The Blackheath Hospital

Updated 16 May 2019

BMI The Blackheath Hospital is an acute independent hospital that provides outpatient, day care and inpatient services. A range of services such as physiotherapy and medical imaging are available on site. The hospital offers a range of surgical procedures and cancer care as well as rapid access to assessment and investigation and level 2 critical care. Services are available to people with private or corporate health insurance or to those paying for one off treatment. The hospital also offers services to NHS patients on behalf of the NHS through local contractual arrangements.

The hospital provides surgery, services for children and young people, outpatients and diagnostic imaging. We inspected only surgical services at this inspection.

We inspected this service using our focussed inspection methodology to follow up on a requirement notice issued following a comprehensive inspection of the hospital in July 2016. This inspection was unannounced and our visit to the hospital took place on 15 January 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services:

• Are they safe?
• Are they effective?
• Are they caring?
• Are they responsive to people's needs?
• Are they 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.

During the inspection, we visited two wards, three theatres and a two-bedded high dependency unit. We spoke with 18 staff including registered nurses, health care assistants, reception staff, medical staff, operating department practitioners, and senior managers. We spoke with nine patients and two carers. During our inspection, we reviewed 11 sets of patient records.

There were no special reviews or investigations of the hospital ongoing by the CQC at any time of or during the 12 months prior to this inspection. The hospital has been inspected two times previously and the most recent inspection, prior to this one, took place in July 2016. At the July 2016 inspection, we found that the hospital was meeting all standards of quality and safety it was inspected against except regulation 12 Safe, care and treatment. This breach of regulation was due to poor decontamination practices in the endoscopy unit and the CQC issued a requirement notice for the hospital to take action. At this inspection, we found that this had improved since the last inspection and was no longer a breach in regulation. Please read the surgery report below for further details.

The hospital had an appropriately appointed registered manager who had started the role in October 2018.

Services we rate

Our rating of this hospital stayed the same. We rated it as Good overall.

We found good practice in relation to surgery:

• The service controlled infection risk well.
• The service had enough staff to provide the right care and treatment.
• The service made sure staff were competent for their roles.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff cared for patients with compassion.
• The hospital planned and provided services in a way that met the needs of local people.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• The hospital and wider organisation had a vision for what it wanted to achieve and workable plans to turn it into action.
• Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The hospital used a systematic approach to continually improving the quality of its services.
• The hospital had effective systems for identifying risks, planning to eliminate or reduce them.

We found areas of outstanding practice in surgery:

• Daily head of department meetings with the executive director and all head of departments had a unique multidisciplinary approach which enabled colloborative working, easy sharing of learning, escalation of concerns and cascading of information to departmental staff.
• Patients received interactive exercise information which included demonstrations videos to help with their recovery at home.

We found areas of practice that require improvement in surgery:

• The hospital should ensure it complies with its own target for mandatory training.
• The hospital should ensure there is an appropriate space to store used surgical equipment.
• The hospital should ensure all incidents are reported in a timely manner.
• The hospital should ensure they compare the difference in patient outcome measures scores (PROMS) between NHS and private patients.
• The hospital should ensure its promotes an inclusive culture with regard to patients with additional needs.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals

Updated 3 February 2016

Patients told us they were involved in their care and had time to discuss treatment options with their consultant. Staff described the hospital as a good place to work and were “proud” to work there.

The number of medical admissions was much smaller than for surgery. The hospital admitted few medical patients (on average three medical patients a week) and staff were aware that they needed to develop clearer pathways of care.

There was limited support and awareness among staff about how to care for patients who were living with dementia or who had learning difficulties.

Staff had little awareness of the Mental Capacity Act 2005 or the hospital’s policy. They were unaware of the action to take if they thought a patient did not have full capacity to make decisions. Staff were aware of how to report safeguarding concerns.

Staff were unaware of the hospital’s Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) policy.

There were omissions and inaccurate information on patients’ records at night, which put patients at risk of not receiving the care they needed.

Patients receiving chemotherapy as a day case were cared for in a dedicated area.

Updated 3 February 2016

Between October 2013 and the end of September 2014 the hospital treated 42 children and young people as inpatients and 250 as day cases. Children and parents we spoke with positive about their care and said they found the staff friendly. Parents said they were involved in their child’s care and knew who to contact for further advice once their child was discharged.

Children were cared for mainly on one of the two adult wards. They were not cared for in a specific area of the ward. None of the rooms had been adapted to accommodate the needs of children. The hospital had specific equipment such as resuscitation equipment for children.

Resources for children were limited. There was one permanently employed staff nurse for children with paediatric trained bank nurses booked as required. There were no dedicated pharmacists for children, but pharmacists reviewed their medicine charts and checked they had been prescribed the correct dose of medicines for their weight.

Nursing staff in theatres and recovery had received specific training in how to care for children and young people undergoing surgery and post operatively. There were also separate documentation to record care and treatment of children.

The hospital did not admit children as emergencies, but used an early warning scoring tool to help with early identification of deterioration in a child or young person

Updated 16 May 2019

Updated 16 May 2019

Updated 16 May 2019