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BMI Sarum Road Hospital Good

Reports


Inspection carried out on 21 August 2018

During an inspection to make sure that the improvements required had been made

BMI Sarum Road is operated by BMI Healthcare Limited. The hospital has 48 beds. Facilities include two operating theatres (both with laminar flow), one minor operations room and 10 consulting rooms.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected medical care. Since our last inspection in February 2016 the provider no longer provided a gastrointestinal endoscopy service.

We carried out this focused inspection to follow up findings within the medical care service from our previous comprehensive inspection in February 2016. We carried out this unannounced inspection on 21 August 2018

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.

Our rating of this service improved. We rated it as good overall.

  • 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.
  • The provider had developed an end of life strategy which at the time of inspection was at the draft stage. The director of clinical services did not give us a times scale of when the strategy would be finalised.
  • Staff were providing care and treatment based on National Institute for Health and Care Excellence (NICE).
  • Staff were caring, sensitive to the needs of patients and compassionate. Patients’ commented positively about the care provided by all the oncology staff.
  • The oncology suite was visibly clean and odour free. Staff used control measures to prevent the spread of infection.
  • The pathway for oncology patients was working effectively.

  • Staff specialist training in oncology was thorough.
  • Staff felt well supported by the oncology consultants and the resident medical officer.

  • We observed good teamwork both within the medical service and across the whole hospital.

However

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

  • 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.
  • Clinical outcomes for oncology patients were not audited.

  • The record of oncology patients’ treatment being discussed at a multidisciplinary team meeting was not stored in the main patients’ medical notes. There was a risk that information may not be known to anyone unaware two records were being maintained.

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

Amanda Stanford

Deputy Chief Inspector of Hospitals 

Inspection carried out on 24 and 25 February 2016

During a routine inspection

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 carried out on 9 December 2013

During an inspection to make sure that the improvements required had been made

We looked at the processes, procedures and records held by the service relating to the use and management of medicines. We observed that medicines were stored securely and at the correct temperatures at all times.

At the time of our inspection there were four in-patients and a further 12 to be admitted. We spoke to one of the in-patients who explained that due to an allergy their medication was changed and they were pain free. A nurse also explained that they can access a number of a medication website for additional information on medicines. They frequently access a website on the administration of medicines by injection.

Inspection carried out on 20 August 2013

During a routine inspection

During our inspection we reviewed the care records relating to four inpatients. We spoke with eight inpatients, six outpatients and two relatives. We spoke with 18 staff including the Director of Nursing, three consultants, the head nurse, a physiotherapy assistant, nurses, ward staff and a member of housekeeping staff.

Inpatients told us that they were involved in decisions about their treatment. No one felt pressured into making a decision about their treatment and all said they had signed a consent form.

Post-operative care and treatment was planned and delivered in a way that was intended to ensure peoples safety and welfare. All patients were nursed in individual rooms with the exception of the High Dependency Unit (HDU) and recovery area.

People were not protected against the risks associated with medicines because the provider does not have appropriate arrangements in place to manage medicines. There was evidence that medicines were stored safely. However, pharmacy reference books were not the most up to date versions and the provider had not acted upon a National Patient Safety Alert (NPSA).

People who use the service and staff were asked for their views about their care and treatment and they were acted on. Feedback cards were available in outpatient waiting areas and one was left in every room. We saw the results for July 2013 which showed that 90% of patients had rated the hospital very good or excellent.

Inspection carried out on 7 November 2012

During a routine inspection

During our visit we spoke with seven people who use the service, they all understood the care and treatment choices available to them. People told us that they were able to discuss any aspects of their care or treatment with the nursing staff or consultants. One person told us �all questions were answered in a way I could understand.�

The service carried out an assessment of each person�s needs before they started their treatment. Pre admission assessments took place for all people and risk assessments were completed. One of the people we spoke with said, �Nothing is too much trouble, I feel safe.�

All staff showed awareness of good hand hygiene. We saw that antibacterial gel dispensers were available in prominent places around the hospital for the use of staff, patients and visitors. Laminated posters demonstrating good hand hygiene techniques were displayed above hand wash sinks.

All the staff we spoke with said that they felt well trained to do their job. We saw the records which were kept by the service to record details of consultants� professional development. These included details of their last appraisal and details of their medical protection insurance.

BMI Healthcare Limited,carried out audits of the service to monitor clinical performance, infection control, patient satisfaction and other aspects of patient care.

Reports under our old system of regulation (including those from before CQC was created)