Archived: BMI Gisburne Park Hospital

Updated 23 January 2017

BMI Gisburne Park Hospital in Clitheroe is housed in a Grade one listed building set in parkland with 35 bedrooms, all of which provide an ensuite facility.

BMI Gisburne Park Hospital is part of BMI Healthcare, the UK’s largest provider of independent healthcare and opened in October 1985. The hospital has two theatres, one with laminar flow, 35 single en-suite rooms used by inpatients and day cases, and six chairs spread over two rooms for minor procedures.

At the time of our inspection the registered manager and accountable officer for controlled drugs for BMI Gisburne park is the hospital’s Executive Director, who has been in post since 2014.

Out of 74 consultants 67 were employed by local NHS trusts. The remaining seven undertook their validation through the provider where they saw the majority of their patients. Three of the consultants undertook validation through BMI Healthcare. The main surgical procedures undertaken at the hospital include cataracts, hip and knee replacements and gynaecological procedures. These are undertaken between Monday to Friday and Monday to Saturday one week a month. The outpatients and diagnostic imaging services at BMI Gisburne park hospital covered a wide range of specialties including orthopaedics, ear nose and throat (ENT), urology, dermatology, gynaecology, neurosurgery, ophthalmology, general surgery, and cosmetic surgery.

The outpatient facilities consist of six consulting rooms, two treatment rooms and a diagnostic service of plain x-ray and ultrasound. Computed Tomography (CT) and magnetic resonance imaging (MRI) scans are not undertaken at this site and instead take place at an alternative, local BMI hospital. The hospital has a designated pharmacy, physiotherapy suite and a radiology department. We inspected the hospital as part of our routine comprehensive inspection programme for independent healthcare services. We carried out an announced inspection visit on 23 and 24 August 2016 and an unannounced inspection on 2 September 2016.

BMI Gisburne Park Hospital has previously been inspected by the Care Quality Commission in June 2013. Six core standards assessed were found to be compliant except one, which was a requirement relating to workers. The provider was re-inspected on 1 October 2013 when the service was found to be compliant.

Updated 23 January 2017

Overall we found services good at BMI Gisburne.

We inspected the core services of surgery and outpatients and diagnostic imaging.

• Incidents were reported by staff through effective systems. Lessons were learnt and investigation findings and improvements made were fed back to staff. There were systems in place to keep people safe and staff were aware of how to ensure patients were safeguarded from abuse.
• Medicines were stored safely and given to patients in a timely manner. The staffing levels and skills mix was sufficient to meet patients’ needs.
• Equipment was maintained, appropriately checked and visibly clean. Medical equipment was checked and maintained by an independent company.
• Patient records were stored securely and access was limited to those who needed to use them.
• There were defects in the carpet on the ward corridor and we found floors in three patient bathrooms which were dirty in the corners and grouting on the tiles were not as clean as they should have been. We found that this had been addressed at our unannounced visit.
• Staff assessed and responded to patients’ risks and used recognised assessments but these were not always fully completed.
• The majority of staff had completed their mandatory training.
• Senior staff were aware of their responsibilities relating to the duty of candour legislation and they were able to give us examples of when this had been implemented. The hospital had a duty of candour process in place to ensure that people had been appropriately informed of an incident and the actions that had been taken to prevent recurrence.
• Surgical procedures were carried out by a team of consultant surgeons and anaesthetists who were mainly employed by other organisations (such as in the NHS) in substantive posts and had practising privileges with the hospital.
• The consultants and anaesthetists were responsible for their individual patients during their hospital stay.
• Resident registered medical officers (RMOs) were employed to provide medical cover when the consultant was not available.

• Patients received care and treatment according to national guidelines such as National Institute for Health and Care Excellence (NICE) and the Royal Colleges of Nursing and Surgeons. Surgery services participated in national audits. Findings from performance reported outcomes measures (PROMs) and the National Joint Registry showed the majority of patients had a positive outcome following their care and treatment.
• The hospital monitored patient outcomes through surveys to ensure that patients were satisfied with the service they received.
• BMI corporate policies were based on National Institute for Health and Care Excellence (NICE), national and royal college guidelines were available to staff on the intranet.
• The rate of unplanned readmissions following surgery was within expected levels when compared to other independent hospitals.
• Care and treatment was provided by suitably trained, competent staff that worked well as part of a multidisciplinary team. The majority of staff had completed their appraisals.
• Procedures were in place to ensure that consultants holding practicing privileges were valid to practice. There were procedures in place to ensure all consultant requests to practice were reviewed by the Medical Advisory Committee (MAC).
• Staff sought consent from patients prior to delivering care and treatment and understood what actions to take if a patient lacked the capacity to make their own decisions.

• Without exception, patients spoke positively about their care and treatment. Staff treated patients with dignity and respect and patients were kept involved in their care. Patient feedback from the NHS Friends and Family test and patient satisfaction surveys showed most patients were positive about recommending services to their friends and family.

• There was daily planning by staff to ensure patients were admitted and discharged in a timely manner. There was sufficient capacity in the ward and theatres so patients could be seen promptly and receive the right level of care before and after surgery.
• There were systems in place to support vulnerable patients. Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.
• The department accessed translation services for those patients whose first language was not English, and information was available to patients in differing formats, if required. A hearing loop was available for those patients who were hard of hearing.
• The hospital had not implemented recognised schemes to help meet the individual needs of patients living with dementia.

• There were governance structures in place which included a risk register. The hospital’s vision and values had been cascaded across the services and staff had a clear understanding of what these involved. There was clearly visible leadership within the services. Staff were positive about the culture within the services and the level of support they received. There was routine public and staff engagement. All staff were committed to delivering good, compassionate care and were motivated to work at the hospital.

Updated 23 January 2017

We rated outpatients and diagnostic imaging as ‘good’ overall because;

Incidents were reported by staff through effective systems. Feedback on the outcomes of the incident was shared across the organisation. From April 2015 to March 2016, there had been no reported cases of healthcare-associated infections.

Equipment was maintained, appropriately checked, and visibly clean. Patient records were stored securely, and access was limited to those who needed to use them.

Care and treatment within the outpatient and diagnostic imaging department was delivered in line with evidence-based practice. Policies and procedures followed recognisable and approved guidelines such as those from the National Institute for Health and Care Excellence (NICE).

The Radiology department had implemented the World Health Organisation (WHO) safety checklist for non-surgical interventional radiology. Regular audits were undertaken to ensure good practice was in place.

The hospital monitored patient outcomes through surveys to ensure that patients were satisfied with the service they received

Patients and their relatives we spoke to told us they were supported by staff that were caring, compassionate and supportive to their needs.

Patients had a choice of appointments available to them through the ‘choose and book’ service. This allowed patients to be able to attend appointments at a time best suited to their needs.

We saw that risks had been identified and actions taken to mitigate the risks in a number of areas that included infection control and patient safety.

Procedures were in place to ensure that consultants holding practicing privileges were valid to practice.

In the BMI Healthcare staff survey 2015, 94% of staff would recommend the hospital as a place to work. This was above the national average of 70%.

All staff told us that managers of the service were approachable and supportive. We observed managers to be present on the department providing advice and guidance to staff and interactions were positive and encouraging.

However,

Carpeting and seating did not assist in maintaining good standards of infection control. The seating and some flooring was not washable or wipe clean if it became soiled and could present an infection risk. This was being addressed by the service and a programme of refurbishment was planned.

We observed that nasal endoscopes were being cleaned in the same room in which the treatment took place this practice was immediately ceased

At the time of inspection the outpatient department was experiencing a shortage of healthcare staff. We were told that staff from another department were able to help cover the unfilled shifts. We observed that this did not happen, and the outpatient manager provided the necessary cover required. This meant that the outpatient manager may not be able to provide effective management support of the outpatient area and ward.

The hospital environment had not been suitably adapted to respond to the needs of patients living with dementia.

Although risk assessments on the radiology department had been reviewed by the radiation protection supervisor in 2016, we saw from records provided that there was no clear evidence that they had been reviewed by the radiation protection advisor on an annual basis.

We found no documentary evidence that staff had the competence to administer eye drops in the outpatients department. Current practice relied upon consultants to ascertain if staff were competent in administration of eye drops.

Updated 23 January 2017

We gave the surgical services at Gisburne Park Hospital an overall rating of ‘good’. This was because: -

Incidents were reported by staff through effective systems. Lessons were learnt and investigation findings and improvements made were fed back to staff. There were systems in place to keep people safe and staff were aware of how to ensure patients’ were safeguarded from abuse. The staffing levels and skills mix was sufficient to meet patients’ needs and staff assessed and responded to patient risks.

Care and treatment was provided by suitably trained, competent staff that worked well as part of a multidisciplinary team. Patients received care and treatment according to national guidelines such as National Institute for Health and Care Excellence (NICE). Staff treated patients with dignity and respect and patients were kept involved in their care. Patient feedback from the NHS Friends and Family Test and patient satisfaction surveys showed most patients were positive about recommending surgical services to friends and family. There were systems in place to support vulnerable patients. Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.

There were governance structures in place which included a risk register. There was a hospital vision which had been cascaded across the surgical services and staff had a clear understanding of the hospital values. There was clear visible leadership within the services. Staff were positive about the culture within the services and the level of support they received.

However,

There were defects in the carpet on the ward corridor and three patient rooms needed further cleaning.Staff assessed and responded to patient’s risks and used recognised assessments but these were not always fully completed.The hospital had not implemented recognised schemes to help meet the individual needs of patients living with dementia.Some staff had not completed their mandatory training or had an up to date appraisal.