BMI Bishops Wood is operated by BMI Healthcare Limited. It is a private acute care hospital built on the grounds of Mount Vernon Hospital - a facility operated by a National Health Service (NHS) trust. The hospital specialises in cancer services but also provides a wide range of services and specialities to adults and children over the age of three.

Pinner Park Oncology Ward (which will be referred to as Pinner Ward in this report) is the medical ward at BMI Bishops Wood. Pinner Ward is one of the two inpatient wards located on the first floor of the hospital. There are 42 beds spread between Pinner Ward and the surgical ward (Northwood). The 42 beds are made up of 29 inpatient beds, five day case beds, one enhanced recovery bed and seven chemotherapy day rooms. Beds on the surgical ward can be used to admit medical patients if all medical beds are full and vice versa. Staff from the medical ward are responsible for any medical patients on the surgical ward. Pinner Ward is open 24 hours a day, seven days a week. The hospital also provides outpatients and diagnostic imaging services.

We inspected this service in October 2016 using our comprehensive inspection methodology. We found BMI Bishops Wood to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including regulation 12, which relates to safe care and treatment. We identified concerns about the administration and prescribing of chemotherapy at this location. We also found that BMI Bishops Wood was in breach of regulation 17 which relates to good governance. This was based on a failure to assess, monitor and mitigate risks related to chemotherapy as well as failure to maintain complete and accurate records for some chemotherapy patients.

We asked BMI Bishops Wood to provide an action plan detailing how they would make improvements to become compliant with the regulations and the hospital provided this action plan. On 4 October 2017, we carried out an unannounced focused inspection to follow up on concerns around the administration and prescribing of chemotherapy and to check whether the provider had made the improvements set out in the action plan provided to us.

Services we rate

We did not rate this hospital following the inspection on this occasion. This was because we only looked at one aspect about which we had concerns at our previous inspection. Our inspection focused on the chemotherapy concern only.

The concerns we had following the October 2016 inspection were:

• Staff administered part bags of chemotherapy to patients putting them at risk of harm.

• There was no uniformity in the protocols and guidance staff referred to in relation to chemotherapy treatment at the hospital.

• We found evidence of staff without prescribing qualifications prescribing or amending prescriptions.

• Not all paper chemotherapy prescriptions altered by Registered Medical Officers (RMOs) were countersigned by a consultant. Failure to countersign prescription alterations made by RMOs in the absence of a consultant was not in line with good practice.

• The hospital did not always use proformas for paper prescribing of chemotherapy and this was not in line with best practice and increased the risk of errors.

• Some chemotherapy prescriptions had been prescribed with no route, volume or diluent. This put patients at risk of having chemotherapy administered via the wrong route or being given the incorrect dose.

• Chemotherapy had been stored in the same fridge as other medicines.

However, during our 4 October 2017 inspection, we found the provider had made changes and improvements which were:

• New processes and procedures had been implemented in relation to chemotherapy in order to improve the clarity and safety of processes at the hospital.

• The administration of part bags of chemotherapy had stopped.

• Staff told us over 93 to 94 % of chemotherapy prescriptions were electronic and this reduced the risk of errors involved with paper prescribing.

• The paper prescriptions we checked during the inspection were on proformas, were legible, and had been completed fully.

• New processes for staff training had been implemented since our visit in October 2016. This included competency based training for oncology pharmacists.

• Staff were able to access and demonstrate how they used BMI policies for chemotherapy and there was uniformity in what protocols and guidance were referred to.

• We also found that staff in the oncology department were continuing to develop further policies and procedures to make processes more robust.

We found the following areas of good practice:

• Improvements had been made in response to our findings during the 2016 inspection. For example, the administration of part bags of chemotherapy had stopped.

• There were clear protocols for the administration and prescribing of chemotherapy which staff were aware of.

• Staff in the oncology department were developing further policies and procedures to further improve medical services in relation to chemotherapy.

• The majority of chemotherapy prescriptions were on the hospital’s electronic system and this meant more safeguards against errors in prescribing and administering chemotherapy.

Amanda Stanford

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

The visit to BMI Bishops Wood Hospital took place over one day. During the inspection we visited the two inpatient wards, the x-ray and scanning department and theatre.

People who used the outpatient department were asked to complete comment cards, and we received 16 of these from people who use the service.

Throughout our visit we spoke with at least 14 people who use the service and/or their relatives or representatives. We also spoke with approximately 13 staff of different disciplines including doctors, nurses, health care assistants and the infection control lead. We also met with senior management staff, including the executive director of the hospital.

The majority of feedback we received from people who use the service and their representatives was positive. Some comments we received from people were: “first class”, “the whole service was excellent”, “I have always received excellent care over the years I have been using the hospital” and “the staff have always treated myself and my family very well.” However, some people did comment that there was a lack of car parking available at the hospital.

People were treated with respect and people’s needs and preferences were catered for. However, we found that the en-suite facilities presented some difficulties to people with mobility issues. This was because only four of the inpatient rooms had walk in showers, whilst the remaining had only a bath for people to use.

We found that the hospital was clean and there were systems for infection prevention and control.

The hospital took action in response to incidents to minimise risks to people who use the service.

The staff felt supported in their role and felt there was good teamwork. However, there were staff vacancies at the hospital, which were the subject of a recruitment campaign at the time of the inspection.

During our visit we spoke with four people who use the service and six staff. We also looked at feedback the service had received from people who had completed a survey about their experiences of using the service.

Feedback from people who use the service was they felt respected by the staff and that they received the right treatment and support to meet their needs. People said that the staff were friendly and ensured they explained what was going to happen to them and sought their consent prior to treatment being given. We observed staff being respectful towards people, and knocking on their bedroom doors prior to entering their rooms. The results of the feedback survey were that people were generally satisfied with the treatment they received. Where people were not satisifed with their care and treatment, this was acknowledged by the service and action taken to make improvements. People were also able to raise any concerns through the provider’s complaint procedure.

Staff told us they received support in their work and that they were supported to attend training relevant to their role.

The hospital and provider had a number of systems to monitor the quality and running of the service to ensure that people received appropriate support in a safe environment.

Patients told us that they had chosen to have their treatment at Bishops Wood Hospital. They said that they were given opportunities to discuss and plan their care and were able to make choices about how they were looked after. They told us that staff respected their privacy and dignity and they knew how and to whom they could make a compliant. Patients said the food and menu choice was good and they had access to drinks whenever they wanted them.

Everyone we spoke to was happy with the care they had received and were complementary about the staff and facilities in the hospital.