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BMI The Princess Margaret Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 3 May 2019

The Princess Margaret Hospital based in Windsor is operated by BMI Healthcare Ltd. The service has 66 beds. Facilities include four operating theatres and an endoscopy suite. There is an outpatient department with consulting and treatment rooms, X-ray, and diagnostic facilities including magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound.

The Princess Margaret Hospital provides surgery, medical care, outpatients and diagnostic imaging to people who have private medical insurance, pay for themselves and some NHS funded patients.

This was a focused inspection to follow up on the four serious incidents that had been reported to the Care Quality Commission (CQC) between May 2017 and December 2017. Two serious incidents related to complications during surgery and two for wrong medical device insertion during surgery. In addition, we looked at the areas of improvement identified in the previous surgery inspection report, published December 2016. As the serious incidents occurred in surgery we only inspected surgery. We inspected this service using our focused inspection methodology but for completeness looked at all five key questions, is the service safe, is the service effective, is the service caring, is the service responsive and is the service well-led. We carried out an unannounced inspection on 06 November 2018.

The hospital offers cosmetic procedures such as dermal fillers, ophthalmic treatments and cosmetic dentistry. We did not inspect these services.

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.

Services we rate

Our rating of this service stayed the same. We rated it as Good overall. However, well-led which was previously rated as Requires Improvement improved to Good. We found the service had learnt lessons from when things had gone wrong and put measures in place to prevent reoccurrence.

We found good practice in relation to surgery:

  • The service provided mandatory training in key skills to all staff.

  • Staff had training on how to recognise and report abuse.

  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

  • The service had suitable premises and equipment.

  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

  • The service had enough staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment. However, there was high usage of bank and agency staff within the service.

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.

  • The service followed best practice when prescribing, giving, recording and storing medicines.

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. 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 of its effectiveness.

  • Staff gave patients enough food and drink to meet their needs and improve their health.

  • Staff assessed and monitored patients regularly to see if they were in pain.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them.

  • The service made sure staff were competent for their role.

  • Staff of different roles worked together as a team to benefit patients.

  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

  • Staff cared for patients with compassion.

  • Staff provided emotional support to patients to minimise their distress.

  • Staff involved patients and those close to them in decisions about their care and treatment.

  • The service planned and provided services in a way that met the needs of local people.

  • The service took account of patients’ individual needs.

  • People could access the service when they needed it.

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

  • The service promoted a positive culture, creating a sense of common purpose based on shared values.

  • There were effective structures, processes and systems of accountability to support the delivery of the strategy and good quality, and sustainable services.

  • The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

  • The service engaged well with patients, staff and the public to plan and manage appropriate services.

However,

  • Gas cylinders in the theatre area were not stored according to national guidance.

  • There was dust in higher to reach parts of the theatre area.

  • Level of patient harm was not always recorded when incidents were reported.

  • Not all information was cascaded down to agency staff.

  • The sepsis screening tool was not embedded by staff.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (Acute South)

Inspection areas

Safe

Good

Updated 3 May 2019

We rated safe as Good because:

  • The service controlled infection risk well.

  • Staff completed and updated risk assessments for each patient.

  • Staff kept detailed records of patients’ care and treatment.

  • The service managed patient safety incidents well.

Effective

Good

Updated 3 May 2019

We rated effective as Good because:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff assessed and monitored patients regularly to see if they were in pain.
  • Staff of different roles worked together as a team to benefit patients.

Caring

Good

Updated 3 May 2019

We rated caring as Good because:

  • Staff put patients at the centre of all that they did.

  • Staff took time to involve patients in their care and provided emotional support to patients to minimise their distress.

  • Staff involved patients and those close to them in decisions about their care and treatment.

  • We observed how staff demonstrated a kind and caring attitude to patients and took time to speak with patients and their relatives in a respectful, patient and considerate way.

  • Staff supported patients through their investigations, ensuring they were well informed and knew what to expect.

Responsive

Good

Updated 3 May 2019

We rated responsive as Good because:

  • The hospital planned services around the needs and demands of patients and considered patients’ individual needs.

  • People could access the service when they needed it.

  • The service treated concerns and complaints seriously, investigated them and learnt lessons from the results.

Well-led

Good

Updated 3 May 2019

We rated well-led as Good because:

  • The service promoted a positive culture, creating a sense of common purpose based on shared values.

  • There was an effective clinical governance structure.

  • There were systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

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

  • The service engaged well with patients, staff and the public to plan and manage appropriate services.

Checks on specific services

Medical care (including older people’s care)

Good

Updated 16 December 2016

Overall we rated this service as good because:

There was an openness and transparency about safety. Staff monitored patient safety and investigated incidents to enable them to improve care.

Ward and clinical areas we visited were visibly clean.

Care and treatment took account of current legislation and nationally recognised evidence-based guidance.

There were sufficient staffing levels, with appropriate numbers of doctors and nurses available to meet the needs of the patients 24 hours a day.

Patient feedback regarding their care and the service was positive. Patients told us they were included in decisions about their care and told us they felt informed about the treatment they received.

The service was developing its cancer services to help it achieve BMI Flagship status. Staff within the service understood this shared vision and were working together to achieve this.

Staff were competent to carry out their role and the hospital maintained a register of training required and undertaken by all staff groups. Staff told us the annual appraisal system worked well and was worthwhile.

Appropriate governance structures were in place for clinical governance, health and safety, infection control and medicines management. Each area had committees meeting to review issues and concerns, and to direct improvements.

Department heads and staff met regularly, in departmental meetings or daily huddles, to discuss and share information about the service.

The oncology service had engaged with patients through focus groups during which they discussed patient concerns. This had resulted in changes to the environment and the provision of fresh fruit and bottled water.

Outpatients and diagnostic imaging

Good

Updated 16 December 2016

Overall, this service was rated as good. We found outpatients and diagnostic imaging (OPD) was good for the key questions of safe, caring, responsive and well-led. We did not rate effective as we do not currently collate sufficient evidence to rate this.

There was a focus on patient safety within outpatient services. Medicines were stored safely and checks on emergency resuscitation equipment were performed routinely. Incidents and adverse events were reported and investigated through robust quality and clinical governance systems. Lessons arising from these events were learned and improvements had been made when needed.There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training specific for their roles. Staff had appropriate safeguarding awareness and people were protected from abusePatient’s privacy was always protected in outpatient and diagnostic areas. Staff knocked on doors before entering rooms, used curtains appropriately and were careful to avoid conversations in corridors.

Feedback from patients who use the service and those close to them was positive about the way staff treated them.

Staff demonstrated they were passionate about caring for patients and clearly put the patient’s needs first, including their emotional needs.

Patients’ treatment and care was delivered in accordance with their individual needs. Patients told us they felt involved in decisions about their care and they were treated with dignity and respect.

Patient’s concerns and complaints were listened and responded to and feedback was used to improve the quality of care.The leadership, governance and culture within the departments promoted the delivery of person centred care. Staff were supported by their managers and were actively encouraged to contribute to the development of the services.

Surgery

Good

Updated 3 May 2019

Surgery was the main activity of the hospital.

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