The Park Hospital

Updated 23 July 2019

BMI The Park Hospital is operated by BMI Healthcare Limited. It is an independent hospital registered with the Care Quality Commission to provide a range of treatments and procedures to people in an inpatient and outpatient setting. It is an independent healthcare hospital in Arnold, Nottinghamshire. The hospital primarily serves the communities of Nottinghamshire but does however, accept patient referrals from outside this area. The hospital provides inpatient services to adults and children over the age of 12 and outpatient services to the whole population.

The hospital has had a registered manager in post since December 2018.

Updated 23 July 2019

BMI The Park Hospital is operated by BMI Healthcare Limited. The hospital has 56 beds across two wards. Facilities include five operating theatres (one of which is allocated as endoscopy), a five-bed critical care unit with three beds allocated to level three care, a cardiac catheterisation laboratory and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care and outpatients and diagnostic imaging. We carried out an unannounced focused inspection of the safe key question in surgery and medical care on 23 May 2018 in response to concerning information we had received about the safety of patient care and treatment across these services.

The main service provided by this hospital was surgery. Where our findings on medical care for example, medicines also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

At our last inspection in September 2016 we rated the hospital as good overall; our rating for safe in medical services was good and surgical services was requires improvement.

Following this unannounced inspection our rating for safe in medical services stayed the same and our rating for safe in surgical services improved from requires improvement to good.

We found good practice in relation to medical care:

• The service managed staffing effectively and had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
• Arrangements to safeguard adults and children were in place and staff had received effective training in safeguarding adults and children at a level appropriate for their role.
• Standards of cleanliness and hygiene were appropriately maintained, there were reliable systems in place to prevent infection and protect people from a healthcare-associated infection. Patient-Led Assessments of the Care Environment’ (PLACE) results were above the England average and local hand hygiene audits showed 100% compliance.
• Recording of all medical information was timely, accurate and legible. However, none of the medical records included the medical practitioner’s general medical council (GMC) number.
• Risks to patients were assessed, and their safety monitored and managed so they were supported to stay safe. Staff consistently identified and responded appropriately to changing risks to patients, including for example, the deteriorating patient.
• The service had a good track record on safety.

We found good practice in surgery:

• Protected time was allocated for staff to complete mandatory training, including safeguarding training relevant to their role. This included training on female genital mutilation (FGM).
• Recording of all medical information was timely, accurate and legible. However, none of the medical records included the medical practitioner’s general medical council (GMC) number.
• When the critical care unit was in use, it was led by an intensivist. There was 24-hour immediate access to the intensivist or an on-call anaesthetist.
• Staff adhered to policies and protocols which kept patients safe from infection. This included wearing appropriate clothing within the theatre environment.
• Staff were encouraged to report significant events. These were used as scenarios in training sessions to inform staff of any changes in process and for sharing learning.
• Integrated records/care pathway documentation were used to ensure all relevant information and risk assessments were documented throughout the patient journey.
• There was a paediatric nurse available who led and coordinated the care of children (aged 12-18 years).

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)

Updated 27 March 2017

We rated this service as good because:

Staff were encouraged to report incidents. Incidents and lessons learned were discussed at integrated governance meetings and shared with all staff.

There was good multi-disciplinary working and relationships throughout the department, with the rest of the hospital and local NHS acute trusts.

Nursing, medical and allied healthcare professionals were caring and patients were positive about their care and experiences. Patients were treated with dignity and respect.

Care and treatment was provided in line with national guidelines and the service contributed data to relevant national audits.

Without exception, staff we spoke with were consistently positive about local leadership across all areas in medical care services at this hospital.

The culture of the ward, endoscopy (theatre team) and oncology team was nurturing and staff were professionally supportive of each other.

Some of the patient rooms and corridors did not comply with the requirements of regulations for infection control as they were carpeted.

Medical record documentation did not always meet satisfactory standards. The handwriting was not always legible. Daily reviews by consultants for inpatients were not documented within the medical records which meant patients may not receive the planned care.

Updated 27 March 2017

We rated this service as requires improvement because:

The hospital depended on bank staff who did not all receive mandatory training, and who were not always available if a child had an appointment at short notice. This posed a risk to patient safety.

The hospital did not have a clear system for allocating sufficient nursing staff to support clinics or for booking clinic rooms.

Equipment checks were not robust to keep people safe. Checks for cardiac monitoring equipment were overdue in diagnostic imaging.

The hospital had not defined its vision for outpatients or for children’s services. Its risk register and risk assessment approach did not include the risks to children, and there were no dedicated areas for children in outpatients.

The services did not use data and performance monitoring to improve quality. Participation in national and clinical audits and benchmarking was poor. There was a lack of formal monitoring of how responsive the service was for outpatients and no quality and performance dashboard reported publicly.

Public engagement and learning from patient comments in outpatients was limited. Although there was a corporate range of informative leaflets, there were no specific leaflets for outpatients who were children, or leaflets in alternative formats.

Staff learnt from safety and quality incidents and shared learning across the hospital, and governance arrangements supported this well. There was an effective process for investigating serious incidents. Staff had a good understanding of safeguarding and how to react to concerns.

The patients we spoke with told us staff were kind, caring and they were likely or extremely likely to recommend the service. Patients received clear information prior to their appointment and were able to ask questions and get clear responses during their appointment. Nurses, doctors and imaging staff obtained consent to care and treatment in line with legislation and guidance.

Staff considered the individualised needs of patients when planning care. Services coordinated appointments to enable patients to see a number of services in one day. Nurses, doctors and imaging staff combined their skills well in a good multidisciplinary team approach to meeting the needs of patients using the service.

The hospital had a clear vision for its imaging services and imaging staff contributed to strategic decisions. Outpatient staff had strong leadership at service level with the ability to problem solve.

Waiting times for outpatient appointments were within the national guidelines Patient care and treatment reflected relevant research and guidance, including the Royal Colleges and National Institute for Health and Care Excellence (NICE) guidance.

Updated 27 March 2017

We rated this service as good because:

Staff were encouraged to report incidents. Incidents and lessons learned were discussed at integrated governance meetings and shared with all staff.

Nursing, medical and allied healthcare professionals were caring and patients were positive about their care and experiences. Patients were treated with dignity and respect.

There were effective systems in place to ensure patients received adequate pain relief following their operation. Patients also received a follow-up phone call within 48 hours of discharge to ensure they were coping at home.

Care and treatment was provided in line with national guidelines and the service contributed data to relevant national audits. Patient outcomes were generally in line with national data.

Safeguarding training was not given enough priority. There was no evidence that the majority of consultants had received safeguarding training and staff were unclear about their responsibilities relating to female genital mutilation (FGM).

Planned level three children’s safeguarding was e-learning which is not in line with intercollegiate guidance.

The critical care unit did not meet the requirements of the Core Standard for Intensive Care Units (2013) which state care must be led by a consultant in intensive care medicine. There was no resident anaesthetist overnight for critical care patients.

Some of the patient rooms and corridors did not comply with the requirements of regulations for infection control as they were carpeted.

Staff did not always observe theatre protocols by changing into appropriate clothing within the theatre environment.

Medical record documentation did not always meet satisfactory standards. The handwriting was not always legible. Daily reviews by consultants for surgical inpatients were not always documented within the medical records which meant patients may not receive the care planned by the surgeons. There was no separate systematic daily review sheet for patients within critical care.