BMI Bath Clinic is an independent hospital and part of BMI Healthcare Limited. It provides care and treatment to both privately funded patients and NHS funded patients.
The hospital provides surgery, medical care, including oncology, outpatient and diagnostic services. Specialties include general surgery, orthopaedic surgery, ear, nose and throat procedures, gynaecology, oncology treatment, ophthalmology and urology services.
The hospital has an outpatients department, which provides diagnostic and screening services, including an MRI scanner. There are 67 beds of which 24 were for inpatients, three operating theatres and an endoscopy unit.
We carried out a comprehensive announced inspection of the Bath Clinic on 3, 4 and 5 May 2016 and an unannounced inspection on 16 May 2016.
We inspected and reported on the following three core services:
We rated the hospital as requires improvement overall. Our key findings were as follows:
Are services safe?
By safe, we mean people are protected from abuse and avoidable harm.
We rated safety overall as requires improvement:
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Only 85% of endoscopy staff were up to date with their mandatory training.
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Anaesthetists were not always documenting that they had obtained consent from patients.
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There was one incident of venous thromboembolism or pulmonary embolism in 2015.
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Staff completed care records for patients attending for follow up appointments in the outpatient department, but these were not kept in one folder and were in different locations. This meant there was not a complete record of patients’ care and treatment available to clinical staff.
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The fire risk assessment was out of date even though a new service with a potential risk of fire had been introduced. Staff were unsure of evacuation procedures for patients with reduced mobility from the first and second floor of Longwood House, in the event of fire.
However:
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Staff acted upon the principles of the duty of candour. They were open, honest and apologised to patients when things went wrong.
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Staff were trained to recognise and respond to signs of abuse of vulnerable people. The director of clinical services had overall responsibility for safeguarding people, and was trained to the appropriate level.
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There was a good culture of incident reporting, and learning from incidents.
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There was a safe level of both nursing, medical and support staff with a good mix and range of skills and experience. The resident medical officer was available 24 hours a day, seven days a week.
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There were no hospital acquired infections from January 2015 to December 2015
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The infection control and prevention lead was improving education and learning around infection prevention and control and took a proactive approach to ensure learning was effective for staff.
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Staff recognised and responded quickly to any deteriorating patients.
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The imaging department had efficient restricted access policies and practices, and staff complied with these.
Are services effective?
By effective, we mean people’s care, treatment and support achieves good outcomes, promotes a good quality of life, and is based on the best-available evidence.
We rated effectiveness overall as good.
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Patients gave valid informed consent where they were able to do so. There were assessments and procedures following legal requirements for patients who might have reduced mental capacity to make their own decisions.
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There were low levels of surgical site infections.
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The hospital monitored all aspects of employment and practising rights for medical staff. These were up to date.
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There were appropriately trained staff to safely care, treat and provide support for patients.
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Patient’s receiving chemotherapy had access to a 24 hour, seven days a week support line.
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An enhanced recovery programme was used for patients undergoing hip or knee replacements.
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There was an effective on call rota for imaging staff that ensured emergency screening could take place out of hours.
However:
Are services caring?
By caring, we mean staff involve patients and treat patients with compassion, dignity and respect.
We rated caring overall as good.
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Patients were given care and compassion that treated them as individuals. Staff respected their human rights including their privacy and dignity.
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There was a high level of patient satisfaction with the service, including the Friends and Family Test results. All the feedback we received from patients about their care and support was positive and highly complementary.
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There was good emotional support for patients, particularly if they were anxious or nervous. Staff recognised and responded to these patients with compassion and kindness.
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People were involved with arranging appointments to suit their needs and circumstances
Are services responsive?
By responsive, we mean services are organised so they meet people’s needs.
We rated responsiveness overall as good.
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Services were planned to meet local needs and provide timely independent medical care to both private and NHS patients.
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People were treated as individuals. This included taking time to support people living with dementia and meeting different levels of need.
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There was good physical access to and around the hospital for patients and visitors. Parking was available.
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Good bed management led to few cancelled or delayed operations. Surgery services met their referral to treatment times (monitored for NHS patients).
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The hospital was commissioned and established to treat non-emergency patients and provide elective medical care and surgical services. The only excluded patients were children and young people under the age of 16.
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There was an appropriate response to complaints. There was learning and action taken from any complaints.
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Referral to treatment time exceeded targets and meant that 100% of patients were seen within 18 weeks from referral.
However:
Are services well led?
By well-led, we mean the leadership, management and governance of the organisation, assure the delivery of high-quality person-centred care, supports learning and innovation, and promotes and open and fair culture.
We rated well-led overall as requires improvement.
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Whilst there was an environmental and corporate risk register, there were no clinical risks mentioned.
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There was no departmental clinical risk register, which meant the services could not proactively manage clinical risks.
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The hospital did not have systems in place to make sure all the consultants were aware of updates, changes in practice or general hospital guidelines.
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Issues around quality and risk management were not being identified or addressed in a timely manner.
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There was a lack of continuous monitoring around quality and improvement in the surgical department with infection prevention and control audits.
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There was a lack of understanding amongst staff in relation to their accountability for driving continuous quality and improvement in the surgical department.
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There was no proactive approach, to monitoring the implementation of actions following areas of service performance that required improvement following incidents.
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However:
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The staff always strived to make every patients experience an excellent one. There were supported in doing this through an open and supportive culture within the hospital.
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There were clear governance arrangements in place.
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Staff at all levels felt support by their line managers and by the hospital executive team.
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There were staff forums which engaged with staff and helped shape the culture and environment of the hospital.
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There was a systematic programme of internal audit used to identify and monitor quality and performance.
We saw areas of outstanding practice including:
However, there were also areas of poor practice where the provider needs to make improvements.
Importantly, the provider must:
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Ensure a single patient record is held in outpatients for each patient which contain patients' complete treatment and care histories.
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Introduce a clinical risk register throughout the hospital.
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Ensure the fire risk assessment is reviewed, and actions previously identified are put in place.
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Ensure staff are fully aware of evacuation procedures for patients on the first and second floor.
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Ensure all action points from risk assessments associated with eye laser treatment is achieved.
In addition the provider should:
- The hospital should ensure that anaesthetists consistently complete the anaesthetic chart and document when consent has been obtained.
- The hospital should ensure that there is a service level agreement in place with the local microbiology department at the local NHS trust.
- The hospital should ensure that yearly staff performance appraisals are carried out to ensure staff competence and ongoing development within their role.
- The senior managers should be more visible around the hospital.
- The hospital should ensure the staff understand their role and accountability to ensure ongoing monitoring of performance and quality.
- The hospital should ensure that there is a risk management system in place to address current and future risks to ensure a proactive approach to risk management.
- Review nurse staffing requirements of the outpatient department as there is a high reliance on bank staff and no clear deputy for the manager
- Review opportunities to collect patient outcome measures to help evaluate the effectiveness of services in outpatients and diagnostic imaging
- Continue to ensure regular department meetings are held in diagnostic imaging to facilitate sharing of information and learning.
- Ensure the imaging department develop local standard operating procedures in line with the recommendations set out in the National Safety Standards for invasive Procedures
- Review opportunities to use and display patient feedback to improve outpatients and diagnostic imaging services
- Review practice in the physiotherapy department regarding documentation of obtained consent.
- Increase staff awareness of the WHO checklist for safer surgery in outpatients and diagnostic imaging
- Review compliance with cleaning schedules in outpatients and diagnostic imaging.
- Ensure staff are aware of who the appointed laser protection supervisor (LPS) is and that staff understand their role.
- Review uniform policy to include nurses wearing belts and the effects this may have on infection control and prevention.
- Increase awareness of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards amongst staff
Professor Sir Mike Richards
Chief Inspector of Hospitals