• Hospital
  • Independent hospital

The Saxon Clinic

Overall: Good read more about inspection ratings

Saxon Street, Eaglestone, Milton Keynes, Buckinghamshire, MK6 5LR (01908) 665533

Provided and run by:
Circle Health Group Limited

All Inspections

17 to 18 September 2019

During a routine inspection

The Saxon Clinic is operated by BMI Healthcare Limited. The hospital has 33 beds. Facilities include two operating theatres, endoscopy services, 12 outpatient consulting rooms and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging for patients, either as outpatient appointments or inpatient admissions. The majority of patients are admitted for day case surgery, however, there is a portion of patients who require longer inpatient stays after more complex surgery. Specialities include orthopaedic surgery, urology, gastroenterology and general surgery. We inspected surgery, medicine, outpatients, diagnostic imaging and services for children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced inspection on the 17 and 18 September 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

We last inspected this provider in September 2016 when we rated it as requires improvement.

Our rating of this hospital improved. We rated it as Good overall.

We found the following areas of good practice:

Staff were aware of their roles and responsibilities and completed training appropriate to their roles. This included safeguarding training. There was a robust process in place to ensure all staff, including consultants had completed training.

The hospital was visibly clean and tidy and there was evidence of a maintenance programme to ensure facilities were of a good standard.

There were enough numbers of staff to ensure that services ran smoothly. Skill mix was appropriate to clinical need and bank and agency staff were fully inducted to the service. Where possible, the same staff were used to improve consistency of care.

Services used safe processes for the storage, prescribing and administration of medicines and radiation.

Any incidents were reported and taken seriously. Staff investigated incidents and took steps to prevent reoccurrence and promote learning across the hospital.

The hospital used national guidance and policies to inform policies and promote best practice.

Patients were assessed and provided with nutrition and hydration across all services and staff ensured that patients pain was well managed. Fasting guidelines were in place to ensure patients were not starved for long periods whilst waiting for operations.

There were processes in place to ensure that patient outcomes were measured and staffs ability to complete their roles were continually assessed and monitored by leads. Teams worked collaboratively to ensure that services ran smoothly and ensure that patient pathways were robust.

Services were provided across six or seven days, although urgent services were provided 24 hours per day.

Patients were supported to make decisions about their care and were given advice on making health choices.

Patients, including adults and children were cared for respectfully and with kindness and compassion.

Services were planned to provide care in a way that met patients’ needs taking into consideration individuals needs and preferences. People could access services at times to suit them and admit, treat and discharge times were in line with national guidance.

Staff took any concerns or complaints seriously, investigating them and ensuring any learning was shared across the organisation.

Leaders were visible, approachable and had the right skills and abilities to manage the services. There was a clear vision and staff were involved with developing their local strategy and clinical areas.

Staff felt supported, valued and were proud to work at the hospital. Senior managers were engaging and collaborated with external partners.

There were robust processes in place to ensure effective governance and risk management. Staff used performance data to make decisions and improvements.

Staff development was encouraged, and services were continually learning and improving. Leaders promoted innovation.

However, we also found the following issues that the service provider needs to improve:

Within Surgery:

  • Non-clinical staff appraisal rate was below the hospital target.

  • Complaints were not responded to in line with the timeline outlined in the policy.

  • Consultants rarely attended governance meetings.

  • The hospital did not have a senior nurse at director of clinical services or ward manager position, who had oversight of the hospital activity.

Within Medicine:

  • Within endoscopy, the service environment did not always follow national guidance.

  • Endoscopy services were not utilising the full WHO five steps to safer surgery checklist.

  • Within endoscopy staff did not always address risk in a timely way. There was no standardised system in place to monitor and escalate deteriorating patients.

  • Endoscopy services did not always follow best practice guidance when gaining patients’ consent.

Within Children and Young People:

  • Compliance with national best practice guidance and clinical outcomes for specific procedures were not checked by managers.
  • The service did not routinely use audit findings to make improvements and achieved good outcomes for patients.

Within diagnostic imaging:

  • Not all radiation protection equipment was clearly labelled as being checked annually.

  • Some staff felt unsupported by the wider BMI corporate team.

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 two requirements notice(s) that affected medicine. Details are at the end of the report.

Name of signatory

Heidi Smoult- Deputy Chief Inspector of Hospitals

26 - 27 January, 9 February 2016

During a routine inspection

We carried out an announced inspection visit of BMI The Saxon Clinic on 26 and 27 January 2016 and an unannounced inspection on 9 February 2016.

Our key findings were as follows:

Overall the hospital required improvement. However, caring was rated good in all the four core services we inspected, medical care (chemotherapy), surgery, children and young people and outpatients, as was effective and responsive in surgery.

Are services safe at this hospital?

  • Systems and processes were not always reliable and appropriate to keep people safe. There was an infection prevention and control programme in place, led by an infection prevention and control nurse and supported by a consultant microbiologist. National guidance and specifications on cleanliness, hygiene and infection prevention and control was not always complied with.
  • There was no audit tool or audits of patients who developed neutropenic sepsis; however the hospital reported to us that no patients had developed neutropenic sepsis during the previous 12 months.
  • The rooms used for chemotherapy, were often used for other services if needed. This meant those patients who may have been immuno- compromised were put at risk of getting a hospital acquired infection.
  • There was a policy in place and staff were aware of the impact of duty of candour legislation. We saw that this had been applied where appropriate.
  • The director of nursing and the lead nurse for children and young people’s services were trained to the appropriate level with regards to safeguarding. Staff were aware of their responsibilities to ensure patients, both adults and children, were protected from abuse and avoidable harm.
  • Incidents were reported appropriately. There was some learning, particularly amongst the more senior staff.
  • There was a system in place to recognise the deteriorating patient. Appropriate triggers were in place to ensure patients, who had deteriorated were treated according to their clinical needs.
  • There was transfer agreement in place with the local trust to ensure that both adults and children could be transferred swiftly to a higher level of care, should this be required.
  • There was an RMO on site 24 hours a day and although they had good general skills, and said they were confident, not all of them had specific qualifications to care for both patients undergoing chemotherapy or children and young people.
  • Handovers between consultants, RMOs and nursing staff were effective.

Are services effective at this hospital?

  • There was limited evidence of how practice was audited against current evidence-based guidance, standards and best practice. The quality and risk manager post had been vacant for eight months prior to the inspection. This had affected the hospital’s audit programme.
  • There was also limited evidence of patient reported outcome measures in the medical (chemotherapy) and children and young people’s services service at the time of our inspection. This meant that staff were unable to confirm how this information was used to improve patient services. There was, however, participation in national audits in surgery, which showed outcomes within an expected range.
  • Patients’ treatment, with regards to chemotherapy, was discussed within the local NHS multidisciplinary (MDT). None of the Saxon Clinic staff were involved in these MDT meetings.
  • The Medical Advisory Committee (MAC) worked closely with the senior hospital managers and the clinical governance committee to ensure that the hospital was supported by the medical society
  • The MAC reviewed all new consultants before practising privileges were approved; this included their scope of practice. The hospital had an effective system in place to ensure that practising privileges were updated with the relevant information, for example appraisal, GMC and MDU membership.
  • All staff were aware of their responsibilities with regard to gaining valid consent from adults, children and those who lacked capacity.

Are services caring at this hospital?

  • Patients were overwhelmingly complementary about the service they received at the hospital.
  • The service provided emotional support to both patients who attended the hospital, and their families. This service extended to counselling and one to one consultations.
  • The Friends and Family survey results, for the period April to September 2015 which had a response rate of 60% showed almost 100 % satisfaction with the quality of care. Over 80% of respondents to the inpatient survey rated the quality of care provided as excellent. The BMI patient satisfaction survey, showed a similar high satisfaction, however the response rates were low at 17%. Another shorter survey undertaken of patients had a response rate of 69%.

Are services responsive at this hospital?

  • There were some shortfalls in how the needs of different people were taken into account. For example there were no formal mechanisms in place to ensure the service was able to meet the individual needs of people living with dementia, or a learning disability.
  • A risk assessment to ascertain patients’ mental capacity was carried out at pre-admission clinics or on admission. However, staff had not completed any training in these areas and were unable to describe any formal links to obtain specialist advice in such circumstances. However staff could not recall caring for people with these needs in this specialist service and therefore the perceived impact was low.
  • The services provided reflected the needs of the local population. Services were flexible, offered choice and continuity of care.
  • The booking system was conducive to patient needs, as where possible patients could select times and dates to suit their family and work commitments.
  • Operating theatre lists for elective surgery were planned with the operating theatre manager and bookings team. This was to ensure all aspects were checked and considered before booking patient on to the list to ensure patients safety and needs were met. In addition it ensured available operating time was used effectively.
  • Children were cared for in an area of the adult ward. The physical environment had not been sufficiently adapted to ensure it was suitable for children and young people’s needs.
  • All surgical patients were risk assessed using American Society of Anesthesiology (ASA) guidelines. If they were unsuitable for surgery, for example they had multiple comorbidities and may require high dependency care post operatively; their surgery was not undertaken at The Saxon Clinic.
  • There was a culture of learning from complaints and concerns, particularly at senior level. However, not all verbal complaints were recorded or processed in a systematic manner.

Are services well led at this hospital?

  • Key risks were not always recognised. It was not clear how often the risk register was updated. Some risks had been on the register for several years and no further action to mitigate the risks had been taken. The service reviewed and acted on feedback about the quality of care received. There were some arrangements for monitoring the quality of the service provided.
  • There was good local leadership and an open culture where staff felt valued.
  • The quality and risk manager post had been vacant for eight months prior to our inspection. A senior member of staff was covering for this post as well as their own role. It was clear that this had directly impacted on the pace at which risk management had been managed.
  • The vision and values of the hospital were incorporated into the appraisal system. However not all staff had undergone an appraisal which meant there was mixed awareness and understanding of the vision’s principles.
  • Staff we spoke with could not describe any defined cancer strategy in place other than a proposed move to new facilities. We noted these plans, but saw no evidence of when they would be implemented.
  • Each department had a business plan which was incorporated into the hospital plan.

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

Action the hospital MUST take to improve

  • The hospital must ensure compliant sinks and taps are available in the clinical areas and patient rooms which conform to Health Building Note 00-10 Part C Sanitary Assemblies to allow correct hand hygiene practice.
  • Improve handwashing facilities in the physiotherapy and outpatients department.
  • The hospital must ensure carpets in clinical areas are replaced with flooring that meets the requirements of Health Building Notice (HBN) 00-09: Infection control in the built environment.
  • The hospital must ensure compliance with national guidance for monitoring and reporting neutropenic sepsis, although the hospital reported that they had not admitted any patients with neutropenic sepsis.
  • The hospital must ensure that when risks are identified that they are recorded, reviewed regularly and timely action is taken to mitigate them.

Action the hospital SHOULD take to improve

  • An audit programme should be in place to ensure compliance with national guidance and to measure patients’ outcomes.
  • Review the MDT arrangements, for patients undergoing treatment for cancer with the local trust.
  • Improve staff attendance at some aspects of mandatory training, for example basic life support, paediatric basic life support and acute illness management.
  • Ensure all staff have an annual appraisal.
  • Ensure that complaints are dealt with consistently.
  • Implement specific children’s and young people’s audits, according to BMI policy, in order to measure patients’ outcomes.
  • Carry out a risk assessment on the children and young people’s service and the areas in which children are cared for.
  • Review the requirement to make child friendly information available.
  • Consider the risks and sustainability surrounding the paediatric service, when there is only one person in a substantive post, supported by temporary staff only, carrying sole responsibility for delivering it.

Professor Sir Mike Richards

Chief Inspector of Hospitals

1 October 2013

During an inspection looking at part of the service

We spoke with two members of staff about their training, they both told us they had received their mandatory training and felt supported by their managers.

We found that there had been improvements in the maintenance of patient's records. We saw that there were systems in place to ensure that record keeping was accurate, relevant and fit for purpose.

We found that there were systems in place to acquire and record the skills and experience of the consultants who have practicing privileges at the hospital.

We found concerns with the recording of controlled drugs in Theatres.

18 June 2013

During a routine inspection

We spoke with six people who were receiving treatment at BMI The Saxon Clinic. They all told us that they had been treated with respect and were well informed about their treatment. One person told us he found the staff to be "absolutely brilliant", another person told us "the staff are very attentive and the doctors explained what they were doing in a way I understand". Two people were being prepared for discharge and we found that they knew when and where their appointments would be.

We found that BMI The Saxon Clinic were providing risk assessments and care that met people's needs. We found improvements in their infection control procedures.

However we found that there had not been adequate improvement in the record keeping. We also found concerns regarding the investigation process when dealing with incidents. We found further concerns with their processes to ensure the standard of skills and competencies of doctors providing care at BMI The Saxon Clinic.

5 December 2012

During a routine inspection

We spoke with three patients who had undergone surgery at The Saxon Clinic. They told us they were very happy with the care they received. One person told us 'the staff are marvellous'. Another patient said 'the staff can't do enough for me'.

We found that the premises were clean and the care and welfare of patients were well managed. However, we found concerns over the record keeping in all areas of the hospital.

26 October 2011

During a routine inspection

People who use the service told us they had been involved in discussions about their care and treatment. They said they had been given the opportunity to ask questions and had received thorough explanations on such things as consent to their treatment and the risks and benefits involved in their procedures. They felt staff were very good at respecting their privacy and dignity.

People told us they had received a pre-admission assessment and a further nursing assessment on arrival at the Saxon Clinic. They said that the assessments had taken into account their needs during their care and treatment. People felt that staff were very knowledgeable about their needs and how to meet them.

People said they felt safe and that their possessions were secure at the Saxon Clinic. One person said: 'I am absolutely comfortable with the way I am treated here'. They told us that staff appeared qualified and well trained in looking after them. They said they were always able to locate a member of staff when they needed one. One person said: 'Staff are brilliant at responding. As soon as I press the call bell someone is here'. Overall, they felt staff were pleasant, respectful and efficient.

One person summarised the general feeling by saying: 'I have no concerns at all about this hospital. Everyone is very friendly and extremely helpful'.