The Chiltern Hospital

Updated 29 November 2021

BMI The Chiltern Hospital is operated by BMI Healthcare Limited. BMI Healthcare Limited has been owned by Circle Health Group since December 2019.

The hospital opened in March 1982 and is a private hospital in Great Missenden, Buckinghamshire. The hospital primarily serves the communities of South Buckinghamshire. It also accepts patient referrals from outside the area. The hospital leadership team including directors and heads of department work at both the BMI Chiltern Hospital and the nearby BMI Shelburne Hospital.

BMI The Chiltern Hospital provides surgery, endoscopy, oncology, outpatients and diagnostic imaging services for adults. The hospital is a non-interventional site for children and young people seeing 0-18 year olds in outpatients and diagnostic services. The hospital provides inpatient/day case facilities for surgery and interventional care in outpatients for 16/17 year olds on an adult pathway. No interventional procedures are performed for children under the age of 16.

The hospital provides care and treatment to adults and children and young people who have private medical insurance, pay for themselves and NHS funded patients.

In the reporting period from September 2020 to August 2021:

• There were 5,448 surgery day cases and 1,134 inpatient episodes of care recorded at the hospital; of these 71% were privately/insured funded patients and 29% NHS funded
• There were 1,274 oncology treatment. All patients were either self -funded or insured.
• There were 1,196 endoscopy patients treated as ambulatory or day cases; of these 65% were privately/insured funded patients and 35% NHS funded.
• There were 4,209 children and young people’s appointments which included, outpatient, imagining and physiotherapy appointments and paediatric blood test.
• There were 60,609 episodes of care in the outpatient department.
• There were 22,143 episodes of care in the diagnostic imaging department.

The hospital has two wards, Chalfont and Shardeloes, with 56 bedrooms in total. Shardeloes is a day case ward and Chalfont an inpatient and day case ward. The majority of rooms have ensuite facilities. The hospital has three theatres (two with laminar flow) and a separate JAG accredited endoscopy theatre. The Oncology suite has four individual pods and four en-suite bedrooms. The outpatient department consists of 12 consulting rooms, minor procedures room, colposcopy room and treatment room. The diagnostic imaging service includes computerised tomography (CT), magnetic resonance imaging (MRI), DEXA (bone density scanning), digital mammography, ultrasound and plain film X-ray. There are no emergency facilities at this hospital.

There were 135 surgeons, anaesthetists and physicians working at the hospital under practising privileges.

The hospital is registered to provide the following regulated activities:

• Diagnostic and Screening Procedures
• Surgical Procedures
• Treatment of Disease, Disorder or Injury

The hospital has a registered manager who has been in post since July 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage a service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how a service is managed.

The hospital was previously inspected in 2019 and rated as requires improvement.

We inspected BMI The Chiltern Hospital using our comprehensive inspection methodology. We carried out a short-announced inspection on 20-21 September 2021.

Where our findings also apply to other services, for example management arrangements, we do not repeat the information but cross-refer to the surgery service level.

Updated 29 November 2021

Our rating of this location improved. 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 collected safety information and used it to improve the service.
• 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. 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 medical records department was cluttered and did not maintain a safe working environment for staff working in the department.
• Not all staff who were required to complete the Care and Communication of the Deteriorating Patient mandatory training had completed it.
• The theatre trolley in endoscopy had a tear which did not allow for effective cleaning. This could pose infection control risks and cross infection.
• The endoscopy service did not always have an appropriately trained staff member to support patients when breaking bad news.

Updated 29 November 2021

Our rating of this service stayed the same. We rated it as good because:

• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe and to provide the right care and treatment.
• Infection prevention and control processes had been reviewed and developed further to support staff practices during the pandemic.
• Equipment in endoscopy and oncology units was managed effectively with evidence of regular checks and clear records were maintained. This included the emergency equipment such as the resuscitation trolleys which were tagged and easily accessible.
• The service provided mandatory training in key skills to all staff and monitored training compliance.
• The service managed medicines safely and followed good practice guidance. Staff followed their procedures for access to the pharmacy out of hours.
• Managers ensured that these staff received training, supervision and appraisal. The staff worked well together and as a multidisciplinary team.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff understood how to protect patients from abuse and had training on how to recognise and report abuse and they knew how to apply it.
• Managers used 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 were focused on the needs of patients and delivering individualised 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.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in their daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
• Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events.

However:

• The theatre trolley in endoscopy had a tear which did not allow for effective cleaning. This could pose infection control risks and cross infection.
• The endoscopy service did not always have an appropriately trained staff member to support patients when breaking bad news.

Medical Care is a small proportion of hospital activity. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring, responsive and well-led.

Updated 29 November 2021

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. The Children’s lead monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, supported them to make decisions about their care, and had access to good information.
• Staff treated children and young people with compassion and kindness, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. 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 children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

However,

• Staff should consider weighing patients in a private area.

The Children and young people’s service is a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring, responsive and well led.

Updated 29 November 2021

Our rating of this service improved. 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 collected safety information and used it to improve the service.
• Staff provided good care to patients, and monitored their pain. 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. People could access the service when they needed it and did not have to wait too long for a diagnostic procedure.
• 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.

Diagnostic imaging is a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring, responsive and well led.

Updated 29 November 2021

Our rating of this service improved. 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. The service managed safety incidents well and learnt lessons from them. Staff collected safety information and used it to improve the service.
• Staff supplied good care to patients. Managers checked the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and had access to good information. Services were available three 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 gave 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. People could access the service when they needed it and did not have to wait too long for a diagnostic procedure.
• 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. Leaders focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients.

Outpatients is a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as good because it was safe, effective, caring, responsive and well led.

Updated 29 November 2021

Our rating of this service 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 collected safety information and used it to improve the service.
• 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. 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 medical records department was cluttered and did not maintain a safe working environment for staff working in the department.
• Not all staff who were required to complete the Care and Communication of the Deteriorating Patient (CCDP) mandatory training had completed it.

We rated this service as good because it was safe, effective, caring, responsive and well led.