The Care Quality Commission
  • Hospital
  • Independent hospital

The Harbour Hospital

Overall: Good read more about inspection ratings

St Marys Road, Poole, Dorset, BH15 2BH (01202) 244200

Provided and run by:
Circle Health Group Limited

All Inspections

26 & 27 October 2021

During a routine inspection

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.

12 May 2017

During an inspection looking at part of the service

BMI The Harbour Hospital is operated by BMI Healthcare Limited. The hospital has 30 beds. Facilities include three operating theatres, X-ray, outpatient and diagnostic facilities and an onsite pharmacy.

The hospital provides surgery, medical care, and outpatients and diagnostic imaging. We inspected surgery and outpatients and diagnostic imaging.

We inspected this service using our focussed follow up inspection methodology. We carried out the unannounced inspection on 12 May 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 service.

We rated this hospital/service as good overall.

We found areas of good practice –

  • The hospital had systems and processes in place to protect patients from avoidable harm and abuse.
  • In surgery, the surgical safety checklist was adhered to.
  • The processes for reporting, investigating and learning from incidents were well established and implemented.
  • Infection prevention and control practices were good, and staff followed hospital policies. The environment was clean and fit for purpose.
  • Medicines were managed and stored correctly; administration was in line with good practice and relevant legislation.
  • Staff assessed risks to patients and responded appropriately when individual patient’s risks increased. Staff used the early warning score to ensure early signs of deterioration in a patient’s condition were responded to.
  • The service participated in national audits where applicable and outcomes were good. The hospital was fully engaged in the Private Healthcare Information Network (PHIN) work to develop outcome measures for private patients.
  • The hospital had a comprehensive internal audit programme in place to monitor services and identify areas for improvement.
  • Staff treated patients with care, kindness and compassion and feedback about the care provided by staff was consistently positive.
  • Complaints and concerns were taken seriously, responded to in a timely way and improvements were made to the quality of care as a result.
  • Adjustments were made to meet the differing needs of individuals using services at this hospital.
  • Managers were visible, approachable and effective.
  • Staff across the hospital enjoyed their work and were proud to work at the hospital. They described an open culture and felt supported and listened to by their managers.

Following this inspection, we told the provider that it should take some actions, even though a regulation had not been breached, to help the service improve.

Action the provider SHOULD take to improve

  • The six practitioners working in theatres should complete the surgical first assistant training undertake the programme of study, as required by BMI group policy, and detailed on the risk assessment dated 11 April 2017.
  • All local risks should be captured on the ward risk register.
  • Documentation pathways should support staff with the documentation of variances during a patient procedure/ treatment.
  • The hospital should ensure patients medical and nursing records integrated, and the risk of unauthorised access to nursing records minimised.
  • The provider should reassess the radiology service continuity and major plant failure business plans on an annual basis.

Professor Edward Baker, Chief Inspector, Hospitals

2-4 & 17 September 2015

During a routine inspection

The Harbour Hospital, established in 1996, is one of 62 hospitals and treatment centres provided by BMI Healthcare Ltd.

The hospital provides a range of medical, surgical and diagnostic services. The on-site facilities include an endoscopy suite, three operating theatres (two with laminar airflow), two treatment rooms, and eight consulting rooms supported by an imaging department offering X-ray and ultrasound. The hospital offers physiotherapy treatment as an inpatient and outpatient service in its own dedicated and fully equipped physiotherapy suite. Alliance Medical Ltd, a separate organisation, provides MRI and CT scanning facilities to patients in an adjacent building. These services were not included in this inspection.

Services offered include general surgery, orthopaedics, cosmetic surgery, refractive eye surgery, gynaecology, ophthalmology, oral and maxillofacial surgery, general medicine, oncology, dermatology, physiotherapy, endoscopy and diagnostic imaging. Most patients are self-pay or use private medical insurance. Orthopaedic and ophthalmology services are available to NHS patients through NHS e-Referral Service.

The announced inspection took place between 2 and 4 September, followed by a routine unannounced visit on 17 September.

This was a comprehensive planned inspection of all core services provided at the hospital: medicine, surgery, outpatient and diagnostic imaging. There is no critical care facility or emergency department at the hospital and no maternity services. There are no services for patients under 16 years, a few outpatients are aged 16 -18 years, and the majority of patients are adults

The Harbour Hospital was selected for a comprehensive inspection as part of our routine inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

Our key findings were as follows:

Are services safe at this hospital?

  • Patients were protected from the risk of abuse and avoidable harm across medical, surgical services and diagnostic services, but safety of some outpatient services required improvement.

  • Staff reported incidents, and openness about safety was encouraged. Incidents were monitored and reviewed in most services and staff gave examples of learning from incidents. There were inconsistencies across some departments with regard to receiving feedback and learning from incidents. Outpatient department (OPD) staff were not assured reported incidents or risks were taken seriously by senior management.

  • There were infection control risks in outpatients due to the poor fabric of the treatment room, which limited effective cleaning to reduce risk of cross infection.

  • The plumes from a piece of equipment used in outpatients posed a risk to patients when used in a room without an extractor fan.

  • There were systems for monitoring infection control risks in the environment across all other services and action taken to address identified shortfalls. Clinical areas were visibly clean and tidy. Infection control practices were followed by staff and this was regularly monitored

  • Although most staff understood the principles of duty of candour regulations, they were less confident in applying the practical elements of the legislation. This included senior managers.

  • Equipment was maintained and tested, in line with manufacturer’s guidance. There were appropriate checks and maintenance on the hospital building and plant.

  • Medicines were stored securely and managed correctly

  • There was regular monitoring of patient records for accuracy and completeness. They were securely stored and available when needed.

  • Staff undertook appropriate mandatory training for their role and electronic records showed more than 90% compliance across the hospital. However, some staff reported difficulties in accessing practical mandatory training sessions due to workloads and cancelled training sessions.

  • In medical, surgical and diagnostic services, staffing levels and skill mix were assessed and managed to meet the needs of patients. In OPD there were occasions when one nurse or two healthcare assistants were on duty in the department, which posed a potential risks to patient safety. There were no assessments completed to identify the level of risk to patients or staff when this occurred.

  • There was sufficient medical cover provided by resident medical officers (RMOs) who covered the hospital 24 hours a day for all specialities. Consultants were available daily and provided on call cover and advice out of hours if necessary.

  • There were suitable arrangements for handover between shifts, and all staff attended the daily ‘huddle’ for a brief update on patients and relevant information for the day.

  • Clinical staff identified and responded to patients’ risks. They received simulation training to ensure they could respond appropriately if a patient became unwell. A sufficient number of staff were trained to provide advanced resuscitation skills.

  • Emergency business contingency plans were in place and regular fire drills practised.

Are services effective at this hospital?

  • Care and treatment followed best practice and evidence-based guidance across services.

  • The medical advisory committee was actively involved in reviewing outcomes and renewal of practising privileges of individual consultants. It also reviewed policies and guidance and advised on effective care

  • Patient outcome data was reported for comparative analysis for surgical services, but there were some gaps in this, particularly for cosmetic surgery. Surgical services performed well in national audits.

  • The collation of outcome data across medical and outpatient services was limited. BMI had applied for JAG) accreditation of endoscopy services at the hospital but data collection on outcomes had not yet started. Oncology patient outcomes were monitored at local NHS hospital cancer multidisciplinary meetings.

  • Staff were competent, skilled and knowledgeable. Surgical staff had good access to training and there were opportunities for staff to attend additional courses to extend their skills. However, some staff across services reported a lack of support in accessing training they believed would enhance the care they provided to patients in their department. Appraisal rates varied across the services.

  • Staff managed pain relief effectively using a patient scoring tool andwere trained to appropriately to patient needs.

  • Patients received a choice of meals and drinks and the chef catered for patients requiring special diets. The hospital had a contract with the local NHS trust for a dietitian and other specialist services.

  • Information about patients, care pathways and the management of the service was available to support effective care and discharge.

  • The consent process for patients was well structured, with written information provided prior to consent being given. Consent was regularly audited.

  • Staff were trained in the Mental Capacity Act 2005 and there was appropriate guidance and tools to assess patient mental capacity.

Are services caring at this hospital?

  • Staff treated patients with kindness and compassion and ensured patients had time to ask questions.

  • Staff listened and responded to patients’ questions positively.

  • Staff treated patients courteously and respectfully, and maintained their privacy and dignity.

  • Patients and relatives commented positively about the care provided and said they were involved in decision-making.

  • Staff demonstrated they were passionate about caring for patients and clearly put the patient’s needs first, including their emotional needs.

  • Results of the latest patient survey showed a high level of patient satisfaction, with the hospital scoring 98.7%.

Are services responsive at this hospital?

  • The hospital had service development plans for improvements at the hospital including meeting future demand. There were plans to develop oncology services, and the endoscopy service was undergoing improvement at the time of our inspection.

  • The hospital worked with Dorset Clinical Commissioning Group (CCG) in developing services for NHS patients.

  • Patients were able to access services when needed and we found services responsive to meeting individual needs.

  • NHS and private patients experienced the same level of care and treatment, except that NHS patients sometimes shared waiting facilities.

  • The hospital had minimal numbers of patients who could not understand English. Staff made use of translation ‘apps’ on their personal mobile telephones and were not aware of interpreter services. In outpatients, relatives were sometimes asked to help with translation. This is not a recommended practice, as it cannot be assured the patient has given consent for their medical information to be shared with their family member.

  • The hospital had a system for responding to and managing patients’ verbal or written complaints; however, the guidance on how to make a formal complaint was not always readily available or consistently given to all patients. There was evidence of learning from complaints

Are services well-led at this hospital?

  • There was a clear vision and strategy for development at the hospital, which aligned with the corporate strategic vision for high quality and convenient patient care.

  • The director of nursing and quality post had been vacant since the end of July 2015 and an action plan to implement the corporate clinical strategy had not been developed.

  • There was an interim director of nursing in post at the time of inspection; they had not had any additional training to undertake the role. A BMI regional director of nursing, who covered 15 hospitals, supported them.

  • There was a governance structure in place but attendance at some committees was patchy, due in part, to the large number and the work pressures of department leads. The provider identified that governance processes needed to be strengthened at the hospital and the governance structure was under review.

  • The medical advisory committee (MAC) membership included consultant leads across specialities. The MAC and was involved in quality assurance of medical staff and monitoring of clinical issues. There was a lack of documentary evidence of how members reviewed actions arising from the meetings.

  • There were not robust systems to monitor quality across all areas of the hospital. The senior management team tended to gain assurance of quality through knowing and working with staff, and informal discussions.

  • There were different reporting forms for clinical and non-clinical incidents and unclear classification of incidents. Leaders were not skilled in investigating incidents and complaints using root cause analysis, so opportunities for learning might be missed.

  • There was limited trend analysis of reported incidents. However, the information circulated to staff on quality and risk issues lacked clarity and focus on learning from incidents and complaints.

  • The senior management team did not consistently understand or apply the systems and processes for identification, assessment and management of risk across all departments. The hospital risk register did not capture some risks identified at inspection; others had not been identified or addressed in a timely way.

  • There were processes in place for robust recruitment of appointments to the senior management team, for example, the appointment of the substantive Director of Nursing and Quality due to start in post late September 2015.

  • The leadership team was accessible to staff and there was a positive, open culture within the service that meant staff challenged poor practice.

  • Staff valued their leaders; however, there was a lack of capacity for departmental managers to carry out their managerial tasks.

  • In June 2015, the hospital was in third place across the BMI group for patient satisfaction scores.

However, there were also areas of poor practice where the provider needs to make improvements.

Importantly, the provider must ensure:

  • incidents and complaints are appropriately investigated, for example through root cause analysis and learning identified

  • learning from investigations is appropriately shared across the hospital

  • risks are identified, assessed and managed effectively across all areas of the hospital

  • there are processes in place to effectively monitor the service provision and identify areas for improvement

  • the outpatient environment is assessed and actions taken to reduce risks of cross infection

  • risks associated with use of hyfrecator and any other equipment is assessed and appropriate action taken to reduce any identified risks

  • a record of decision-making discussions held between consultants and their patient is maintained in hospital records, as well as private patient records.

  • an assessment is made of the staffing levels in outpatients to ensure they are sufficient to meet the needs of patients and reduce risks to patients and staff

In addition the provider should ensure :

  • accessible guidance on how to make a complaint is available to all patients

  • all staff have the opportunity to contribute to annual appraisals

  • staff are aware of the practical implications of the duty of candour regulation

  • patient record templates are clear, consistent and easy for staff to use

  • policies are up to date and reflect current guidance, legislation and best practice

  • a cleaning list is maintained in endoscopy theatres that clearly demonstrates the equipment that has been cleaned, date and time when it happened, and the products used.

  • the equipment stored in the endoscopy theatre is stored elsewhere to avoid clutter and minimise risks

  • an assessment of the suitability of the outpatient environment is completed and adjustments made so that access to the storeroom is not through the treatment room

  • translation and interpreter services are available and relatives are not used to translate in medical consultations

Professor Sir Mike Richards

Chief Inspector of Hospitals

7 January 2014

During an inspection looking at part of the service

This inspection was to follow up on the shortfalls identified in record keeping at our inspection in September 2013.

We spoke with the manager, director of nursing and quality and risk manager and looked at people's records. We looked at five people's records. However, we did not speak with people who use the hospital at this inspection.

We found people were protected from the risks of unsafe or inappropriate care and treatment because information about them was kept securely and was complete and accurate.

2, 3, 12 September 2013

During a routine inspection

We spoke with nine people, nine staff, the manager and the director of nursing. We inspected the oncology ward, general ward and theatres. We were accompanied by a theatre specialist advisor. Further analysis of theatre records were undertaken by anaesthetics specialist advisor.

All of the people we spoke with were positive about their experiences at the hospital. Comments from people included; 'Brilliant I couldn't want for better', 'Excellent care and the treatment has been planned to my convenience' and, 'I'm very happy with all aspects of the hospital'.

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes. We found and people told us they experienced care, treatment and support that met their needs.

Overall, people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that there were enough qualified, skilled and experienced staff to meet people's needs.

There were effective systems in place to assess and monitor risks to people and to regularly check and monitor the care and quality of the service people received.

Overall, people's records in relation to the care and treatment provided were accurate. However, we identified some shortfalls in the records of the type of anaesthetic used, the monitoring during anaesthesia and the anaesthetic consent records.

9 January 2013

During a routine inspection

Two of the people we spoke with confirmed that they were encouraged to express their views and were involved in making decisions about their care and treatment. One told us "I talked it all through with the consultant and agreed what was going to happen. I'd come back here, anytime." The other told us "I understand exactly what my treatment is and what the problems might be. I'm on this new drug now and they explained all about the risks before I agreed to proceed."

One person told us "I did the research before I came so I knew what preparation I needed to do." Another said "I understand my condition and when I noticed my symptoms returning I knew I was getting ill again so I e-mailed my specialist and was here the next day." The care plans that we examined reflected these experiences.

We found that there were suitable arrangements in place to ensure that people were safe, through the safeguarding processes.

One qualified member of staff told us how the service had enabled them to be "fully qualified and a safe practitioner" through a scheme of post-qualification experience and learning.

One member of staff told us "We're thinking of introducing some 'you said, we did' posters to show people what we've changed as a result of what they told us." We saw evidence of service changes as a result of reviews of incidents and complaints.

10 November 2011

During a routine inspection

During our inspection visit of The Harbour Hospital on 10 November 2011 we spoke with seven people who were using the service.

Three of the people were in the hospital's outpatient department. Two of the three were having preadmission assessments and the third was attending for a regular blood test. The remaining four people of the people we spoke with were all inpatients and were recovering from various surgical procedures.

Everyone we spoke with told us that they were given information about the treatment they had or were due to receive. They told us that staff were friendly, polite, professional, considerate and respectful.

The inpatients we spoke with told us they felt safe and that the catering was good. They said they particularly appreciated the choice and quality of food that was available. They told us they received their medication for pain control when they needed it and that staff responded quickly when they required help.

Some people we spoke with had received healthcare services from the hospital several times. They told us that they were asked for their views about the service they received.

We spoke with nine of the hospital's staff during our visit in order to obtain their views. They included management staff, general and specialist nurses, a doctor/ medical officer and physiotherapist. Staff that we spoke with told us that they received induction and on going training. They said they were well supported, received regular appraisals and attended meetings where they could suggest how the service could be improved.