BMI Goring Hall Hospital is operated by BMI Healthcare Limited. The hospital has 52 registered beds. Facilities include five operating theatres, an endoscopy unit, radiology offering digital mammography, CT and MRI scanning, a pharmacy and outpatient facilities.

The hospital provides surgery, medical care including chemotherapy, services for adults, and outpatients and diagnostic imaging.

Mulberry Suite provides outpatient medical interventions and systemic anti-cancer treatments. Mulberry Suite has four treatment chairs and access to a single bedroom for emergency admissions or for individual patients to use as a day case.

The hospital was last inspected in 2016. The overall rating of the hospital was judged as ‘good’ with the exception of ‘safe’ which was rated as ‘requires improvement’. The concerns within the safe domain related to practice within the chemotherapy service in the hospital.

This inspection focused on the current practicere in chemotherapy services. We assessed the improvements implemented since the previous comprehensive inspection. An announced visit to the hospital was carried out on 23 May 2018.

Following this focused inspection, we found the following areas of good practice:

• Clear standard operational policies for the admission of unwell patients who had received chemotherapy in the previous 21 days.

• A hospital cancer strategy for 2018 - 2020.

• An operational policy for Mulberry Suite.

• A 24 hour provision of specialist cancer nurse and oncology consultant advice via a mobile phone. This telephone number was accessible to patients or staff who needed advice or support.

• Each set of patient clinical notes contained a record of a cancer patient multidisciplinary meeting discussion.

• There was a medical cancer lead in place to represent cancer within the within the Medical Advisory Committee and Clinical Governance Committee.

• The cancer service was on the standing agenda for the Medical Advisory Committee and Clinical Governance Committee and the clinical governance meeting.

• The Mulberry Suite had been awarded a Macmillan Quality Environment Mark.

• All nursing staff had access to clinical supervision with a psychologist.

• The cancer team met regularly to discuss current issues within the cancer service.

• The BMI cancer cluster had appointed a lead and links were being formed across the organisation to ensure the team had peer support.

However, we also found the following issues that the service provider needs to improve:

• The United Kingdom Oncology Nursing Society triage tool was not always followed to make admission decisions for each unwell chemotherapy patient.

Name of signatory

Amanda Stanford

Deputy Chief Inspector of Hospitals

At this inspection we took a theatre specialist to look in depth at the care and welfare of people having surgery at BMI Goring Hall Hospital. The theatre specialist observed operating procedures, inspected the theatre environment and equipment and spoke with theatre staff. We spoke with two patients prior to their surgery and followed their patient journey through theatre and back onto the ward. We also spoke with seven other patients who had received inpatient care and treatment and two relatives who were visiting the hospital. We spoke with 13 members of staff including members of the senior management team, ward, therapy and theatre staff.

We found that patients received good care that was well documented. Obtaining valid consent was well managed with patients fully involved at all stages in their care and treatment. Staff knew how to escalate concerns and were confident that action would be taken if needed. Staff were well supported with training and development opportunities. We found that where agency or bank nurses were used they were supported to deliver care to an appropriate standard.

All the patients we spoke with were very pleased with the quality of the care that they received. Comments included,” … wonderful experience”, “Excellent, I can’t fault them” and “No hesitation in recommending it”.

We spoke with six people who had received inpatient care and treatment and three people that were attending out patient appointments. We also spoke with 15 members of staff including members of the senior management team, ward, theatre and outpatient staff together with staff from radiology and physiotherapy.

All of the people who used the service spoke positively about the care they received from staff at the hospital. They said that staff were caring and that they received good information and support in relation to their treatment. They told us they were more than happy with the service. Several people we spoke with had attended the hospital for treatment more than once. One person said “Staff always do what they say they will, like calling when they said they will." Another person told us that the staff were “Real gems, I’m very happy - five stars!”

We found that areas where there was direct interaction with people such as the wards and outpatients were managed well and provided safe and appropriate care. However there were areas where the hospital could not provide assurance that the systems and processes in place protected people. For example the process for escalating concerns to the corporate body was slow and had resulted in a person being injured. We found that staff training was poorly recorded but there was a process in place for staff support although a formal process for supervision was yet to be implemented.

BMI Goring Hall Hospital is operated by BMI Healthcare Limited. It is a private hospital in Goring by Sea, near Worthing, West Sussex. Ownership transferred to BMI Healthcare Limited in 1994. The hospital primarily serves the communities of West Sussex. It also accepts patient referrals from outside this area.

The hospital has had a registered manager in post since 2010.

The hospital also offers cosmetic procedures such as dermal fillers and laser hair removal, ophthalmic treatments and cosmetic dentistry. Assisted conception services are also offered with the hospital operating as a satellite to BMI Esperance Hospital, where the main unit is based. We did not inspect these services.

Our comprehensive announced inspection took place on the 16th and 17th August 2016.

The team that inspected the service comprised three CQC inspectors, and specialist advisors with expertise in theatre management, nursing, chemotherapy nursing, a consultant surgeon and consultant physician and a radiographer.

The hospital had four theatres (two of which are laminar flow, one general theatre and an endoscopy theatre). At the time of the inspection, the hospital was using 39 of its 52 registered beds. The 39 beds were spread over two main wards; Ilex (22 beds and 4 extended recovery beds) and a day surgery unit (DSU) which offered 12 beds and 4 outpatient procedure chairs. The Mulberry Oncology Suite had 4 chairs for day case chemotherapy and a single patient room for longer day care treatments. The hospital also had comprehensive outpatient facilities with 14 Consulting rooms (11 in Consulting Suite and 3 additional rooms in Main Hall), two treatment rooms (one ophthalmic and one general). The diagnostic service consists of X-ray, Ultrasound, Digital Mammography, Echocardiogram, Mobile CT and MRI on alternate days.

During the inspection, we visited all areas of the hospital. We did not visit the onsite MRI Scanner as these are provided by a third party. We spoke with 22 staff including; registered nurses, health care assistants, reception staff, medical staff, operating department practitioners, and senior managers. We spoke with 19 patients and one relative. We also received 43 ‘tell us about your care’ comment cards which patients had completed prior to our inspection. During our inspection, we reviewed 32 sets of patient records.

There were no special reviews or investigations of the hospital ongoing by the CQC at any time during the 12 months before this inspection. The hospital has been inspected four times, and the most recent inspection took place in September 2013, which found that the hospital was meeting all standards of quality and safety it was inspected against.

Activity (April 2014 to March 2015)

• In the reporting period April 2015 to March 2016 there were 5,073 inpatient and day case episodes of care recorded at The Hospital; of these, 14% were NHS-funded and 86% other funded.

• During the same reporting period, 47% of all NHS-funded patients and 22% of all other funded patients stayed overnight at the hospital.

• There were 12,016 outpatient total attendances in the reporting period; of these 80% were other funded and 20% were NHS-funded.

  140 consultants worked at the hospital under practising privileges. Nineteen regular resident medical officers (RMO) worked on a rota. BMI Goring Hall employed 38.9 registered nurses, 28.5 care assistants and a total of 86 other administrative and ancillary staff, as well as having its own bank staff. The accountable officer for controlled drugs (CDs) was the registered manager.

  Track record on safety

• One Never Event was reported during the reporting period April 2015 to March 2016. This was a near miss when an incorrect implant was handed to a surgeon but which did not came into contact with the patient. The incident was a significant risk of harm but no harm occurred.
• Clinical incidents 274 no harm, 207 low harm, 64 moderate harm, 2 severe harm, 0 death
• 1 serious injury but where the patient had attended several healthcare providers and the cause was not attributable to BMI Goring Hall Hospital.

0 incidences of hospital acquired Meticillin-resistant Staphylococcus aureus (MRSA),

0 incidences of hospital acquired Meticillin-sensitive staphylococcus aureus (MSSA)

0 incidences of hospital acquired Clostridium difficile (c.diff)

0 incidences of hospital acquired E-Coli

55 complaints, of which 3 were referred to the Ombudsman.

Services provided at the hospital under service level agreement:

• Clinical and or non-clinical waste removal

• Cytotoxic drugs service

• Interpreting services

• Grounds Maintenance

• Laser protection service

• Laundry

• Maintenance of medical equipment

• Pathology and histology

• RMO provision

• Catering

• MRI Scanning

The inspection team was overseen by Terri Salt, Inspection manager