The Clementine Churchill Hospital

Updated 18 November 2021

BMI The Clementine Churchill Hospital is operated by BMI Healthcare Limited which is owned by Circle Health Group.

The hospital has 98 beds. Facilities include five operating theatres, an endoscopy suite, a minor procedures unit, six-bed level two and three critical care unit, outpatients and diagnostic imaging facilities. The hospital provides surgery, medical care, critical care, outpatients and diagnostic imaging. At the time of the inspection, the hospital provided services to adults and young adults over the age of 16; both private and NHS patients, as well as a paediatric non-interventional outpatients’ service.

The service was last inspected on 3 September to 5 September and 29 October to 30 October 2019. Following the 2019 inspection, the service was rated as good with one Requirement Notice in critical care for failing to comply with the Heath and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 18 (Staffing).

BMI The Clementine Churchill Hospital has a six-bed critical care unit providing level two and level three care. Level three care is where patients require advanced respiratory support alone or basic respiratory support with support of two other organ systems. Level two care is where patients require more detailed observation and higher levels of care such as those receiving basic respiratory support or with single organ failure. The unit has two individual side rooms and four cubicles. The cubicles are semi-permanent structures used to divide the unit area into separate individual spaces resembling rooms. Patients could be admitted directly to the unit, post-operatively from theatres, or from medical wards. The critical care unit sees patients across a range of medical and surgical specialities. The service admits patients mostly from the United Kingdom, however, also admits patients from international places of origin. Staffing on the critical care unit consists of critical care consultants, resident medical officers and nursing staff, and is managed by a clinical services manager. There is also multidisciplinary team support that included pharmacy, physiotherapy, dietitian, onsite pathology, imaging, and phlebotomy.

The unit submits data to the Intensive Care National Audit and Research Centre (ICNARC). This is carried out by two nurses. In the last 12 months there were 487 level two and three critical care bed days available in the hospital.

Between August 2020 and July 2021 there were 249 patients. Of these, 198 were planned admissions and 50 were unplanned. There were 220 level two patients and 29 level three patients.

Updated 18 November 2021

BMI The Clementine Churchill Hospital is operated by BMI Healthcare Limited. The hospital has 121 beds. Facilities include five operating theatres, an endoscopy suite, a minor procedures unit, six-bed level two and three critical care unit, outpatients and diagnostic imaging facilities.

The hospital provides surgery, medical care, critical care, outpatients and diagnostic imaging. The hospital provides services to adults and young adults over the age of 16; both private and NHS patients, as well as a paediatric non-interventional outpatients’ service.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 3 September 2019 to 5 September 2019 for outpatients, medical care and surgery and an unannounced inspection of critical care and diagnostic imaging services on 29 and 30 October 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. Where our findings for outpatients and diagnostic imaging also apply to services for children and young people, we do not repeat the information but cross-refer to the outpatients and diagnostic imaging sections of the report.

Our rating of this hospital improved. We rated it as Good overall.

• 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 hospital controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The hospital managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

• At our last inspection, we identified various concerns related to infection prevention and control (IPC). At this inspection we found that IPC had improved across services and staff took measures to reduce the risks of infection. Surgical wards no longer had carpeted flooring and were now compliant with infection control guidance. All areas of the intensive care unit were visibly clean and free from dust. This had improved since the last inspection.

• 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.

• The endoscopy service had received Joint Advisory Group on gastrointestinal endoscopy (JAG) accreditation in March 2019.

• 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 hospital 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 services when they needed it and did not have to wait too long for treatment. The hospital had dementia champions who could provide staff with advice and support to help care for patients living with dementia.

• At our last inspection we were told by staff that they had difficulty accessing diagnostic imaging services. At this inspection we were told by staff that they did not experience difficulty accessing these services and there were protected slots for inpatients.

• 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.

However:

• In outpatients, we found patient notes were filed untidily, were not always complete and were difficult to follow.

• In diagnostic imaging, here was no clear signage warning people of the MR controlled access area and no additional locked door separating the waiting area from the controlled access area. This meant there was a risk that unauthorised persons could access the MR controlled access area. This was on the department’s risk register.

• In diagnostic imaging, not all staff competencies and patient group directions were fully signed by the relevant staff members.

• The service was not meeting all of the building standards for critical care services. This was on the department’s risk register. However, it should be noted this requirement is for new units only.

• We were not assured in the event of an outreach call and/or emergency resuscitation call the intensive care unit would have appropriate medical cover. This was due to the unit’s resident medical officer (RMO) holding multiple roles. There was also no documented escalation procedure in place to show how the ward was medically covered if the RMO was called out.

• We were not assured there was appropriate medical cover on the intensive care unit at all times. In addition, consultants were working over 24 hour periods which was against national guidelines.

• We noted that for two of the five notes we checked in critical care, we could not identify if a daily ward round had happened. Therefore, we were not assured ward rounds were happening for all patients.

• Agency usage in critical care was above the recommended 20% in some months. This was on the department's risk register.

• Physiotherapy and pharmacy were not able to attend daily ward rounds on the intensive care unit due to staffing issues, which was not compliant with Guidelines for the Provision of Intensive Care Services. The pharmacy team also did not have a suitable post graduate qualification for critical care pharmacy.

• The intensive care unit still did not have a follow up clinic where patients could reflect upon their critical care experience and be assessed for progress which was not in line with the Guidelines for the Provision of Intensive Care Services.

• We found that the BMI practising privileges policy and the BMI care of the deteriorating patient policy did not align. The hospital was following the BMI practising privileges policy which stated that consultants and anaesthetists retained responsibility for their patient for the patient’s entire clinical pathway. However, the BMI care of the deteriorating patient policy stated that there should be an anaesthetist rota in place. Both policies had been reviewed in January 2019, but the discrepancy had not been picked up. The hospital subsequently informed us that this discrepancy had not been identified by the corporate provider’s National Clinical Governance Board who were responsible for these policies. The hospital had also not identified or escalated this discrepancy to the corporate governance board but told us that they had escalated the issue of the anomaly following our inspecti on.

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, to help the service improve. We also issued the provider with a requirement notice. Details are at the end of the report.

Nigel Acheson, Deputy Chief Inspector of Hospitals

Updated 24 December 2019

Medical care services were a small proportion of hospital activity.

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

Updated 24 December 2019

Services for children and young people were a small proportion of hospital activity within the outpatients and diagnostic imaging service.

We rated this service as good because it was safe, effective, caring, responsive and well led. We did not have sufficient evidence to rate effective and caring. 

Updated 24 December 2019

Critical care services were a small proportion of hospital activity. The hospital has a six-bed intensive care unit providing level two and level three care.

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

Updated 24 December 2019

Diagnostic imaging was one of the main services of the hospital’s activity. We rated this service as good because it was safe, effective, caring, responsive and well led. 

Updated 24 December 2019

The outpatients department was one of the main services of the hospital’s activity. We rated this service as good because it was safe, effective, caring and responsive and well led.

Updated 24 December 2019

Surgery was the main activity of the hospital. Staffing was managed jointly with medical care. We rated this service as good because it was safe, effective, caring, responsive and well led.