The Lancaster Hospital

Updated 15 October 2019

BMI The Lancaster Hospital is operated by BMI Healthcare Limited. The hospital opened in 1985 and was acquired by BMI Healthcare in 2008. It is a private hospital in Lancaster, Lancashire. The hospital primarily serves the communities of the Lancaster, Morecambe Bay and South Cumbria areas. It also accepts patient referrals from outside this area. The hospital did not treat anyone under the age of 18 years.

The hospital has had the current registered manager in post since 2017.

Updated 15 October 2019

BMI The Lancaster Hospital is operated by BMI Healthcare Limited. The hospital has 25 beds and four chairs for day-case procedures. Facilities include one operating theatre and an endoscopy suite where injections for pain are carried out, outpatients and x-ray diagnostic facilities.

The hospital provides surgery, medical care (endoscopy only), outpatients and diagnostic imaging. We inspected surgery, outpatients, diagnostics, and medical care.

We inspected this hospital using our comprehensive inspection methodology. We carried out this unannounced inspection on 14 and 15 May 2019.

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 section.

We have provided guidance for services that we rate and do not rate.

Services we rate

Our rating of this hospital stayed the same, we rated it as Requires improvement overall. We found that diagnostic imaging services and outpatients required improvement, however we found good practice in surgery services.

• The static X-ray equipment was ageing, we were told by staff that the fluoroscopy function of the equipment was no longer in working order. There were no clear timescales for when it would be replaced.

• The documentation of cleaning schedules was not consistently completed in the outpatients and diagnostic imaging departments.

• The hospital was using an administration office for weighing outpatients. Patients were weighed in front of administration and healthcare staff which impeded on the patient’s privacy and dignity

• During the previous inspection we told the provider it should consider improving the outpatient environment as it was not suitably adapted to respond to the needs of patients living with dementia. However, during our inspection we did not see an improvement in this.

• The static x-ray machine bed was not accessible to all patients. The bed had to be accessed using mobile steps as it was fixed at a high level and was not adjustable.

• Not all staff we spoke with were aware of the vision and strategy for the hospital.

• The diagnostic imaging service had Ionising Radiation (Medical Exposure) Regulations 2017 policies which were outside of their review date and some were not in line with up to date legislation.

• In diagnostic imaging we found standard operating procedures for specific diagnostic imaging procedures had been reviewed annually. However, there was no evidence of the involvement of other staff members in the review process since 2015 and staff confirmed this was the case.

• Staff told us that no meetings had taken place since March 2019 in the outpatient  and diagnostic imaging services reported that they did not have regular team meetings.

• The diagnostic imaging service did not hold regular discrepancy meetings or peer review. This meant that they were not formally evaluating the quality of the service provided and working to improve it.

However,

• The hospital provided mandatory training in key skills to all staff and made sure everyone completed it. Mandatory training compliance rates were high.

• Staff understood how to protect patients from abuse and the hospital worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

• The hospital controlled infection risk well. They used control measures to prevent the spread of infection and infection rates were low.

• The hospital had enough nursing and medical staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• The hospital provided care and treatment based on national guidance. Managers checked to make sure staff followed guidance. Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other hospitals to learn from them.

• Staff gave patients enough food and drink to meet their needs and improve their health. Patients were assessed regularly to see if they were in pain.

• The hospital made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them. Appraisal compliance rates were high across the hospital.

• Staff cared for patients with compassion and provided emotional support to minimise their distress.

• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. Patients felt well informed about their care and treatment.

• People could access the hospital when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

• The hospital treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff. Complaints were low and there was evidence of shared learning.

• Managers in the hospital had skills and abilities to run a service providing high-quality care.

• Managers across the hospital promoted a positive culture that supported and valued staff. Staff reported good team working and a sense of pride in their work.

• The hospital engaged well with patients and staff to plan and manage appropriate services. The senior leadership team was passionate about engagement with staff and patients.

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 hospital improve. We also issued the provider with two requirement notices that affected outpatient and diagnostic services. Details are at the end of the report.

Name of signatory

Anne Ford Deputy Chief Inspector of Hospitals (North West)

Updated 15 October 2019

Medical care services were a small proportion of hospital activity. This included endoscopy.

Due to the nature of the service provided and the limited activity at the time of our inspection we did not have evidence to rate medical care at the hospital.

Updated 15 October 2019

Diagnostic imaging services were available to

consultants with practising privileges who were

authorised as referrers.

We rated the service as requires improvement overall, because we identified it required improvement in safe, responsive and well led. However, we rated caring as good, we inspected but did not rate effective.

Updated 15 October 2019

Outpatient services were available for consultants

with practising privileges to refer patients.

We rated this service as requires improvement because we identified it required improvement in responsive and well led.

However, we rated safe and caring as good. We inspected but did not rate effective.

Updated 15 October 2019

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

Staffing was managed jointly with medical care.

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