The Beaumont Hospital

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