During this inspection we visited the in patient and theatre areas and the out patient unit. We spoke with four people using the service and two relatives. We also spoke with staff from all departments.

People using the service told us they were happy with care, treatment and advice they had received. Comments included, "I have had no problems from start to finish", "The facilities are very good and I have been given all the information I need to make a decision about what is right for me", "I am very satisfied with the service; I have been given good aftercare advice". People spoke very favourably about the service. One person said, "I have absolutely no complaints about the standard of the service I have received”.

People told us they enjoyed the food. Comments included, "The food is very nice" and "There is a very good choice and it is all good quality food which is nicely presented".

There were sufficient skilled and experienced specialist, nursing, care and ancillary staff to meet people's needs. People made positive comments about the staff team and described them as, 'pleasant', 'helpful', 'lovely' and 'professional'.

Staff had access to 'safeguarding' and 'whistle blowing' procedures and had received training to help them recognise and respond to any signs of abuse or neglect. They told us they would feel confident to speak out against poor practice if needed.

During our visit we spoke with three people from both the in-patient and out-patient units. They made complimentary comments about their experiences. People said, "It has been a smooth process from start to finish" and "I could not have wished for better care; the nursing and medical team have been so caring and attentive". None of the people spoken with had any concerns or complaints about the service.

People told us they were involved in discussions about their treatment. Comments included, "I was given a full explanation about my procedure and was able to discuss any concerns that I had before my operation" and "I had access to useful information and was able to make an informed choice about my care and treatment".

On the day of our visit we found the service to be safe, clean and well maintained. There were effective systems in place to reduce the risk and spread of infection. One person said, "It's spotless".

During our visit we observed positive and respectful interactions between staff and people using the service. People spoken with made positive comments about the staff team. Comments included, "They are always smiling and friendly, they gave me confidence" and "Everyone is nice and pleasant".

We spoke with four staff. They told us they were provided with ongoing opportunities for training, support and development. They made positive comments about the organisation and said they enjoyed their work.

There were established systems in place to monitor all aspects of the quality and operation of the service. People were regularly consulted with, and their comments were used to improve and develop the service.

The Beardwood Hospital is operated by BMI Healthcare. We carried out a comprehensive inspection of BMI The Beardwood Hospital on the 5 and 6 October 2016 and an unannounced visit on the 10 October 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of surgical services and outpatients and diagnostic services as these incorporated the main activities undertaken by the provider, BMI Healthcare Limited, at this location.

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 services provided by this hospital were surgery and outpatients and diagnostics. The hospital also offered a dedicated oncology service for patients undergoing chemotherapy which we have incorporated in the review of the outpatient core service. We did not inspect a private service that operated at this location as this was a service from another provider, Alliance Medical. 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 surgical core service.

We rated this hospital as good overall because:

• There was a strong incident reporting culture within the hospital, however, incidents that occurred were of no or low harm. There was a safety focused culture within the hospital and when incidents did occur they were fully investigated, lessons were cascaded to staff through a variety of means and action plans were implemented to prevent reoccurrence.
• The hospital provided care and treatment that was in line with national guidelines and recommendations. There was a programme of audit in place to assess hospital compliance with policies and care pathways. Compliance with hospital policies and care pathways was good.
• Staff at the hospital provided care that was compassionate and caring. We observed staff treating patients with respect and dignity at all times. Patients reported that staff were very caring. The hospital participated in the NHS friends and family questionnaire and 98% of patients responded that they would recommend the hospital to others.
• The hospital was responsive to the needs of the local population and services were planned with patient needs in mind. Patients had flexibility about when they could attend for appointments and treatment. The hospital provided services to patients in a timely manner.
• The hospital leadership was effective in disseminating the organisational vision. There were systems in place which articulated a clear vision for services based on the needs of the patient and the provision of clinically effective services. There were robust governance structures in place which ensured that services provided were clinically effective and patient centred. Staff morale at the hospital was high, with staff reporting that they felt well supported to deliver good care to patients.

We found areas of practice that require improvement in surgery.

• The different incident reporting systems did not always correspond. Surgical site infections were not recorded as clinical incidents, even when they required a root cause analysis, and the number of falls on the quality dashboard did not match those on the incident log. An incident involving a serious injury to a patient did not appear on the incident log.

• We reviewed five world health organisation (WHO) safety checklists and observed a further two. We found that most steps were undertaken appropriately, but it was not consistently undertaken or embedded.

• Surgical site infection rates were higher than other independent hospitals.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals