Bishops Wood Hospital

Updated 19 October 2021

BMI Bishops Wood is operated by BMI Healthcare Limited which is owned by Circle Health Group. It is a private hospital in Northwest London with 42 beds. Facilities include two operating theatres, a minor procedures theatre, a recovery area, a medical and surgical ward as well as outpatient and diagnostic imaging facilities. The hospital serves patients aged 18 years and over with private insurance or self-funding. The hospital also served NHS patients for a variety of surgical procedures, including orthopaedic, ear, nose and throat (ENT), gynaecology, urology, pain management and other general surgical procedures.

At the time of the inspection, there was a registered manager and a nominated individual.

The hospital provides surgery, medical care, outpatients and diagnostic imaging. The hospital is registered to provide the following regulated activities:

• Diagnostic and screening procedures
• Family planning
• Surgical procedures
• Treatment of disease, disorder or injury

The hospital has been inspected five times since it registered with CQC in May 2011, with the most recent inspection taking place in October 2017.

On this occasion, we inspected surgery and medical care using our comprehensive inspection methodology. The hospital provides day case surgery, inpatient surgery and cancer treatment services. The service offered a range of different surgical specialties, including orthopaedic, ophthalmology, urology, gynaecology, and ear, nose, and throat (ENT). The in-patient and day case facilities were located on the first floor of the hospital and were comprised of the surgical ward (Northwood) and the medical ward (Pinner) where oncology patients are treated.

Activity (July 2020 to June 2021):

• There were 2,700 day and inpatient visits to theatre at the hospital; of these, 43% were NHS-funded and 57% were privately funded.
• The top three surgical specialities were orthopaedic (34.5%), ophthalmology (16.7%) and gynaecology (11.8%).
• There were 269 inpatient medical episodes, 1423-day case chemotherapy episodes and 1923 outpatient treatments under medical care.

Updated 19 October 2021

Our rating of this location improved. We rated it as good because:

• 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 Hospital controlled infection risk effectively and introduced enhanced precautions since the beginning of the COVID-19 pandemic.
• Staff provided good care and treatment and gave patients pain relief when they needed it.
• Managers monitored the effectiveness of the service and made sure staff were competent.
• 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 and their families.
• 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 and people could access services when they needed them.
• 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.
• Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities. The hospital engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

• The service was not doing all it could to remove or minimise risks to patients. Nationally recognised tools and guidance were not always used in a way that minimised risk. The World Health Organisation (WHO) safety checklist for surgery was not always completed in a way that kept people safe. When changes were made in the order of the theatre list, it was not always updated in line with best practice. Staff did not always complete the anaesthetic machine logbook.
• Patient notes were not always comprehensive, and information was not always easy to locate.
• National early warning scores (NEWS) were not always calculated accurately and there was a risk, patients might not be escalated appropriately.
• Medicines were not always stored securely in theatres.
• There was variable understanding and learning from never events and incidents, that occurred both within the service and in other organisations. Not all staff were able to articulate what had been learnt from incidents they described or how processes had changed to prevent incidents from happening again.
• Staff across surgical services thought multidisciplinary team working could improve in pre-operative assessment. Staff did not always agree nor feel supported on admission criteria and there was room for improvement in learning from patient cancellations.

Updated 19 October 2021

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service controlled infection risk effectively and managed medicines well. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives and supported them to make decisions about their care.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of patients, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

• Patient notes were not always comprehensive, and information was not always easy to locate in the paper notes.
• National early warning scores (NEWS) were not always calculated accurately and there was a risk patients might not be escalated appropriately.
• Not all staff could articulate shared learning from incidents and complaints.

End of life care is a small proportion of hospital activity. The main service was medical care. We have reported end of life care in the medical care section of the report as staff, leadership and governance fall within the medical care service.

Updated 2 June 2017

Updated 19 October 2021

Our rating of this service stayed the same. We rated it as good because:

• 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.
• Staff provided good care and treatment and gave patients pain relief when they needed it.
• Managers monitored the effectiveness of the service and made sure staff were competent.
• 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 and their families.
• 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.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learnt with all staff. The service included patients in the investigation of their complaint.
• 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.
• 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.

However:

• The service was not doing all it could to remove or minimise risks to patients. Nationally recognised tools and guidance were not always used in a way that minimised risk. The World Health Organisation (WHO) safety checklist for surgery was not always completed in a way that kept people safe.
• When changes were made in the order of the theatre list, it was not always updated and re-printed in line with best practice.
• Staff did not always complete the anaesthetic machine logbook to record checks that had been completed.
• Medicines were not always stored securely in theatres.
• There was variable understanding and learning from never events and incidents, that occurred both within the service and in other organisations. Not all staff were able to articulate what had been learnt from incidents they described or how processes had changed to prevent incidents from happening again.
• Staff across surgical services thought multidisciplinary team working could improve in pre-operative assessment. Staff did not always agree nor feel supported on admission criteria and there was room for improvement in learning from patient cancellations.

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