The Droitwich Spa Hospital

BMI The Droitwich Spa Hospital was purpose built and constructed in 1985. In 2013, the hospital opened an additional wing, which provided additional bedrooms and consulting rooms. The hospital has 46 registered beds, three operating theatres, 11 outpatient consulting rooms and an endoscopy suite.

The hospital provides outpatient consultations and a range of surgical procedures for adults aged 19 and over, to privately funded, insured and NHS patients.

We carried out this comprehensive inspection, as part of our national programme to inspect and rate all independent hospitals under our new methodology. We carried out an announced inspection of BMI The Droitwich Spa Hospital on the 16, 17 of August 2016 and an unannounced inspection on 31 August 2016.

We did not inspect the MRI or CT scanning services as these are provided and managed by another registered provider.

Our key findings were as follows:

We rated the hospital as requires improvement overall, with surgery rated requires improvement and outpatients and diagnostic imaging rated as good. Three of the five key questions we always ask, namely is the hospital effective, caring and responsive were rated as good overall, with safe and well-led rated as requiring improvement.

Are services safe at this hospital/service?

• The provider did not have robust procedures to ensure that invasive equipment (naso-endoscopes) were decontaminated in line with national guidance.
• Clinical areas were observed to be clean and tidy. However, we did observe some individual instances of poor infection control and prevention practice.
• The service complied with the completion of the five steps to safer surgery checklist. However, consultants had to be encouraged by the theatre nursing team to complete this in a consistent way.
• Clinical areas at the hospital that had not been refurbished were not compliant with current Health Building guidance.
• The hospital did not have an in-date service level agreement with local hospitals regarding the emergency transfer of patients should they deteriorate and require additional intervention. However, subsequent to our inspection, the hospital has provided a copy of an SLA for transfer of critically ill patients to a nearby NHS trust, signed in January 2017.
• We found that safe medicines management procedures were not consistent with hospital policy at all times, in the operating theatres. However, the issues we identified had been rectified at our unannounced inspection.
• The director of clinical services was the lead for safeguarding at the hospital and was trained to level three in both safeguarding children and vulnerable adults. There were arrangements in place to safeguard adults from abuse that reflected relevant legislation and local requirements. Staff knew how to recognise and report a safeguarding incident.
• Patient safety was monitored and incidents were investigated to assist learning and improve care. Staff had awareness of the importance of the duty of candour regulation.
• Handovers were well structured within the service with both safety and resuscitation huddles taking place each morning in theatres and on the ward.

Are services effective at this hospital/service?

• Patients received care according to national guidelines such as National Institute of Health and Care Excellence (NICE) and Royal College of Surgeons.
• Patients had their needs assessed, care goals identified, care planned and delivered in line with evidence-based guidance, standards and best practice.
• Policies and procedures reflected current guidelines and adherence was monitored with a schedule of local audits. There was evidence of actions and audit results being shared with staff.
• There were processes and procedures in place for staff to manage patients’ pain and ensure that patients’ nutrition and hydration needs were met.
• Staff were aware of their responsibilities surrounding consent and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA).
• There were effective arrangements for the admission and discharge of patients. Discharge planning began during the pre-operative assessment process.
• All personal files of consultants with practising privileges at the hospital contained details of indemnity insurance and evidence of registration with the GMC. However, out of 151 consultants with practising privileges, 51 consultant’s files required their biennial review, as per the hospital’s policy. This meant that we could not be assured that all the practising agreements terms were being met.
• Staff appraisal rates were low within theatres. We saw that 35% of registered nurses and 40% of operating department practitioners had received their annual appraisal.

Are services caring at this hospital/service?

• Patients were unanimously complimentary about the care they had received. This was also reflected in the positive feedback in patient satisfaction surveys.
• Patients felt that they were part of the decision making process regarding their treatment plan. We saw that staff provided an unhurried approach and treated patients with respect.
• Patient’s privacy and dignity was maintained at all times during our inspection.
• There were appropriate arrangements to support and meet the emotional and spiritual needs of patients including an open visiting policy and access to chaplaincy.

Are services responsive at this hospital/service?

• Patients’ specific requirements such as learning disabilities or mental capacity issues were identified at pre assessment. This included screening for patients living with dementia to ensure appropriate arrangements were made to meet individual patient needs, such as longer appointments or arrangements for relatives or carers to stay with them in hospital.
• The hospital met its national (admitted) target with 94% of NHS funded patients being treated within 18 weeks from referral.
• Patients had short waiting times in departments prior to consultations or appointments.
• Complaints were handled effectively and confidentially. Themes from complaints were communication of fees and consultant’s attitude. We saw that action had been taken to address these issues.

Are services well led at this hospital/service?

• Practising privileges were not being reviewed as per hospital policy. This meant the appropriate systems and processes were not the in place to ensure consultants with practising privileges met required standards to practice.
• Leaders had not ensured that there was an in-date service level agreement in place for patients who became critically ill and required transfer to a local NHS hospital. Subsequent to our inspection, the hospital provided a copy, confirming that this was now in place (January 2017).
• There were improvements that were required related to infection prevention, medicines management and storage at the hospital. We could not always be assured that identified quality and performance issues were being addressed.
• The hospitals risk register was at a corporate level. This meant that it did not always describe risks found at a local or departmental level.
• The vision and values were clearly displayed in the hospital and had been shared with staff across the ward and theatre areas. Most staff had an awareness of these and knew where to find the information.
• There was clear and visible leadership at both an executive and head of department level. Staff including administrators, nurses and catering staff told us they were highly motivated and felt valued and supported by their immediate line managers
• The team safety “huddle’ meeting, had been introduced within the hospital to improve communication across departments. This appeared to have been positively received by staff from different departments and disciplines.

Importantly, the provider must:

• Implement procedures to ensure that invasive equipment (naso-endoscopes) are decontaminated in line with national guidance.
• Ensure that all members of clinical staff work within infection prevention and control guidelines.
• Ensure that all staff consistently participate and complete the five steps to safer surgery checklist.

In addition the provider should:

• Ensure the safe management of medicines at the hospital complies with policy and guidelines. This includes the procedure for managing the medicine keys within the ward area.
• Ensure all staff receive a regular appraisal to support and promote development.
• Ensure all consultants practising privileges are reviewed in line with company policy
• Ensure that sinks and taps which conform to Health Building Note 00-10 Part C Sanitary Assemblies are available in clinical areas to allow correct hand hygiene practice.
• Ensure carpets in clinical areas are replaced with flooring that meets the requirements of Health Building Note (HBN) 00-09: Infection control in the built environment.

Professor Sir Mike Richards

Chief Inspector of Hospitals