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Inspection Summary


Overall summary & rating

Good

Updated 19 November 2019

BMI Thornbury is operated by BMI Healthcare Limited and cares for adults and children undergoing a wide range of surgical procedures and those requiring other medical interventions. The hospital has a dedicated cancer unit offering both chemotherapy and supportive therapies to patients. Diagnostic imaging services include a 161 slice CT scanner and a 1.5T MRI scanner. A new digital mammography unit has been installed.

BMI Thornbury Hospital offers a level two critical care facility for those patients requiring additional monitoring and support. The hospital attracts consultants and is located close to a local NHS trust. The hospital offers a wide range of services including orthopaedics, general surgery, gynaecology, spinal surgery, urology, oncology, ophthalmology, ear nose and throat services, cosmetic surgery and physiotherapy.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the hospital on 23 and 24 July 2019, and on 02 August 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

Our rating of this hospital improved. We rated it as Good overall. The rating for Safe stayed the same as requires improvement. Effective improved from requires improvement to good. Caring, responsive and well-led stayed the same and were rated as good.

We rated each core service - surgery, medical care, services for children and young people, outpatients and diagnostic services - as good overall. Critical care was rated as requires improvement.

The ratings for surgery, medical care and critical care stayed the same. The ratings for services for children and young people improved from requires improvement to good. Outpatients and diagnostic services were inspected as one service at the last CQC inspection. At this inspection we rated them separately.

Although the hospital was rated a good overall, we found some issues that the service provider needs to improve.

Following this inspection, we told the provider it must take some actions to comply with the regulations and it should make other improvements, even though a regulation had not been breached, to help the service improve. We issued the provider with three requirement notices. These were related to Regulations 12 (safe care and treatment) and 17 (good governance) in the critical care unit, and Regulation 15 (premises and equipment) in relation to the hospital fire safety corrective action plan Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North East)

Inspection areas

Safe

Requires improvement

Updated 19 November 2019

Our rating of safe stayed the same. We rated it as Requires improvement because:

  • The design, maintenance and use of facilities, premises and equipment posed a risk to people’s safety. We saw a Fire and Rescue Authority regulatory reform safety order had been issued and numerous actions were outstanding from this work.
  • Senior leaders recognised that investment in hospital infrastructure and equipment was needed.
  • Although the service used systems and processes to safely prescribe, administer, record and store medicines, they were not always followed by staff in the critical care unit.
  • We saw high rates of bank and agency staff were utilised in theatres. Although the service provided mandatory training in key skills to all staff and made sure everyone completed it, compliance rates were lower among this staff group and nursing staff from critical care.
  • Staff told us that when the consulting rooms were in use on the ground floor, there was no member of nursing staff in that area. We were concerned that if a patient deteriorated in this area, the consultant would have to call for help before assisting the patient and they would not have access to any emergency equipment. The director of clinical services told us the consultant would call for the crash team and assistance would be provided immediately.
  • Improvements were needed to the environment and design of the endoscopy. There was no separate recovery area and there was no separate clean and dirty room for the decontamination of endoscopes. Two patient cubicles were too small, and the unit had carpeted floors which was not compliant with infection control standards.

However:

  • Services for children and young people had improved from requires improvement to good.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • With the exception of nurse staffing in critical care, services had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service managed patient safety incidents well although levels of harm were not always entered against incident records. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

Effective

Good

Updated 19 November 2019

Our rating of effective improved. We rated it as Good because:

  • Services for children and young people service from requires improvement to good.
  • Critical care improved from requires improvement to good.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff gave patients practical support and advice to lead healthier lives.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

However:

  • The hospital’s new leadership team recognised that annual appraisal compliance was an area that required improvement and they had implemented a plan to ensure that all staff had an appraisal by the end of 2019.
  • We saw some patient information leaflets which were used to support staff to gain informed consent had exceeded their renewal date.

Caring

Good

Updated 19 November 2019

Our rating of caring stayed the same. We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 19 November 2019

Our rating of responsive stayed the same. We rated it as Good because:

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
  • The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

However:

  • Patients did not always agree they had their communication needs assessed at pre-assessment.
  • Correct (clinical or non-clinical) classifications were not always attributed to cancellation records.
  • The service did not clearly display information in communal patient areas, such as waiting areas about how to raise a concern or make a complaint.
  • Although staff made reasonable adjustments to help patients access services where they could, the service had limited facilities for patients with individual needs.

Well-led

Good

Updated 19 November 2019

Our rating of well-led stayed the same. We rated it as Good because:

  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

  • The information systems were integrated and secure; however, data handling process had not always been correctly followed.
  • We were not assured the service had always (historically) acted in a timely way to minimise risks; for example, with respect to ensuring compliance of ventilation and air handling units in theatres, and complying with fire safety recommendations.
Checks on specific services

Medical care (including older people’s care)

Good

Updated 19 November 2019

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

The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

Services for children & young people

Good

Updated 19 November 2019

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

The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

Critical care

Requires improvement

Updated 19 November 2019

We rated this service as requires improvement overall and in safe and well led. However, we rated it as good in effective, caring and responsive.

The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

Surgery

Good

Updated 19 November 2019

We rated this service as good because it was effective, caring, responsive and well-led. However, we found it required improvement for being safe.

Surgery was the main activity of the hospital.

Diagnostic imaging

Good

Updated 19 November 2019

We rated this service as good because it was safe, caring, responsive and well led. We do not rate the effectiveness of diagnostic imaging departments. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

Outpatients

Good

Updated 19 November 2019

We rated this service as good because it was safe, caring and responsive and well-led. We do not rate the effectiveness of outpatient departments.

The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.