The Beaumont Hospital

Updated 11 January 2016

BMI The Beaumont Hospital in Bolton, Lancashire, is a private hospital that opened in 1984 and is part of BMI Healthcare. It is registered for 32 beds, which are positioned across 20 rooms. Currently there are 25 beds available for use. The registered manager is Mr. Wyn Davies who has been in post since 01 September 2013.

The hospital offers a wide range of procedures from routine investigations to complex surgery for inpatient and day-case patients aged 16 years and over. The hospital accepts children aged three to 16 for outpatient consultations. No invasive procedures (such as phlebotomy) are provided at the hospital for children and young people below the age of 16 and this is explained to parents or guardians at the time of the booking. Limited imaging and physiotherapy services are also available for children aged 12 or above.

The hospital has three theatres; two major theatres one of which has laminar flow and is used for orthopaedic procedures. The other is a minor operations theatre used for local anaesthetic procedures and endoscopy. The hospital also offers a well-equipped physiotherapy department supporting the hospital’s significant orthopaedic activity.

Theatre Sterile Supply Unit (TSSU) services have been taken off-site to a corporate hub to ensure compliance with regulatory requirements for decontamination. The hospital’s imaging department provides for most core modalities through a mixture of static and mobile solutions. More complex tests such as MRI and CT scans were provided by an external provider on certain days of the week at The Beaumont Hospital site. These facilities combined with on-site support services, enable consultants to undertake a wide range of procedures from routine investigations to complex surgery.

We carried out this inspection using our comprehensive inspection methodology. As part of our inspection we looked at surgery services and outpatient and diagnostic imaging services.

Updated 11 January 2016

BMI The Beaumont Hospital is a private hospital that opened in 1984 and is part of BMI Healthcare. We carried out an announced inspection of BMI The Beaumont Hospital on 2 and 3 September 2015. We also carried out an unannounced visit on 17 September between 6pm and 7.30pm to check how patients were cared for out of hours. We carried out this inspection as part of our comprehensive inspection programme of independent healthcare hospitals.

Overall, we have rated BMI The Beaumont Hospital as good.

Are services safe at this hospital/service

Incidents, accidents and near misses were recorded and investigated appropriately. Incidents were discussed during daily ‘comms cell’ meetings and at monthly staff meetings so shared learning could take place. Staff were familiar with the term ‘Duty of Candour’ (meaning they should act in an open and transparent way in relation to care and treatment provided). Policies were in place to ensure the principles and requirements of the duty of candour process were followed. There were systems in place in the event of a patient deteriorating. The hospital had a transfer agreement in place so patients could be transferred to a local acute trust if needed. Staff had received mandatory training in safeguarding adults and children. They were aware of how to identify potential abuse and report safeguarding concerns. The director of clinical services was the named safeguarding lead for the hospital. The areas we inspected had a sufficient number of trained nursing staff with an appropriate skills mix to meet patients’ needs. Staffing levels were monitored using the BMI Healthcare nursing dependency and skill mix tool. The theatres did not have a full establishment of trained permanent staff (there were 11 nursing staff vacancies). However, staffing levels were maintained through the use of regular bank and agency staff. Nursing staff handovers occurred three times a day and included discussions around patient needs, their medication and their present condition. There was appropriate medical cover. A resident medical officer (RMO) was based at the hospital 24 hours per day over a two week period. The RMOs had received appropriate induction training and had access to relevant trust policies, such as the policy for patient transfer. They were appropriately trained in Immediate Life Support (ILS) and Advanced Life Support (ALS) for adults and children. Surgical procedures and outpatient consultations were carried out by a team of surgical and medical staff who were mainly employed by other organisations (usually in the NHS) in substantive posts and had practising privileges with the Beaumont Hospital.

Are services effective at this hospital/service

Patients received care and treatment in line with national guidelines such as National Institute for Health and Clinical Excellence (NICE) and the Royal Colleges. The rate of unplanned readmissions and unplanned patient transfers to other hospitals was within expected levels when compared to national averages and other independent hospitals. The hospital participated in national audit programmes such as performance reported outcomes measures (PROMs) and the National Joint Registry. Results showed patient outcomes were in line with the national average. Audit findings were reviewed and monitored at routine clinical governance and medical advisory committee meetings. Staff were aware of the legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberties Safeguards (DoLS). Staff sought consent from patients prior to delivering care and treatment and understood what actions to take if a patient lacked the capacity to make informed decisions. Consultants working at the hospital were employed under practising privileges (authority granted to a physician or dentist by a hospital governing board to provide patient care in the hospital) that were monitored by the Medical Advisory Committee (MAC). Any changes to policies were reviewed by a consultant with the relevant expertise and discussed and ratified during MAC meetings. Staff appraisals had been identified as an area for improvement by the management team. We were told appraisals were now more robustly recorded using an appraisal system but historically the formal reporting of appraisals had not been updated on the hospital database consistently, leading to poor evidence that appraisals were being conducted on a regular basis. Whilst improvements had already been seen, the registered manager and director of clinical services were fully aware that the current position in this area remained a ‘work in progress’.

Are services caring at this hospital/service

Staff treated patients with dignity and respect. Patients were kept involved in their care and treatment and staff were clear at explaining their treatment to them in a way they could understand. Patient feedback from the NHS Friends and Family Test showed most patients were positive about recommending the surgical services to friends and family. The hospital also asked patients to complete a patient satisfaction survey. This was administered by an independent third party organisation. Results from the survey for 2015 consistently showed high levels of patient satisfaction in all areas surveyed including overall quality of care and nursing care. Surgical patients had an allocated nurse who was able to support their understanding of care and treatment and ensure that they were able to voice any concerns or anxieties.

Are services responsive at this hospital/service

There were clear inclusion and exclusion criteria in place to determine which patients could be treated safely at the hospital. As part of the pre-operative assessment process, patients with certain medical conditions were excluded from receiving treatment at the hospital. This meant the majority of patients treated at the hospital were considered to be “low risk”. Vulnerable adults, such as patients with learning disabilities and those living with dementia were identified at referral and appropriate steps were taken to ensure they were appropriately cared for. In most cases, this meant they were usually referred to NHS establishments. There was sufficient capacity to provide care and treatment for patients undergoing surgery at the hospital. The hospital met the target for 90% of admitted NHS patients beginning treatment within 18 weeks of referral for each month between April 2014 and July 2015. Waiting times for outpatient appointments were within the national guidelines. Daily ‘comms cell’ meetings took place to monitor staffing and capacity issues so that patients could be managed and treated in a timely manner. Staff demonstrated an awareness of the religious needs of patients and facilities such as prayer rooms were available for patients from different faiths. Complaints were responded to in a timely manner. Complaints were discussed during daily ‘comms cell’ meetings and at monthly staff meetings so shared learning could take place.

Are services well led at this hospital/service

There was a clear governance structure in place with committees for medicines management, infection control and health and safety feeding into the clinical governance committee and medical advisory committee (MAC). There was a robust policy and process in place for reviewing consultant practising privileges every 12 months by the MAC with oversight by the registered manager. There were clearly defined and visible leadership roles at corporate, hospital and department level. The hospital’s vision and values were visible throughout the hospital and staff had a good understanding of these. The governance strategy and quality improvement plan 2015/16 included specific performance targets and actions relating to patient safety, clinical effectiveness and patient experience. One of the areas identified for improvement was the hospital’s endoscope cleaning and decontamination process. At the time of inspection the service was not JAG accredited because scopes were decontaminated in a small decontamination room that did not have clear segregated clean and dirty areas in accordance with best practice guidelines. Whilst practice was safe, the layout of equipment was not in line with best practice guidelines due to the size of the room. Investment in this area was a priority for the hospital to enable it to achieve JAG accreditation. Improvement plans to refurbish the room, increase the size and have separate dirty and clean areas was in place and was due to be completed prior to accreditation during 2016.The risk register highlighted key risks to the service. Actions taken to control or minimise the risks were detailed but where there was a residual risk it was not always clear what action was still required or was being taken to further mitigate or minimise the risk. In some instance the status of the risk was recorded as “outstanding controls/actions” but it did not detail what they were or the timeframe for completion. The risk register was reviewed quarterly as part of the senior management team meetings but we were told that these meetings were not recorded.

Our key findings were as follows:

Overall service leadership

• There were clearly defined and visible leadership roles at corporate, hospital and department level.
• Senior staff provided clear leadership and motivation to their teams.
• The theatres staff spoke positively about the recently appointed theatre manager. They told us the theatre manager had shown good leadership and had made positive improvements in planning and organisation within the theatres.

Cleanliness and infection control

• There had been no cases of Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia infections, Methicillin-Sensitive Staphylococcus Aureus (MSSA) bacteraemia infections or Clostridium difficile (C. diff) infections at the hospital between April 2014 and March 2015.
• All admitted patients underwent MRSA screening. Patients identified with an infection could be isolated in their rooms to support the management of cross infection risks.
• There were no surgical site infections following knee replacement surgery at the hospital between April 2014 and March 2015. The hospital had reported one surgical site infection following hip replacement surgery during this period.
• Hospital records showed there had been a total of 16 surgical site infections following surgery (all surgical procedures) between October 2014 and July 2015. Each incident was investigated to look for improvements. There were no recurring themes or trends that could attribute to the infection rates.
• All the areas we visited were visibly clean and tidy. Staff were aware of current infection prevention and control guidelines. Cleaning schedules were in place with clearly defined roles and responsibilities for cleaning the environment and cleaning and decontaminating equipment.
• There were arrangements in place for the handling, storage and disposal of clinical waste, including sharps. There were hand wash sinks and hand gels available in all areas of the hospital. We observed most staff following hand hygiene and 'bare below the elbow' guidance. However, some staff did not always carry out hand hygiene practices in between contact with patients. This was not in line with best practice guidance and may increase the risk of cross infection between patients.
• Staff were observed wearing personal protective equipment, such as gloves and aprons, while delivering care. Gowning procedures were adhered to in the theatre areas.
• The trust had employed a number of infection control link nurses to provide training and to liaise with staff so patients that acquired infections could be identified and treated promptly.

Staffing levels

• The areas we inspected had a sufficient number of trained nursing and support staff with an appropriate skills mix to meet patients’ needs.
• Staffing levels were monitored using the BMI Healthcare nursing dependency and skill mix tool. The theatres did not have a full establishment of trained permanent staff (there were 11 nursing staff vacancies). However, staffing levels were maintained through the use of regular bank and agency staff.
• A recent initiative had seen a restructure of the theatre team to introduce lead practitioners that the hospital hoped would stimulate recruitment success. In addition, the recruitment of newly qualified nurses with a desire to work on the wards and theatres who could be mentored and trained internally was an area of focus going forward for the hospital.
• In outpatients, the staff rota showed how many staff were needed for the different clinics based on the nature of the clinic and the acuity of the patients in conjunction with the consultant. This was reviewed weekly to provide safe staffing levels when extra clinics were needed.

Nutrition and hydration

• Patient records included an assessment of patients’ nutritional requirements.
• Patients told us they were offered a choice of food and drink and spoke positively about the quality of the food offered.
• Patients with difficulties eating and drinking were placed on special diets. Special meals were also prepared for patients with diabetes.
• Staff understood people’s cultural needs. For example, staff could provide ‘halal’ or ‘kosher’ meals if requested

There were areas of practice where the provider should make improvements.

The provider should:

• Ensure that all staff follow hand hygiene best practice processes in all areas of the hospital.
• Ensure all staff receive a regular appraisal to support and promote development.
• Continue to prioritise recruitment of theatre staff.
• Ensure the risk register clearly identifies any outstanding actions required to mitigate risks and expected date of completion.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 11 January 2016

We rated the Outpatients and Diagnostic Imaging service (OPD) at The BMI Beaumont Hospital as ‘Good’ overall. Safe systems were in place for reporting incidents, duty of candour and safeguarding issues. Staff knew about current infection prevention and control guidelines, however, hand hygiene wasn’t always carried out in line with best practice guidelines. Sufficient equipment was available and well maintained, appropriately checked and decontaminated regularly with checklists in use. Records were safely stored, structured, legible and up to date. Staff attended mandatory training courses with good compliance rates. Staffing levels were sufficient to meet the needs of patients and staff were aware of how to escalate key risks that could affect patient safety.

Patients received care and treatment in line clinical care pathways and local and national guidance. Patients were assessed for pain relief and provided with medication or treatment where appropriate. Staff undertook clinical audits such as patient consent and quality assurance for equipment in radiology by certified national organisations. Most staff confirmed they had received yearly appraisals; however, the overall rate was low. We observed effective multi-disciplinary working and staff sought consent from patients appropriately. Staff were enthusiastic and respectful whilst providing care. We observed positive interactions between staff and patients. All patients spoke highly of the care they had received regardless of how they were referred or funded.

Waiting times for outpatient appointments were within the national guidelines. The diagnostic and imaging department provided scans on the same day for patients who had attended clinics. This reduced waiting times in the long term and meant patients didn’t have to return another day. Interpreters could be booked for patients whose first language was not English, if required. Wheelchair access was available throughout the hospital. Information on how to raise compliments and complaints was displayed in the waiting areas.

The BMI vision was embedded in the departments and staff embraced the values in the work they undertook. There were clearly defined and visible local leadership roles in each speciality within the outpatients and diagnostic imaging areas. Senior staff provided visible leadership and motivation to their teams. The services were appropriately represented at executive level and there was appropriate management of quality, governance and risks at a local level.

Updated 11 January 2016

We rated surgical services at The Beaumont Hospital overall as ‘Good’. Patient safety was monitored and incidents were investigated to assist learning and improve care. Patients received care in visibly clean and suitably maintained premises and appropriate equipment was available to meet their needs. Medicines were stored safely and given to patients in a timely manner. Patient records were completed appropriately. The staffing levels and skills mix was sufficient to meet patients’ needs and staff assessed and responded to patient risks. Patients received care and treatment by competent staff that worked well as part of a multidisciplinary team.

Patients received care and treatment in line with national guidelines such as National Institute for Health and Clinical Excellence (NICE) and the Royal Colleges. The rate of unplanned readmissions and unplanned patient transfers to other hospitals was within expected levels when compared to national averages and other independent hospitals. Staff sought consent from patients prior to delivering care and treatment and understood what actions to take if a patient lacked the capacity to make their own decisions. Patients spoke positively about their care and the way they were treated by staff. Patient feedback from the NHS Friends and Family Test showed most patients were positive about recommending the surgical services to friends and family.

Patients admitted for surgery were seen promptly and received the right level of care. The service consistently achieved the 18 week referral to treatment standards for admitted patients. There were systems in place to support vulnerable patients. Complaints about the service were investigated and lessons learnt were shared with staff. There was a clear governance structure in place with committees such as clinical governance, infection control, health and safety and medicines management feeding into the medical advisory committee (MAC) and hospital management team. There was effective teamwork and clearly visible leadership within the department. Staff were positive about the culture and the support they received from the managers.