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BMI Sarum Road Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 13 July 2016

The Sarum Road Hospital is one of 59 hospitals and treatment centres provided by BMI Healthcare Limited.

The hospital provides a range of medical, surgical and diagnostic services. The onsite facilities include an endoscopy suite, two operating theatres (both with laminar airflow), 48 registered beds (36 in use), one minor operations room, one treatment room and 10 consulting rooms. The hospital offers physiotherapy treatment as an inpatient and outpatient service in its own dedicated and fully equipped physiotherapy suite. In-health, a separate organisation, provides MRI scanning facilities. These services were not included in this inspection.

Services offered included general surgery, orthopaedics, cosmetic surgery, ophthalmology, general medicine, oncology, endoscopy, and diagnostic imaging. Most patients are self-paying or use private medical insurance. Some services are available to NHS patients through the NHS e-referral service.

The announced inspection took place between 25 and 26 February 2016, followed by a routine unannounced visit on 3 March 2016.

This was a comprehensive planned inspection of all core services provided at the hospital: medicine, surgery, outpatient and diagnostic imaging and services for children and young people.

The Sarum Road Hospital was selected for a comprehensive inspection as part of our routine inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

The overall rating for this service was ‘good'.

Our key findings were as follows:

Are services safe at this hospital?

  • Patients were protected from the risk of abuse and avoidable harm across medical, surgical services, outpatient and diagnostic imaging services for children and young people. However, the five steps to safer surgical checklist used in endoscopy was not always fully completed. Two out of ten safer surgical checklists we reviewed in endoscopy patient records were not signed by a clinician and one was incomplete.
  • Staff reported incidents and openness about safety was encouraged. Incidents were monitored and reviewed. We saw examples of changes in practice that occurred as a result of learning from incidents.
  • Staff were aware of Duty of Candour legislation and how it should be applied.
  • Staffing (nursing and medical) was sufficient to provide good care and treatment across all areas.
  • All areas inspected were visibly clean and tidy and staff mostly adhered to Bare Below the Elbows (BBE) guidance. However, we observed theatre recovery staff were not always BBE. Equipment was maintained and tested in line with manufacturer’s guidance.
  • There were suitable arrangements for handovers between shifts and there was a hospital wide ‘huddle’ that took place daily which gave all departments oversight of the hospital’s safety concerns and actions for that day. Clinical staff identified and responded to patient’s risks.
  • Staff received regular simulation training to ensure they could respond appropriately if a patient became unwell. When needed, arrangements were in place to ensure patients could be safely transferred to a local NHS hospital. Bank staff compliance with mandatory training ranged from 55% to 80%, against a target of 85%.

Are services effective at this hospital?

  • Care and treatment followed best practice and evidence based guidance across services.
  • The hospital routinely collected and monitored information about patients’ surgical outcomes for comparative analysis against the BMI corporate dashboard and national performance audits. Patient outcomes were not routinely measured following endoscopy procedures. Endoscopy staff followed National Institute for Clinical Excellence (NICE) guidelines and were working towards Joint Advisory Group (JAG) on gastrointestinal endoscopy accreditation. The Medical Advisory Committee were actively involved in reviewing patient outcomes and renewal of practicing privileges of individual consultants.
  • Staff were competent and sufficiently skilled to deliver effective care and treatment.
  • This hospital provided core training for staff in Mental Capacity Act, 2005, and Deprivation of Liberty Safeguards. Staff routinely considered patients mental capacity to make decisions about their care and treatment. Where staff were unsure about the capacity of a patient to consent to care and treatment, they would seek advice from senior staff in the first instance. Written consent records for surgery took account of Department of Health guidance.

Are services caring at this hospital?

  • Staff treated patients with kindness and compassion. Staff treated patients courteously and respectfully, and patients’ privacy and dignity were maintained.
  • Feedback from patients about their care and treatment was consistently positive. Patients told us they had sufficient information about their treatment and were involved in decisions about their care. Results of the latest patient survey showed a high level of patient satisfaction, with the hospital scoring over 95%. Caring was good in the outpatients and diagnostic imaging service. This included the provision of emotional support.
  • Staff verbally offered a chaperone to all outpatients and 95% of patients had accepted the offer of a chaperone. The same service received exemplary feedback from patients.

Are services responsive at this hospital?

  • The hospital had service development plans for improvements at the hospital including meeting future demand. There were plans to upgrade the endoscopy service environment to achieve JAG accreditation.
  • The medical service met national waiting times for endoscopy patients to wait no longer than 18 weeks for treatment after referral. The service was responsive to patients in the inclusion criteria, with waiting times of one to four weeks. There were no waiting lists for oncology services at this hospital. However, the hospital did not always meet national waiting times for surgical treatments.
  • The needs of different people were taken into account when planning and delivering services. The provider planned and delivered services in a way that met the needs of the local population. The service reflected the importance of flexibility and choice. Staff took account of individual patient’s spiritual, religious and emotional needs when delivering care and treatment. Suitable adjustments were made to meet individual needs. For example, we saw the use of dementia friendly clocks and picture signs on the ward.
  • Complaints and concerns were always listened to, lessons learnt and shared.

Are services well led at this hospital/service

  • Staff were clear about the vision and strategy for their services, driven by quality and safety.
  • All staff spoke highly of their senior management team, stating that they provided a visible and strong leadership within the hospital.
  • There was an open and supportive learning culture.
  • There was a clear governance framework to monitor quality, performance and risk at department, hospital and corporate level. Staff knew the risks, and action taken to mitigate these risks for their individual department. The risk register was not fully embedded and did not always include well known risks. The hospital did not have an end of life care strategy, pathway, or a named leader.

Our key findings were as follows:

  • Leadership at this hospital was strong. All staff were positive about their senior managers and there were daily meetings in place to ensure that concerns were escalated in a timely way.

  • Patients were protected from abuse and avoidable harm.

  • Staffing was sufficient in all areas. There was low use of bank and agency staffing across all areas.Staff were competent, skilled and well supported by their managers to deliver safe and effective care and treatment.

  • All clinical areas were visibly clean and equipment was well maintained.

  • Infection control practices were mostly good. Staff in theatre recovery did not always adhere to bare below the elbow guidance but action was taken to address this during the course of our inspection.

  • Patients’ nutrition and hydration needs were met. The hospital offered a wide range of food choices, and could cater for individual dietary requirements.

  • Patients reported staff managed their pain effectively and they had access to a variety of methods for pain relief.

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

The provider should ensure:

  • The business plan to achieve Joint Advisory Group (JAG) accreditation is progressed.

  • There is an end of life strategy, which informs pathway development.

  • There is consistent staff compliance with WHO Safer surgery checklist in endoscopy.

  • There is a strategy for the children and young peoples’ service.

  • That service risks hospital-wide are recorded and actions to mitigate are recorded and tracked.

  • Recovery staff consistently adhere to the bare below the elbow policy in clinical areas.

  • That all Patient Group Directions are in date and authorised by the required members of staff.

  • The service meets national referral to treatment time targets for NHS surgical patients.

  • Bank staff training compliance should meet the hospital’s own target of at least 85%.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 22 November 2018

  • The electronic prescribing of chemotherapy was safe and working well. The system ensured that medication could not be prescribed, dispensed or administered until all safety checks completed.

  • There were sufficient nursing and medical staff for procedures and chemotherapy treatment to proceed as planned.

  • Effective processes were in place to assess and respond to patient risks.

  • Staff followed policies and procedures to ensure effective control and prevention of infection.

However

  • The process in place for when servicing of medical equipment next due was not clear.

Effective

Not sufficient evidence to rate

Updated 22 November 2018

  • Staff were providing care and treatment based on National Institute for Health and Care Excellence (NICE). 
  • Staff monitored a patient for any pain, and responded promptly if any pain relief required.
  • Staff were encouraged to participate in training and development to enable them to deliver good quality care.
  • There was effective multidisciplinary working.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

However

  • Patient clinical outcomes were not measured.

  • Although BMI Healthcare had a process in place to oversee and manage policies, we found three policies or guidelines that were currently under review in oncology, that were out of date in the case of two policies by over 18 months.

  • Patients records were not complete as they did not contain records of multidisciplinary team meetings.

Caring

Good

Updated 22 November 2018

  • Staff were caring, sensitive to the needs of patients and compassionate. Patients’ commented positively about the care provided by all the oncology staff.
  • Patients felt informed and involved in their care and treatment. This included their care after a chemotherapy treatment in the oncology suite.
  • Staff supported patients’ emotionally with the care and treatment as needed.

Responsive

Good

Updated 22 November 2018

Are services responsive?

  • The hospital planned services in a way that met the needs of those people who chose to access services. These people were happy with access to services, and facilities provided.
  • Care and treatment was co-ordinated with other providers.
  • The needs of different people were considered when planning and delivering services. Staff took account of individual patients’ needs when delivering care and treatment.
  • Staff working in this service, listened to concerns, complaints and communicated lessons learnt.

Well-led

Requires improvement

Updated 22 November 2018

  • The risk register did not identify all risks to the patients that used the service.

However

  • The provider, BMI Healthcare Limited had a corporate lead for end of life care and an end of life care lead was in place at the hospital.

  • Staff spoke passionately about the service they provided, the care they offered to patients and had a vision for their services. Staff achievement was recognised through staff awards.
  • Patients were given opportunities to feedback about their experiences.
Checks on specific services

Medical care (including older people’s care)

Good

Updated 22 November 2018

Medical care services were a small proportion of hospital activity. The main service was surgery.

Services for children & young people

Good

Updated 13 July 2016

Overall, we found services for children and young people were good. We did not rate this service for caring as there was insufficient evidence to do so. The children and young people’s service had a good track record on safety with no serious indents reported. The hospital safeguarded children and young people through offering care tailored to their needs. There are two fully qualified paediatric nurses employed by the hospital to manage the care of children and young people. A resident medical officer (RMO) with a current certification in paediatric advanced life support is employed whenever a child is admitted.

The hospital lacked specific waiting areas and consulting rooms for children, but staff minimised the potential impact of mixing children with adults by using dividing screens if needed.

The director of clinical services and the paediatric nurses were all qualified in safeguarding to level 3 and the director of clinical services took the role of safeguarding lead at the hospital. Children and young people’s services are planned and delivered in line with best practice and guidance. The provider monitors outcomes and the service benefitted from the same standards of care and infection prevention and control measures activities afforded to adults in the hospital.

Children’s and young people’s services were responsive and provided access at times to suit children, young people and their parents. Child-friendly information was available for children about their procedures; nurses encouraged them to ask questions about their care. Nursing staff offered children and parents emotional support when needed. The paediatric nurses gave a feedback questionnaire to all children and young people and the results were collated annually and used to improve the service for children and young people.

Staff felt well supported by the paediatric nurse leads as well as the director of clinical services and the senior leadership team. There were no serious incidents related to the care of children or young people within the past year and there was a positive culture of reporting, investigating and learning from incidents across the hospital. There were no known risks associated with the care of children and young people at the time of our inspection.

The executive director told us the risk register was not fit for purpose in its current format but senior managers were aware of this and were in the process of reviewing their processes for recording, reviewing and tracking mitigating actions across the hospital. There was no written strategy for the care of children and young people at this hospital though staff shared the overall vision of providing excellent care and value for money.

Outpatients and diagnostic imaging

Good

Updated 13 July 2016

Overall, this service was rated as good. We found outpatients and diagnostic imaging 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 enable a rating.

Medicines were stored securely and well managed. However, the patient group direction was in need of review, as it was two years past its review date. Staff had a good understanding of how to report incidents and learning from incidents was shared at departmental level. Staff undertook appropriate mandatory training for their role.

Patients were protected from the risk of abuse and avoidable harm. Hospital infection prevention and control practices were followed and these were regularly monitored, to reduce the risk of spread of infections. Equipment was well maintained and tested annually or in accordance with manufacturers’ guidelines. Staffing levels and the skill mix of staff was appropriate for both the outpatient department and diagnostic imaging services. Although the outpatient nurse manager had been under pressure, the situation had recently improved with posts being filled. Agency staff were not used. Longstanding bank staff were occasionally employed to provide cover. Staff received as a minimum training in basic life support to ensure they could respond appropriately in an emergency situation.

We inspected but did not rate ‘effective’ as we do not currently collate sufficient evidence to rate this.

Staff followed national and local guidance when providing care and treatment. For example, guidance related to diagnostic imaging to ensure safe practice. Staff were supported in their role through a corporate performance review process. Staff were encouraged to participate in training and development to enable them to deliver good quality care. Patients’ pain needs were met appropriately during a procedure or investigation. The consent process for patients was well structured and staff demonstrated a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Clinics were available six days a week, Monday to Saturday.

We rated caring as good. During the inspection we observed care was provided compassionately by caring staff. Patients’ feedback through interviews and comments cards was entirely positive; they commended the professionalism and kindness of staff. Patients praised all aspects of the service with comments such as “I am always listened to”, “Great advice”, “Brilliant”, “Fantastic”, “Welcoming and supportive” and “Exceptional care”. Patients were treated with dignity and respect. They felt they were fully involved in planning their care and treatment. Staff took time to ensure they listened to and responded to patients’ questions appropriately. This included the provision of emotional support. Staff verbally offered a chaperone to all outpatients. Signs were also clearly displayed in waiting areas and clinical rooms offering a chaperone and the patient’s acceptance or rejection of the offer was recorded on the clinic list. Since the new chaperone service had been implemented over 95% of patients had accepted the offer of a chaperone.

We rated responsive as good. Services were planned and delivered in a way which met the needs of patients. Access to appointments was timely. Clinics were held on weekdays into the evening and Saturday mornings to suit patients’ preferences. Interpretation services were available, however, staff could not recall the need to access this service for the patients they cared for. Staff made practical adjustments to accommodate patients’ individual needs, for example, when caring for patients with hearing difficulties. Patients were aware of how to provide feedback and complain about the service if needed. Complaints were investigated and changes made if necessary.

We rated well-led as good. Effective governance and risk management systems were in place. Staff were well informed about issues relating to their department. They had opportunities to raise ideas and concerns when needed, which they were confident would be addressed by their managers. Service managers were committed to provide high quality care and facilities for patients. Local and senior managers were visible and approachable to all staff.  There was an open and supportive learning culture. Patients were given opportunities to provide feedback about their experiences and this was used to improve the service.

Surgery

Good

Updated 13 July 2016

Overall, we found surgical services provided good care and treatment to patients. Nursing and medical staff were caring, compassionate and patient centred in their approach. Patients felt they received enough information about their treatment and were involved in decisions about their care.

We observed that staff maintained patients’ respect and dignity at all times.

All areas of the service we visited were visibly clean, and there were systems in place to support the safe delivery of care and treatment.

Medical and nursing staff carried out effective risk assessments from pre-assessment through to discharge. They planned treatment, recovery and discharge in line with patients’ specific needs.

Staff followed evidence based care and treatment, and monitored and reviewed patient outcomes.

Staff worked effectively across different disciplines and had good links with staff at other BMI hospitals and local NHS services.

Nursing and medical competence was good and trained professionals took pride in their work.

Nurse staffing levels were based on an assessment of patient needs and there was a low level of agency usage across the department. Consultants and the RMO provided 24 hour medical cover to respond to any clinical issues.

There was a strong sense of loyalty and teamwork among staff. Staff valued the support from their leaders and liked working in the service

During our inspection, we observed recovery staff did not consistently adhere to the bare below the elbow policy in clinical areas.

Some Patient Group Directions for staff to administer and supply named medicines without a prescription were out of date and needed review.

Managers and staff did not use the risk register effectively to identify and manage risks within the service. The hospital had recently started to implement changes to address this.

The hospital did not produce formal action plans that detailed the person responsible for any actions in response to incidents.

The hospital did not always meet the referral to treatment time targets for NHS patients for surgical patients.