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BMI The Priory Hospital Requires improvement

Reports


Inspection carried out on 14 to 15 May 2019 and 17 to 18 July 2019

During a routine inspection

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 carried out on 16/02/2016, 17/02/2016, 18/02/2016, 25/02/2016

During a routine inspection

This location is part of BMI Healthcare Limited.

The hospital is a purpose built facility in the suburb of Edgbaston near the city centre. It is a mile away from a sister BMI hospital and shares some functions and staff with it.

The work undertaken is mostly elective. We inspected as a core service Medical care, Surgery, Outpatients & diagnostic imaging. We looked at but not as a stand-alone core service intensive care. We did not inspect the fertility clinic as that is regulated by the Human Fertilisation Embryology Authority (HFEA). We inspected the hospital as part of our commitment to inspect all independent health providers. We undertook this as a comprehensive inspection.

From October 2014 to September 2015, there were 1,316 medical procedures. There were 314 diagnostic endoscopic examinations such as colonoscopy and cystoscopy, between August 2015 and January 2016

Between October 2014 and September 2015 there were 6,773 surgical procedures completed at the hospital. The most common surgical procedures being; Multiple Arthroscopic Surgery – Knee (266 procedures), Phacoemulsification of lens with implant – unilateral (245 procedures) and Total prosthesis replacement knee joint (200 procedures).

  • 16% of all patients were NHS funded (Oct 2014 to Sep 2015).

  • There were 118 registered beds however, only 84 were in operation
  • Five theatres
  • The Registered Manager is Mrs Paula Naylor who had been in post for two months.

Inspection carried out on 15 October 2013

During a routine inspection

During our inspection we spoke with six people who used the service. We also spoke with eleven clinical and non clinical members of staff. This included theatre staff, staff on the Dudley and Bournville suites (ward areas) and senior managers and administrative staff.

At our last inspection we were concerned that people had been put at risk of unsafe care in the operating theatres. During this visit we were accompanied by a specialist advisor for theatres who helped us to look at the safety of people who underwent surgical procedures at the hospital. We found that the provider had acted on these concerns and that improvements had been made to ensure the safety of people who used the service.

The people we spoke with told us that they were happy with the care and treatment they had received at the hospital. Comments we received from people about the service included; �I�m very happy with the experience, it has all been extremely positive� and �It has been excellent. The doctors informed me about what they were going to do and kept me updated.�

People told us that they were given sufficient information to enable them to make informed choices about their treatment before giving consent.

Systems in place ensured people were protected from the risk of infection. Staff understood their responsibilities in maintaining a hygienic environment for people who used the service and were supported with this.

People were cared for and supported by suitable staff because appropriate checks of staff had been carried out before they commenced work at the hospital.

Quality monitoring processes helped to ensure that people received a good service. Although it was not always clear how information obtained through audits and investigations of incidents had been acted on.

Inspection carried out on 31 January and 5 February 2013

During a routine inspection

During our inspection we spoke with eleven people who had or were about to receive treatment at the hospital. We also spoke with fifteen clinical and non clinical members of staff (on the wards and in theatres), including the Executive Director, Director of Nursing and the Quality and Risk Manager who we spoke with by telephone.

The people we spoke with told us that they were happy with the care and treatment they had received. People told us that they were given sufficient information to enable them to make informed choices about their treatment before giving consent. Comments we received from people about the service included; �Honestly could not have asked for anyone to give me a better service, faultless� and �Second to none.�

However we were not assured that people received safe services in theatres. People had been put at risk from unsafe practice and the provider�s response to the reported incident had been inadequate in addressing the issues raised.

Inspection carried out on 16 December 2011

During a routine inspection

We carried out this review to check on the care and welfare of people using this hospital.

We spoke with six people using the hospital who told us they were happy with the quality of care and treatment received which met their goals along their road to recovery. Comments made by people included, ��Surgeons saw me everyday��, ��Beyond expectations��, and ��You can�t teach empathy and they have it here��.

A person described to us that when they came to the hospital they were shown their room and met staff. This person told us that information about the hospital and how to make complaints was also given to them.

All of the people we spoke with told us that they were well aware of the care, treatment and support they would receive whilst in hospital as they had received information prior to their treatment.

People told us that whilst in hospital, doctors and nurses spoke with them regularly, and explained what was happening and why. People were positive about the staff at the hospital. Comments included ��Could not ask for better care��, ��Very experienced staff, so reassuring��, ��The porter arrived, a smile, wonderful welcome which was good as I felt vulnerable��.

The hospital was making sure that people had opportunities to give their views about the service. Records showed that people's views were being used to make sure that the hospital was being run in the best interests of the people who use it.