BMI The Park Hospital is operated by BMI Healthcare Limited. The hospital has 56 beds across two wards. Facilities include five operating theatres (one of which is allocated as endoscopy), a five-bed critical care unit with three beds allocated to level three care, a cardiac catheterisation laboratory and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care and outpatients and diagnostic imaging. We carried out an unannounced focused inspection of the safe key question in surgery and medical care on 23 May 2018 in response to concerning information we had received about the safety of patient care and treatment across these services.

The main service provided by this hospital was surgery. Where our findings on medical care for example, medicines also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

At our last inspection in September 2016 we rated the hospital as good overall; our rating for safe in medical services was good and surgical services was requires improvement.

Following this unannounced inspection our rating for safe in medical services stayed the same and our rating for safe in surgical services improved from requires improvement to good.

We found good practice in relation to medical care:

• The service managed staffing effectively and had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
• Arrangements to safeguard adults and children were in place and staff had received effective training in safeguarding adults and children at a level appropriate for their role.
• Standards of cleanliness and hygiene were appropriately maintained, there were reliable systems in place to prevent infection and protect people from a healthcare-associated infection. Patient-Led Assessments of the Care Environment’ (PLACE) results were above the England average and local hand hygiene audits showed 100% compliance.
• Recording of all medical information was timely, accurate and legible. However, none of the medical records included the medical practitioner’s general medical council (GMC) number.
• Risks to patients were assessed, and their safety monitored and managed so they were supported to stay safe. Staff consistently identified and responded appropriately to changing risks to patients, including for example, the deteriorating patient.
• The service had a good track record on safety.

We found good practice in surgery:

• Protected time was allocated for staff to complete mandatory training, including safeguarding training relevant to their role. This included training on female genital mutilation (FGM).
• Recording of all medical information was timely, accurate and legible. However, none of the medical records included the medical practitioner’s general medical council (GMC) number.
• When the critical care unit was in use, it was led by an intensivist. There was 24-hour immediate access to the intensivist or an on-call anaesthetist.
• Staff adhered to policies and protocols which kept patients safe from infection. This included wearing appropriate clothing within the theatre environment.
• Staff were encouraged to report significant events. These were used as scenarios in training sessions to inform staff of any changes in process and for sharing learning.
• Integrated records/care pathway documentation were used to ensure all relevant information and risk assessments were documented throughout the patient journey.
• There was a paediatric nurse available who led and coordinated the care of children (aged 12-18 years).

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)

During our visit we spoke with five patients who were receiving treatment at the hospital. Everyone we spoke with spoke highly of the staff and the care they received. Patients said staff always introduced themselves and knocked before entering bedrooms.

Patients told us they had been given sufficient information about their care and treatment and had been asked for their consent. They confirmed that any risks relating to surgery had been explained.

Patients received their medications as they were prescribed. Staff regularly asked patients about the level of pain they were experiencing and gave pain relieving medicines if they were needed.

Medicines were suitably stored in lockable cupboards and the temperature of medicine storage areas was monitored.

Staff received appropriate professional development. We found that staff were properly supported to provide care and treatment to patients who use this service.

Senior managers had ensured that all new staff had completed inductions when they began working at the hospital.

A range of record audits were completed to assess if they were being completed fully and correctly. We saw that immediate actions had been taken to rectify any gaps but long term action plans to address systemic problems such as consultants forgetting to sign records had not been considered.

We visited the location to carry out a scheduled inspection. However, we also carried out the inspection to check that the provider had met the compliance action that we set at our previous inspection on 1 November 2012.

We spoke with seven patients, all of whom confirmed they had signed consent forms before their treatment began. Feedback from all the patients was positive regarding the care that they had received.

Patients were happy with the cleanliness of their rooms.Two of the patients we spoke with told us that staff had not always stayed with them when their medicines had been administered. Patients were happy that staff were competent to provide care that met their needs.

We found that before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We also found that patients experienced care, treatment and support that met their needs and protected their rights.

We found that patients were protected from the risk of infection. However, patients were not fully protected against the risks associated with medicines because medication was not always administered correctly.

We found that not all staff had received appropriate training. We also found that patients were not adequately protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

We spoke with three patients. They told us they had received sufficient information before consenting to treatment at the service. They also told us they were treated with dignity and respect and their privacy was maintained. They told us they were very pleased with the quality of the care provided by the service. One patient said, “I’ve been treated better here than anywhere else I’ve been. Absolutely excellent, I couldn’t fault the care and attention.” Another patient said, “It’s always very good here.”

Patients told us they felt safe using the service and staff appeared well trained and competent. Patients knew what to do if they needed to make a complaint and staff knew how to manage this information appropriately. One staff member said, “It is important to make sure the patients and their relatives are supported at all times.”

We found that patients were treated with dignity and respect and received care that met their needs. We found that patients were safe and the premises were safe.

We found that the provider took steps to assess the quality of the service being provided. However, we found that there was insufficient evidence to demonstrate that staff received induction, supervision, training and appraisal.