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BMI The Cavell Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 20 August 2019

BMI The Cavell Hospital is operated by BMI Healthcare Limited. The hospital provided inpatient and day care services and had a total of 27 beds. hospital has two theatres, endoscopy, phlebotomy and minor operations room, outpatients and diagnostic imaging department.

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

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 8 to 9 April 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 level.

Services we rate

Our rating of this hospital improved. We rated it as good overall.

We found the following areas of good practice:

  • Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Staff used control measures to prevent the spread of infection. The treatment and consultation rooms we saw were clean. Trolleys were also clean.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The service planned and provided services in a way that met the needs of local people.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with staff. We were given examples where the service had learned from complaints. Patients told us that when something was not to their satisfaction and they raised it with staff, the response was constructive and helpful.
  • The service took account of patients’ individual needs.
  • The service had a vision for what it wanted to achieve. The strategy was developed by the corporate senior management team, with objectives cascaded to the hospital teams.
  • The service managed and used information to support its activities, using secure electronic systems with security safeguards. The service worked to good information governance processes.
  • The service engaged well with patients and staff, the public and local organisations to plan and manage appropriate services.

However, we also found areas of practice that require improvement:

Medical Care

  • The service lacked an effective system to assess, respond to and manage risks to oncology patients during out of hours including medical emergencies. For example, the oncology 24 hours help line was not always staffed by appropriately trained oncology staff.
  • Not all staff had received an annual appraisal. Current appraisal rates for nursing staff were 75% which was below the hospital standard of 90%. This was still an on-going issue and no improvement noted since the last inspection. The hospital aimed to complete staff appraisal by June 2019.
  • The hospital wide pain audits showed low compliance in the completion of pain assessment.
  • The nurses working in the endoscopy unit had not been endoscopy trained.
  • There was low morale among the endoscopy staff due to insufficient break times when the clinics were over booked and the lack of an endoscopy lead. There was a vacancy for the new role of an endoscopy clinical support manager.

Surgery

  • There continued to be some issues where records were not always available, clear or up-to-date, especially in pre-operative assessment.
  • The service did not always have enough permanent nursing staff. During our inspection there were not enough permanent staff members in pre-operative assessment.
  • Not all staff received an annual appraisal. The hospital standard was 90% and the service reported 70% of theatre staff completed an annual appraisal. On the ward, 76% of nursing staff completed an annual appraisal. Annual appraisal rates for healthcare assistants was 60% on the ward.

Outpatients

  • Although the service followed best practice most of the time, we found some issues with the storage of medicines. Resuscitation trolleys were not in a temperature controlled area as advised by the pharmacist due to the storage of medicines on them. Sachets of fluids were found on nurse trolleys kept in treatment rooms that were not temperature controlled.
  • Not all staff were not aware of the General Data Protection Regulation 2016 (GDPR).
  • Patients were not always kept informed of delayed appointment times. Waiting times for clinics were not displayed in waiting areas.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 20 August 2019

We rated safe as good because:

  • The service had established systems for reporting, investigating, and learning from incidents and serious adverse events. There was an improved open culture of reporting incidents and learning was shared with staff to make improvements.
  • Staff understood how to protect patients from abuse and the service 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 service controlled infection risk well. Staff kept the equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service had suitable premises and equipment and looked after them well.
  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

However:

  • The service lacked an effective system to assess, respond to and manage risks to oncology patients during out of hours including medical emergencies. For example, the oncology 24 hours help line was not always staffed by appropriately trained oncology staff.
  • Although the service in outpatients followed best practice most of the time, we found some issues with the storage of medicines. Resuscitation trolleys were not in a temperature-controlled area as advised by the pharmacist due to the storage of medicines on them. Sachets of fluids were found on nurse trolleys kept in treatment rooms that were not temperature controlled.
  • There continued to be some issues where records were not always available, clear or up-to-date, especially in pre-operative assessment.
  • The service did not always have enough permanent nursing staff. During our inspection there were not enough permanent staff members in pre-operative assessment.

Effective

Good

Updated 20 August 2019

We rated effective as good because:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff assessed and monitored patients regularly to see if they were in pain. They supported patients, used suitable assessment tools and gave additional pain relief to ease pain.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

Caring

Good

Updated 20 August 2019

We rated caring as good because:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.

Responsive

Good

Updated 20 August 2019

We rated responsive as good because:

  • The service planned and provided services in a way that met the needs of local people.
  • The service took account of patients’ individual needs.
  • People could access the service when they needed it.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

However,

  • At the last inspection we found that the hospital did not monitor patients’ waiting times from the time to arrival to the appointment. At this inspection patients told us that waiting beyond appointment times was common, often for long periods of up to an hour. They felt they received a good service from the doctors and did not mind if the doctor was delayed or overrunning but just wanted to be informed of this. Waiting times for clinics were not displayed in waiting areas. There was a notice on display at the reception desk that advised patients to report to reception if they had been waiting more than 20 minutes. This was an action taken from a complaint regarding waiting times.
  • There was an access policy that required six weeks’ notice of any clinic cancellation. We were told this was difficult to implement, as clinics were cancelled at late notice.

Well-led

Good

Updated 20 August 2019

We rated well-led as good because:

  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.
  • The service had a vision for what it wanted to achieve. The strategy was developed by the corporate senior management team, with objectives cascaded to the hospital teams.
  • The service managed and used information to support its activities, using secure electronic systems with security safeguards. The service worked to good information governance processes.
  • The service engaged well with patients and staff, the public and local organisations to plan and manage appropriate services.
  • Following the inspection the provider made immediate plans to enhance the capability of its staff in dealing with the clinical management of oncology.

However:

  • Not all staff were not aware of the General Data Protection Regulation 2016 (GDPR).
  • There was low morale among the endoscopy staff due to insufficient break times when the clinics were over booked and the lack of an endoscopy lead. There was a vacancy for the new role of an endoscopy clinical support manager.
Checks on specific services

Medical care (including older people’s care)

Good

Updated 20 August 2019

We rated this service as good overall and good in each domain of safe, effective, caring,

responsive and well-led.

Surgery

Good

Updated 20 August 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 on wards was managed jointly with medical care.

We rated this service as good overall and good in each domain of safe, effective, caring, 

responsive and well-led.

Outpatients

Good

Updated 20 August 2019

We rated this service as good overall because it was safe, caring, and responsive and well-led. We do not rate the effective domain in outpatients.