Archived: BMI Southend Private Hospital

BMI Southend Private Hospital is operated by A. K. Medical Centre Limited. The hospital has three beds. Facilities include the Ophthalmic outpatients suite comprising of three consulting rooms, laser room and treatment room, main reception area. As well as a theatre suite comprising of two theatres, recovery area with one bed, ward with three trolleys and sub-ward with ambulatory chairs. Within theatre two there is uses the femto laser cataract machine. The first floor comprises a further three consulting rooms, treatment room, and the administration offices, staff rooms and theatre changing facilities.

The hospital provides surgery and outpatients services. We inspected both surgery and outpatients using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 October 2016, along with an unannounced visit to the hospital on 26 October 2016.

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, for example on management arrangements, also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated this hospital as requires improvement overall.

We found areas of practice that require improvement in surgery and outpatient services:

• The hospital did not have access to translations services.
• The hospital did not have an identified lead for learning disabilities or dementia. Staff at the hospital had not received training on learning disabilities.
• Only 78% of patients were offered another surgery date within 28 days of the cancellation.
• Hand hygiene was not always observed to be undertaken in line with the service policy, though this had improved by the time of our unannounced inspection.
• The rate of use of bank and agency nurses working in theatre departments averaged at 65% and up to 50% in outpatients.
• There was inconsistent use of risk assessments for venous thromboembolism prior to surgery.
• The undertaking of surgical pre-assessment for local anaesthetic procedures was not consistent.
• Training rates for safeguarding adults and children level two was low in surgery. Data provided showed that 0% of theatres nursing staff completing any level two training. Patient moving and handling training rates were low across all staff groups except theatres nurses. Ward based nurses, theatre healthcare assistants and operating department practitioners (ODPs) were recorded with a 0% compliance rate for this training.

We found areas of practice that were inadequate in surgery:

• We identified several areas of risk during our inspection, which had not been identified by the service. The quality and illegibility of records, the inconsistent practice around VTE, low training rates for moving and handling and safeguarding, inconsistent use of surgical pre-assessment for local anaesthesia were all identified through the inspection not by the service. The risks around not monitoring outcomes, providing dementia and learning disability support and language support were also risks identified by the inspection, not by the service. This was despite the hospital conducting and passing hand hygiene, and record management audits.
• The hospital risk register was not fit for purpose. There was a lack of date that the risk was added, no review date specified, no control measures, no forward plans for mitigation and we were unable to identify who the lead for identified risk was.

We found areas of good practice in surgery and outpatients:

• We saw low rates of surgical site infections, which was positive.
• Staff were passionate and proud of their service. We saw compassionate and caring interactions with patients.
• Patient satisfaction surveys were consistently high. In April 2016 100% of patients described their overall care as very good or excellent.
• Overall response to treatment times (RTT) rates for admitted patients for surgery and non admitted patients were within expectations. The outpatient RTT for NHS patients and access for private patients through outpatients was excellent.
• Complaints management processes were well embedded and utilised well.
• There was good practice noted around incident reporting, though there were areas where this could improve.

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 issued the provider with one requirement notice and one warning notice that affected surgery and outpatients. Details are at the end of the report.

Ted Baker

Deputy Chief Inspector of Hospitals