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BMI The Priory Hospital Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 15 January 2020

BMI The Priory Hospital is operated by BMI Healthcare Limited. The hospital has 65 inpatient beds (Bournville, Dudley, Aston, ITU and Highbury) and 17 day-case beds (Highbury and Paediatric Unit). Facilities include five operating theatres, a six-bed intensive treatment unit, a dedicated oncology centre, cardiac catheterisation lab, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, critical care, services for children and young people, and outpatients and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology, however we did not inspect services for children and young people or outpatient services. We carried out unannounced inspections of the surgical and diagnostic imaging services on 14 and 15 May 2019 and medical care and critical care on 17 and 18 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

Our rating of this hospital stayed the same. We rated it as Requires improvement overall.

We found areas of practice that require improvement:

  • The service did not always provide mandatory training in key skills to all staff and make sure everyone completed it.

  • The design, maintenance and use of facilities and premises was not always in line with national guidance.

  • Staff did not always complete and update risk assessments for each patient and remove or minimise risks.

  • Records were not always stored securely.

  • In critical care staff showed a lack of understanding about the mental capacity act and deprivation of liberty safeguards. There was no set space for staff to record capacity concerns in patient notes.

  • Managers did not always ensure staff followed up-to-date guidance in respect of diabetic foot care. In medical care, staff did not always support patients to make informed decisions about their care and treatment. They did not always know how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

  • In medical care and diagnostic imaging, staff did not always ensure patients privacy and dignity was respected and took account of their individual needs.

  • The service did not always take into account patients’ individual needs and preferences. Staff did not always make reasonable adjustments to help patients access services.

  • In critical care, patients and visitors may not know how to give feedback and raise concerns about care received.

  • Leaders did not always operate effective governance processes throughout the service.

We found areas of good practice:

  • 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.

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.

  • 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. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

  • Key services were available seven days a week to support timely patient care.

  • Staff gave patients practical support and advice to lead healthier lives.

  • Staff treated patients with compassion and kindness.

  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.

  • Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

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, even though a regulation had not been breached, to help the service improve.

We also issued the provider with four requirement notices. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 15 January 2020

Our rating of safe stayed the same. We rated it as Requires improvement because:

  • The service did not ensure everyone had completed mandatory training.
  • The design, maintenance and use of facilities and premises was not always in line with national guidance.
  • Staff did not always complete and update risk assessments for each patient and remove or minimise risks.
  • Records were not always stored securely.

However:

  • The service provided mandatory training in key skills to all staff.
  • Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
  • Records were clear and up-to-date.
  • Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • 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 and reported incidents and near misses.

Effective

Requires improvement

Updated 15 January 2020

Our rating of effective went down. We rated it as Requires improvement because:

  • In medical care, staff did not always support patients to make informed decisions about their care and treatment. They did not always know how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

  • Staff did not always monitor the effectiveness of care and treatment.

  • Managers did not always ensure staff followed up-to-date guidance in respect of diabetic foot care.

  • In critical care staff showed a lack of understanding about the mental capacity act and deprivation of liberty safeguards. There was no set space for staff to record capacity concerns in patient notes.

However:

  • 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 and gave pain relief in a timely way.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

Caring

Good

Updated 15 January 2020

Our rating of caring stayed the same. We rated it as Good because:

  • 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.

Responsive

Good

Updated 15 January 2020

Are services responsive?

Our rating of responsive improved. We rated it as Good because:

  • The service worked with others in the wider system and local organisations to plan care.
  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
  • The service treated concerns and complaints seriously, investigated them and shared lessons learned with staff.

However:

  • The service did not always plan and provide care in a way that met the needs of local people and the communities served.
  • The service did not always take into account patients’ individual needs and preferences. Staff did not always make reasonable adjustments to help patients access services.
  • In critical care, patients and visitors may not know how to give feedback and raise concerns about care received.

Well-led

Requires improvement

Updated 15 January 2020

Our rating of well-led stayed the same. We rated it as Requires improvement because:

  • Managers did not always have the right skills and abilities to run the service.

  • The service did not always have a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy was not always focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff did not always understand and know how to apply them and monitor progress.

  • Leaders did not always operate effective governance processes.

  • All staff were not always committed to continually learning and improving services.

However:

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

  • Leaders and teams did not always use systems to manage performance effectively. They did not always identify and escalate relevant risks and issues and identified actions to reduce their impact.

Checks on specific services

Medical care (including older people’s care)

Requires improvement

Updated 15 January 2020

Medical care services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as requires improvement as it required improvement in Effective, responsive and well-led. However, we found it was good in safe and caring.

Outpatients and diagnostic imaging

Requires improvement

Updated 17 January 2017

We rated this this service as Requires Improvement overall.

We rated safe as Inadequate because;

  • The progress of incidents could not be easily followed, we saw a serious incident that had not been investigated and the affected patients had not been notified.

  • Details on all patient consultation were not kept onsite.

  • The ‘5 steps to safer surgery’ checklist was not embedded within Diagnostic imaging and did not take place in the outpatient department.

  • The capital replacement programme for Diagnostic imaging was inadequate and radiology equipment was past its replacement date.

  • Radiation doses delivered exceed the national dose reference levels for under 50’s and the gamma camera was placed on the risk register seven years ago.

We have inspected but not rated this service for effective.

  • We found that the referral and justification for exposure to medical exposure of radiation was unclear. Out of date protocol was still in circulation the diagnostic imaging department but discrepancy rates were less than the national target.

We have rated responsive and well led as requires improvement;

  • Computed Tomography CT cardiac scans for the

  • The waiting times in diagnostic imaging were not communicated with patients.

  • We were not assured that appropriate governance systems were in place to track incidents reported by staff.

  • Feedback from the provider’s corporate diagnostic imaging lead to the radiology manager regarding equipment replacement was poor. The equipment in the department was in urgent need of replacement with no vision of how BMI will be addressing the issues.

  • The hospital risk register did not reflect the risks occurring in diagnostic imaging.

    However we did see some good practice:

  • However we also saw that departments were clean. Adequate staffing levels ensured patient safety and medicine prescriptions were stored safely.

  • Multi-disciplinary team working was seen throughout the hospital and staff appraisals were up to date. Extended working hours were evident to accommodate patient need.

  • We have rated this service as good for caring. We observed kind, compassionate care, all patients we spoke to recommended the service. Patients were supported through their treatments.

  • We also saw that learning from complaints was evident in the physiotherapy department.

  • The provider was meeting it’s referral to treatment targets and patients were provided with suitable appointments to reflect their needs.

  • Staff were familiar with the vision and strategy for the service.

  • Leadership was visible.

  • Innovative practice was evident in physiotherapy and diagnostic imaging departments.

Surgery

Requires improvement

Updated 15 January 2020

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 requires improvement because it was good for effective, caring and responsive although it requires improvement for being safe and well-led.

Critical care

Good

Updated 15 January 2020

Critical care services were a small proportion hospital activity. The main service was surgery. Where arrangements with the same we have reported findings in the surgery section. We rated the service as good because it was safe, effective, responsive and well led. Caring was not rated because we could not speak to enough patients or relatives.

Diagnostic imaging

Requires improvement

Updated 15 January 2020

Diagnostic imaging services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as requires improvement because it was good for caring and responsive, although the safety and leadership requires improvement.