The Shelburne Hospital

Updated 24 April 2019

BMI The Shelburne Hospital is operated by BMI Healthcare. The hospital opened in August 2000. It is a private hospital in High Wycombe, Buckinghamshire located in the grounds of Wycombe General Hospital and has some service level agreements for services including pathology, cardiology and cardiac catheterization with the trust. The hospital primarily delivers care to self-funding and insured patients but also has contracts with a local NHS trust to deliver specific treatments. The hospital offers day surgery, outpatients, x-ray and diagnostics to adults only.

The hospital has had a registered manager, Fraser Dawson who has been in post since July 2016.

The hospital leadership team including directors and heads of department work at both the Shelburne Hospital and the nearby Chiltern Hospital.

Updated 24 April 2019

BMI The Shelburne Hospital is operated by BMI Healthcare. The hospital has 26 beds and is a day case facility operating from 8am to 8pm Monday to Friday only. Facilities include three operating theatres, five outpatient consulting rooms, a physiotherapy department and diagnostic facilities.

The hospital is in the grounds of a NHS trust and utilises a number of its services. These include pathology, cardiology, cardiac catheterisation laboratory, nuclear medicine, magnetic resonance imaging (MRI) and computed tomography (CT) scans.

The Shelburne hospital provides surgery, outpatients and diagnostic imaging to adult patients only. We inspected surgery, outpatients and diagnostics, using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 15 January 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 core service.

Services we rate

Our rating of this hospital stayed the same. We rated it as Requires improvement overall.

We found the following issue that the service provider needs to improve:

• The service provided mandatory training in key skills to all staff and processes in place to monitor compliance, but not all staff had completed this training.

• Most equipment was suitable but the paperwork to evidence that equipment had been tested and serviced to ensure it was fit for purpose was not always available, up to date or accurate.

• While staff understood how to protect patients from abuse. However, not all staff had completed the required level of safeguarding training.

• Not all departments had sufficient numbers of nurses with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• While staff recognised incidents, they did not always report these appropriately.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Whilst managers checked to make sure staff followed guidance, this guidance was not always the most up to date.

• Management for the diagnostic department was still in its infancy and was in the process of developing the right skills and abilities to run a service or had just begun to address some of the challenges in their area.

• The provider had a governance framework which was used to improve their clinical, corporate, staff and financial performance. However, these were not always fully embedded into operational practice.

However, we also found the following areas of good practice:

• The service controlled infection risks and kept equipment and the premises clean.

• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

• The service had enough medical staff with the right qualifications, skills, training and experience to keep people 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 and easily available to all staff providing care.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other BMI services to learn from them.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• Staff provided emotional support to patients to minimise their distress.

• Staff involved patients and those close to them in decisions about their care and treatment.

• The hospital planned services around the needs and demands of patients, taking into account patients’ individual needs.

• People could access the service when they needed it.

• The service treated concerns and complaints seriously, investigated them and learnt lessons from the results, sharing these both internally and with other BMI hospitals.

• The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it had developed with staff and patients.

• The service engaged well with patients and staff to and manage appropriate services.

  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.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South Central),

Updated 24 April 2019

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

We rated this service as required improvement in safe and well led in relation to the services oversight on equipment safety. The service was rated as good in the caring and responsive domains.

We currently do not rate the effective domain.

Updated 24 April 2019

Outpatients was not the main hospital activity. The main service was day case surgery. Where arrangements were the same, we have reported findings in the surgery section.

We rated this service as required improvement in safe and well led. The service was rated as good in the caring and responsive domains.

We currently do not rate the effective domain.

Updated 24 April 2019

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

Staffing was managed jointly with medical care.

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