The Harbour Hospital

Updated 7 February 2022

BMI The Harbour Hospital was established in September 1996 and is managed by the provider BMI Healthcare Limited. In January 2020, Circle Health Holdings Limited (Circle) acquired the BMI Healthcare Limited group. Facilities include two operating theatres, X-ray, outpatient and diagnostic facilities and an onsite pharmacy. The hospital provides surgery, medical care, outpatients and diagnostic imaging.

The provider is registered to provide four regulated activities:

• Surgical procedures
• treatment of disease, disorder and injury.
• diagnostic and screening procedures.
• family planning.

The registered manager has been in post since August 2021.

Hospital activity;

From June 2020 to May 2021 there were 2,261 NHS-funded admissions and 1,624 NHS-funded outpatient attendances at BMI the Harbour Hospital.

From 1 April 2020 to 31 March 2021 this organisation provided 1,395 private patient admissions (44.6% of all admissions) and 1,735 NHS patient admissions (55.4% of all spells).

From 1 April 2020 to 31 March 2021 BMI the Harbour Hospital carried out 1,905 private patient procedures and 1,560 NHS patient procedures.

The oncology service provided 368 chemotherapy sessions from 1 October 2020 to30 September 2021. During the COVID-19 pandemic, the service provided some chemotherapy sessions to support the local NHS trust.

The endoscopy service provided 116 gastroscopies (thin tube used to examine the inside of the oesophagus, the stomach and upper part of the small intestine), 115 colonoscopies (thin tube used to examine the large and parts of the small bowel) and 46 flexible sigmoidoscopies in the same period.

From 1 October 2020 to30 September 2021, the diagnostic service provided: 1898 MRI scans, 1242 CT scans, 799 ultrasound scans, 160 mammograms and 1903 X-rays.

Track record on safety for the period from 1 October 2020 to 30 September 2021:

One death had occurred within 30 days of surgery.

One never event had happened - A never event is a serious incident that is wholly preventable as guidance, or safety recommendations providing strong systemic protective barriers, are available at a national level, and should have been implemented by all providers. They have the potential to cause serious patient harm or death, has occurred in the past and is easily recognisable and clearly defined.

No external review or investigations have been undertaken.

There were no incidences of healthcare acquired infections.

The service received 34 formal complaints.

No Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) reportable incidents have occurred.

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 service.

Updated 7 February 2022

We carried out a comprehensive inspection of BMI The Harbour on 26 and 27 October 2021. The service was last inspected in May 2017 and was rated as good overall. BMI The Harbour provided the following services: surgery (several specialities to include general, orthopaedic and cosmetic), medical care (for example, chemotherapy and endoscopy) outpatients and diagnostic imaging. We inspected all these service during this inspection.

Diagnostic imaging and outpatients' services were also last inspected in 2017, both services were rated as ‘good’. At that time, the outpatient’s department and diagnostic imaging was inspected under one inspection framework. The Care Quality Commission (CQC) now inspects diagnostic imaging and outpatients as separate core services.

Before the inspection we reviewed information, we had about the location, including information we received and available intelligence. The inspection was unannounced.

We rated safe as requires improvement in medical care, outpatients and diagnostics imaging. In surgery it was rated as good. Effective was rated as good in surgery and medical care but is not rated in outpatients and diagnostic imaging. Caring, responsive and well led were rated as good in four services inspected.

Our rating of this location stayed the same. We rated it as good because:

• The service mostly had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff mostly assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service mostly managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to health information. Key services were mostly available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs and made it easy for them to give feedback. Patients could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and some community services to plan and manage services and all staff were committed to improving services continually.

However:

• Staff were not always following hospital guidance when wearing personal protective equipment (PPE) to reduce the risk of cross infection during some aerosol generating procedures. Cleanliness audits in some areas were not being completed in line with national guidance.
• Emergency evacuation drills were not carried out in the MRI/CT department in line with national guidance.
• Staff kept records of patients’ care and treatment, but these did not always contain up to date or legible information. Some staff had to use three different record keeping systems which meant not all care was not always clearly documented.
• Staff were not always following their own policy or national guidance when caring for patients when under anaesthetic.
• Qualified staff did not always receive clinical supervision in a timely way to maintain their skills and for managers to make sure they had the required skills. The service had been applying for national accreditation of one of their departments since 2016 and staff were not able to explain the delay.
• Not all staff were aware of the translation service provided or how to access this for patients whose first language was not English.
• Recruitment of some staff did not obtain all the required information prior to them starting work at the service. Not all staff were aware of the Freedom to Speak up Guardian role or who their local member of staff was. Not all staff had frequent staff meetings where information was shared. Some staff did not feel supported or valued in the department they worked. Some services were not always engaging with local networks for the benefit of their patients.

Updated 7 February 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service mostly controlled infection risk well and managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all staff wore COVID-19 personal protective equipment in line with the provider policy in areas where aerosol generating procedures (AGPs) (where small droplets are formed which increase the risk of transmission of airborne viruses) were carried out.
• Patient risk assessments were not always carried out by staff who had received training. It was not clear that consultants had reviewed and made a clinical decision on risks in line with hospital policy.
• The processes for documenting care and treatment delivered in oncology services were not clear. Staff used three different systems and meant care was not always clearly documented. There was a risk errors could be made as staff had to duplicate information into different patient records.
• Cleanliness audits were not carried out as often as they should be to comply with national standards.
• The endoscopy service had not completed the application process to gain national accreditation. This had been an ongoing process since 2015.

Medical services are a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was effective, caring, responsive and well-led, although safe requires improvement.

Updated 7 February 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in most key skills, understood how to protect patients from abuse, and managed safety mostly well. The service mostly controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care to patients. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week to support in-patient services.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait long for a diagnostic procedure.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities and most staff felt supported and valued.

However:

• Staff did not receive training in how to recognise a deteriorating patient, sepsis awareness and how to monitor vital observations in the event of a clinical incident.
• Processes to assess and mitigate risks of the spread of communicable diseases such as tuberculosis were not always clear.
• and fire alarm test were not always carried out when they should be.
• The service level agreement with the local trust had not been formally reviewed since 2018 but continued of a rolling term basis.
• Processes to mitigate identified risks were not always shared effectively with staff. Emergency evacuation drills were not carried out in line with national guidance.

Diagnostic services were a small proportion of hospital activity. The main service was surgical services. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was effective, caring and responsive and well led although safe requires improvement.

Updated 7 February 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. They managed medicines well.
• Staff provided good care and treatment, gave patients enough to eat and drink, and pain relief when they needed it. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, and supported them to make decisions about their care.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well. Staff felt respected, supported and valued.

However:

• Staff kept records of patients’ care and treatment but these did not always contain up-to-date or legible information.
• The service did not always ensure staff were given adequate time to complete mandatory training requirements.
• The service did not always ensure premises and equipment were visibly clean.
• The service did not ensure learning from incidents was shared.
• Team meetings did not always take place.
• Staff were not always aware of, or did not use, translation services for patients whose first language was not English.

Outpatients is a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was effective, caring, responsive and well led although safe requires improvement.

Updated 7 February 2022

Our rating of this service stayed the same. We rated it as good because:

• The service mostly had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were mostly available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for them to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all patient prescriptions were written clearly. Not all staff were following their policy and national guidance when checking patients body temperature when they were under anaesthetic. There was no specific audit on sepsis management. Staff did not receive specific training about the mental health, learning disabilities or autism.
• Not all new staff had the required information obtained prior to them starting work at the service. Interview records were not always detailed about any gaps in new staff employment history.