The Care Quality Commission
  • Hospital
  • Independent hospital

The Lancaster Hospital

Overall: Requires improvement read more about inspection ratings

Meadowside, Lancaster, Lancashire, LA1 3RH (01524) 62345

Provided and run by:
Circle Health Group Limited

All Inspections

14 to 15 May 2019

During a routine inspection

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)

25 to 26 October 2016 and 8 November 2016

During a routine inspection

BMI The Lancaster is operated by BMI Healthcare Limited. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 25 and 26 October 2016 along with an unannounced visit to the hospital on 8 November 2016. This was part of our national programme to inspect and rate all independent hospitals. We inspected the core services of surgical services and outpatients and diagnostic services as these incorporated the activity undertaken by the provider.

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-reference the surgery core service.

We rated this hospital as requires improvement because:

  • The hospital had received a Regulation 28 report from the coroner. A Regulation 28 is a report that the coroner has a duty to make where they believe action should be taken to prevent future deaths. The report highlighted areas where failings occurred and improvements were required. We found an action plan had been implemented for this but there had been elements of the action plan that had not been followed through completely.

  • We found that some areas of compliance with mandatory training were low.

  • The environment had not been suitably adapted to respond to the needs of patients living with dementia. For example signage was not clear, and there were no quiet spaces for patients who may be feeling anxious or confused.

  • The hospital had a newly appointed management team who were in the process of identifying gaps in governance and assurance. However, this process had not yet been completed and embedded fully across the hospital.

  • There were examples of where the hospital had put controls in place to mitigate the level of certain risks. However, we found that they had not always been implemented in a timely manner. Some actions that had been implemented had not always been monitored to ensure compliance had improved.

  • The governance processes did not ensure the correct or most current policies and procedures were being used. This included staff dependency tools to assess nurse staff numbers and assessments of staff competence.

In surgery we also found:

  • We observed that the ‘sign out’ phase of the 5 steps of safer surgery including the WHO surgical safety checklist was not always completed fully following a patient undergoing surgery.

  • Hand washing facilities in the inpatient ward did not meet current guidance.

  • Records indicated that some members of key staff had not been assessed for appropriate competencies before undertaking certain roles within the hospital. This was brought to the attention of the manager following the inspection and assurance was given that action would be taken.

  • Records indicated that anaesthetic equipment was not being checked on a daily basis in line with AAGBI guidelines.

  • We found that the storage of endoscopes was not compliant with Department of Health guidelines.

  • Written patient information was available in English language only.

In diagnostics and outpatients we also found:

  • There were patient records which did not have a clinical entry made on the day of consultation and the copy letter to the GP was not signed.This meant that records were not always accurate, complete and contemporaneous. This was brought to the attention of the manager following the inspection and assurance was given that action would be taken.

  • There was no separate dirty utility room in the outpatient department which meant staff were disposing of waste, such as urine samples, in the clean treatment room. A formal risk assessment had not been completed to ensure this was being managed effectively.

  • Carpeting and seating in the outpatient department did not assist in maintaining good standards of infection control. This was being addressed by the service.

We found areas of good practice including:

  • We observed all areas to be visibly clean and uncluttered.

  • The hospital had clear safeguarding policies and processes for staff to follow. Staff were able to describe what constituted a safeguarding incident and how this was reported.

  • Care and treatment was provided in line with up to date Evidence Based practice.

  • Care and treatment was delivered in a caring and compassionate way. Privacy and dignity was maintained for patients when they received care and treatment.

  • Complaints and concerns were dealt with in a timely manner and there were examples of the services provided being improved as a result.

  • The hospital had a vision and strategy which was underpinned by the overall BMI vision and strategy.

  • There was a clear leadership structure in place. Staff informed us that the new management team were visible and approachable.

  • Staff throughout the hospital described there being a friendly and open culture.

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 it move to a higher rating. We also issued the provider with two requirement notices that affected both surgery and outpatients and diagnostic services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals North.

10 September 2013

During a routine inspection

On the day of the visit we looked at the hospital facilities, spoke with the manager, staff, relatives and patients. This helped us to gain a balanced overview of what people experienced receiving treatment at the hospital.

During the inspection we looked at patients care records, staffing levels, infection control processes and how the service monitored the performance of the hospital. Comments from patients and relatives were positive and included, 'Great service from the start of my treatment to my post-operative care.' Also, 'The staff from the receptionist to the consultants have been excellent.'

We saw that the hospital had a number of internal and external audit systems in place to monitor the quality of the service provided. The manager told us they responded appropriately when they were given information of concern. They reviewed their own processes as a result of concerns raised and made amendments to their systems if required.

There was evidence the service had systems in place to keep the hospital clean and meet infection control guidance documentation. Comments from patients and staff were positive about the cleanliness of the hospital. One patient said, 'The hospital is kept clean, the staff do a great job here.'

Staff told us they enjoyed working in their particular departments, and they felt supported, both by their colleagues and the senior management team.

17 May 2012

During a routine inspection

We spoke with a range of people about the hospital. They included, the registered manager, senior staff, nurses, patients and visitors. This is in order to gain a balanced overview of what people experience.

We spoke with patients about how they were treated and support they received. They told us staff were good at discussing all their treatment options and given time to make informed decisions. Comments included, "Excellent information was provided to me all the way through my treatment." Also, "All the nurses made me feel at ease and always made sure everything was ok." One patient recently recovering from surgery said, "We went through all the stages of my treatment from the start. They were very good."

Patients and visitors spoke highly of staff and how they were treated with respect and dignity. One patient said, "All my consultations were conducted in private." Also, "Every member of staff I came across were so polite."A relative we spoke with said, "All the people here are so thoughtful and polite and treat you with respect."

Staff we spoke with told us they are supported by management. Comments included, "Most of the people working here have been here for a long time that tells you something." Also, "Everybody is so supportive it is a happy atmosphere to come to everyday."

None of the people we spoke with had any issues about the standard of care they were receiving and people told us that they would be comfortable in raising any concerns they may have.