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BMI The Clementine Churchill Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 24 December 2019

BMI The Clementine Churchill Hospital is operated by

BMI Healthcare Limited.

The hospital has 121 beds. Facilities include five operating theatres, an endoscopy suite, a minor procedures unit, six-bed level two and three critical care unit, outpatients and diagnostic imaging facilities.

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

The hospital provides services to adults and young adults over the age of 16; both private and NHS patients, as well as a paediatric non-interventional outpatients’ service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 3 September 2019 to 5 September 2019 for outpatients, medical care and surgery and an unannounced inspection of critical care and diagnostic imaging services on 29 and 30 October 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.

Where our findings for outpatients and diagnostic imaging also apply to services for children and young people, we do not repeat the information but cross-refer to the outpatients and diagnostic imaging sections of the report.

Our rating of this hospital improved. We rated it as

Good

overall.

  • 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 hospital controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The hospital managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

  • At our last inspection, we identified various concerns related to infection prevention and control (IPC). At this inspection we found that IPC had improved across services and staff took measures to reduce the risks of infection. Surgical wards no longer had carpeted flooring and were now compliant with infection control guidance. All areas of the intensive care unit were visibly clean and free from dust. This had improved since the last inspection.

  • 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 available seven days a week.

  • The endoscopy service had received Joint Advisory Group on gastrointestinal endoscopy (JAG) accreditation in March 2019.

  • 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 hospital 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 services when they needed it and did not have to wait too long for treatment.

    The hospital had dementia champions who could provide staff with advice and support to help care for patients living with dementia.

  • At our last inspection we were told by staff that they had difficulty accessing diagnostic imaging services. At this inspection we were told by staff that they did not experience difficulty accessing these services and there were protected slots for inpatients.

  • 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.

However:

  • In outpatients, we found patient notes were filed untidily, were not always complete and were difficult to follow.

  • In diagnostic imaging, here was no clear signage warning people of the MR controlled access area and no additional locked door separating the waiting area from the controlled access area. This meant there was a risk that unauthorised persons could access the MR controlled access area. This was on the department’s risk register.

  • In diagnostic imaging, not all staff competencies and patient group directions were fully signed by the relevant staff members.

  • The service was not meeting all of the building standards for critical care services. This was on the department’s risk register. However, it should be noted this requirement is for new units only.

  • We were not assured in the event of an outreach call and/or emergency resuscitation call the intensive care unit would have appropriate medical cover. This was due to the unit’s resident medical officer (RMO) holding multiple roles. There was also no documented escalation procedure in place to show how the ward was medically covered if the RMO was called out.

  • We were not assured there was appropriate medical cover on the intensive care unit at all times. In addition, consultants were working over 24 hour periods which was against national guidelines.

  • We noted that for two of the five notes we checked in critical care, we could not identify if a daily ward round had happened. Therefore, we were not assured ward rounds were happening for all patients.

  • Agency usage in critical care was above the recommended 20% in some months. This was on the department's risk register.

  • Physiotherapy and pharmacy were not able to attend daily ward rounds on the intensive care unit due to staffing issues, which was not compliant with Guidelines for the Provision of Intensive Care Services. The pharmacy team also did not have a suitable post graduate qualification for critical care pharmacy.

  • The intensive care unit still did not have a follow up clinic where patients could reflect upon their critical care experience and be assessed for progress which was not in line with the Guidelines for the Provision of Intensive Care Services.

  • We found that the BMI practising privileges policy and the BMI care of the deteriorating patient policy did not align. The hospital was following the BMI practising privileges policy which stated that consultants and anaesthetists retained responsibility for their patient for the patient’s entire clinical pathway. However, the BMI care of the deteriorating patient policy stated that there should be an anaesthetist rota in place. Both policies had been reviewed in January 2019, but the discrepancy had not been picked up. The hospital subsequently informed us that this discrepancy had not been identified by the corporate provider’s National Clinical Governance Board who were responsible for these policies. The hospital had also not identified or escalated this discrepancy to the corporate governance board but told us that they had escalated the issue of the anomaly following our inspecti

    on.

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, to help the service improve. We also issued the provider with a requirement notice. Details are at the end of the report.

Nigel Acheson,

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 24 December 2019

Our rating of safe improved. We rated it as Good because:

  • Services 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.
  • Staff assessed risks to patients, acted on them and kept good care records. At our last inspection, we had concerns that staff were not assessing patients after a fall. During this inspection, we found the hospital had improved this process.
  • Services managed medicines well.
  • Services managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • The phlebotomy environment was newly renovated and now provided ample space for safe working.
  • We found that infection, prevention and control had improved across services and staff took measures to reduce the risk of infection.
  • Surgical wards no longer had carpeted flooring and was now compliant with infection control guidance.
  • All areas of the intensive care unit were visibly clean and free from dust. This had improved since the last inspection.
  • At our last inspection we were told by staff that they had difficulty accessing diagnostic imaging services. At this inspection we were told by staff that they did not experience difficulty accessing these services and there were protected slots for inpatients.

However:

  • In outpatients, we found patient notes were filed untidily, were not always complete and were difficult to follow.
  • In diagnostic imaging, there was no clear signage warning people of the MR controlled access area and no additional locked door separating the waiting area from the controlled access area. This meant there was a risk that unauthorised persons could access the MR controlled access area. This was on the department’s risk register.

  • The service was not meeting all of the building standards for critical care services. This was on the department’s risk register.
  • We were not assured in the event of an outreach call and/or emergency resuscitation call the intensive care unit would have appropriate medical cover. This was due to the unit’s resident medical officer (RMO) holding multiple roles. There was also no documented escalation procedure in place to show how the ward was medically covered if the RMO was called out.
  • We were not assured there was appropriate medical cover on the intensive care unit at all times. In addition, consultants were working over 24 hour periods which was against national guidance.
  • We noted that for two of the five notes we checked in critical care, we could not identify if a daily ward round had happened. Therefore, we were not assured ward rounds were happening for all patients.
  • Agency usage in critical care was above the recommended 20% in some months. This was on the department's risk register.

Effective

Good

Updated 24 December 2019

Our rating of effective improved. We rated it as Good because:

  • 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. New staff received a comprehensive week-long hospital induction and completed competency booklets.
  • 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.
  • The endoscopy service had received Joint Advisory Group on gastrointestinal endoscopy (JAG) accreditation in March 2019.
  • Adherence to and understanding of NICE guidelines was embedded and evidenced through the use of audit programmes to benchmark practice. The service provided care and treatment based on national guidance and evidence-based practice
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

However:

  • Physiotherapy and pharmacy were not able to attend daily ward rounds on the intensive care unit due to staffing issues, which was not compliant with Guidelines for the Provision of Intensive Care Services. The pharmacy team also did not have a suitable post graduate qualification for critical care pharmacy.

Caring

Good

Updated 24 December 2019

Our rating of caring stayed the same. We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
  • Staff provided emotional support to patients, families and carers.
  • Staff took time to interact with patients and those close to them in a respectful and considerate way. We observed staff greet patients appropriately and introduce themselves by name.
  • BMI friends and family test scores were consistently high in all services.
  • Patients spoke positively about the care they received and how they were treated on the ward. Patients told us staff were respectful and provided them with space to ask questions about their care.

Responsive

Good

Updated 24 December 2019

Our rating of responsive stayed the same.We rated it as Good because:

  • 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.
  • The hospital had dementia champions who could provide staff with advice and support to help care for patients living with dementia.
  • Staff told us they would ensure they respected cultural preferences for example, they told us they always checked if a patient needed a female interpreter.

However:

  • Patient information leaflets were not on display in different languages or formats but were available on request.

  • The critical care service still did not have a follow up clinic for patients following discharge from the hospital which was not in line with Guidelines for the Provision of Intensive Care Services.

Well-led

Good

Updated 24 December 2019

Our rating of well-led stayed the same.We rated it as Good because:

  • 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, staff and the community to plan and manage services and all staff were committed to improving services continually.
  • There were clear lines of management in all services.
  • Staff reported an open and honest culture and told us they felt able to raise concerns with their manager.
  • The senior management team were visible throughout the hospital and were actively involved in the daily management of services.

However:

  • We found that the BMI practising privileges policy and the BMI care of the deteriorating patient policy did not align. The hospital was following the BMI practising privileges policy which stated that consultants and anaesthetists retained responsibility for their patient for the patient’s entire clinical pathway. However, the BMI care of the deteriorating patient policy stated that there should be an anaesthetist rota in place. Both policies had been reviewed in January 2019, but the discrepancy had not been picked up. The hospital subsequently informed us that this discrepancy had not been identified by the corporate provider’s National Clinical Governance Board who were responsible for these policies. The hospital had also not identified or escalated this discrepancy to the corporate governance board but told us that they had escalated the issue of the anomaly following our inspection.
  • We found one risk which was not on the critical care service's risk register. The resident medical officer held multiple roles including outreach and resuscitation at the same time which meant that in the event of an emergency this could leave the intensive care ward with no medical cover.
Checks on specific services

Medical care (including older people’s care)

Good

Updated 24 December 2019

Medical care services were a small proportion of hospital activity.

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

Critical care

Good

Updated 24 December 2019

Critical care services were a small proportion of hospital activity. The hospital has a six-bed intensive care unit providing level two and level three care.

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

Surgery

Good

Updated 24 December 2019

Surgery was the main activity of the hospital. Staffing was managed jointly with medical care. We rated this service as good because it was safe, effective, caring, responsive and well led.

Services for children & young people

Good

Updated 24 December 2019

Services for children and young people were a small proportion of hospital activity within the outpatients and diagnostic imaging service.

We rated this service as good because it was safe, effective, caring, responsive and well led. We did not have sufficient evidence to rate effective and caring. 

Diagnostic imaging

Good

Updated 24 December 2019

Diagnostic imaging was one of the main services of the hospital’s activity. We rated this service as good because it was safe, effective, caring, responsive and well led. 

Outpatients

Good

Updated 24 December 2019

The outpatients department was one of the main services of the hospital’s activity. We rated this service as good because it was safe, effective, caring and responsive and well led.