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Inspection Summary


Overall summary & rating

Good

Updated 10 March 2017

BMI Goring Hall Hospital is operated by BMI Healthcare Limited. It is a private hospital in Goring by Sea, near Worthing, West Sussex. Ownership transferred to BMI Healthcare Limited in 1994. The hospital primarily serves the communities of West Sussex. It also accepts patient referrals from outside this area.

The hospital has had a registered manager in post since 2010.

The hospital also offers cosmetic procedures such as dermal fillers and laser hair removal, ophthalmic treatments and cosmetic dentistry. Assisted conception services are also offered with the hospital operating as a satellite to BMI Esperance Hospital, where the main unit is based. We did not inspect these services.

Our comprehensive announced inspection took place on the 16th and 17th August 2016.

The team that inspected the service comprised three CQC inspectors, and specialist advisors with expertise in theatre management, nursing, chemotherapy nursing, a consultant surgeon and consultant physician and a radiographer.

The hospital had four theatres (two of which are laminar flow, one general theatre and an endoscopy theatre). At the time of the inspection, the hospital was using 39 of its 52 registered beds. The 39 beds were spread over two main wards; Ilex (22 beds and 4 extended recovery beds) and a day surgery unit (DSU) which offered 12 beds and 4 outpatient procedure chairs. The Mulberry Oncology Suite had 4 chairs for day case chemotherapy and a single patient room for longer day care treatments. The hospital also had comprehensive outpatient facilities with 14 Consulting rooms (11 in Consulting Suite and 3 additional rooms in Main Hall), two treatment rooms (one ophthalmic and one general). The diagnostic service consists of X-ray, Ultrasound, Digital Mammography, Echocardiogram, Mobile CT and MRI on alternate days.

During the inspection, we visited all areas of the hospital. We did not visit the onsite MRI Scanner as these are provided by a third party. We spoke with 22 staff including; registered nurses, health care assistants, reception staff, medical staff, operating department practitioners, and senior managers. We spoke with 19 patients and one relative. We also received 43 ‘tell us about your care’ comment cards which patients had completed prior to our inspection. During our inspection, we reviewed 32 sets of patient records.

There were no special reviews or investigations of the hospital ongoing by the CQC at any time during the 12 months before this inspection. The hospital has been inspected four times, and the most recent inspection took place in September 2013, which found that the hospital was meeting all standards of quality and safety it was inspected against.

Activity (April 2014 to March 2015)

  • In the reporting period April 2015 to March 2016 there were 5,073 inpatient and day case episodes of care recorded at The Hospital; of these, 14% were NHS-funded and 86% other funded.

  • During the same reporting period, 47% of all NHS-funded patients and 22% of all other funded patients stayed overnight at the hospital.

  • There were 12,016 outpatient total attendances in the reporting period; of these 80% were other funded and 20% were NHS-funded.

    140 consultants worked at the hospital under practising privileges. Nineteen regular resident medical officers (RMO) worked on a rota. BMI Goring Hall employed 38.9 registered nurses, 28.5 care assistants and a total of 86 other administrative and ancillary staff, as well as having its own bank staff. The accountable officer for controlled drugs (CDs) was the registered manager.

    Track record on safety

  • One Never Event was reported during the reporting period April 2015 to March 2016. This was a near miss when an incorrect implant was handed to a surgeon but which did not came into contact with the patient. The incident was a significant risk of harm but no harm occurred.
  • Clinical incidents 274 no harm, 207 low harm, 64 moderate harm, 2 severe harm, 0 death
  • 1 serious injury but where the patient had attended several healthcare providers and the cause was not attributable to BMI Goring Hall Hospital.

0 incidences of hospital acquired Meticillin-resistant Staphylococcus aureus (MRSA),

0 incidences of hospital acquired Meticillin-sensitive staphylococcus aureus (MSSA)

0 incidences of hospital acquired Clostridium difficile (c.diff)

0 incidences of hospital acquired E-Coli

55 complaints, of which 3 were referred to the Ombudsman.

Services provided at the hospital under service level agreement:

  • Clinical and or non-clinical waste removal

  • Cytotoxic drugs service

  • Interpreting services

  • Grounds Maintenance

  • Laser protection service

  • Laundry

  • Maintenance of medical equipment

  • Pathology and histology

  • RMO provision

  • Catering

  • MRI Scanning

The inspection team was overseen by Terri Salt, Inspection manager

Inspection areas

Safe

Requires improvement

Updated 10 March 2017

We rated safe as requires improvement because:

Records made by the consultant for private patients were not retained on site with hospital records but were kept by the consultant This is a breach of regulation. You can read more about it at the end of this report.

Oncology patients seeking advice out of hours were seen on the mulberry suite by an on call chemotherapy nurse. Although emergency call bells were available in all clinical areas, this posed a risk that a lone nurse would need to care for a potentially seriously unwell patient and would not be able to seek assistance in a timely way.

There was no Standard Operating Procedure for oncology.

The staff including ward nurses and the RMO were not trained to care for acutely unwell people with cancer.

Ilex ward had twenty three side rooms of which, eight were carpeted. Carpet in a clinical environment presents a risk for infection control. The infection control risk associated with carpets had been identified, risk assessed and being appropriately managed by the provider with a planned programme for replacing the carpets and frequent steam cleaning until all carpets had been replaced.

However, we also found

  • The admission policy included patients who could be cared for on the ward with support from the critical care team (such as neutropenic patients). At the time of the inspection there was no critical care facility. This posed a risk that patients who were potentially unsuitable for care at Goring Hall were being admitted instead of being immediately referred to the local NHS trust cancer services.
  • People were protected from avoidable harm and abuse. Openness and transparency was encouraged with staff being supported to report any incidents. There were robust investigations with senior clinicians having oversight of any clinical incidents. Where mistakes occurred, these were acknowledged and apologies were given to the patient or relative.
  • There were well embedded processes and protocols used throughout the hospital to keep people safe. The theatre team provided care in line with best practice guidance, including the routine and full use of the ‘Five Steps to Safer Surgery’ Checklist. There was ‘buy in’ from the entire theatre team including anaesthetists and surgeons. The pre-assessment process and explicit admission criteria resulted in patients who could not safely be cared for at the hospital being referred to other hospitals.
  • Staff in all departments had a sound understanding of the provider child and adult safeguarding arrangements. Training completion rates were high and staff recognised when they needed to seek advice.
  • Medicines were managed safely and in accordance with national guidance. There was good oversight of medicines management and adequate pharmacist involvement to meet the needs of the patients.
  • In general, staffing levels were adequate. Although there was high agency and bank use these staff had been given a comprehensive induction and were well supervised. The senior management team used staffing planning tools to ensure that they had adequate numbers of staff, with an appropriate skills mix to provide safe care to patients.
  • There were clear arrangements in place and known to staff in the event of a major incident such as power failure or fire

Effective

Good

Updated 10 March 2017

We rated effective as good because:

In the main, peoples’ care and treatment was planned and delivered in line with current evidence based guidelines, standards and best practice. The quality of service delivery was monitored to ensure consistency of practice.

Patients had comprehensive assessments of their needs which included their clinical needs and wider preferences and support needs. The hospital was clear which patient’s needs they were able to meet and which patients would benefit from a referral to a hospital better suited to their individual circumstances.

The hospital participated in national and local audits. Some data was collected and submitted to national programmes but for some audits there was insufficient numbers to allow comparative outcomes. Local audits were used to drive service improvements, to reduce risks such as from cross infection and to improve patient outcomes.

The provider supported the professional development and learning of staff and had used this as a recruitment tool as well as to improve patient care. The appraisal rate was high across all staff groups. Consultants with practicing privileges were required to provide evidence that they had a valid NHS appraisal annually. Where this was not provided, a reminder was sent and if necessary, practicing privileges were suspended until the documents were supplied.

Pain was well managed, with patients reporting adequate analgesia during endoscopic procedures and post-surgery.

Consent was obtained in line with national and GMC guidance. Staff always obtained verbal or implied consent before providing care or treatment. Written consent was obtained from the patient by the consultant undertaking the procedure. A discussion took place about potential complications, risk and expected outcomes with each patient and this was recorded on the consent form. Consent was checked again as part of the patient’s preparation for surgery. Staff had completed training and could demonstrate an understanding to their responsibilities in respect of the Mental Capacity Act 2005.

However, we also found the following issues that the service provider needs to improve:

  • Multidisciplinary review of patients with cancer was not taking place in accordance with NICE Guidelines.
  • The RMOs who provided on site medical care for admitted cancer patients had no specialist training in oncology and ward staff were not trained to care for severely neutropenic patients. The patient’s oncology consultant was available to give advice by telephone to discuss the treatment options but emergency care was led by the RMO.

Caring

Good

Updated 10 March 2017

We rated caring as good because:

Patients were treated with dignity and respect and were supported to be partners in their care. If patients wished, relatives were also included in discussions about care and treatment.

Feedback from patients across the hospital was very positive. All the patients that we spoke with were pleased with the quality of care they received and the attitude of staff.

Staff took time to make sure people understood what they were being told and that they had the opportunity to ask questions, where they wanted something clarifying.

Responsive

Good

Updated 10 March 2017

We rated responsive as good because:

Services were planned and delivered in a way that met people’s needs and preferences. The needs of different people were taken into consideration when planning and delivering services. There were well developed relationships with the local clinical commissioning group who purchased a significant amount of treatments from BMI Goring Hall Hospital.

The provider was very aware of which patients it could safely provide care for and whose needs they were able to meet. There were specific criteria that prevented inappropriate admissions being accepted. Breaches of the criteria were not tolerated.

Services were delivered in a timely way, with no delays in patients accessing diagnostic tests or treatment. The provider met the referral to treatment times for all specialities it provided.

The hospital staff were very kind in the way they responded to individual needs, fears, wishes and preferences. They served a predominantly ageing patient base and understood that this group were often reluctant to show they needed or wanted assistance. Staff provided support without patronising and appeared genuinely responsive to individual needs.

The response to complaints was a strength of the service, with senior oversight of all complaints. The investigations were robust and responses showed compassion and a pragmatism that allowed local resolution in most cases. The hospital director offered to meet with complainants to discuss their concerns.

However

  • Support services for patients having chemotherapy were not available on site. Patients wanting wigs or advice on coping during cancer treatment were signposted to the Macmillan centre at the local NHS trust.

Well-led

Good

Updated 10 March 2017

We rated well-led as good because:

From senior management team to local leadership, managers were held in high regard by the staff. The senior management team had a real grip and understanding of how services were being provided, what their strengths were and where they needed to bring about improvements.

There was a clear vision for the service with the corporate vision providing an overarching perspective that was used to build a local strategy that was known and understood by the staff. The staff at all levels talked to us about the quality of the patient experience being central to how they wanted to develop. They talked about planned projects and timescales for these.

The Hospital Director and Director of Nursing both had a wide and deep knowledge of their hospital and their sense of ownership was clear. There was little we asked that they could not immediately answer. The Director of Nursing in particular knew every complaint, every incident, every staff member, every audit result for the preceding year and was able to talk to us about these in detail.

The senior team’s knowledge was supported by strong formal governance arrangements. The reporting process was clear and lines of accountability were known to all. There was a good relationship with the MAC chair who worked closely with the senior management team and provided oversight of the consultants working at the hospital.

Theatre management was strong with evidence of good planning and oversight of the procedures being undertaken. The theatre staff were an effective gatekeeping service that ensured only patients whose needs could be met at the hospital were added to theatre lists.

However,

There was no strategy for cancer services at the hospital. There was no Standard Operating Procedures for cancer services at the hospital.

The leadership of the oncology service was not clear and the lead consultant was not providing leadership to the wider oncology staff team.

The MAC had not considered or identified risks around the cancer provision at the hospital.

The lead oncology nurse had a very wide remit and insufficient clarity about their role.

Checks on specific services

Medical care (including older people’s care)

Updated 24 July 2018

Summary of service

The hospital had clear standard operating policies for the admission of unwell patients who had received chemotherapy in the previous 21 days. A specialist cancer nurse and oncology consultant provided advice to patients and staff caring for cancer patients via a mobile phone. The hospital had agreed a cancer strategy for 2018 – 2020 and operational policy for Mulberry Suite.

We reviewed six patient notes and found each set of notes contained a record of a cancer patient multidisciplinary meeting discussion, which was safe practice. In general, the team followed the United Kingdom Oncology Nursing Oncology Group triage tool for assessing unwell patients following chemotherapy treatment.

A medical cancer lead had been appointed to represent cancer within the Medical Advisory Committee and Clinical Governance Committee. The cancer service was on the standing agenda for the Medical Advisory Committee and Clinical Governance Committee, which had raised the profile of the cancer service within the hospital.

The BMI cancer cluster had appointed a lead and links were being formed across the organisation to ensure the team had peer support. The cancer team met regularly to discuss current issues within the cancer service.

Outpatients and diagnostic imaging

Good

Updated 10 March 2017

  • The hospital had systems and processes in place to keep patients free from harm.

  • Infection prevention and control practices were in line with national guidelines.

  • Areas we visited were visibly clean, tidy and fit for purpose. The environment was light, airy and comfortable.

  • Medicines were stored in locked cupboards and administration was in line with relevant legislation.

  • Staff kept medical records accurately and securely in line with the Data Protection Act 1998.

  • The hospital had a comprehensive audit programme in place to monitor services and identify areas for improvement.

  • The outpatient and diagnostic imaging services had sufficient numbers of appropriately trained competent staff to provide their services.

  • Staff completed appraisals regularly and managers encouraged them to develop their skills further.

  • Staff interacted with patients in a kind, caring and considerate manner and respected their dignity. Patients told us they felt relaxed when having their treatment.

  • The hospital was responsive to the needs of the local populations. Appointments could be accessed in a timely manner and at a variety of times throughout the day.

  • Managers were visible, approachable and effective.

However:

  • The hospital did not keep a record of consultations for private patients attending the outpatient departments

    .

Surgery

Good

Updated 10 March 2017

Surgery was the main activity of the hospital. We rated surgery as good because;

  • Patients who used the service experienced safe, effective and appropriate care and treatment and support that met their individual needs and protected their rights.

  • The care delivered was planned and delivered in a way that promoted safety and ensured that peoples individual care needs were met. We saw patients had their individual risks identified, monitored and managed and that the quality of service provided was regularly monitored.

  • We found the clinical environments we visited and other communal areas in the hospital meticulously cleaned. Hospital-acquired infections were monitored and rates of infection were of a statistically acceptable range for the size of the hospital.

  • Outcomes for patients were good and the department followed national guidelines.

  • Complaints were investigated and handled in line with standard policy. We saw the hospital use patient’s complaints and comments used as a service improvement tool and the hospital actively encourage feedback from its patients and their relatives or loved ones

  • We saw theatre staff were fully compliant with the World Health Organisation (WHO) five steps to safer surgery surgical checklist.

  • Surgical theatres equipment was available and working correctly.

  • The surgical theatres were well managed and managers had gained the trust and support of their staff and also had good working relationships with senior staff at the hospital

  • The morning Huddle was an effective way to plan for the day ahead and learn from the previous day’s events. A record of what was covered in these meetings was also kept.

  • Staffing levels in surgical theatres were very close to full time equivalent (FTE) complement. This had been achieved by converting bank and agency staff into permanent staff.

  • We saw that there was an open culture among staff for reporting incidents and a commitment to learn from them.

  • The hospital had clear and robust policies and protocols for cleaning and infection prevention and control

  • Patients were overwhelmingly positive about the level of care they received from all staff from the beginning of their contact with the hospital to the end.

However:

  • There was Insufficient storage space in theatres.
  • During working hours the drug cupboards in the recovery unit were left unlocked

    and intravenous fluids were not locked away.