • Over 97% of patient responses regarded the quality of their pre-admission information as either Excellent or Good.
  • 97% of patient responses regarded the nursing staff as either Excellent or Good.
  • Over 92% of patient responses regarded the food as either Excellent or Good.
  • 99% of patient responses regarded the service given to their visitors as either Excellent or Good.
Quality and Standards Chart

Complaints

The Hospital Management Team takes seriously all complaints received and works closely with consultants to ensure that as far as is reasonably practicable clinical complaints are resolved in a satisfactory manner.

Patients, their relatives and visitors are advised that, should they feel their complaint has not been dealt with satisfactorily by the Hospital, they are entitled to contact The Care Quality Commission with whom St Anthony's is registered.

Their address is:

The Care Quality Commission (Head Office)
Finsbury Tower
103-105 Bunhill Row
London
EC1Y 8TG