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BMI The Highfield Hospital Good

Reports


Inspection carried out on 2 to 3 July 2019

During an inspection looking at part of the service

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 carried out on 2, 3 and 18 August 2016

During a routine inspection

We carried out an announced inspection of BMI Highfield Hospital on 2 and 3 August 2016. We also carried out an unannounced visit on 18 August 2016 to check the service had implemented improvements from the announced inspection. This was particularly to check that correct numbers of staff were on duty with the appropriate skills to meet the needs of patients and improvements had been made to infection control and environmental issues raised at the announced inspection.

We carried out this inspection as part of our comprehensive inspection programme of independent healthcare hospitals.

Overall, we have rated BMI Highfield Hospital as requiring improvement.

Are services safe at this hospital

  • Reviews and investigations following incidents was not always sufficiently thorough and actions were not put in place to prevent the incident recurring. Consequently lessons were not being learned and similar incidents were repeatedly occurring.
  • Premises and equipment were not visibly clean in the theatre area and cleaning schedules in theatres were not always completed. This meant the level of cleanliness required for a surgical environment was not being appropriately monitored. Two Department of Health standards for the clinical environment were not met.
  • There were no hand washing facilities in the ultrasound room and the chair in this clinical area could not be cleaned following patient consultations.
  • We raised these concerns with the executive director at the time of the inspection.
  • Immediately following the inspection the hospital arranged a deep clean of the service areas. The areas were appropriately clean at the time of the unannounced inspection.
  • Arrangements for the service, maintenance, renewal and replacement of premises and equipment were not adequate in the theatre department. Service records for electronic equipment were not up to date and some equipment was in a state of disrepair.
  • We raised these concerns with the executive director at the time of the inspection. Immediately following the inspection the hospital contacted engineers who started the process of servicing and registering each piece of equipment, logging them all onto an asset register with dates of last service and next service due. We received a copy of this register within one week of the inspection ending, with assurance from the hospital that any equipment not up to date with servicing would not be used.
  • Staffing levels in theatre did not meet the required standards as set out by the Association for Perioperative Practice (AfPP), the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and in BMI’s own staffing policy. This posed a potential risk to patient safety.
  • Documentation around the completion of VTE assessments and prophylaxis medication in patient records was inconsistent, despite the hospital reporting 100% completion rates.
  • In surgical service despite issues being identified in an audit with the management of controlled drugs, there was no action plan in place and we found they had not been checked the previous day in one area.
  • In the outpatient department a medication fridge was being used to store blood products awaiting collection. An additional fridge was in place when we returned for our unannounced inspection.
  • Mandatory training figures including adult and child safeguarding courses were lower than the hospital target.
  • Completion of the World Health Organisation (WHO) surgical safety checklist was variable also there had been no audit of the use of the World Health Organisation checklist in diagnostic imaging since September 2014.
  • Records used in the outpatient department did not contain full details of patients’ medical history. This posed a risk that treatment could be unsafe or inappropriate.

However

  • There was good cover by the responsible medical officer (RMO) and consultants.
  • Incidents were reported. Staff understood the importance of being open and honest and the duty of candour.
  • Medicines were stored securely. Patient group directives were in place and up to date where required.
  • Staff knew how to respond to deteriorating patients. Training, systems and processes were in place to ensure risks to patients were minimised.
  • Bank workers were used to supplement the establishment and add to the skill mix. Bank workers were inducted to departments appropriately.
  • Apart from the theatre area, rooms on the wards were visibly clean and tidy.
  • Record keeping was mostly good in the surgical department, with evidence of falls assessments, assessment of pressure areas and assessment of nutritional status in patients’ case notes. However, records used in the outpatient department did not contain full details of patients’ medical history. This posed a risk that treatment could be unsafe or inappropriate.
  • There were processes in place for safeguarding patients and most staff were familiar with these.

Are services effective at this hospital/service

  • Local policies and procedures were based on evidence and guidelines produced by Royal Colleges and the National Institute for Health and Care Excellence (NICE).
  • Outcomes data indicated that the hospital was performing at a comparable level with other independent hospitals in terms of unplanned returns to theatre, unplanned transfers and unplanned readmissions.
  • The hospital operated an enhanced recovery model to improve outcomes for patients following surgery.
  • We saw good evidence of pain being assessed and treated accordingly.
  • Assessments for nutrition and hydration were being completed and documented.
  • There were opportunities for staff to undertake courses and work in different roles which allowed them to develop professionally.
  • There were link nurses in place to represent their clinical areas at meetings in particular specialties, eg pathology and resuscitation, and cascade information from the meetings back to their teams.
  • Audits of care and discrepancy meetings were in place in the imaging department.
  • The diagnostic imaging service was working towards the Imaging Services Accreditation Scheme (ISAS).
  • Staff were supported in their personal development and attended both internal and external courses to develop their skills and knowledge.
  • There was a BMI policy in place for granting and reviewing the practising privileges of doctors. Consultant files we reviewed contained details of medical revalidation and an up to date appraisal.
  • There was good multi-disciplinary working between consultants, nursing staff and allied health professionals.
  • Staff we spoke to had an understanding of the need to consider mental capacity when taking consent, but not all staff fully understood the processes required if a patient lacked capacity to consent for themselves.

Are services caring at this hospital/service

  • Patients were supported and were involved in planning their treatment and care.
  • Patients understood their treatment and, where applicable, were informed of any associated costs prior to treatment.
  • Feedback from patients and those who were close to them was positive about the way staff treated and cared for them.
  • Staff were kind, caring and compassionate. They were sensitive in their communications with patients and understood and respected individual needs.
  • Staff took steps to promote privacy and dignity. Patients told us they felt staff went above and beyond what was expected of them.
  • Friends and family test results showed that 97.2% of patients would recommend the service to their friends and family.
  • The hospital sought feedback from patients about the service using a BMI questionnaire and the NHS friends and family test.
  • Staff in the MR department took time to provide emotional reassurance to patients, particularly those who were nervous or claustrophobic. Patients told us staff made them feel at ease.

Are services responsive at this hospital/service

  • Services had been planned to meet the needs of local people. There was flexibility in treatment and appointment times and access to a one stop breast clinic.
  • The hospital had an admissions policy which detailed criteria for patients who could be safely treated at the hospital.
  • Patients’ needs were assessed through the use of a range of BMI clinical pathways, which included the use of a pre-operative assessment health questionnaire.
  • Patients were kept informed of any delays and patients told us appointments ran to time.
  • Overall, the 95% 18-week target for non-admitted patients was met between April 2015 and March 2016. Waiting times for diagnostic imaging were low.
  • Individual needs were understood and considered when delivering care and treatment. Adjustments were made to remove barriers to people accessing services. Staff received training in dementia awareness and equality and diversity.
  • Staff understood the complaints process and told us learning from complaints was discussed at departmental meetings and at the medical advisory committee.
  • An interpreting service was available for patients who did not speak English and staff could access patient information sheets in different languages.
  • There was an open visiting policy within the hospital.
  • Patients were given opportunities to feedback on the care they received and we saw evidence that patient feedback was acted on.
  • Patients agreeing to undergo cosmetic surgery could change their minds and cancel the procedure at any point prior to the commencement of surgery.
  • National waiting time indicators for referral to treatment (RTT) were below the 90% indicator for admitted patients beginning treatment within 18 weeks of referral for each month in the reporting period (April 2015 to March 2016).
  • Reasons for cancelled operations were not being investigated consistently, so there was no learning or actions in place to prevent the same issues recurring.
  • Information about how to complain was not readily available in the departments we visited.

Are services well led at this hospital/service

  • Frequent changes to leadership across the theatre departments and change in hospital manager had led to a lack of direction for staff and a need to improve governance systems.
  • There was no strategic oversight of incidents so lessons were not always learned from these.
  • Communication and sharing of action plans had been identified by the hospital as a problem. Communication meetings (comms cells) were being to improve this.
  • A number of senior staff had not seen a risk register at the hospital.
  • There was a risk assessment folder on Cedar ward, however this included several expired review dates and some incomplete assessments.
  • Clinical governance meetings were not well attended and actions were not completed in a timely way. BMI clinical governance bulletins were not shared with the medical advisory committee.
  • Not all consultants who held practicing privileges at the hospital had all the required documentation in place.

However;

  • There was an open culture where staff felt confident to raise concerns if required. Staff spoke positively about their work and their colleagues.
  • Leadership in the imaging department was good and staff felt well supported. Work was in progress to ensure the sustainability of the one stop breast clinic and to improve the service by gaining accreditation via the Imaging Services Accreditation Scheme (ISAS).
  • ‘Comms cell’ boards displayed key information about the quality measurement and risk management.
  • There was an experienced medical advisory committee (MAC) chair who was able to give examples of how the committee monitored and influenced clinical practice.
  • The private healthcare information network (PHIN) had commenced outcome collection and covered hip, knee, hernia and cataract surgery.
  • All the staff we spoke with felt supported by their managers, and were positive about their roles and about working at the hospital.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 3 September 2013

During an inspection looking at part of the service

We did not speak with any people who use the service as part of the inspection.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 2 May 2013

During a routine inspection

We spoke with two people who use the service. They told us the staff discussed the treatment options with them and clearly explained the process to them. They also told us they were happy with the staff and that the ward staff were helpful and knowledgeable.

The people we spoke with told us they were very happy with the care they received. They told us they were kept informed and that they were looked after well during all stages of their treatment.

The people we spoke with told us that they had no concerns about the service they received. They told us they would speak to the senior ward staff if they had any concerns and were confident their concerns would be dealt with effectively.

Inspection carried out on 12 November 2012

During a routine inspection

We spoke with three people who use the service and they told us they were asked for written consent prior to receiving treatment. They also told us that they were offered a choice and the treatment options were explained to them by staff.

The people we spoke with told us they were happy with the services they received. They told us the staff explained the treatment options available to them. One person told us they felt comfortable because they were seen by the same Consultant during each visit.

The people we spoke told us they were happy with the staff. One person told us the staff were knowledgeable and that the nursing staff responded quickly when they were called. They also told us they did not have any concerns about the service they received but were aware of how to raise a complaint if they did have any issues.

Reports under our old system of regulation (including those from before CQC was created)