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BMI The Meriden Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 22 June 2018

BMI The Meriden Hospital is operated by BMI Healthcare. The hospital is registered for 52 beds, 48 of which are on the inpatient ward, with a further four beds in the endoscopy suite. Facilities include three operating theatres, all with laminar flow, a dedicated endoscopy suite, cardiac catheter laboratory and outpatient and diagnostic facilities.

The hospital provides surgery, outpatients and diagnostic imaging. We inspected surgery, outpatients and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 24 and 25 April 2018, along with an unannounced visit to the hospital on 2 May 2018.

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 core service.

See the surgery section for main findings.

Services we rate

We rated this hospital as good overall because:

  • The hospital had systems and processes in place to protect patients from avoidable harm and abuse.

  • The processes for reporting, investigating and learning from incidents were well established and implemented. This was an improvement from the last inspection in May 2016.

  • Infection prevention and control practices were performed well, and staff followed hospital policies. The environment was clean and fit for purpose.

  • Medicines were managed and stored correctly. This was an improvement from the last inspection in May 2016.

  • Staff assessed risk to patients and responded appropriately when individual patient’s risks increased.

  • The hospital participated in national audits where applicable. The hospital was fully engaged in the Private Healthcare Information Network (PHIN) work to develop outcome measures for independent healthcare patients.

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

  • Staff treated patients with care, kindness and compassion.

  • Complaints and concerns were taken seriously, responded to in a timely way and managed with face to face meetings with the complainant where needed.

  • Managers were visible, approachable and performed well.

  • Staff we spoke with, enjoyed their work and were proud to work at the hospital. They described an open culture and felt supported and listened to by their immediate managers.

We found areas of good practice in relation to surgery:

  • Patients had access to care and treatment in a timely way and cancellations to surgery were minimal.

  • Patients were appropriately assessed prior to surgery and there were processes in place to transfer patients should they require a higher level of care.

  • Comprehensive risk assessments were carried out for specific patient groups and risk management plans were developed in line with national guidance.

And some areas for improvement:

  • During one medicines round a nurse did not follow one standard for administering medicines.

  • Not all patient outcomes were measured for patients undergoing colonoscopies.

  • There was only one toilet in the endoscopy unit, and patients were admitted in the cubicles where some information could be over heard by other patients.

  • We found areas of good practice in relation to outpatient care:

  • There were robust systems in place to ensure that patients and staff were protected by adherence to national guidelines relating to ionising radiation and diagnostic imaging.

  • Patient care and treatment was delivered in line with national guidance.

And some areas for improvement:

  • There were no patient leaflets in the diagnostic imaging department.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 22 June 2018

We rated safe as good because:

  • There was evidence of learning from incidents and complaints, and effective processes were in place to reduce risk.

  • Staff were encouraged to report incidents and the duty of candour regulation was applied when things went wrong.

  • Controlled medicines were safely stored and the keys were secure. This was an improvement since the inspection in May 2016.

  • The management of medicine prescription pads in outpatients was robust, and there was an audit trail meaning that the risk of possible loss of, or inappropriate use of prescriptions, was minimised.

  • Safeguarding systems were in place and staff knew how to respond to safeguarding concerns. All staff had been trained to the required level.

  • Clinic rooms had been refurbished which meant that they were compliant with current Health and Building Note regulations 2013.

  • The environment was visibly clean and there were systems in place to maintain the safety of equipment used across clinical areas.

  • There were reliable systems in place to prevent and protect people from a healthcare associated infection.

  • The wards, endoscopy unit and theatres were visibly clean and tidy.

  • There were effective arrangements for the receipt, storage, dispensing and disposal of unwanted medicines.

  • Patients’ individual care records were accurate, complete, legible, up-to-date, and stored securely.

  • Comprehensive risk assessments were carried out for specific patient groups and risk management plans were developed in line with national guidance.

  • There were arrangements in place with a local acute NHS trust to provide 24 hour emergency support should patients require high dependency nursing or urgent diagnostics.

    However;

  • We found medicine administration standards were not followed during one medicine round. During the unannounced inspection the senior management team had mitigated the risk and further medicines rounds we observed were compliant.

  • Some equipment in the imaging and cardiac catheter laboratory was nearing the end of its life span however; this was monitored and recorded on the department’s risk register.

Effective

Good

Updated 22 June 2018

We rated effective as good because:

  • Care was provided in line with best practice guidelines.

  • Patients we spoke with said they had been offered pain relief and felt their pain was being managed appropriately. Patient outcomes were audited and showed results in line with those nationally.

  • Patient Led Assessment of the Care Environment (PLACE) audit from March to June 2017 showed the hospital scored 98% for organisational food, which was significantly better than the England national average of 88%.

  • BMI the Meriden was one of the first to submit to the Private Healthcare Information Network (PHIN) system as recommended by the Competition and Markets Authority.

  • Staff had access to information needed to deliver effective care and treatment to patients.

  • Patients at risk of venous thromboembolism (VTE) were prescribed VTE prophylaxis in accordance with NICE guidelines.
  • Practising privileges for consultants were reviewed annually and included all aspects of a consultant’s performance.
  • Patients said they had been given clear information about the benefits and risks of their surgery in a way they could understand prior to signing the consent form.

  • The hospital monitored adherence to policies with the use of local audits.

  • Patient outcomes were audited in outpatients and services adapted to improve outcomes for patients.

  • Outpatient and imaging staff provided patient appointments over weekends according to clinical needs. On call provision for MRI and CT emergencies out of hours was provided by the local NHS trust.

  • There were arrangements to ensure staff could access all necessary information to provide effective care.

  • Most staff we spoke with were clear about what actions they would take if they had concerns about a patient’s capacity to understand information and consent to treatment

  • Staff had received training on the Mental Capacity Act and Deprivation of Liberty although had limited exposure to patients requiring mental capacity assessments.

  • Multi-disciplinary teams worked well together to provide effective care. Multi-disciplinary team working included hospital staff, local NHS trusts, clinical commissioning groups and general practitioners.

  • Staff had received an up to date appraisal to identify individual training needs. Staff were supported to engage with specialised training to improve care and treatment within their modality.

However;

  • Not all patient outcomes were measured for endoscopy patients undergoing colonoscopies. However, following our unannounced inspection, we saw evidence that senior staff had acted to ensure compliance.

  • Not all corporate policies were up to date.

Caring

Good

Updated 22 June 2018

We rated caring as good because:

  • Staff treated patients with dignity and respect and provided emotional support throughout their treatment. Staff helped patients to understand their condition or treatment by giving written information after their treatment and allowing time to ask questions.
  • All outpatient services offered patients a chaperone and departments clearly displayed signs in waiting areas and consulting rooms.

  • We saw examples of staff taking measures to ensure patients’ privacy and dignity were respected.

  • Patients understood their care and treatment and had opportunities to ask questions.

  • Patient satisfaction scores results from January to December 2017 showed 98% of all patients said the quality of the care was very good.

  • The Patient Led Assessment of the Care Environment for the period of March to June 2017 showed the hospital scored 87% for privacy, dignity, and well-being, which was higher than the England average of 84%.

  • Patients told us that staff had enough time to provide them with adequate emotional support.

Responsive

Good

Updated 22 June 2018

We rated responsive as good because:

  • The hospital had an admissions policy which detailed criteria for NHS patients who could be safely treated at the hospital.

  • Patients were admitted on a planned basis for elective surgery, this included self-funded patients and NHS patients.

  • Theatre list for elective surgery were planned and ensured all aspects of patient’s. requirements were checked and considered before booking a patient.

  • Patients had timely access to initial assessment and treatment. At the time of the May 2016 inspection, hospital data showed that 95% of patients started non-admitted treatment within 18 weeks of their referral from January to December 2015. This was above the England average of 92%.

  • Patient Led Assessment of the Care Environment showed the hospital scored 84% for dementia, which was better than the England average of 77%.

  • There were arrangements for patients to be seen promptly by a doctor if they became unwell.

  • Waiting times, delays and cancellations were monitored and were managed appropriately.

  • Cancellations were minimal and managed appropriately.

  • The OPD and diagnostic imaging department provided services in an environment that met people’s needs.
  • Patients could access the majority of services in a timely way for initial assessments, diagnoses or treatment.
  • The service had good working relationships with the local clinical commissioning group to manage services for NHS patients.
  • Complaints were always responded to in a timely manner.
  • Patients could book appointments at a time to suit themselves. Clinics were made available at weekends to meet individual needs.
  • The hospital had very low ‘did not attend’ (DNA) rates. All patients who missed their appointment were followed up and offered a second appointment within 28 days.
  • The physiotherapy service had extended the department’s opening times to enable patients to access the service during evenings and at weekends. A seven day a week service was available.

However;

  • Staff admitted and discharged patients in cubicles within the endoscopy unit. Other patients in adjacent cubicles could overhear confidential information. We could not be assured that patient confidentiality was being maintained. This was raised with senior staff at the time of our inspection who had taken actions to mitigate risk by the time of our unannounced inspection.

  • We were not assured that toilet facilities were adequate in the endoscopy suite to meet the needs of patients who were administered bowel preparation. However, this concern was rectified once highlighted to the senior management team.

  • There were no radiology patient information leaflets however, corporate information leaflets were being adapted and would be available once approved.

Well-led

Good

Updated 22 June 2018

We rated well-led as good because:

  • The hospital’s senior management team were visible, approachable, and supportive. Staff could raise concerns or share ideas and felt that they were listened to.

  • Audit results were discussed at governance meetings, with findings cascaded to staff through team meetings and via email.

  • The provider had a five-year vision from 2015 to 2020, with eight strategic objectives to drive positive change and further improve the quality of service provision.

  • Training and development was a focus for 2018 as reflected in the ‘BMI Say’ action plan. Heads of departments identified training needs of staff through appraisal.

  • Clinical leads were visible, approachable and integral to daily functioning of the service.

  • Service level agreements were reviewed regularly to ensure they were still fit for purpose

  • Patients were actively encouraged to give feedback through patient satisfaction questionnaires, Friends & Family Test and via the hospital’s complaint process.

  • Staff had equal opportunities for accessing training and development.

  • There was good working relationships between staff, their managers and senior staff and their managers and staff morale was generally good.

  • Staff were aware of the department’s vision and strategy and posters were displayed in offices.

  • There was a robust governance process in place to manage risks.

  • The department had taken action to ensure risks identified during the May 2016 inspection, were actioned.

  • There was a culture of learning and improvement across the service.

    However;

  • We were not assured of effective communication of concerns between the endoscopy staff and the senior management team.

  • There was no effective governance system in place to monitor, interrogate, and collate colonoscopy outcomes. The hospital used a gastrointestinal reporting tool to measure colonoscopy outcomes. However, the system was not interrogated to monitor colonoscopy outcomes including individual consultant outcomes to drive improvement. Following our inspection, we saw evidence that senior staff had taken action to ensure compliance.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 22 June 2018

We rated this service as good because it was safe, caring, responsive and well-led. We did not rate the service for being effective.

Surgery

Good

Updated 22 June 2018

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.