Patients told us they felt fully involved in their assessment and treatment. One patient said communication between the hospital and patients was; "Excellent." Patients said treatment options were fully discussed and they received the necessary information in a way they could understand and in a timely manner.

We looked at care record files for seven people; including inpatients and outpatients. We saw documentation included patient personal details such as address and date of birth, consent to treatment, clinical history of the patient, operation and treatment details. This showed patients' needs were assessed and care and treatment was planned and delivered in line with their individual care plan and in a way that was intended to ensure patients' safety and welfare.

We spoke with a senior pharmacist who explained the system for monitoring medication brought into the hospital by patients. They told us pharmacist support was available 24hrs each day, including through an out of hours system. This meant staff could access advice and medication at any time patients required it. This showed appropriate arrangements were in place in relation to obtaining medicine. They described the system for accurately recording medication administered on the wards. This confirmed medicines were prescribed and given to people appropriately.

We looked at five staff recruitment files. They included an enhanced Criminal Records Bureau (CRB) or Disclosure and Barring Service (DBS) check. We saw at least two references had been taken up and checked, there was photographic proof of identity and a full employment history. We found the right to work in the United Kingdom had been established and health checks had been carried out to establish applicants' physical and mental fitness. This showed appropriate checks were undertaken before staff began work.

Patients were made aware of the complaints procedure, in a format which met their needs. Patients told us they were aware they were able to make complaints if they felt they needed to. We saw there were notices and information leaflets about how to complain throughout the hospital. We saw patient feedback was positively canvassed and facilitated. For example, we saw a leaflet informed patients; "We want your stay with us to be trouble-free. So if you have any comment on the level of service or care, please speak to a member of staff right away..."

All of the people we had conversations with told us they were satisfied with the care they received. They said it had met their expectations and in three cases people told us it had exceeded them. People said they had been able to understand the treatment choices available to them.

We spoke with three in-patients about their experience. They told us they had completed a thorough pre-admission assessment and consultation process. This had established their medical history and they told us they had been involved at every stage in determining treatment options. One person told us they had not been under any pressure at any time and had been able to take their time discussing alternative courses of action open to them. Two of the people we spoke with were post-operative. They said the standard of the surgical team had been 'outstanding' and 'excellent'. They were particularly positive about the nursing support they had received immediately following their operations.

We were told all staff involved with paediatric patients had completed their paediatric safeguarding training. We were able to confirm staff training undertaken and planned from records seen. We saw the provider had policies and procedures in place on safeguarding adults and children.

We saw there were boxes and feedback forms readily available in reception. This provided people with an easy and early opportunity to comment on their experience if they chose to do so.

People who use the service told us that staff were very good at respecting their privacy and dignity. They told us they had been involved in discussions about their care and treatment. They said they had been given the opportunity to ask questions and had received thorough explanations on such things as consent to their treatment and the risks and benefits involved in their procedures. They said that where possible they had been encouraged to do as much for themselves as they could.

People told us they had completed a pre-admission assessment and a further assessment on arrival at the Chiltern Hospital. They said they had been asked about their needs as part of the assessment process. People felt that staff were very familiar with their needs and how to meet them. They said that staff always provided an explanation of what they were doing and why when providing care and treatment.

People said they felt safe and that their possessions were secure at the Chiltern Hospital. They told us they had no concerns about the way staff treated them. They said that staff appeared competent in looking after them and were generally very responsive. They felt that staff were polite and respectful.

All the people we spoke with had been provided with questionnaires asking for their views on their care and their stay at the Chiltern Hospital. They felt confident in raising any concerns with staff and said that there was always an opportunity to feedback or comment if they wanted to.

One person summarised her time at the Chiltern Hospital by saying: “My experience here has been very good. I feel that my treatment has achieved everything I wanted it to. This is a very pleasant environment”.

Our rating of this hospital stayed the same. We rated it as Requires improvement overall.

We found the following issue that the service provider needs to improve:

• The service provided mandatory training in key skills to all staff and processes in place to monitor compliance, but not all staff had completed this training.

• Not all areas were patients received care and treatment were fit for purpose.

• Most equipment was suitable but the paperwork to evidence that equipment had been tested and serviced to ensure it was fit for purpose was not always available, up to date or accurate.

• Despite children being seen and treated at the hospital not all staff required to completed training in paediatric basic life support (PBLS) as part of their mandatory training had done so.

• The service stored medicines safely and securely however did not always follow best practice when prescribing and recording the medicines administered in all departments.

• There was a lack of oversight of which staff had had read and were competent to use Patient Group Directions (PGDs).

• Not all departments had sufficient numbers of nurses with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Not all departments used a system to monitor safety results and in areas that did collect this data this was not displayed

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Whilst managers checked to make sure staff followed guidance, this guidance was not always the most up to date.

• Children did not always have their care and treatment delivered or overseen by appropriately qualified staff in line with the provider’s staffing policies and procedures.

• Not all departments had ensured their staff were competent for their roles. In the event of a paediatric emergency a competent member of staff may not always be available.

• Management of the diagnostic department was still in its infancy and was in the process of developing the right skills and abilities to run a service or had just begun to address some of the challenges in their area.

• While systems were in place to identify risks and mitigate these, the systems were not always effective in identifying where improvements were required.

• The provider had a governance framework which was used to improve their clinical, corporate, staff and financial performance. However, these were not always fully embedded into operational practice.

However, we also found the following areas of good practice:

• Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The service controlled infection risks and kept equipment and the premises clean.

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately.

• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

• The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other BMI services to learn from them.

• Staff put patients at the centre of all that they did.

• Staff took time to involve patients in their care and provided emotional support to patients to minimise their distress.

• We observed how staff demonstrated a kind and caring attitude to patients and took time to speak with patients and their relatives in a respectful, patient and considerate way.

• The hospital planned services around the needs and demands of patients, taking into account patients’ individual needs.

• People could access the service when they needed it.

• The service treated concerns and complaints seriously, investigated them and learnt lessons from the results, sharing these both internally and with other BMI hospitals.

• The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it had developed with staff and patients.

• The service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The service engaged well with patients and staff to and manage appropriate services.

  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 the service improve. We also issued the provider with three requirement notices that affected children and young people and diagnostic services. Details are at the end of the report.

  Nigel Acheson

  Deputy Chief Inspector of Hospitals (London and South Central)