24 and 25 June 2019
During a routine inspection
The BMI The London Independent Hospital is an independent acute hospital located in Stepney Green, east London. It is operated by BMI Healthcare Limited.
There are a total of 69 inpatient and day care beds and 20 outpatient consulting rooms. There are four operating theatres, five critical care beds, a cardiac catheterisation unit, a JAG accredited endoscopy suite, physiotherapy department and diagnostic imaging.
We inspected surgery, critical care and outpatients. The inspection was carried out on 24 and 25 June 2019 and was unannounced.
We inspected services using our comprehensive inspection methodology. 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? We rate services as outstanding, good, requires improvement or inadequate.
We spoke with 42 members of staff including nursing, healthcare assistant and medical staff specific to each area inspected, managers, cleaners, receptionists and physiotherapists. We reviewed the healthcare records of 22 patients and spoke with 16 patients and relatives. We checked items of clinical and non-clinical equipment. We looked at information provided by the hospital.
Services we rate
Our rating of this hospital improved. We rated it as good overall. All three core services were rated good in all domains where we have a duty to rate.
We found the following areas of good practice across all services:
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
- Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
- The design, maintenance and use of facilities, premises and equipment kept people safe.
- Staff completed and updated risk assessments for each patient and removed or minimised risks.
- The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients 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, stored securely and easily available to all staff providing care.
- The service used systems and processes to safely prescribe, administer, record and store medicines.
- The service managed patient safety incidents well. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
- The service provided care and treatment based on national guidance and evidence-based practice.
- Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
- Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
- The service made sure staff were competent for their roles.
- Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
- Staff treated patients with compassion and kindness.
- Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
- Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
- The service took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
- Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
- It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
- Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff.
- The service had a vision for what it wanted to achieve and a strategy to turn it into action.
- The service had an open culture where patients, their families and staff could raise concerns without fear.
- Leaders operated effective governance processes throughout the service and with partner organisations.
- Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
We found areas of practice that require improvement:
Surgery
- At the last inspection hand hygiene audits showed variable results for bare below the elbow and for hand hygiene at appropriate times. At this inspection although we found good practice and audit results that showed good hand hygiene, we also observed instances where hand hygiene standards were not being maintained. In theatres we observed excessive glove usage with minimal hand hygiene taking place between glove changes. In the anaesthetic room we observed instances where staff were not decontaminating their hands after patient contact. In pre assessment we observed an occasion where a member of staff did not use alcohol gel or wash hands prior to applying gloves and did not wash hands post procedure.
- Information was collected for monitoring ongoing harm free care. However, this information was not on display to patients.
Outpatients
- Although the service generally controlled infection risk well, compliance levels with hand hygiene and bare below the elbow standards were low. Hand hygiene audits for January and February 2019 found that compliance rate was 32% and 29% respectively. The department had an action plan in place.
- The treatment room did not meet all the environmental requirements set out in the BMI policy Surgical Procedures in Outpatients, due to a lack of ventilation and the presence of a suspended ceiling. An appropriate local standard operating procedure was in place to mitigate the risk.
Critical Care
- At the last inspection the intensive treatment unit did not have a follow up clinic where patients could reflect upon their critical care experience and be assessed for progress. The service still did not have a follow up clinic for patients following discharge from the hospital. This was not in line with Guidelines for the Provision of Intensive Care Services which state that patients discharged from ITU must have access to a follow up clinic.