BMI the Clementine Churchill Hospital Quality Report
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BMI Healthcare Limited BMI The Clementine Churchill Hospital Quality Report Sudbury Hill Harrow Middlesex HA1 3RX Date of inspection visit: 29 - 31 July and 11 August Tel:020 8872 3872 2015 Website: Date of publication: 07/03/2016 This report describes our judgement of the quality of care at this hospital. It is based on a combination of what we found when we inspected and a review of all information available to CQC including information given to us from patients, the public and other organisations. Ratings Overall rating for this hospital Requires improvement ––– Urgent and emergency services Requires improvement ––– Medical care Good ––– Surgery Good ––– Critical care Requires improvement ––– Outpatients and diagnostic imaging Good ––– 1 BMI The Clementine Churchill Hospital Quality Report 07/03/2016 Summary of findings Letter from the Chief Inspector of Hospitals BMI The Clementine Churchill hospital is an acute independent hospital that provides outpatient, day care and inpatient services. The hospital is owned and managed by BMI Healthcare Limited. A range of services such as physiotherapy and medical imaging are available on site. The hospital offers a range of surgical procedures and as well as rapid access to assessment and investigation. The hospital also provides level three critical care facilities. Services are available to people with private or corporate health insurance or to those paying for one off treatment. Fixed prices, agreed in advance are available. The hospital also offers services to NHS patients on behalf of the NHS through local contractual arrangements. We carried out a comprehensive inspection of BMI The Clementine Churchill Hospital on 29 - 31 July 2015 (announced) and 11 August 2015 (unannounced). The inspection reviewed how the hospital provided outpatient services (including to children), medical care, surgical services, critical care and minor injuries service as these were the five core services provided by the hospital from the eight that that are usually inspected by the Care Quality Commission (CQC) as part of its approach to hospital inspection. Prior to the inspection, the hospital's senior management team took the decision to stop treating and admitting children under the age of 16 other than in an outpatient setting. At a previous CQC inspection, in January 2014, we found concerns with a number of areas including governance, safeguarding, medicines management, the physical environment, equipment, staffing levels, infection control, staff support, auditing, and records. Our key findings in July and August 2015 were as follows: Are services safe? • There was an appropriate system for reporting and learning from incidents with a paper based reporting system that was logged electronically. Although staff were able to demonstrate that there was a robust investigation of incidents, this was not always fully evidenced due to the template that BMI used. Risks were mostly recorded but some had been fully mitigated but not archived. • The hospital performed well in relation to preventing patients coming to harm with a low rate of falls and pressure ulcers in particular. • Medicines were well managed. Regular audits were carried out although they did not include medicine reconciliation. However, there were some concerns with legibility of medicine administration records. • There were some concerns with equipment checks, particularly in outpatients, the intensive care unit (ITU) and surgical wards where mostly portable appliance tests were not up to date. • The environment in phlebotomy was not fit for purpose with a lack of space meaning there was a risk of safety related incidents. • A new endoscopy unit had been opened in recent weeks that had been built with the assistant of a JAG accreditor. • Infection prevention and control (IPC) was poor in the medicine ward and ITU. There was poor compliance of hand hygiene and wearing personal protective equipment on the medical ward and poor cleanliness in the ITU on our announced visit although this had improved on our unannounced visit. The hospital currently had a temporary lead IPC nurse and was due to appoint a permanent one. Many areas of the hospital were still carpeted. 2 BMI The Clementine Churchill Hospital Quality Report 07/03/2016 Summary of findings • Staff were aware of their responsibilities regarding safeguarding vulnerable adults and children and knew who to contact if they had any concerns. • Mandatory training was up to date in most areas although we received a lack of detail as to whether some subjects had better compliance rates than others. • Patients who deteriorated were appropriately monitored and responded to. • There were insufficient permanent nurses employed although staffing levels mostly met the acuity and dependency of patients. There was a high reliance on agency staff in some areas although recruitment drives were taking place that had some recent success and there was a robust checking and induction of agency nurses. • The hospital contracted four resident medical officers (RMO)s who rotated mostly two at a time on a weekly basis 24/7. to cover the wards. Additionally there is 24 hour RMO cover in ITU, and a further RMO to cover ECC while it is open. However there were concerns that one RMO covered the ITU and crash calls at the same time. • Although there were 462 consultants who had practising privileges and either were in attendance for their patients or had cover if there was a deterioration, the emergency care centre was not meeting national guidance for seniority of doctors on shift. • The hospital used paper records for patient care, however there was varying quality of completion of medical records with poor completion on the medical and surgical wards but satisfactory records in the emergency care centre, ITU and theatres. Are services effective? • National guidance was mostly followed. However some of both BMI and hospital policies and procedures required updating, particularly with regard to the removal of children's inpatient and emergency services. • Where we could benchmark the hospital nationally for patient outcomes, the hospital either met or was better than the national average. However, we were provided with little information to benchmark the hospital either to other BMIs or independent hospitals. • There was a robust induction and orientation process for bank and agency staff with checklists they had to complete before they started a shift. These staff also had to evidence their competencies such as giving intravenous therapy (IV). Staff were also developed including support for external courses. However there was a lack of ITU nurses that were critical care trained. • Medical and surgical staff were required to have practising privileges to work at the hospital and these were appropriately checked and maintained by the Medical Advisory Committee as necessary. We saw evidence of consultants being removed or suspended if they did not meet the practising privileges criteria. However there were a number of consultants that had practising privileges that had not conducted a clinical activity at the hospital in the last year. • Although there was mostly an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards, some of the patient records for these were not complete. • Internal multidisciplinary working was in place in most departments. Although there was a lack of formal external working, when working with other organisations was required, there were no concerns with how this operated. • Some of the records regarding nutrition were not complete. Most patients were happy with the food they received but there had been a high amount of complaints regarding food quality in recent months. The hospital had started taking action to address this. Are services caring • Mostly all the patients we spoke with gave a positive experience about their care. They reported staff were caring and maintained their privacy and dignity. 3 BMI The Clementine Churchill Hospital Quality Report 07/03/2016 Summary of findings • Patients and their families reported being involved in their care including being informed about potential costs in most departments. • Staff offered support to patients and families who wanted or required it including having difficult conversations. Are services responsive? • Flow through the hospital was well managed including discharge although targets for discharging were not always in place and there was some improvement still to make with pre-operative assessment. • There was some specific support given for individual patient needs such as those living with dementia or those that required translation services but support for other patient groups, including children, was limited. • The hospital met and exceeded targets responding to patient needs such as referral to treatment and waiting time in the emergency care centre. • Complaints were mainly well-managed and learnt from across the hospital. Are services well-led? • Most services were well-led with visible leaders and local visions and strategies. However ITU leaders had limited visibility and forward planning. • Governance and performance monitoring was in place across most services. All services were involved in briefing sessions, called Comm Cells which were effective in all areas other than ITU. ITU also lacked auditing and improvements were not made from audits undertaken. • Although the senior management team were risk aware and actions were in place to address areas of risk, there were some areas that had