We spoke with four people who use the service, and observed care given to people on the wards and in the recovery area of the theatres. People were happy with the service they received, and told us “Everything has gone amazingly well, as I was led to expect”, and “I can’t fault the place”.

We reviewed five sets of care records and found evidence that people were given appropriate information about the hospital and services offered. People told us that they had received plenty of information on their specific procedures, including risks, benefits and expected length of stay.

We toured the premises and found that the ward bedrooms were spacious, clean and well laid out, with call bells in all rooms and communal areas. We found that the provider had taken reasonable steps to ensure the safety of all the people who worked at or use the service.

We spoke with six staff members and the manager, and reviewed staff recruitment records. We found evidence of initial vetting and verification of staff and their qualifications, as well as continuous supervision of the staff. Staff told us that they felt well supported in their roles.

We reviewed the complaints log, and found that information on complaints received was appropriate. We saw that there was information readily available for people on how to complain, and what to expect from the process. People told us that they had no reason to complain, but would be happy to raise any issues of concern with staff or the manager.

We spoke with four people at the hospital, and they all told us that they were happy with the care they had received. One person said "The staff have been lovely, and have cared for me very well". Another person told us " I have had very good care here, my consultant was excellent".

We toured the hospital, and found it to be clean tidy, and free from offensive odour. There were antibacterial hand gel products readily available throughout the hospital, and we saw staff wearing aprons and gloves when delivering care.

We reviewed four sets of medical records, and found them to be comprehensive, including medical and nursing assessments, completed consent forms, and detailed information about the care people had received. We found that there were systems in place to assess the quality of care provided, and to reduce risk to people, staff and visitors.

The provider might find it useful to note that we found that one of the three resuscitation trolleys had not been checked daily, as stated in the hospital policy, and the resuscitation drills had not always been attended by the appropriate staff.

BMI Chaucer Hospital is operated by BMI Healthcare Limited. The hospital is registered for 60 beds, and these are split across two inpatient wards, one of which has four enhanced recovery beds with integral patient monitoring and telemetry. The hospital has two main theatres (1 with laminar flow) and a minor operations theatre based in outpatients. The hospital also has a dedicated Endoscopy Suite, 11 consulting rooms, a colposcopy suite, a Macmillan accredited Oncology unit, a physiotherapy department, Health Screening department and an HFEA licensed Assisted Conception Unit. The hospital has MRI, CT, ultrasound, X-ray and digital mammography within its imaging department. The hospital offers a wide range of surgical and medical procedures, including ENT, orthopaedics, gynaecology, oncology, general surgery, general medicine, gastroenterology, fertility services, ophthalmology, cosmetic surgery, urology, pain management.

We inspected this service using our comprehensive inspection methodology. We carried out the comprehensive announced of the inspection on 1 and 2 November 2016. With an unannounced inspection taking place on 11 November 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.

We rated this hospital as good overall.

• The senior management team, supported by the Heads of Departments, had a good knowledge of how services were being provided and were quick to address any shortcomings that were identified. Although relatively new in post the hospital executive director had made a significant impact on the hospital and staff felt that they had been a positive influence. They accepted full responsibility and ownership of the quality of care and treatment within their hospital and encouraged their staff to have a similar sense of pride in the hospital. Both the hospital director and the Director of nursing were able to talk to us in detail about all aspects of the services provided.
• The care delivered was planned and delivered in a way that promoted safety and ensured that peoples individual care needs were met. We saw patients had their individual risks identified, monitored and managed and that the quality of service provided was regularly monitored.
• The Executive Director was in overall charge of the hospital and all employed staff were line managed through her direct reports. She had eight heads of departments reporting directly to her including the Director of Nursing, quality and risk manager, imaging manager, pharmacy manager, physiotherapy manager, hospital services manager and materials manager.
• The Medical Advisory Committee (MAC) met bi-monthly and included representation from all specialities offered at the hospital. It was attended by the Executive Director and the director of nursing. A wide range of topics were discussed and action taken in response to any concerns raised. The minutes of the MAC meetings were distributed to all consultants.
• The MAC reviewed practising privileges every year. This included a review of patient outcomes, appraisals, General Medical Council (GMC) registrations and medical indemnity insurance. The hospital told us that 22 consultants had had their practising privileges removed; this was due mainly to no longer providing paediatric services at the hospital, along with retirement or relocation. One consultant had their practising privileges suspended this was due to failing to provide up to date documentation the hospital required to renew their practising privileges. This showed the hospital had a good procedure in place to make sure all consultants were experienced and fit to care for patients.
• Consultant revalidation was part of the requirement for maintaining their practising privileges. Consultants only performed operations they were used to performing at the acute NHS trust where they were employed. This ensured they were competent and confident in undertaking operations and procedures. If a consultant wanted to carry out a new procedure, this had to be agreed as part of their practising privileges.
• The hospital used an agency that provided a Resident Medical Officer (RMO) onsite 24-hours a day, seven days a week, on a rotational basis. The RMO worked two weeks on, followed by two weeks off. The RMO undertook regular ward rounds to make sure the patients were safe. If the RMO was called out during a significant part of the night or was unwell, the RMO told us there were contingency plans in place to obtain cover. All staff and the RMO told us there were no concerns about the support they received from consultants and their availability.
• The hospital used the corporate BMI Healthcare Nursing Dependency and Skill Mix Planning Tool, to determine staffing levels. The nursing rota was entered into the system monthly and adjustments made 24 hours in advance based on patient numbers and dependency. This meant that the hospital ensured that staffing levels and mix were sufficient to provide safe care for patients.
• We saw a strong safety culture with policies and systems in place to allow staff to challenge practice they felt posed a risk. The hospital risk register 2016 was divided into categories such as patient safety, information management, financial, reputation, governance, operational, leadership and workforce, workforce health and safety, and facilities and infrastructure. The risk register detailed the risks, mitigations, actions, allocated key lead, and committee who had responsibility for ensuring existing risk controls and actions were completed for the identified risks.
• There were robust governance systems that were known and understood by staff and which were used to monitor the provision and to drive service improvements. The Clinical Governance Committee (CGC), met monthly and discussed complaints and incidents, patient safety issues such as safeguarding and infection control, risk register review. There was also a standing agenda item to review external and national guidance and new legislation, such as National Institute of Health and Care Excellence (NICE) guidance, such as NICE CG42, Dementia: supporting people with dementia and their carers in health and social care. This ensured the hospital implemented and maintained best practice, and any issues affecting safety and quality of patient care were known, disseminated managed and monitored.
• A clinical governance bulletin was produced across the BMI Healthcare organisation which supported the hospital monthly to manage risk. The bulletin identified changes in legislation relating to NICE publications and alerts regarding medicines and equipment. It also provided details of issues of best practice at other hospitals so that shared learning could be applied locally.
• There was a positive staff culture with many staff having worked at the hospital for a very long time. These core staff offered stability and continuity which was balanced by newer appointed staff who brought a fresh perspective and allowed for the introduction of new ways of working.
• The hospital was undergoing major renovation works at the time of our inspection. Despite this we found that corridors and patient areas were clean, and kept safe. Although we still found areas in need of renovation the Executive director was able to show us a plan of current works along with a plan of works going forward. The changes already made had improved the appearance and safety of the hospital, for example flooring that met with requirements for infection control.

We found areas of practice that required improvement in both surgery and in outpatients and diagnostic imaging services.

• All waste bins should be correctly labelled in line with in accordance with Health Technical Memorandum (HTM): Safe Management of Healthcare Waste, control of substances hazardous to health (COSHH), and health and safety at work regulations

• The procedure for cleaning of nasoendoscopes should be reviewed to ensure dirty instruments do not come into contact with clean areas.

• The hospital should ensure that language interpreters are only accessed via the formal translation service.

• Take action to ensure all staff have an annual performance appraisal.

• Ensure that staff document consent in line with national guidance from the General Medical Council and Royal College of Surgeons.

• Ensure there is an accurate checklist is available for staff to use when checking equipment for the difficult intubation trolley.

• Ensure all medical equipment is up-to-date with service and safety checks.

• Ensure there are systems in place for making sure all medicines are within date.

• The provider should ensure that that appropriate balance checks of all Controlled Drugs (CDs) are carried out regularly.

• Take action to ensure all staff are compliant with safeguarding of vulnerable adults and safeguarding children training.

• Take action to ensure staff are aware of the mental capacity act, and deprivation of liberties, and how it applies to their role.

• Ensure dedicated hand hygiene sinks in patient bedrooms are included when carrying out refurbishment in accordance with the Department of Health’s Health Building Note 00-09.

• Ensure carpets are removed from clinical areas and patient bedrooms in accordance with Department of Health’s Health Building Note 00-09.

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, even though a regulation had not been breached, to help it move to a higher rating.

Professor Edward baker

Deputy Chief Inspector of Hospitals (South East)