The London Independent Hospital

Updated 18 September 2019

The BMI The London Independent Hospital is an independent acute hospital located in Stepney Green, east London. It is operated by BMI Healthcare Limited.

There are a total of 69 inpatient and day care beds and 20 outpatient consulting rooms. There are four operating theatres, five critical care beds, a cardiac catheterisation unit, a JAG accredited endoscopy suite, physiotherapy department and diagnostic imaging.

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

The main service provided by this hospital is surgery. Where some of our core service findings also apply to other services, we do not repeat the information but cross-refer to the service level report.

Updated 18 September 2019

The BMI The London Independent Hospital is an independent acute hospital located in Stepney Green, east London. It is operated by BMI Healthcare Limited.

There are a total of 69 inpatient and day care beds and 20 outpatient consulting rooms. There are four operating theatres, five critical care beds, a cardiac catheterisation unit, a JAG accredited endoscopy suite, physiotherapy department and diagnostic imaging.

We inspected surgery, critical care and outpatients. The inspection was carried out on 24 and 25 June 2019 and was unannounced.

We inspected services using our comprehensive inspection methodology. 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? We rate services as outstanding, good, requires improvement or inadequate.

We spoke with 42 members of staff including nursing, healthcare assistant and medical staff specific to each area inspected, managers, cleaners, receptionists and physiotherapists. We reviewed the healthcare records of 22 patients and spoke with 16 patients and relatives. We checked items of clinical and non-clinical equipment. We looked at information provided by the hospital.

Services we rate

Our rating of this hospital improved. We rated it as good overall. All three core services were rated good in all domains where we have a duty to rate.

We found the following areas of good practice across all services:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The design, maintenance and use of facilities, premises and equipment kept people safe.
• Staff completed and updated risk assessments for each patient and removed or minimised risks.
• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• 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 service used systems and processes to safely prescribe, administer, record and store medicines.
• The service managed patient safety incidents well. 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-based practice.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
• The service made sure staff were competent for their roles.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
• Staff treated patients with compassion and kindness.
• Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
• Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had the integrity, 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.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action.
• 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.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.

We found areas of practice that require improvement:

Surgery

• At the last inspection hand hygiene audits showed variable results for bare below the elbow and for hand hygiene at appropriate times. At this inspection although we found good practice and audit results that showed good hand hygiene, we also observed instances where hand hygiene standards were not being maintained. In theatres we observed excessive glove usage with minimal hand hygiene taking place between glove changes. In the anaesthetic room we observed instances where staff were not decontaminating their hands after patient contact. In pre assessment we observed an occasion where a member of staff did not use alcohol gel or wash hands prior to applying gloves and did not wash hands post procedure.
• Information was collected for monitoring ongoing harm free care. However, this information was not on display to patients.

Outpatients

• Although the service generally controlled infection risk well, compliance levels with hand hygiene and bare below the elbow standards were low. Hand hygiene audits for January and February 2019 found that compliance rate was 32% and 29% respectively. The department had an action plan in place.
• The treatment room did not meet all the environmental requirements set out in the BMI policy Surgical Procedures in Outpatients, due to a lack of ventilation and the presence of a suspended ceiling. An appropriate local standard operating procedure was in place to mitigate the risk.

Critical Care

• At the last inspection the intensive treatment unit did not have a follow up clinic where patients could reflect upon their critical care experience and be assessed for progress. The service still did not have a follow up clinic for patients following discharge from the hospital. This was not in line with Guidelines for the Provision of Intensive Care Services which state that patients discharged from ITU must have access to a follow up clinic.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Updated 22 November 2016

• There was evidence of suitable investigation, learning and dissemination of learning from incidents. Suitable governance processes were in place and the Medical Advisory Committee (MAC) were involved in a number of key processes, including performance reviews and quality measurement.

• Risk registers contained items considered as issues by the leadership team and reflected our inspection findings. Key risks were displayed on posters in staff areas to raise awareness.

• Safety indicators showed good results and we observed suitable infection prevention and control procedures in use.

• We saw evidence-based practice in place, compliance with recommendations from the National Institute for Health and Care Excellence (NICE) and British Society of Gastroenterology.

• Patients received care from competent staff, including staff in endoscopy who had undergone nationally recognised training.

• Staff had good access to patient information and liaised with internal as well as external agencies to plan and deliver patient care.

• Patient feedback forms about their overall experience and their opinions of the nursing staff demonstrated positive results, with scores frequently above 95% satisfaction.

• Relatives were confident in the care provided throughout the service and told us they were suitably involved in the care of their loved one.

• Access to medicine services for NHS patients and privately funded patients was straight forward and efficient. A points-based system for procedures in endoscopy ensured a smooth running service, with limited delays and no non-clinical cancellations.

• There was a positive culture throughout the service, and low sickness rates. Staff described a visible and approachable leadership team and told us they felt able to raise concerns or report incidents without fear of repercussions.

However;

• Most clinical staff received level one safeguarding training, which is not sufficient to comply with recommendations from NHS England.

• There were no designated hand wash sinks in patient rooms on the ward, which meant staff washed their hands in patient basins. This was not compliant with hand hygiene protocols.

• Many doors were not labelled with suitable fire door labels, although a replacement programme was ongoing at the time of our inspection.

• Medical care staff knowledge of Deprivation of Liberty Safeguards (DoLS) was limited and told us, in their opinion, that it was only relevant when patients were being restrained.

• The medicine service was unable to accommodate patients with significant mental health needs, including patients living with dementia, or those with a learning disability.

Updated 18 September 2019

We rated this service as good because it was safe, caring, effective, responsive and well led. We found good practice in all areas.

Updated 18 September 2019

We rated this service as good because it was safe, caring, responsive and well led. We found good practice in all areas. We do not rate effective in outpatients.

Updated 18 September 2019

We rated this service as good because it was safe, caring, effective, responsive and well led. We found good practice in all areas.