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BMI The London Independent Hospital Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 18 September 2019

The BMI The London Independent Hospital is an independent acute hospital located in Stepney Green, east London. It is operated by BMI Healthcare Limited.

There are a total of 69 inpatient and day care beds and 20 outpatient consulting rooms. There are four operating theatres, five critical care beds, a cardiac catheterisation unit, a JAG accredited endoscopy suite, physiotherapy department and diagnostic imaging.

We inspected surgery, critical care and outpatients. The inspection was carried out on 24 and 25 June 2019 and was unannounced.

We inspected services using our comprehensive inspection methodology. 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? We rate services as outstanding, good, requires improvement or inadequate.

We spoke with 42 members of staff including nursing, healthcare assistant and medical staff specific to each area inspected, managers, cleaners, receptionists and physiotherapists. We reviewed the healthcare records of 22 patients and spoke with 16 patients and relatives. We checked items of clinical and non-clinical equipment. We looked at information provided by the hospital.

Services we rate

Our rating of this hospital improved. We rated it as good overall. All three core services were rated good in all domains where we have a duty to rate.

We found the following areas of good practice across all services:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks.
  • The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The service provided care and treatment based on national guidance and evidence-based practice.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
  • The service made sure staff were competent for their roles.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
  • Staff treated patients with compassion and kindness.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action.
  • The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes throughout the service and with partner organisations.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.

We found areas of practice that require improvement:

Surgery

  • At the last inspection hand hygiene audits showed variable results for bare below the elbow and for hand hygiene at appropriate times. At this inspection although we found good practice and audit results that showed good hand hygiene, we also observed instances where hand hygiene standards were not being maintained. In theatres we observed excessive glove usage with minimal hand hygiene taking place between glove changes. In the anaesthetic room we observed instances where staff were not decontaminating their hands after patient contact. In pre assessment we observed an occasion where a member of staff did not use alcohol gel or wash hands prior to applying gloves and did not wash hands post procedure.
  • Information was collected for monitoring ongoing harm free care. However, this information was not on display to patients.

Outpatients

  • Although the service generally controlled infection risk well, compliance levels with hand hygiene and bare below the elbow standards were low. Hand hygiene audits for January and February 2019 found that compliance rate was 32% and 29% respectively. The department had an action plan in place.
  • The treatment room did not meet all the environmental requirements set out in the BMI policy Surgical Procedures in Outpatients, due to a lack of ventilation and the presence of a suspended ceiling. An appropriate local standard operating procedure was in place to mitigate the risk.

Critical Care

  • At the last inspection the intensive treatment unit did not have a follow up clinic where patients could reflect upon their critical care experience and be assessed for progress. The service still did not have a follow up clinic for patients following discharge from the hospital. This was not in line with Guidelines for the Provision of Intensive Care Services which state that patients discharged from ITU must have access to a follow up clinic.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 18 September 2019

We rated safe as good because:

  • There was good compliance with the World Health Organisation Five Steps to Safer Surgery checklist.
  • The service controlled infection risk well. Staff kept equipment and the premises clean. We found the wards, day unit, theatres and the recovery area clean and hygienic.
  • The service provided mandatory training in key skills to all staff and made sure most staff completed it.
  • Staff understood how to protect patients from abuse and the service 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.
  • There was an improved reporting culture which had led to more incidents being reported. Staff were encouraged to raise incidents for learning and improving outcomes for patients.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The hospital completed audits of infection control practices and produced specific action plans for improving practices throughout the hospital.
  • Emergency equipment such as a resuscitation trolleys and crash bags were available. Staff checked resuscitation equipment daily.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

However:

  • We observed some instances where hand hygiene standards were not always being maintained. In theatres we observed excessive glove usage with minimal hand hygiene taking place between glove changes. In the anaesthetic room we observed instances where staff were not decontaminating their hands after patient contact. In pre assessment we observed an occasion where a sister did not use alcohol gel or wash hands prior to applying gloves and did not wash hands post procedure. In outpatients hand hygiene audits for January and February 2019 found that compliance rate was 32% and 29% respectively. The department had an action plan in place.
  • Information was collected for monitoring ongoing harm free care. However, this information was not on display to patients.
  • The treatment room did not meet all the environmental requirements set out in the BMI policy Surgical Procedures in Outpatients due to a lack of ventilation and a suspended ceiling. However, an appropriate local standard operating procedure was in place to mitigate the risk.
  • Adult and children safeguarding policies were in place which outlined staff responsibilities should they have any safeguarding concerns. The adult safeguarding policy was currently under review as it was out of date (November 2018).

Effective

Good

Updated 18 September 2019

We rated effective as good because:

  • The service provided care and treatment based on national guidance.
  • Staff assessed and monitored patients regularly to see if they were in pain. Staff assessed patients’ nutritional states and food and drink was provided to meet their needs.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them.
  • The service made sure staff were competent for their roles.
  • Surgery lists, including Saturday lists, were supported by multidisciplinary teams. There was effective multidisciplinary working across teams within the hospital.
  • Staff gave patients practical support and advice to lead healthier lives. On all pathways, patients were asked about health lifestyle.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
  • The service submitted data to the Intensive Care National Audit & Research Centre (ICNARC) for all patients treated within the intensive care setting. This meant care delivered and patient outcomes were benchmarked against similar units nationally.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff were aware of their responsibilities to patient consent, including in relation to the MCA and DoLS.

Caring

Good

Updated 18 September 2019

We rated caring as good because:

  • Staff treated patients with compassion and kindness. Patients we spoke with said that staff were caring and told us their privacy and dignity was respected. During the inspection we saw staff treating patients with dignity, compassion and respect.
  • Staff provided emotional support to patients, families and carers to minimise their distress. Patients said that staff were quick to respond to questions about pain relief and other medical concerns.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service had a satisfaction survey by which patients could feed back their thoughts about the service. The results and trends were discussed and reviewed at the monthly patient experience committee and, when needed, improvement actions were agreed.
  • Staff provided reassurance and support for patients throughout their care. Staff demonstrated a calm and reassuring attitude to put patients at ease.
  • We spoke with two family members of patients on the critical care ward. Family members were positive about the care the patients received and stated that staff members were professional and welcoming.

Responsive

Good

Updated 18 September 2019

We rated responsive as good because:

  • The service planned and provided care in a way that met the needs of local people and the communities served.
  • Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
  • The service took account of patients’ individual needs. Individualised care was provided at every stage of the patient pathway.
  • There were a variety of leaflets available explaining many health conditions and could be printed off in several different languages. Staff had access to interpreters for patients whose first language was not English.
  • The service provided food that catered to dietary requirements and cultural preferences.
  • People could access the service when they needed it. Patients told us that appointment choice was flexible and sufficient for their needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff. All complaints were reviewed at the weekly complaints meeting that monitored the progress of complaints responses to ensure compliance with the complaints policy.

However:

  • The outpatient area had step free access and was accessible to individuals using a wheelchair. However, during our last inspection it was found that the reception desk within outpatients was not lowered to take in to account the needs of wheelchair users, and this remained the same during this inspection. The desk was due to be reconfigured and relocated as part of a five year refurbishment plan.
  • A recurrent theme in the complaints received within outpatients was in relation to waiting times for consultant clinics once at the hospital and clinic cancellation. The department had started to record lateness and cancellations to see where any patterns emerged, however data provided by the hospital showed that this was still a challenge.
  • The critical care service did not have a follow up clinic for patients following discharge from the hospital. This was not in line with Guidelines for the Provision of Intensive Care Services which state that patients discharged from critical care services must have access to a follow up clinic.

Well-led

Good

Updated 18 September 2019

We rated well led as good because:

  • Leaders had the integrity, skills and abilities to run the service. Staff felt supported by local leadership and considered the senior leadership team to be visible and approachable.
  • There were systems and process in place that adequately identified and minimised risk. Risk registers were sufficiently added to, reported on and actioned.
  • Managers at all levels had the right skills and abilities to run a service providing high-quality sustainable care.
  • The hospital had a vision for what it wanted to achieve and workable plans to turn it into action.
  • Managers promoted a positive culture that supported and valued staff. Staff were engaged in quality measures and had opportunities to be involved in service development.
  • The hospital used a systematic approach to continually improving the quality of its services. There was a good system of governance in place.
  • The hospital had a number of meetings and systems in place to provide engagement opportunities both for patients and for staff.
  • The hospital measured patient satisfaction results using friends and family recommendations. Where individual staff were mentioned in patient feedback for providing good care this was recognised by managers.
  • Staff we spoke with told us that there was a no blame culture, and that they felt valued and respected.
Checks on specific services

Medical care (including older people’s care)

Good

Updated 22 November 2016

  • There was evidence of suitable investigation, learning and dissemination of learning from incidents. Suitable governance processes were in place and the Medical Advisory Committee (MAC) were involved in a number of key processes, including performance reviews and quality measurement.

  • Risk registers contained items considered as issues by the leadership team and reflected our inspection findings. Key risks were displayed on posters in staff areas to raise awareness.

  • Safety indicators showed good results and we observed suitable infection prevention and control procedures in use.

  • We saw evidence-based practice in place, compliance with recommendations from the National Institute for Health and Care Excellence (NICE) and British Society of Gastroenterology.

  • Patients received care from competent staff, including staff in endoscopy who had undergone nationally recognised training.

  • Staff had good access to patient information and liaised with internal as well as external agencies to plan and deliver patient care.

  • Patient feedback forms about their overall experience and their opinions of the nursing staff demonstrated positive results, with scores frequently above 95% satisfaction.

  • Relatives were confident in the care provided throughout the service and told us they were suitably involved in the care of their loved one.

  • Access to medicine services for NHS patients and privately funded patients was straight forward and efficient. A points-based system for procedures in endoscopy ensured a smooth running service, with limited delays and no non-clinical cancellations.

  • There was a positive culture throughout the service, and low sickness rates. Staff described a visible and approachable leadership team and told us they felt able to raise concerns or report incidents without fear of repercussions.

However;

  • Most clinical staff received level one safeguarding training, which is not sufficient to comply with recommendations from NHS England.

  • There were no designated hand wash sinks in patient rooms on the ward, which meant staff washed their hands in patient basins. This was not compliant with hand hygiene protocols.

  • Many doors were not labelled with suitable fire door labels, although a replacement programme was ongoing at the time of our inspection.

  • Medical care staff knowledge of Deprivation of Liberty Safeguards (DoLS) was limited and told us, in their opinion, that it was only relevant when patients were being restrained.

  • The medicine service was unable to accommodate patients with significant mental health needs, including patients living with dementia, or those with a learning disability.

Critical care

Good

Updated 18 September 2019

We rated this service as good because it was safe, caring, effective, responsive and well led. We found good practice in all areas.

Surgery

Good

Updated 18 September 2019

We rated this service as good because it was safe, caring, effective, responsive and well led. We found good practice in all areas.

Outpatients

Good

Updated 18 September 2019

We rated this service as good because it was safe, caring, responsive and well led. We found good practice in all areas. We do not rate effective in outpatients.