The Cavell Hospital

Updated 20 August 2019

BMI The Cavell Hospital in Enfield, London is operated by BMI Healthcare Limited. The hospital has 27 beds and provides a range of services including surgical procedures, surgical and medical inpatient care and outpatient consultations with a ‘walk in walk out’ unit, a dedicated endoscopy unit, CT scanning and MRI facilities. 

There are two operating theatres, 13 outpatient consulting rooms, and a minor procedures room, minor treatment room, imaging suite and a physiotherapy department.

Services are provided to both insured, self-pay private patients and to NHS patients through both GP referral and contracts.

Updated 20 August 2019

BMI The Cavell Hospital is operated by BMI Healthcare Limited. The hospital provided inpatient and day care services and had a total of 27 beds. hospital has two theatres, endoscopy, phlebotomy and minor operations room, outpatients and diagnostic imaging department.

The hospital provides surgery, medical care, outpatients and diagnostic imaging. We inspected surgery, medical care and outpatients.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 8 to 9 April 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 improved. We rated it as good overall.

We found the following areas of good practice:

• Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
• Staff used control measures to prevent the spread of infection. The treatment and consultation rooms we saw were clean. Trolleys were also clean.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment.
• The service 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 staff. We were given examples where the service had learned from complaints. Patients told us that when something was not to their satisfaction and they raised it with staff, the response was constructive and helpful.
• The service took account of patients’ individual needs.
• The service had a vision for what it wanted to achieve. The strategy was developed by the corporate senior management team, with objectives cascaded to the hospital teams.
• The service managed and used information to support its activities, using secure electronic systems with security safeguards. The service worked to good information governance processes.
• The service engaged well with patients and staff, the public and local organisations to plan and manage appropriate services.

However, we also found areas of practice that require improvement:

Medical Care

• The service lacked an effective system to assess, respond to and manage risks to oncology patients during out of hours including medical emergencies. For example, the oncology 24 hours help line was not always staffed by appropriately trained oncology staff.
• Not all staff had received an annual appraisal. Current appraisal rates for nursing staff were 75% which was below the hospital standard of 90%. This was still an on-going issue and no improvement noted since the last inspection. The hospital aimed to complete staff appraisal by June 2019.
• The hospital wide pain audits showed low compliance in the completion of pain assessment.
• The nurses working in the endoscopy unit had not been endoscopy trained.
• There was low morale among the endoscopy staff due to insufficient break times when the clinics were over booked and the lack of an endoscopy lead. There was a vacancy for the new role of an endoscopy clinical support manager.

Surgery

• There continued to be some issues where records were not always available, clear or up-to-date, especially in pre-operative assessment.
• The service did not always have enough permanent nursing staff. During our inspection there were not enough permanent staff members in pre-operative assessment.
• Not all staff received an annual appraisal. The hospital standard was 90% and the service reported 70% of theatre staff completed an annual appraisal. On the ward, 76% of nursing staff completed an annual appraisal. Annual appraisal rates for healthcare assistants was 60% on the ward.

Outpatients

• Although the service followed best practice most of the time, we found some issues with the storage of medicines. Resuscitation trolleys were not in a temperature controlled area as advised by the pharmacist due to the storage of medicines on them. Sachets of fluids were found on nurse trolleys kept in treatment rooms that were not temperature controlled.
• Not all staff were not aware of the General Data Protection Regulation 2016 (GDPR).
• Patients were not always kept informed of delayed appointment times. Waiting times for clinics were not displayed in waiting areas.

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.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Updated 20 August 2019

We rated this service as good overall and good in each domain of safe, effective, caring, responsive and well-led.

Updated 20 August 2019

We rated this service as good overall because it was safe, caring, and responsive and well-led. We do not rate the effective domain in outpatients.

Updated 20 August 2019

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other  services, we do not repeat the information but  cross-refer to the surgery section.

Staffing on wards was managed jointly with medical care.

We rated this service as good overall and good in each domain of safe, effective, caring,  responsive and well-led.