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BMI The Runnymede Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 25 January 2017

We carried out a comprehensive inspection of BMI The Runnymede Hospital on 1-3 August 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of medical care, surgery, and outpatients and diagnostic imaging as these represented the activity undertaken by the provider, BMI Healthcare, at this location.

We rated medical care, surgery and outpatients and diagnostic imaging as good.

Are services safe at this hospital?

  • We saw evidence of comprehensive and detailed investigations into incidents and complaints with learning appropriately shared throughout the hospital to improve standards of care and avoid recurrence. Staff understood the duty of candour and we saw evidence of this in practice.
  • Staff recognised and responded to changing levels of risk for the patient in line with current guidance and best practice.
  • There were clearly defined and embedded systems to keep patients safe, with staff demonstrating knowledge of safeguarding and an understanding of referral processes. The Director of Clinical Services was the safeguarding lead for adults and children.
  • There were effective handovers between shifts with information about patients being shared appropriately to ensure continuity of care. Nursing handovers took place three times per day and there was a formal handover between the RMOs who undertook regular ward rounds.
  • There was a service level agreement with the local NHS hospital which allowed for the transfer of patients who needed additional care.

Are services effective at this hospital?

  • Staff worked to national guidance and followed best practice standards to deliver consistently good quality care to patients, which the hospital monitored to ensure consistency of practice.
  • The role of the medical advisory committee was clear, with comprehensive paperwork circulated in advance so that members could be fully prepared. We saw minutes which demonstrated robust discussions of policy, shared learning and appropriate challenges
  • Mandatory training compliance was high across the hospital, with staff able to access additional training for personal development with the support of their line manager.
  • Although there was no dedicated pain team, staff had received specialist training and were able to discuss anticipated pain levels with patients in advance of their surgery. Patients told us their pain had been well managed.
  • There was a thorough system for managing the review and granting of practising privileges which ensured there was appropriate clinical and managerial oversight of this.
  • We reviewed patient records and noted that informed consent was clearly documented, with details of risks and benefits being discussed with patients in a manner which could be easily understood.

Are services caring at this hospital?

  • Patients and their relatives described the care they received at the hospital in very positive terms, with both clinical and non-clinical staff understanding the need for privacy and dignity and taking steps to ensure this.
  • Patients knew the name of the nurse who was looking after them, and we saw how staff made the effort to include relatives in the care of patients and explained to them what was happening.
  • The hospital made arrangements to allow parents to stay with their child overnight, and we observed staff being particularly gentle and reassuring with children undergoing procedures.

Are services responsive at this hospital?

  • Appointments were offered promptly to patients with flexibility to suit their preferences as far as possible. Patients told us they were seen on time.
  • Although the hospital saw very few patients with dementia, all staff had been trained in dementia awareness and were sensitive to the needs of patients living with dementia.
  • There was a clear process for managing urgent admissions which allowed for better planning and a more effective use of staff time.
  • The complaints process was well publicised and patients who chose to complain were treated compassionately throughout the process. Senior managers would invite the patient in to the hospital for a meeting, and we saw evidence that managers had visited a patient in their home when the patient did not wish to return to the hospital.
  • Provision was made to meet the individual needs of patients, including a hearing loop at reception for patients with a hearing disability, a list of languages that different staff members spoke, an interpreting service and careful planning of theatre lists to reduce anxiety for patients with a learning disability.

Are services well led at this hospital?

  • Staff were aware of the overall BMI strategy as well as the local mission statement and understood how it applied to their role and work in the hospital.
  • The senior management team was highly regarded by staff who told us they found them visible, approachable and supportive.
  • The registered manager was on annual leave at the time of the inspection but this did not impact upon the smooth and effective running of the hospital. The overall leadership and culture was not dependant on a single individual but continued to be demonstrated by the management team in the director’s absence.
  • The management team had taken steps to address the difficulties around recruitment and retention of staff by researching salaries across their independent competitors and NHS trusts and ensuring there was pay parity, and by providing training and development opportunities to retain experienced staff.
  • There was an effective system of governance with departmental meetings and a clinical governance committee with oversight by a well-managed and well attended medical advisory committee.
  • There was a culture of transparency and honesty amongst staff, who told us that managers actively encouraged them to report incidents. Staff told us they felt valued and respected by their leaders.
  • There were plans to develop medical services with the provision of four dedicated medical beds.

Our key findings were as follows:

  • There were effective systems to keep patients safe and to allow staff to learn and improve from incidents.
  • The hospital was visibly clean and we saw evidence that policies were implemented and monitored to prevent the spread of infection. Where audits had shown the need for improvement (for example, clinical staff being bare below the elbows), we saw measures had been put in place to improve performance.
  • The process for obtaining consent from patients was clear and ensured that staff followed national guidelines and met legal requirements.
  • Appointments were arranged so that patients could access care when they needed it.
  • Care was delivered in line with national guidelines and BMI corporate policy.
  • Staffing levels were adequate, with some vacancies which were managed through the use of bank or agency staff to ensure that there was no impact on patient care. There were robust arrangements to ensure that staff had the required training and skills to do their jobs.
  • The leadership had the confidence and respect of their staff, who felt supported and motivated by them to provide the best possible care for patients.
  • There was appropriate management of quality and governance through departmental meetings and committees with regular reports to the medical advisory group for comment, debate and decision. Managers were able to identify risks and challenges within the hospital and were able to escalate and take action as required.

We saw several areas of outstanding practice including:

  • The working of the medical advisory committee, with engagement from members, strong leadership from the chair and an effective working relationship between the chair and both the executive director and director of clinical services.

However, there were also areas where the provider needs to make improvements.

Importantly, the provider should:

  • Ensure that the flooring in all clinical areas is fit for purpose.

  • Ensure clinical staff who assess children are trained in safeguarding children level three.

  • Ensure that the governance policy is up-to-date.

  • Consider improving the environment for children in the outpatients department so that it is child-friendly.

  • Consider providing written information to service users for whom English is not their first language

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 25 January 2017

Effective

Good

Updated 25 January 2017

Caring

Good

Updated 25 January 2017

Responsive

Good

Updated 25 January 2017

Well-led

Good

Updated 25 January 2017

Checks on specific services

Medical care (including older people’s care)

Good

Updated 25 January 2017

Overall, we rated medical care as good. This was because:

  • Staff demonstrated a clear understanding of incident reporting and there was an effective process which ensured that thorough investigations were undertaken with learning shared throughout the hospital. Staff could describe the duty of candour and we saw evidence of how this had been applied in practice.
  • Staff were supported in doing both their mandatory training and undertaking additional training for development. Staff spoke highly of the support they received from managers to do this.
  • All medical staff who treated children were trained to safeguarding level three and the hospital had good links with the local safeguarding teams.
  • Despite some difficulties in recruiting which had led to a higher level of bank and agency nurse use, patients told us that the care they received was good, with staff taking the time to explain and reassure.
  • The Medical Advisory Committee met regularly and provided input and challenge where appropriate.
  • Although there were challenges around the physical environment in endoscopy which meant it could not achieve JAG accreditation, these issues had been raised on the risk register and there were measures in place to mitigate potential risk.

Outpatients and diagnostic imaging

Good

Updated 25 January 2017

Overall, we rated the outpatients department and diagnostic imaging as good. This was because:

  • The outpatients and diagnostic imaging departments provided a broad range of services for both privately funded and NHS funded patients. The patients we spoke with were complimentary about the care, treatment, and service they had received in both departments.

  • Staff were competent and worked to national guidelines, and ensured patients received the best care and treatment.

  • The culture within both departments was patient focused, open and honest. The staff we spoke with felt valued and worked well together. Staff followed policies and procedures to manage risks and made sure they protected patients from the risk of harm.

  • There were short waiting times for appointments. Private patients were seen within one week, and NHS patients were usually seen within four weeks of referral. Patients described that they could get appointments with their chosen consultant and were seen on time.

  • Patients we spoke with told us they were treated with dignity and respect. All patient feedback during the inspection was positive. They described the service as ‘first class’, ‘very good’ and ‘professional’.

  • Both departments were visibly clean.

Surgery

Good

Updated 25 January 2017

Overall, we rated surgical services as good. This was because:

  • The hospital had effective systems to assess and respond to patient risk and we saw examples during our inspection.

  • Staff planned and delivered patient care in line with current evidence-based guidance, standards, best practice and legislation. We saw that the hospital monitored this to ensure consistency of practice.
  • The hospital participated in relevant local and national audits and contributed to national data to monitor their performance such as the National Joint Registry (NJR). Staff we spoke to understood and fulfilled their responsibilities to raise concerns and report incidents and we saw examples of this.
  • We saw the hospital fully investigated incidents and shared learning from them to help prevent recurrences.
  • Patient consent was recorded in line with relevant guidance and legislation.
  • We saw staff treated patients with dignity, respect and kindness during all interactions. Patients told us they felt safe, supported and cared for by staff.
  • There was a governance structure that promoted the delivery of high quality person-centred care.
  • Leaders modelled and encouraged cooperative, supportive relationships among staff. The majority of staff told us they felt respected, valued and supported.
  • Services generally ran on time. Waiting times, delays and cancellations were minimal and the service managed these appropriately. We saw when a delay occurred there was an immediate explanation and apology.

However:

  • There was a low percentage of staff that had undergone an appraisal in 2016, and in addition only 11% of theatre staff had an appraisal in 2015.
  • We saw that some of the clinical areas had carpets.
  • Fire doors within the theatre suite did not have intumescent strips around the edges of doors or doorframes.
  • In theatres we saw three bowl stands had rusty wheels.
  • We could not find evidence of an electrical safety check on three patient trolleys.
  • Electrical cables in theatres were not secured.
  • In theatres there was a door on one of the preparatory rooms with a faulty closure mechanism which was potentially unsafe.