All inspections: The Alexandra Hospital

Our rating of this location stayed the same. 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, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
Staff provided good care and treatment, gave patients enough to eat and drink, and gave them 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, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
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 local people, took account of patients’ individual needs, and made it easy for people to give feedback. Most people could access the service when they needed it and did not have to wait too long for treatment.
Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. 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 and the community to plan and manage services and all staff were committed to improving services continually.

However:

The children and young people service was not always inclusive and did not take account of children, young people and their families' individual needs and preferences. Staff could not always make reasonable adjustments to help children, young people, and their families access services.
Leaders and staff did not actively and openly engage with children and young people, equality groups, the public and local organisations to plan and manage services.

The Alexandra Hospital is operated by BMI Healthcare. The hospital was built in 1981 and is currently using 128 of its 172 registered beds for inpatient/day case activity. The hospital has an urgent care centre, seven theatres, an endoscopy unit, a minor procedure unit, dedicated children and young person’s ward, a complex range of diagnostic imaging services, a physiotherapy department, on site pharmacy, a five bedded level three/level two critical care ward and three progressive care beds and outpatients.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 30 July to 1 August 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, effective, caring, responsive to people's needs, and 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.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Services we rate

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

Staff worked especially hard to make the patient experience as pleasant as possible. Staff recognised and responded to the holistic needs of their patients from the first referral before admission to checks on their wellbeing after they were discharged from the hospital.
The hospital controlled infection risk well. The service used systems to identify and prevent surgical site infections. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
Staff understood how to protect patients from abuse and the hospital 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 completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
The hospital had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
The hospital managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
The hospital provided care and treatment based on national guidance and evidence-based practice.
Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other hospitals to learn from them.
Staff gave patients enough food and drink to meet their needs and improve their health. Patients were assessed regularly to see if they were in pain.
The hospital made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
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.
Leaders ran services well using reliable information systems. Staff understood the vision and values, and how to apply them in their work. Staff felt respected and valued. They were focussed on the needs of patients receiving care. The hospital engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However, we also found the following issues that the service provider needs to improve:

The children’s and young peoples service did not always provide safe care and treatment to those using the service. During inspection, we identified a number of concerns that had not been escalated to the senior management team prior to our inspection despite opportunities available to do this. In response to the risks raised on inspection, senior manages voluntarily closed the service to review the provisions and mitigate any risks.
The staffing provision in children and young people services was not always meeting national guidance to ensure there were enough nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The senior management team were not aware the service did not meet paediatric staffing standards. On inspection the service was suspended until the ward was staffed with a minimum of two registered paediatric nurses.
The children and young people services was not always inclusive in taking account of children, young people and their families' individual needs and preferences. Staff did not always make reasonable adjustments to help patients access services.
Information received post inspection confirmed the senior leadership team were reviewing the children and young people service leadership structure. They had also reviewed policies and processes to ensure the service was safe.
In children and young people services governance processes required strengthening to ensure risks and issues were identified and escalated and identified actions taken to reduce their impact.
Although staff completed patients’ fluid and nutrition charts where needed they did not always fully record the total fluids given or recorded what actions they had taken.
Information was not always easily accessible to patients and their relatives in formats that met their individual needs.
In medicine not all staff understood how and when to assess whether a patient had the capacity to make decisions about their care under the Mental Capacity Act 2005
Not all medical staff complied with the ‘bare below the elbows’ policy.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected services for children and young people. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals North

BMI The Alexandra Hospital in Cheadle is part of BMI Healthcare, the UK’s largest provider of independent healthcare. BMI Alexandra Hospital is registered to provide the following regulated activities:

Diagnostic and screening.

Surgical procedures.

Treatment of disease, disorder or injury.

Our inspection was undertaken as part of our on-going programme of comprehensive Independent Health Care inspections. We carried out an announced inspection visit of BMI Alexandra Hospital on 5th and 6th July and an unannounced inspection on 13th July 2016.

We inspected the core services of Surgery, Medicine, Urgent and Emergency Care, Critical Care services for Children and Young People and the Outpatients and Diagnostics service.

Are services safe at this hospital:

Surgical procedures were carried out by a team of consultant surgeons and anaesthetists who were mainly employed by other organisations (such as in the NHS) in substantive posts and had practising privileges with the hospital.

Senior staff were aware of their responsibilities relating to duty of candour legislation and were able to give us examples of when this had been implemented. The hospital had a duty of candour process in place to ensure that people had been appropriately informed of an incident and the actions that had been taken to prevent recurrence.

Incidents were reported by staff through effective systems. Lessons were learnt and investigation findings and improvements made were fed back to staff. There were systems in place to keep people safe and staff were aware of how to ensure patients’ were safeguarded from abuse.

Staff assessed and responded to patient’s risks and used recognised assessments. We found these had been fully completed.

There were systems in place for reporting risk and safeguarding patients from abuse. Staff were aware of how to report incidents that took place in the departments and we saw evidence of incidents being investigated and learning being shared within the team.

Staffing levels and skills mix was sufficient to meet patients’ needs.

Equipment was maintained, appropriately checked, and visibly clean. Medical equipment was checked and maintained by an independent company.

Patient records were stored securely, and access was limited to those who needed to use them.

Staff had completed their mandatory and specialist training.

Resident registered medical officers [RMOs] were employed to provide medical cover when the named consultant was not available.

Are services effective at this hospital:

Patients received care and treatment according to national guidelines such as National Institute for Health and Clinical Excellence (NICE) and the Royal Colleges.

The hospital monitored patient outcomes through surveys to ensure that patients were

satisfied with the service they received.

BMI corporate policies based on national institute for health and care excellence (NICE), national and royal college guidelines were available to staff on the intranet.

Care and treatment was provided by suitably trained, competent staff that worked well as part of a multidisciplinary team.

Procedures were in place to ensure that consultants holding practicing privileges were valid to practice. We saw there were procedures in place to ensure all consultant requests to practice were reviewed by the Medical Advisory Committee (MAC).

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.

Are services caring at this hospital:

Patients spoke positively about their care and treatment. Staff treated patients with dignity and respect and patients were kept involved in their care.

Patient feedback from the NHS Friends and Family Test and patient satisfaction surveys showed 97% of patients were positive about recommending services to friends and family.

Staff provided emotional support to patients and chaperones were used across the departments at the request of patients or for intimate examinations or procedures.

All of the patients we spoke to during our visit told us that they had been treated exceptionally well by staff.

We observed that staff were sensitive and understanding of the emotional impact of care and treatment. Staff told us that they put the needs of patients first.

Patients consultants, named nurse looking after them. This was to ensure continuity of care. Patients we spoke with said that staff always introduced themselves and made them feel that they were involved.

Are services responsive at this hospital:

There was daily planning by staff to ensure patients were admitted and discharged in a timely manner. There was sufficient capacity in the ward and theatres so patients could be seen promptly and receive the right level of care before and after surgery.

There were systems in place to support vulnerable patients. Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.

Staff had attended equality and diversity training, the cultural needs and specific requirements of patients were taken into account when planning and delivering services. For example, patients attending the wards were asked about their religious beliefs and dietary requirements, in case these affected their treatment options or meal choices.

The services accessed translation services for those patients whose first language was not English, and information was available to patients in differing formats if required.

Are services well led at this hospital:

There were governance structures in place. The hospital’s vision and values had been cascaded across the services and staff had an understanding of what these involved.

There was clearly visible leadership within the services staff were positive about the culture within the services overall and the level of support they received.

All staff were committed to delivering good, compassionate care and were motivated to work at the hospital.

On the whole, staff across the departments spoke positively about the leaders and the culture within the hospital.

Our key findings were as follows:

There were systems in place for reporting risk and safeguarding patients from abuse. Staff were aware of how to report incidents that took place in the departments and we saw evidence of incidents being investigated and learning being shared within the team. Staff completion of mandatory training for their roles was high.

Equipment was maintained, appropriately checked, and visibly clean. Medical equipment was checked and maintained by an independent company. We saw records to confirm that electrical equipment had been tested.

There were systems in place to keep people safe and staff were aware of how to ensure patients’ were safeguarded from abuse.

The staffing levels and skills mix was sufficient to meet patients’ needs and staff assessed and responded to patient risks. Care and treatment was provided by suitably trained, competent staff that worked well as part of a multidisciplinary team.

Patients received care and treatment according to national guidelines such as National Institute for Health and Clinical Excellence (NICE) and the Royal Colleges. Surgery services participated in national audits.

There was sufficient capacity in the ward and theatres so patients could be seen promptly and receive the right level of care before and after surgery.

Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.

Staff treated patients with dignity and respect and patients were kept involved in their care. Patients and their relatives we spoke to told us they were supported by staff that were caring, compassionate and supportive to their needs.

There were governance structures in place which included a risk register. We saw that risks had been identified and actions taken to mitigate the risks in a number of areas that included infection control and patient safety.

All staff were committed to delivering good, compassionate care and were motivated to work at the hospital.

Patient records were stored securely, and access was limited to those who needed to use them. This ensured that patient confidentiality was maintained at all times.

Patients had a choice of appointments available to them through the ‘choose and book’ service. This allowed patients to be able to attend appointments at a time best suited to their needs.

Procedures were in place to ensure that consultants holding practicing privileges were valid to practice. We saw there were procedures in place to ensure all consultant requests to practice were reviewed by the Medical Advisory Committee (MAC).

Staff felt appreciated and valued, they discussed with us the different ways BMI recognised staff for their hard work. At a corporate level BMI championed the ‘Above and Beyond’ nominations, senior staff were asked to nominate staff in for this award.

There were some areas where the provider needs to make improvements.

Action the hospital SHOULD take to improve

The hospital should ensure that appropriate procedures are in place to ensure children using the diagnostic imaging department received appropriate images.

The outpatient department should ensure that sufficient action is taken when the fridge containing medication lays outside of the acceptable temperature range.

The hospital should ensure that patient temperatures and visual infused phlebitis (VIP) scores were not being recorded in theatres in line with evidence-based practice in the prevention of surgical site infections.

The hospital should ensure the development of multidisciplinary working, for all teams across the hospital. For example teams should attend multidisciplinary meetings to discuss the care of patients with complex cases.

The hospital should consider including the ‘cool off’ period for cosmetic surgery in the consent policy.

Professor Sir Mike Richards

Chief Inspector of Hospitals

During this inspection we visited an orthopaedic ward and a general surgical ward. We spoke with 13 people using the service, eight members of ward staff, the registered manager for the service, the director of clinical services and the governance and risk manager.

People using the service told us they were happy with the care, treatment and advice they had received. Comments included, "I am very happy with the care and cannot ask for more,” “The staff are very good, I cannot fault them” and “I feel better and less anxious because staff always give me an update regarding my wound.”

People told us they enjoyed the food. Comments included, "Meals are beautifully presented which increases my appetite,” “The food is superb” and “When I have little or no appetite I am always encouraged to have some soup, which is always very tasty.”

There were sufficient skilled and experienced staff to meet people's needs. One person said “Staff are great they are always available.”

Staff had access to 'safeguarding' and 'whistle blowing' procedures and had received training to help them recognise and respond to any signs of potential abuse or neglect. We were told that people felt safe and staff were described as polite and knowledgeable. One person said “It gives me an assurance of safety because staff are well organised and experienced.”

We spoke with four people who used the service and one visiting relative. They all told us that they were they were happy with the services they received. They said they had been asked for written consent prior to receiving any treatment. They also told us that they were offered a choice and their treatment options were fully explained to them by staff.

One person told us they felt comfortable because they were seen by the same consultant during each visit.

The people we spoke told us they were happy with the staff and care received. One person told us the staff were knowledgeable and that the nursing staff responded quickly when they were called.

People spoken with also told us they did not have any concerns about the service they received but were aware of how to raise a complaint if they did have any issues.

During this inspection visit we spoke with six members of staff. Staff told us they were happy working at the hospital. One person said she “Really enjoyed the job.”

Staff spoken with were able to clearly explain the process for obtaining patient consent prior to treatment and knew the process if a patient had a complaint or a concern.

We found there were various information leaflets on display around the hospital for people to take.

'The staff are very good and I am very happy with my treatment so far.'

'It has been a fantastic experience; the consultant gave me information about what the surgery entailed, the risks involved and how long I should expect to be away from work afterwards.'

'The nurses and healthcare assistants are helpful and caring and always explain whatever they are doing in a way you can understand.'

'The staff are very efficient.'

'They are well trained and always know what they doing.'

These older reports are from our old approaches to inspection, including those from before CQC was created.

The Alexandra Hospital

All Inspections

9th December 2021 to 10th December 2021

During a routine inspection

30 July - 1 August 2019

During an inspection looking at part of the service

5 6 and 13 July 2016

During a routine inspection

Professor Sir Mike Richards

Chief Inspector of Hospitals

10 February 2014

During a routine inspection

6 March 2013

During a routine inspection

1 November 2011

During a routine inspection

Reports under our old system of regulation