All inspections: The Hampshire Clinic - Care Quality Commission

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 critical care service did not have its own governance processes, but the used the ward’s governance arrangements. The ward manager represented both services at clinical governance meetings and daily communication cells and was responsible for escalating risks. There was lack of opportunities for critical care staff to meet, discuss and learn from the performance of their service and no formal risk management process in the department.
A theatre storeroom was found to be visibly dirty and did not appear on the cleaning rota.
In the theatre environment there was a broken light, held together by tape and glass protecting one set of medical gas switches was broken.
The sluice area within recovery contained open bottles of cleaning solutions and was cluttered. A sharps bin, without a lid, was being used as a general waste bin.
Not all staff were familiar with the location of policies, procedures and IR(ME)R procedures.
The computerised tomography (CT) scan procedures were out of date (March 2020).

The Hampshire Clinic is operated by BMI Healthcare Ltd. The hospital has 62 beds. Facilities include four operating theatres, a three-bed level three care unit, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We focused our inspection in two areas, namely surgery and medical care.

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.

We carried out an unannounced focussed inspection on 23 January 2019, to assess compliance against three warning notices which were issued to the provider on 06 July 2018.

Our inspection targeted the key concerns identified in the warning notice.

At our inspection we found the provider had made considerable progress on all issues identified in the warning notice. For example, we found the following:

There was evidence of audit being carried out to confirm the effectiveness of infection control procedures and practices. All audits were dated and each had a separate action plan to address issues highlighted.
The hospital ensured staff followed the pathway and guidance for assessing deteriorating patients.
To support staff in the safe delivery of care, policies and procedures were reviewed regularly.
The service undertook observational audits of the World Health Organisation surgery checklists.
Staff were aware of the sepsis policy for sepsis management and the provider's sepsis care pathway. The sepsis screening tool made reference to the 2017 NICE guidance.
There was an overall corporate risk register and specialty level risk register. The specialty level risk register accurately reflected current risks at the service. The senior leadership team were aware of the five top risks the hospital faced.
There were effective processes developed for incidents that affected the health and safety of people using the service.
In the endoscopy unit, there were arrangements in place for the management and control of spread of infection.
Venous thromboembolism assessments (VTA) were fully completed. There was evidence these assessments were always reviewed when patients' risks were identified.

The hospital was compliant to the warning notice.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (South and South West)

BMI The Hampshire Clinic is operated by BMI Healthcare Limited . The hospital has 62 registered beds. Facilities include four operating theatres, a three-bed level three intensive care unit, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care including endoscopy and oncology, services for children and young people, and outpatients and diagnostic imaging.

We carried out a responsive inspection to follow up on concerns relating to a number of recent incidents at the hospital. We also had concerns that governance systems and processes were not operating effectively. We carried out the unannounced part of the inspection on 24 and 25 April 2018, with an announced visit to the hospital on 16 May 2018 as part of our well- led inspection.

During this inspection we looked at the core services for surgery including, surgical intensive care, children and young people services, and medical care which included endoscopy and oncology. Children and intensive care are small services, please refer to the main Surgery report for further information.

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

We rated this hospital as requires improvement overall.

The intensive care unit did not manage medicines including controlled medicines and intravenous drugs effectively which could impact on patients’ safety.
The service did not manage incidents effectively as these were not investigated in a timely way for improvement and learning.
There was a National Early Warning System (NEWS) in use however; the patients’ notes we reviewed included scores that were inconsistent. There were gaps in the observations on NEWS records as not all parameters were completed.
The sepsis screening tool was out of date and did not reflect 2017 national guidance. Staff had not received updates on the management of sepsis in line with recent guidelines.
The systems and processes for ensuring patients ‘safety prior to surgery was not consistently followed. We were not assured safety briefings and debriefings were being completed in the operating theatres to safeguard patients.
Not all the theatre team were in attendance at the safety briefings.
Governance systems and processes for the management of incidents and never events were not operating effectively.

However;

There was a process for safeguarding children and adults which staff were confident in using.
The Intensive Care Unit (ICU) doctors reviewed patients who had been recently discharged to the ward, identifying deterioration and providing support and guidance to the ward nurses. Staff from the ICU also worked on the wards if there were no patients in ICU, this enabled patients discharged from ICU to be provided with 1:1 care when needed.
All paediatric patients who were under five had the ‘red books’ which contained their current health records. The paediatric nurses ensured these were available at the pre -admission assessments stage.
There were designated paediatric nurses when children were admitted for care and treatment.
Staff told us they had adequate staff to meet the patients’ needs and they used their bank system and could access agency staff to cover for staff’s shortages.

Following this inspection, we served the Hampshire Clinic with a Warning Notice under Section 29 of the Health and Social Care Act 2008, on July 2018. The notice required the provider to make significant improvements by 3 August 2018.

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 requirement notices and two warning notices that affected BMI the Hampshire Clinic. Details are at the end of the report.

Name of signatory

Amanda Stanford

Deputy Chief Inspector of Hospitals

The Hampshire Clinic is one of 62 hospitals and treatment centres provided by BMI Healthcare Ltd. It is located in Old Basing, Hampshire, and on-site facilities include 58 available beds, four theatres (two laminar flow), an endoscopy suite, and outpatient suite offering consulting and treatment rooms, and an imaging department offering X ray and ultrasound. The hospital also has a static MRI and CT run under a service contract with Alliance Medical: this service was not included during this inspection as it is a separate organisation.

The BMI Hampshire Clinic provides a range of medical, surgical and diagnostic services to patients who pay for themselves, are insured, or are NHS-funded patients. Services offered include general surgery, orthopaedics, highly-specialist gastro intestinal surgery, general medicine, oncology, dermatology, physiotherapy, endoscopy and diagnostic imaging.

Medical services can be thought of as those services that involve assessment, diagnosis and treatment of adults by means of medical interventions rather than surgery. The medical service consists of two separate components; oncology chemotherapy treatment, and a diagnostic endoscopy service. Endoscopy or chemotherapy services undertaken as a day case are therefore included within medical care in this report.

The announced inspection took place on 21 and 22 March 2016, followed by a routine unannounced visit on 5 April 2016.

This was a comprehensive planned inspection of all core services provided at the hospital: medicine, surgery, outpatient and diagnostic imaging. There is a small critical care facility and this was inspected under surgical services. There are some surgical and outpatient services for patients under 16 years, and these are reported on within the surgical report by Specialist Advisers, but the majority of patients are adults

The Hampshire Clinic was selected for a comprehensive inspection as part of our routine inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

Our key findings were as follows:

Are services safe at this hospital?

By safe, we mean people are protected from abuse and avoidable harm.

Patients were protected from the risk of abuse and avoidable harm acrossall inspected services.
Staff reported incidents and openness about safety was encouraged.
Incidents were monitored and reviewed in most services and staff clearly demonstrated examples of learning from these.
Clinical areas were visibly clean and tidy. Hospital infection prevention and control practices were followed and these were regularly monitored, to reduce the risk of spread of infections. Where necessary, action was taken to address any identified learning.
Staff received appropriate training for their role, were supported to keep their skills up-to-date and were further supported in their role through a corporate performance review process. BMI set a target of 90% compliance with mandatory training. Records provided by the hospital showed that the compliance rate for OPD staff was 100% and 100 % for diagnostic imaging staff
Staff followed national and local guidance when providing care and treatment.
Equipment was maintained and tested, in line with manufacturer’s guidance. There were appropriate checks and maintenance on the hospital building and plant.
Medicines were stored securely and chemotherapy was prepared safely. Nursing staff were trained to administer chemotherapy.
There was regular monitoring of patient records for accuracy and completeness. They were securely stored and available when needed.
Staffing levels and skills mix were planned, implemented and reviewed to keep patient’s safe at all times.
Plans were in place to respond to emergencies and major situations.

Are services effective at this hospital?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

Patients care and treatment was planned and delivered in line with current evidence based guidance, best practice and legislation.
The medical advisory committee (MAC) reviewed patient outcomes and the renewal of practising privileges of individual consultants. It also reviewed policies and guidance and advised on effective care. The Medical Advisory Committee (MAC) also monitored outcomes of individual consultants and fed back any concerns that were not within normal ranges.
Regular communication between BMI Hampshire Clinic Hospital Medical Advisory Committee (MAC) Chair and the various trust medical directors was maintained to ensure a coordinated approach to consultant engagement. Consultant concerns were discussed by the hospital management team with the MAC Chair, and if considered serious enough, with the BMI Group Medical Director. Concerns that related to standards of practice, quality or patient safety were also shared with the consultant’s responsible officer.
Oncology patient outcomes were monitored at cancer multi-disciplinary meetings and doctors monitored them in their follow up clinics.
Patients’ pain needs were met appropriately during a procedure or investigation. Pain relief was managed effectively using a patient scoring tool,
The consent process for patients was well structured and, although rarely used in practice, staff demonstrated a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Completed consent forms were seen in the oncology unit’s patient records. These were clear and concise and showed consent had been obtained from the patient for planned treatment.
Quarterly consent audits were completed as part of the hospital audit programme. Results of audits for 2015 showed 75% compliance with standards. Actions for improvement included ensuring the consultant’s full name as well as signature was recorded on the form.
The endoscopy service did not have Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accreditation. Preliminary work by the corporate endoscopy team to assess the status of the endoscopy service had led to a proposal to redesign the service at BMI Hampshire Clinic which was about to commence at the time of our inspection
Patient outcome data was reported for comparative analysis for surgical services, but the endoscopy service was not auditing their performance or collecting data on patient outcomes.
Patient satisfaction regarding food quality had declined recently since outsourcing the contract. The hospital management were closely monitoring and addressing these issues to ensure improvements were made. A dietician was onsite every Thursday and oncology patients were referred as needed.
Staff were competent, skilled and knowledgeable, and were supported to further enhance their clinical and counselling skills.

Are services caring at this hospital?

By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.

There were substantial observations and comments about the emotional care afforded to patients undergoing highly -specialist and complex surgery. The responsible surgeons made themselves available and accessible to patients, ward staff and the RMO, beyond expectation.
Staff responded compassionately when patients needed help and supported them to meet their personal needs as and when required. Some patients described “exceptional care” delivered by highly-motivated and caring staff. These staff were noted to be not just nursing staff, but across a wide range of professional and non professional staff bodies.
Patients and staff worked together to plan care and there was shared decision-making about care and treatment.
Staff helped patients and those close to them to cope emotionally with their care and treatment.
Patients commented that they had been well supported by staff, particularly if they have received upsetting or difficult news at their outpatient appointment.
Patients were treated courteously and respectfully, and their privacy and dignity was maintained.
Staff described how all children were involved in the discussions and decision making processes about their treatment and care, in a way which supported their understanding.
Patients and relatives commented positively about the care provided and said they were involved in decision making.
The hospital took part in the Friends and Family Test (FFT). For the reporting period April 2015 to September 2015, 99% of patients said they would recommend the hospital to their friends and families. Between 20% to 38% of patients responded to the FFT.

Are services responsive at this hospital?

By responsive, we mean that services are organised so they meet people’s needs.

Services were planned and delivered in way which met the needs of the local population. Patients told us that there was good access to appointments and at times which suited their needs.
Waiting times, delays, and cancellations were minimal and managed appropriately. Facilities and premises were appropriate for the services being delivered.
The hospital was a provider of Choose and Book which is an E-Booking software application for the National Health Service (NHS) in England: this allows patients needing an outpatient appointment or surgical procedure to choose which hospital they are referred to by their GP, and to book a convenient date and time for their appointment.
There was openness and transparency in how complaints were dealt with, and staff could demonstrate where learning and actions had taken place. Patient’s comments and complaints were listened to and acted upon. Information on how to make a complaint was provided on the BMI Hampshire website. However, we did not see any guidance, posters or leaflets instructing patients on how to make a complaint.
A complaints database enabled the executive director and the director of nursing to track progress and close complaints when the complainant was satisfied.
For the reporting period January 2015 to December 2015, the hospital consistently met the target of 95% of non-admitted patients beginning their treatment within 18 weeks of referral.
Patients were able to access services when needed and we found services responsive to meeting individual needs. They were satisfied with the appointments system. Most patients told us it was easy to get an appointment when they needed it.
Staff recognised the need to support people with complex or additional needs and made adjustments wherever possible. However, staff noted there were rarely patients who had complex or additional needs.
Patient Led Assessments of the Care Environment (PLACE) for February to June 2015 showed the hospital scored 78% for dementia which was slightly lower than the England average of 81%.

Are services well led at this hospital?

By well led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovations and promotes an open and fair culture.

There was a clear statement of vision and values, which was driven by quality and safety. This aligned with the corporate purpose and vision of providing high-quality and convenient patient care
Staff knew and understood the vision, values and strategic goals.
Quality of care was regularly discussed in board meetings, and in other relevant meetings below the board level.
There was an effective and comprehensive process in place to identify, understand and monitor and address current and future risks. Staff attended governance meetings and committees such as infection prevention and control meetings. Staff received feedback from hospital-wide meetings in emails and we saw team meeting minutes that were available to all staff.
There were effective governance structures, and a hospital- wide risk register which was updated regularly. Departmental risk registers also identified specific risks in that area which may affect staff, patients and visitors. The risk registers reflected actions to be taken to mitigate any risks. However, the Hospital’s risk register captured high level, hospital wide risks, but this was not fully mature at theatre level.
The Medical Advisory Committee (MAC) met monthly. The MAC had standing agenda items, which included regulatory compliance, practicing privileges, incidents and complaints, quality assurance and proposed new clinical services and techniques. There was representation at this meeting from anaesthetics, and different surgical disciplines.
The departments provided the senior management team (SMT) with a weekly report, which effectively updated them with operational information from that week. This included any risk issues.
There was a culture of collective responsibility between teams and services. Information and analysis was used proactively to identify opportunities to drive improvement in care.
All policies were approved at local and corporate level. Staff had access to policies in hard copy and on the intranet and signed a declaration to confirm they had read and understood the policy relevant to their area of work.
Staff reported an open and transparent culture. They were positive about the leadership at management level. They told us the leadership team were visible, accessible and approachable. They felt concerns were listened to and where possible acted upon.
Consultants we spoke with were positive about senior members of the hospital and described good working relationships.
Patients were encouraged to leave feedback about their experience by the use of a patient satisfaction questionnaire and for NHS patients by the Friends and Family Test.
Results of the latest patient survey (February 2016) showed high levels of satisfaction with 99.6% recommendation.The hospital was 32nd place (out of 59 BMI hospitals) across the BMI group for patient satisfaction scores.

However, there were also areas of less good practice where the provider needs to make improvements.

Importantly, the provider must ensure:

accessible guidance on how to make a complaint is available to all patients
the plan to upgrade the endoscopy unit to meet Joint Advisory Group on gastrointestinal endoscopy (JAG) standards is progressed.
data on patient outcomes is collated to monitor performance.
staff are aware of and engaged with risks relating to their department.

Professor Sir Mike Richards

Chief Inspector of Hospitals

People who used the Hampshire Cline we spoke with told us they were well informed by staff about the treatments or procedures they were undergoing. Patients were required to sign consent forms prior to receiving any treatment. People we spoke with said that staff were friendly and professional and treated them with respect. People were positive about their care and treatment.

The hospital required that all staff were trained in adult and child protection to ensure that a safe environment was promoted.

We found that there safe systems and procedures in place for the storing and administering of medication. Patients were provided with appropriate information about their medication by the hospital staff.

The hospital had systems in place to monitor and manage risks and also the quality of care and treatment provided. Regular feedback was sought from patients and the information circulated to the staff. Patients were made aware of how to raise a concern or make a complaint. The hospital responded promptly to complaints that were made.

Following our inspection of 29th November 2012 we received an action plan from the registered manager detailing the actions to be taken and the date by which those actions would be completed. We were subsequently sent confirmation that the improvements had been made.

We have not revisited the BMI Hampshire Clinic as part of this review because they were able to demonstrate that they were meeting the standards without the need for a visit.

We met and talked with nine people staying at the hospital. They were all positive about the care they were receiving and many told us they had stayed at the hospital before. One person told us "You couldn't fault any of the nurses here', and another told us "My stay here has been A1." This was supported by our own observation that the staff were polite, professional and respectful in their dealings with people.

All of the care records we looked at were well completed and indicated a person centred approach to care. There were procedures in place to keep records secure and confidential.

The provider had enough skilled and experienced staff to meet people's needs and the nursing teams were supported by health care assistants and agency nurses.

We found that overall the premises provided good standards of general cleanliness and comfort and were being appropriately maintained.

We found that there were large numbers of items of portable electrical equipment which the provider had not regularly inspected and we asked them to take action to address this.

There were systems in place to audit and monitor the quality of the services being provided.

We previously visited the hospital on 22 September 2011 and identified non-compliance with Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010, relating to safeguarding people using the service. We also said improvements needed to be demonstrated for Regulation 9 (care and welfare) and Regulation 23 (supporting workers). We returned to the hospital in January 2012 to assess whether compliance had been achieved for these regulations and to review arrangements for handling complaints.

On this occasion, we did not talk to people who used services during our visit, so we cannot report on people's comments and experiences.

We spoke to six patients during our visit, both inpatients on wards and patients waiting to attend clinics. People told us that they were satisfied with the way they were cared for and spoken to. They said that staff treated them with respect and dignity although some consultants could be brusque at times. Inpatients told us that the catering was good and they appreciated the choice and quality of food. People said they felt safe at the hospital.

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

The Hampshire Clinic

All Inspections

22 and 23 September 2021

During a routine inspection

23 January 2019

During an inspection looking at part of the service

Dr Nigel Acheson

24 to 25 April and 16 May 2018

During an inspection looking at part of the service

21 and 22 March

During a routine inspection

Professor Sir Mike Richards

Chief Inspector of Hospitals

28 January 2014

During a routine inspection

During a check to make sure that the improvements required had been made

29 November 2012

During a routine inspection

10 January 2012

During an inspection looking at part of the service

20 September 2011

During a routine inspection

Reports under our old system of regulation