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BMI The Highfield Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 23 September 2019

BMI The Highfield Hospital is operated by BMI Healthcare Limited. The hospital/service has 43 beds plus three ambulatory pods, which in total hold 12 ambulatory chairs. Facilities include four operating theatres, three of which have laminar flow, two wards, an X-ray department, outpatient and diagnostic facilities and an house pharmacy service provision for inpatients and outpatients

The hospital provides surgery, services for adults aged 18 and over, outpatients and diagnostic imaging. We inspected surgery, diagnostic screening and outpatients.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 2 and 3 July 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

We rated this service as Good overall.

  • 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 in the surgery and outpatient departments were high.
  • 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.
  • However, we also found the following issues that the service provider needs to improve:
  • 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.
  • Intra-operative temperatures were not being routinely recorded and this was not in line with recognised guidelines and we could not be assured that patients were being kept at an optimum temperature for surgery and protected from hypothermia.
  • Staff within diagnostics had not had an annual appraisal.
  • Not all risks identified during the inspection were recorded on a risk register and risk assessments in the diagnostic department required updating. The service did not currently record the radiology report turnaround times which was raised in the Care Quality Commission’s report ‘radiology review’ published in July 2018.

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 one requirement notice. Details are at the end of the report.

Name of signatory

Ann Ford, Deputy Chief Inspector of Hospitals (North West)

Inspection areas

Safe

Good

Updated 23 September 2019

We rated safe as Good because:

  • There were high levels of compliance with mandatory training, including safeguarding training.

  • There were high levels of compliance in cleanliness and hand hygiene audits.

  • All areas of the hospital and equipment were visibly clean and storage rooms were well ordered.

  • There were appropriate procedures and pathways in place to recognise and manage the deteriorating patient and to ensure they were transferred to the NHS hospital in a timely way, if required.

  • Surgical safety checklists were being carried out in accordance with recognised best practice guidelines to ensure the safety of the patient during surgery.

  • There were sufficient trained nursing, support and medical staff, with an appropriate skill mix, to ensure that patients were safe and received the right level of care.

  • Patient records were well-structured and legible.

  • Staff knew how to report incidents, incidents were being recorded at the right level of severity and were investigated and reviewed appropriately.

  • Radiographer staff provided a twenty-four hour on call service seven days a week for urgent imaging requests.

However:

  • Intra-operative temperatures were not being routinely recorded and this was not in line with recognised guidelines and we could not be assured that patients were being kept at an optimum temperature for surgery and protected from hypothermia.

  • Some equipment in the diagnostics department was not labelled with, ‘I am clean stickers’ to show when it was last cleaned.

  • The flooring area in the main buildings imaging department was cracked in the imaging reception area and was visibly damaged in the cubicle changing area.

Effective

Good

Updated 23 September 2019

We rated effective as Good because:

  • Care and treatment was evidence based and policies and procedures included up to date recognised guidance.

  • The hospital participated in national benchmarking clinical audits. Patient outcome measures were submitted to national databases where appropriate.

  • Pain relief management was good and patients were offered a preference of post-operative pain relief.

  • Staff had opportunities to undertake additional formal learning activities.

  • Staff worked well together as a multidisciplinary team to provide good care and outcomes for patients.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and Mental Capacity Act 2005.

However:

  • Patients were not fully supported in pain management post-discharge and follow-up calls were not generally being to patients within 48 hours of discharge from the hospital.

  • There was no formal quality assurance process for peer reviewing of images. The new clinical services manager had added this to their action plan.

  • Diagnostics staff had not received an appraisal in the last 12 months.

Caring

Good

Updated 23 September 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 involved patients and those close to them in decisions about their care and treatment.

  • Staff provided emotional support to patients to minimise their distress and reassure them.

Responsive

Good

Updated 23 September 2019

We rated responsive as Good because:

  • The hospital worked with other providers and stakeholders to plan and deliver its services to meet the needs of local people.

  • People could access the service in a timely way. Waiting times from assessment to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

  • Individual patient needs were taken account of.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with staff.

Well-led

Good

Updated 23 September 2019

We rated well led as Good because:

  • The provider had managers at all levels with the right skills and abilities to run a service providing high quality sustainable care.

  • The provider had a vision for what it wanted to achieve and plans to turn it into action.

  • There was culture of openness and honesty with a strong focus on patient-centred care. Staff reported a positive experience of working in the hospital.

  • There was a clear governance system in place.

  • There was a systematic approach to continually improving the quality of services and safeguarding high standards of care.

  • The provider collected, analysed, managed and used information well to support its activities.

  • The provider engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborate with partner organisations effectively.

  • Radiographers could access scans that had been undertaken at other hospitals, this helped to reduce duplication for patients and patient images could be transferred securely to NHS trusts.

However:

  • Although risks were being managed, they were not always identified and recorded. Risk assessments in the diagnostic department needed updating. The service did not currently record the radiology report turnaround times which was raised in the Care Quality Commission’s report ‘radiology review’ published in July 2018.

Checks on specific services

Surgery

Good

Updated 23 September 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.

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

Diagnostic imaging

Requires improvement

Updated 23 September 2019

Diagnostic imaging services were available to

consultants with practising privileges who were

authorised as referrers.

We rated the service as requires improvement overall. We rated safe and caring as good. We rated responsive and well led as requires improvement.

We inspected but did not rate effective.

Outpatients

Good

Updated 23 September 2019

Outpatient services were available for consultants

with practising privileges to refer patients.

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

We inspected but did not rate effective.