You are here

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 24 September 2018

BMI Three Shires Hospital is operated by BMI Healthcare. The hospital opened in 1982 as a private elective surgery hospital. The hospital is registered for 53 beds. Facilities include five operating theatres, an ambulatory care unit, and outpatient facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients. We inspected surgery, medicine, outpatients and services for children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 27 and 28 June 2018 along with an unannounced visit to the hospital on 3 July 2018 and 10 July 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.

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.

Services we rate

This is the first time BMI Three Shires has been inspected since it registered in June 2015. We rated it as good overall.

Summary of main findings:

  • There were systems in place to keep patients protected from avoidable harm, including the reporting and investigation of incidents. Learning from incidents was cascaded to staff.

  • Staffing levels were sufficient to meet the needs of patients and there was an effective multidisciplinary approach to care and treatment. Staff worked well together to benefit patients.

  • Staff were proud of the hospital and were committed to providing the best possible care for their patients. We observed positive interactions between staff and patients. All patients spoke highly of the care they had received.

  • The hospital was focused on providing quality care and had a defined strategy, which was aligned to its vision. Staff were committed to providing a positive patient experience.

  • Services had a vision and strategy for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

  • Staff told us they felt appreciated and supported by service leaders and said they were visible and approachable, this included the executive director.

  • There were governance structures in place to ensure that risk and quality were regularly reviewed and actions were taken to address performance issues, where indicated.

  • There was a complaints management process with a culture of being open and honest with patients. There was a complaints policy and complaints were taken seriously and investigated.

  • When things went wrong, staff apologised and gave patients honest information and suitable support.

  • Patients’ views and experiences were gathered and acted on to shape and improve the services and culture.

  • Staff ensured that patients’ privacy and dignity was maintained at all times.

However:

  • Arrangements were in place for the management of medicines, however we saw incidences where patients were not always given their medication as prescribed.

  • Not all staff within surgery services received relevant resuscitation training at the level appropriate to their role, including in the use of emergency equipment.

  • The records maintained by the cancer breast nurse were not assessed or audited which meant that we could not be assured the hospital had oversight to validate the information contained was legible, accurate and up to date.

  • Although the service managed patient safety incidents well, staff within the oncology unit did not always recognise incidents and report them appropriately.

  • Although the hospital had an audit and risk management structure there were no specific audits regarding breast cancer patients. Compliance to risk assessments, including the use of NEWS2 and sepsis guidance were not audited either.

  • Consultants provided the interaction between their patients and the NHS multi-disciplinary team (MDT) meetings. However, the minutes from these meetings were not provided to the hospital.

  • Not all entries in patient records had been signed and dated by the consultant.

  • The hospital had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, we found some risks had not been escalated to the risk register where relevant and some risks were not monitored or acted upon.

  • The service and the hospital had identified risks to children and young people but were not recorded on risk registers.

We found areas of practice that require improvement in surgery:

  • Not all staff received relevant resuscitation training at the level appropriate to their role, including in the use of emergency equipment.

  • Not all patients were given all medication as prescribed.

  • Action plans were not routinely completed where audit results had fallen below required rates.

  • Some risk assessments were carried out on patients. However, the service did not audit its compliance to risk assessments, including use of NEWS2 or compliance to sepsis guidance.

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 one requirement notice that affected surgery services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 24 September 2018

We rated safe as good because:

  • The service provided mandatory training in key skills to all staff.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had completed safeguarding adult and children’s training which was above the hospital target of 90%.

  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. Control measures were in place to prevent the spread of infection. Most staff complied with the infection prevention and control policy.

  • The service had processes in place to assess the risk to patients using the service and developed risk management plans in line with national guidance.

  • Pre-operative risk assessments for surgical patients were carried out in line with national guidance.

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.

  • The resident medical officer (RMO) had the appropriate training and experience to meet the needs of CYP.

  • There was an embedded culture of incident reporting and staff said they received feedback and learning from incidents.

  • There was access to appropriate equipment for children and young people (CYP) to ensure the provision of safe care and treatment. Resuscitation equipment was age appropriate, checked daily and stored safely.

  • Records were up to date, legible and had clear plans in place for each patient and were stored securely.

  • The risks associated with anticipated events and emergency situations were recognised and systems were in place to deal with these.

However:

  • The records maintained by the cancer breast nurse were not assessed or audited which meant that we could not be assured the hospital had oversight to validate the information contained was legible, accurate and up to date.

  • Although the service managed patient safety incidents well, staff within the oncology unit did not always recognise incidents and report them appropriately. This meant that we could not be assured of the hospital’s oversight of risk regarding the service.

  • Not all staff within the surgery service had the required level of life support training. Some staff had not received training in the use of a new defibrillator and some staff were unable to identify items used for life support stored on the emergency trolley.

  • Some patient rooms used post operatively did not have piped oxygen and the service relied on portable oxygen supplies only.

  • Items required for resuscitation in an emergency were not immediately available in the resuscitation trolley.

  • Commode chairs were used to transport patient’s short distances.

  • Medicines within the surgery service were not always administered as prescribed. Medicines were not always managed according to the hospitals medicines management policy. Some medical guidelines were out of date.

  • Some risk assessments were carried out on patients. However, the service did not audit its compliance to risk assessments, including use of NEWS2 or compliance to sepsis guidance.

  • There were limited facilities available for CYP in outpatients although the hospital had mitigated the risks to CYP through regular safety checks and the provision of a limited supply of toys.

Effective

Good

Updated 24 September 2018

We rated effective as good because:

  • The service provided care and treatment based on national guidance and evidence of this effectiveness. They assessed staff compliance with guidance and identified areas for improvement.

  • 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 dietary adjustments for patients for religious, cultural, personal choice or medical reasons when required.

  • The service monitored the effectiveness of care and treatment and consistently used the findings to improve them.

  • Policies and procedures reflected current guidelines and adherence was monitored with a schedule of local audits which were CYP specific. Staff reviewed the outcomes of audits and there was evidence of action plans and changes to practice.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them, when required, to provide support and monitor the effectiveness of the service.

  • Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

  • Staff understood the guidance and legislation relevant to consent and informed decision making with regards to CYP.

  • There was a hospital policy to ensure that staff were meeting their responsibilities under the MCA and Deprivation of Liberty Safeguards (DoLS).Staff said they had had training in MCA and DoLS as part of their mandatory training.

However:

  • Although the hospital had a comprehensive audit and risk management structure there were no specific audits regarding breast cancer patients which meant that we could not be assured what oversight the MAC had of the service being provided by the breast care nurse.

  • Consultants provided the interaction between their patients and the NHS multi-disciplinary team (MDT) meetings. However, the minutes from these meetings were not provided to the hospital which meant that we could not be assured that the information provided was accurate and up to date.

  • Not all entries in patient records had been signed and dated by the consultant.

  • There was a high number of patients transferred out to the local NHS hospital following their operation and there were no action plans to reduce the number of transfers. The transferring of patients out of hospital was not on the service risk register.

  • Not all staff working in theatres had the necessary skills to assist in all operations. This was on the service risk register.

Caring

Good

Updated 24 September 2018

We rated caring as good because:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

  • Staff provided emotional support to patients to minimise their distress.

  • Staff involved patients and those close to them in decisions about their care and treatment.

  • We saw excellent interactions between staff, children and their parents. All interactions were kind and compassionate and very caring. Staff were skilled at communicating with CYP and we observed this in every area we visited.

  • Children spoke about the ‘kind nurses and doctors who looked after them’ and ‘the wonderful toys and games at the hospital’.

  • Staff minimised emotional distress to children by encouraging parents to lie or sit beside their child to distract them whilst waiting for their procedure. For example, we saw a parent lying on their child’s bed and holding them when they returned from theatre.

Responsive

Good

Updated 24 September 2018

We rated responsive as good because:

  • The hospital planned and provided services in a way that met the needs of local people.

  • Services were planned to consider the individual needs of patients. Adjustments were made for patients living with a physical disability and a new dementia friendly room had been set up for patients.

  • Patients could access the service when they needed and there was minimal waiting time for patients to receive their procedure.

  • The service provided reflected the needs of children and young people (CYP) and ensured flexibility, choice and continuity of care.

  • Areas used were not dedicated solely for the use of CYP but were adapted where possible to make them more appropriate for any age of child. For example, beds for CYP had age appropriate bed linen and activities were provided to entertain and distract children of all ages.

However:

  • There was a high number of cancelled operations which could have been avoided. This included cancellations for reasons which should have been identified at a pre-operative assessment, and operations cancelled due to the inappropriate skill levels of staff.

  • The service’s Patient-Led Assessment of the Care Environment (PLACE) audit for 2017, scored 73% for dementia and 77% for disability which was lower than the England average score.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. However, it was unclear if staff completed a complaints report which meant that we could not be assured that lessons were identified and learnt.

  • There was no information for CYP in age appropriate formats.

Well-led

Good

Updated 24 September 2018

We rated well-led as good because:

  • The hospital was committed to the BMI Healthcare corporate vision, which was to offer “the best patient experience and best outcomes in the most cost-effective way”.

  • The service had managers at most levels with the right skills and abilities to run a service providing high-quality sustainable care.

  • Children and young people’s (CYP) services were overseen by a lead paediatric nurse (LPN) and a named consultant paediatrician. Staff told us the LPN and consultant paediatrician had raised the profile of children’s services and were recognised as being clinical experts in the care of CYP. Staff told us they were approachable and could be contacted for advice and support.

  • Services had a vision and strategy for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

  • Services collected, analysed, managed and used most information well to support all its activities, using secure electronic systems with security safeguards.

  • There was an internal audit programme in place which aimed at improving patient care, treatment and outcomes. Audit and data was used to inform practice and change within the service. However, we found in surgery services action plans were not always implemented as a result of the audit findings.

  • Staff told us they felt appreciated and supported by service leaders and said they were visible and approachable.

  • Information needed to deliver effective care and treatment was available to relevant staff in a timely and accessible way.

However:

  • The hospital had systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. However, we found some risks had not been escalated to the risk register where relevant and some risks were not monitored or acted upon.

  • Some policies were out of date.

Checks on specific services

Medical care (including older people’s care)

Good

Updated 24 September 2018

Medical care services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

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

Services for children & young people

Good

Updated 24 September 2018

Children and young people’s services were a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

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

Outpatients and diagnostic imaging

Good

Updated 24 September 2018

Outpatients was a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the outpatient’s section.

We rated this service as good because it was safe, caring, responsive and well led. We did not rate the service for being effective.

Surgery

Requires improvement

Updated 24 September 2018

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.

Staffing was managed jointly with medical care.

We rated this service as requires improvement overall, and for being safe and well-led. However, we rated is as good for effective, caring and responsive.