Archived: BMI The Somerfield Hospital

Updated 16 May 2017

BMI The Somerfield Hospital is operated by BMI Healthcare Ltd. The hospital opened in 1983. It is a private hospital in Maidstone, Kent. The hospital primarily serves the communities of the Maidstone. It also accepts patient referrals from outside this area. The Hospital is led by a senior management team that consists of the Executive Director, Director of Clinical Services and Operations Manager and a team of clinical and functional heads of each department.

The hospital has had a registered manager in post since May 2012.

Updated 16 May 2017

BMI The Somerfield Hospital in Maidstone Kent, is operated by BMI Healthcare Ltd. Facilities include three operating theatres and the Hospital provides surgery, outpatients and diagnostic imaging. We inspected surgery and outpatients and diagnostic imaging services.

The hospital has 38 beds split across two inpatient wards. The hospital has three main theatres, 8 consulting rooms, as well a physiotherapy department and health screening. The hospital has ultrasound, X-ray and digital mammography within its imaging department. The hospital offers a wide range of surgical and medical procedures, including ENT, orthopaedics, gynaecology, general surgery, general medicine and ophthalmology,

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 and 13 December, on along with an unannounced visit to the hospital on 21 December 2016.

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 core service.

We rated this hospital as Good overall.

• The senior management team, supported by the heads of departments, had a good knowledge of how services were being provided and provided string leadership to teams.

• The care delivered was planned and delivered in a way that promoted safety and ensured that peoples individual care needs were met. We saw patients had their individual risks identified, monitored and managed and that the quality of service provided was regularly monitored.

• The executive director was in overall charge of the hospital and all employed staff were line managed through her direct reports.

• The Medical Advisory Committee (MAC) met quarterly and included representation from all specialities offered at the hospital. It was attended by the Executive Director and the director of clinical services. A wide range of topics were discussed and action taken in response to any concerns raised. The minutes of the MAC meetings were distributed to all consultants.

• The hospital used an agency that provided a Resident Medical Officer (RMO) onsite 24 hours a day, seven days a week, on a rotational basis. The RMO undertook regular ward rounds to make sure the patients were safe.

• The hospital used the corporate BMI Healthcare Nursing Dependency and Skill Mix Planning Tool, to determine staffing levels. The nursing rota was entered into the system monthly. This meant that the hospital ensured that staffing levels and mix were sufficient to provide safe care for patients.

• We saw a strong safety culture with policies and systems in place, and we saw that staff reported incidents appropriately.

• There were robust governance systems that were known and understood by staff and which were used to monitor the provision and to drive service improvements. The Clinical Governance Committee (CGC), met every two months and discussed complaints and incidents, patient safety issues such as safeguarding and infection control, risk register review.

We found areas of practice that required improvement in both surgery and in outpatients and diagnostic imaging services.

• The outpatient undertook their own decontamination of nasendoscopes using a three-wipe system. This system had a barcode tracking system. This enabled the hospital to track the cleaning of nasendoscopes used by individual patients for quality control. Staff we spoke to were able to describe the decontamination process however, it was unclear if personal protective equipment (PPE) was worn during the decontamination process. This meant the endoscopy policy and Health Technical Memorandum 01-01 Decontamination of medical devices within acute services was not being adhered to as both documents recommend staff should wear PPE during the decontamination process.

• There was no designated area for cleaning of the nasendoscopes, a desk in one of the main corridors was used. This was not in compliance with Code of Practice on the prevention and control of infections and related guidance and HTM 01-01.

• Not all outpatient records were not retained by the hospital, which meant that there were no comprehensive patient records that were accessible by all staff.

• Outpatient staff did not have up to date with competencies in relation to decontamination of reusable medical devices, to ensure compliance with the “Choice Framework for local Policy and Procedures (CFPP) 01-06–Decontamination of Flexible Endoscopes: Policy and management.”

• There were no dedicated hand wash basins in patient bedrooms, staff and visitors used the basin in the bedrooms en-suite bathroom or the hand washing facilities in the sluice.

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. Details are at the end of the report.

Professor Edward Baker

Deputy Chief Inspector of Hospitals (South East)

Updated 16 May 2017

We rated this service as good because it was, safe, effective, caring, responsive and well-led.

People who used the services were protected from abuse and avoidable harm and staff were aware of the processes and reporting systems for recording  incidents and safeguarding concerns. Staffing levels  were sufficient to provide care in a safe way.

Hygiene and infection control practices were followed.

Patient records were held securely.

Safeguarding of vulnerable adults training was undertaken every two years for levels one and two. Data indicated, 98% of required staff had completed level one, and 93% of required staff had completed level two, which was better than the BMI Healthcare target of 90%.

The care and treatment provided to people was evidence based and in line with relevant standards  and legislation, including National Institute for Health  and Care Excellence (NICE) and professional  organisational guidelines.

We observed staff providing care and treatment to people who used the services in a caring and compassionate way and people were involved in decisions about their care.

The hospital planned the services to meet the needs of the local population.

A range of outpatient clinics were available to meet the needs of the client group. According to data provided by the hospital, this included cardiology, dermatology, ear, nose and throat, general medicine, endocrinology, general surgery, haematology, gynaecology, pain control, podiatry, rheumatology, urology, neurology, orthopaedic, ophthalmology and dietitian. Orthopaedics, general surgery, general medicine, and ophthalmology had the highest attendance rates.

There were no waiting times for physiotherapy treatment and staff saw NHS as well as private patients.

The hospital met the target of 92% of patients on incomplete pathways waiting 18 weeks or less from time of referral in the reporting period (July 2015 to June 2016).

Access to outpatient appointments was fast and patients told us they were more than satisfied with the amount of time it had taken, to get the appointment. Patients also told us they were able to get appointments at times that suited them.

There was a robust governance framework and strong management and leadership within the hospital.

However:

The outpatient undertook their own decontamination of nasendoscopes using a three-wipe system. This system had a barcode tracking system. This enabled the hospital to track the cleaning of nasendoscopes used by individual patients for quality control. Staff we spoke to were able to describe the decontamination process however, it was unclear if personal protective equipment (PPE) was worn during the decontamination process. This meant the endoscopy policy and Health Technical Memorandum 01-01 Decontamination of medical devices within acute services was not being adhered to as both documents recommend staff should wear PPE during the decontamination process.

Not all the staff who decontaminated reusable medical equipment had up to date competencies.

There was no designated area for cleaning of the nasendoscopes, a desk in one of the main corridors was used.

Not all outpatient records were not retained by the hospital, which meant that there were no comprehensive patient records that were accessible by all staff.

Updated 16 May 2017

We rated this service as good because it was, effective, caring, responsive and well-led, although it requires improvement for being safety.

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

All the staff we spoke with on the ward and in theatre told us they were encouraged to report incidents using the paper reporting system which is then entered into an electronic system. All incidents were placed on an electronic tracker to monitor the progress and completion of the investigation. The hospital was in the process of moving to an electronic reporting system but this was not complete at the time of the inspection. This system will also include the risk register and complaints/claims.

Patients received care and treatment according to national guidelines such as National Institute for  Health and Clinical Excellence (NICE) and the Royal  Colleges. Surgery services participated in national  audits.

Patients spoke positively about their care and we saw that patients were treated with privacy and dignity.

The hospital was meeting national targets for referral to treatment times and processes were in place to support vulnerable patients. Complaints were dealt with efficiently.

Governance structures were good and there was effective teamwork with visible leadership within the  services. Staff were positive about the culture within  the surgical services and the level of support they  received from their managers.

However:

We found patient bedrooms did not have dedicated hand hygiene sinks.

We found that some clinical areas still had carpet in situ.