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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 22 November 2016

BMI The London Independent is an acute private sector hospital located in Stepney Green, East London. The hospital is a purpose built 5 storey single building which opened in 1986. The hospital provides services to patients aged 16 years or over. Services are provided by UK registered health care professionals and support teams across a range of specialties including Cardiology; Cardio-Thoracic surgery; Dermatology; ENT; Endoscopy; General Medicine; General Surgery [including upper GI, lower GI and breast]; Maxillo-facial; Ophthalmology; Orthopaedics; Pain Management; Physiotherapy; Plastic Surgery; Podiatry; Renal Medicine [including Dialysis]; Renal Surgery [including live donor transplant]; Spinal; Urology and Vascular.

We inspected the core inpatient services of inpatient medicine, surgery, critical care as well as outpatients and diagnostic imaging.

We rated this hospital as good overall. We rated it good for effective, caring, responsive and well-led. We rated safe as requires improvement. We rated medicine, critical care and outpatients and diagnostic imaging as good. We rated surgery as requires improvement.

Our key findings were as follows:

We found evidence of outstanding practice:

  • The endoscopy suite had been recently refurbished and was purpose built with excellent patient and treatment facilities.

We found evidence of the following good practice:

  • There was evidence of suitable investigation, learning and dissemination of learning from incidents.
  • Hospital infection prevention and control practices were followed and these were regularly monitored by the infection control lead, to reduce the risk of spreading of infections.
  • Appropriate equipment was available for patient procedures and tests. Equipment was well maintained and tested annually or in accordance with manufacturers’ guidelines.
  • The provider had begun a refurbishment programme of the whole hospital which was recognised as requiring updating in parts.
  • Medicines were suitably prescribed, stored and administered.
  • We observed suitable infection prevention and control procedures in use, and audit results showed 100% compliance with hand hygiene and bare below the elbow principles.
  • There were sufficient nursing and medical staffing levels to enable safe care.
  • Staff had undertaken appropriate mandatory training for their role, were up-to-date with training and were well supported to undertake training.

  • We saw evidence-based practice in place, compliance with recommendations from the National Institute for Health and Care Excellence (NICE) and other national guidelines according to speciality.
  • Patients received care from competent staff who had received the necessary training to undertake their respective roles.
  • Staff had good access to patient information and liaised with internal as well as external agencies to plan and deliver patient care.
  • Patients received suitable nutrition and hydration, and additional support was available for those with specific dietary requirements.
  • Patient outcomes, including mortality, unplanned returns to theatre and unplanned readmissions to hospital, were good.
  • Pain was well managed and we observed staff asking patients if they had pain during their routine observations.
  • Most staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.
  • We observed staff provided care in a compassionate and respectful manner. Patients were treated with dignity and respect.
  • Patient feedback forms about their overall experience and their opinions of the nursing and medical staff demonstrated positive results, with scores frequently above 95% satisfaction.
  • Patients felt they were fully involved in planning their care and treatment. Staff ensured they listened to and responded to patients’ questions appropriately. Patients commented that they had been well supported.
  • 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 services for NHS patients and privately funded patients was straight forward and efficient.
  • Services were tailored to meet the needs of individual people and there was flexibility in the provision of care.

  • Staff demonstrated a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met their needs and promoted equality.
  • Support was available for international patients from Kuwait. This included translation support and liaison with the Kuwaiti embassy. The hospital had an international team working closely with ITU in the admission and discharge of patients.
  • Services were planned and delivered in a way which met the needs of patients. Patients had timely access to appointments. Clinics were held on weekdays into the evenings and Saturday mornings to suit patients’ preferences.
  • 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.
  • Suitable governance processes were in place with a clear clinical and organisational structure. The Medical Advisory Committee (MAC) were involved in a number of key processes, including performance reviews and quality measure.
  • There was a positive culture throughout the hospital, and low sickness rates.
  • Staff had a good understanding of the organisation’s visions and values.
  • Staff described a visible and approachable leadership team and told us they felt able to raise concerns or report incidents without fear of repercussions.
  • There was evidence of some innovative practice and plans for additional service development, with quality, safety and sustainability at the forefront of the decision making process.

However we found evidence of the following poor practice:

  • Compliance with the World Health Organisation (WHO) Five Steps to Safer Surgery checklist was variable.
  • Theatres did not have access to an uninterruptible power supply UPS, which was not in line with recommendations for surgical estates, and meant theatres could temporarily lose power in the event of a power cut.
  • There were no designated hand wash sinks in patient rooms on wards, which meant staff washed their hands in patient basins. This was not compliant with hand hygiene protocols.
  • Most clinical staff received level-one safeguarding training, which is not sufficient to comply with recommendations from NHS England.

  • We saw that information, including information on how to complain, was in English only. Although staff had access to interpreters, there was no translated literature and no translated signage.
  • There was no visitors’ waiting room for ITU or HDU.
  • The reception desks in outpatients and in diagnostic imaging did not have lowered areas for accessibility to wheelchair users.
  • The changing room in the nuclear medicine area did not have direct access to the consulting rooms. Patients had to wear gowns and walk down the corridor where they could be seen by other patients.
  • Importantly the hospital should:
  • Review and ensure full compliance with the World Health Organisation (WHO) Five Steps to Safer Surgery checklist by all surgical staff..
  • Take steps to ensure that theatres  have access to an uninterruptible power supply (UPS).
  • Provide designated hand wash sinks in patient rooms on wards, to  comply with hand hygiene protocols.
  • Review and implement  safeguarding training sufficient to comply with recommendations from NHS England.
  • Although numbers of patients aged 16-18 are low, review safeguarding, paediatric nurse cover and assessment of suitable patient pathways for these patients.
  • Provide information, including information on how to complain, in other languages as well as English.
  • Provide a visitors’ waiting room for ITU or HDU.
  • Ensure that  reception desks in outpatients and in diagnostic imaging have lowered areas for accessibility to wheelchair users.
  • Take appropriate steps to preserve patient dignity in the nuclear medicine area by providing direct access to the consulting rooms from changing areas.
  • Take steps to modify the temperature in the OPD sluice room.
  • Complete its replacement programme for fire doors.
  • Prepare an action plan to address the health and safety audit results for May and June 2016 which recorded that ‘power tools and electrical tools in good working order, free from splits, cracks and deformities’ was rated poor.

  • The above list is not exhaustive and the provider should review all elements of the report in order to continually improve the quality of its services to patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 22 November 2016

We rated safety at this hospital as requires improvement overall because:

  • Compliance with the World Health Organisation (WHO) Five Steps to Safer Surgery checklist was variable.
  • Theatres did not have access to an uninterruptible power supply UPS, which was not in line with recommendations for surgical estates, and meant theatres could temporarily lose power in the event of a power cut.
  • There were no designated hand wash sinks in patient rooms on wards, which meant staff washed their hands in patient basins. This was not compliant with hand hygiene protocols.
  • Most clinical staff received level one safeguarding training, which is not sufficient to comply with recommendations from NHS England.
  • However:
  • There was evidence of suitable investigation, learning and dissemination of learning from incidents.
  • Hospital infection prevention and control practices were followed and these were regularly monitored by the infection control lead, to reduce the risk of spreading of infections.
  • Appropriate equipment was available for patient procedures and tests. Equipment was well maintained and tested annually or in accordance with manufacturers’ guidelines.
  • Medicines were suitably prescribed, stored and administered.
  • We observed suitable infection prevention and control procedures in use, and audit results showed 100% compliance with hand hygiene and bare below the elbow principles.
  • There were sufficient nursing and medical staffing levels to enable safe care.
  • Staff had undertaken appropriate mandatory training for their role, were up-to-date with training and were well supported to undertake training.

Effective

Good

Updated 22 November 2016

We rated effective at this hospital as good overall because:

  • We saw evidence-based practice in place, compliance with recommendations from the National Institute for Health and Care Excellence (NICE) and other national guidelines according to speciality.
  • Patients received care from competent staff who had received the necessary training to undertake their respective roles.
  • Staff had good access to patient information and liaised with internal as well as external agencies to plan and deliver patient care.
  • Patients received suitable nutrition and hydration, and additional support was available for those with specific dietary requirements.
  • Patient outcomes, including mortality, unplanned returns to theatre and unplanned readmissions to hospital, were good.
  • Pain was well managed and we observed staff asking patients if they had pain during their routine observations.
  • Most staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Caring

Good

Updated 22 November 2016

We rated caring at this hospital as good overall because:

  • We observed staff provided care in a compassionate and respectful manner. Patients were treated with dignity and respect.
  • Patient feedback forms about their overall experience and their opinions of the nursing and medical staff demonstrated positive results, with scores frequently above 95% satisfaction.
  • Patients felt they were fully involved in planning their care and treatment. Staff ensured they listened to and responded to patients’ questions appropriately. Patients commented that they had been well supported.
  • Relatives were confident in the care provided throughout the service and told us they were suitably involved in the care of their loved one.

Responsive

Good

Updated 22 November 2016

We rated responsive at this hospital as good overall because:

  • Access to services for NHS patients and privately funded patients was straight forward and efficient.
  • Services were tailored to meet the needs of individual people and there was flexibility in the provision of care.

  • Staff demonstrated a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met their needs and promoted equality.
  • Support was available for international patients from Kuwait. This included translation support and liaison with the Kuwaiti embassy. The hospital had an international team working closely with ITU in the admission and discharge of patients.
  • Services were planned and delivered in a way which met the needs of patients. Patients had timely access to appointments. Clinics were held on weekdays into the evenings and Saturday mornings to suit patients’ preferences.

However:

  • We saw that information, including information on how to complain, was in English only. Although staff had access to interpreters, there was no translated literature and no translated signage.
  • There was no visitors’ waiting room for ITU or HDU.
  • The reception desks in outpatients and in diagnostic imaging did not have lowered areas for accessibility to wheelchair users.
  • We were informed and saw that the changing room in the nuclear medicine area did not have direct access to the consulting rooms, patients had to wear gowns and walk down the corridor where they could be seen by other patients.

Well-led

Good

Updated 22 November 2016

We rated well led as good overall because:

  • 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.
  • Suitable governance processes were in place with a clear clinical and organisational structure. The Medical Advisory Committee (MAC) were involved in a number of key processes, including performance reviews and quality measure.
  • There was a positive culture throughout the hospital, and low sickness rates.
  • Staff had a good understanding of the organisation’s visions and values.
  • Staff described a visible and approachable leadership team and told us they felt able to raise concerns or report incidents without fear of repercussions.
  • There was evidence of some innovative practice and plans for additional service development, with quality, safety and sustainability at the forefront of the decision making process.
Checks on specific services

Critical care

Good

Updated 22 November 2016

  • We found significant areas of good practice through our review of clinical audits, staff training, patient notes and minutes of intensive therapy unit (ITU) governance meetings.

  • Leadership in the unit had a clear structure, and leaders were respected by staff. This contributed to a cohesive team that demonstrated an innovative approach to treatment and care.

  • The unit contributed to national audits compiled by the Intensive Care National Audit and Research Centre (ICNARC) and provided patient-centred, evidence-based care.

  • The critical care unit (CCU) team had access to multidisciplinary specialists who contributed to decision-making and ward rounds to ensure safe care for patients.

  • Both ITU and the high dependence unit (HDU) appeared clean, hygienic and well maintained and staff demonstrated good infection control practices.

  • The CCU was responsive to the international patient client group they regularly admitted to the unit and there were robust arrangements in place to meet the individual needs of these patients.

  • Patients were protected from avoidable harm and there were processes and systems in place, which prioritised patient safety.

  • Incident reporting was embedded in the culture of the unit and there was evidence that learning from investigations had taken place with a system in place to ensure all staff were aware of updates to practice. This contributed to an environment in which safety was prioritised and patients received individualised care.

  • Staffing levels were reviewed continually using an established nursing acuity tool and there were enough staff to provide care and treatment in accordance with Royal College of Nursing (RCN) guidance. The use of agency staff at the time of our inspection had significantly decreased in comparison to the start of 2015.

  • All staff we spoke with told us they were supported and valued by the senior team and they felt proud to work in the unit.

However:

  • Staff did not always accurately record the daily checks for medicine management.

  • There was one oxygen port (air and suction) per bed space in the high dependency unit (HDU). This was not in line with the building regulations for critical care (HBN 04-02) which suggests three to four oxygen outlets per bed space. We took into account the fact that the regulations came into force after the building of HDU however; we asked the provider to consider the requirements set out within the building regulations for critical care (HBN 04-02) in terms of risk and patient safety.

Outpatients and diagnostic imaging

Good

Updated 22 November 2016

  •    Medicines were stored securely      and well managed.
  • Staff had a good understanding of how to report incidents and learning from incidents was shared at departmental level.

  • Staff undertook appropriate mandatory training for their role and support was available for non-mandatory training.

  • Patients were protected from the risk of abuse and avoidable harm.

  • Hospital infection prevention and control practices were followed and these were regularly monitored by an infection control lead, to reduce the risk of spread of infections.

  • Equipment was well maintained and tested annually or in accordance with manufacturers’ guidelines.

  • Staffing levels and the skill mix of staff was appropriate for both the outpatients department and diagnostic imaging services. Work pressures were manageable as there has been ongoing recruitment with posts being filled. Bank staff are used when the department gets busy and some bank staff were made permanent. Trained staff in basic life support were available to respond appropriately in an emergency situation.

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.

Surgery

Requires improvement

Updated 22 November 2016

  • There was evidence of suitable investigation, learning and dissemination of learning from incidents and infections, and safety indicators, such as the numbers of pressure ulcers, patient falls and urinary tract infections, showed good results.

  • Patient outcomes, including mortality, unplanned returns to theatre and unplanned readmissions to hospital, were good.

  • We saw evidence-based practice in place, including enhanced recovery programmes for certain procedures and compliance with recommendations from the National Institute for Health and Care Excellence (NICE).

  • Patient feedback about the care they received was positive and questionnaire results supported this feedback. Staff maintained privacy and dignity, and provided emotional support to patients.

  • Access to surgical services for NHS patients and privately funded patients was efficient, with 91-97% compliance within the 18 week referral to treatment time target for NHS patients between April 2015 and March 2016.

  • The flexibility of the surgical service meant it could absorb patients who needed to return to theatre unexpectedly as well as those with longer length of stays than expected. There were no procedures cancelled for nonclinical reasons between April 2015 and March 2016.

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

  • Suitable governance processes were in place and the Medical Advisory Committee (MAC) was involved in a number of key processes, including performance reviews and quality measurement.

  • There was evidence of some innovative practice and plans for additional service development, with quality, safety and sustainability at the forefront of the decision making process.

However:

  • Compliance with the Five Steps to Safer Surgery WHO checklist was variable.

  • Between April 2015 and March 2016 there were 22 surgical site infections, including higher rates per 100 procedures than the average in NHS hospitals for hip and knee primary arthroplasties.

  • Theatres did not have access to an uninterruptible power supply (UPS), which was not in line with recommendations for surgical estates, and meant theatres could temporarily lose power in the event of a power cut.

  • Risks documented on the risk register were not always fully mitigated. For example, not all operating staff were formally informed about the lack of UPS, which could cause delays in appropriate action being taken in the event of power loss.