At our inspection on 17 December 2013 we found that risks to people's health welfare and safety had not been effectively identified and managed. We found that maintenance issues had not been reported and managed promptly, governance of infection control was being intermittently applied, and records of care were not consistently completed or audited.

At this inspection we found that the service was safe as maintenance and infection control issues had been corrected. The service was well-led as the provider had improved governance arrangements for each of the issues of concern. There had been prompt action to ensure that safe equipment in operating theatres was available for use, and some obsolete unused equipment had been removed. Managers had implemented regular reporting and spot checks related to equipment and housekeeping. Clinical staff had implemented comprehensive auditing and reporting of care records and infection control matters.

We spoke with three people who used the service. People told us they were very satisfied with the service. One person said they and their family had been given excellent support at a time of great anxiety. The service was responsive to people’s needs. We saw that people had been provided with good information about their care or if they needed help prior to admission or after discharge.

The service was safe as there were arrangements were in place to deal with foreseeable emergencies and the service had systems to prevent and control the risk of infection. There were adequate records of care although we found some gaps in the continuity of information in care plans.

There were systems to continuously monitor the quality of the service but these had not been effective in all areas. Systems were not fully developed or comprehensive and therefore had not informed managers about some risks to people’s care. When we discussed this with managers they immediately put measures in place to protect people’s safety and welfare such as advising clinical staff about a potential short delay in power supply resumption.

We spoke with 11 people who were using the service on the day of our inspection. Everyone confirmed to us that they were happy with the treatment they had received. People told us that they had been well informed about their surgical procedure. One person told us, "The patient information brochure was very useful to read, as this provided you with the care you can expect and I must say it all happened as was written and there was an information pack in my room that also helped.”

Everyone we spoke with told us that staff treated them with dignity. One person said, “Respect for patients, it appears to me, is of high importance to all the staff, doctors, nurses and cleaners. They even knock on your bedroom door and do not enter until you say they can.”

We found that the service was providing a good level of care to people. Risk assessments were appropriate to the needs of each individual and were reviewed in line with the provider's policy. The World Health Organisation surgical checklist was in use to promote safety of patients during surgery. Arrangements were in place to deal with emergencies. Guidelines were in place to ensure that people's pain was well managed. Re-admissions rates following surgery were low at this service and no-one had contracted a serious infection during the past 12 months.

BMI St Edmunds is operated by BMI Healthcare. The hospital/service has 26 beds although at the time of reporting eight rooms were not in regular use. Facilities include three operating theatres, a three-bed level two care unit (recovery room), and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, and outpatients and diagnostic imaging. We inspected the surgery and outpatient services.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 6 November 2018, along with a further unannounced visit to the hospital on 12 November 2018.

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? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

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

Services we rate

Our rating of this hospital improved. We rated it as Good overall.

We found areas of good practice in relation to surgery and outpatient care:

• The hospital had systems and processes in place to protect patients from avoidable harm and abuse.

• The environment and equipment were clean and suitable for use and staff ensured patients were protected from infection by using the appropriate infection, prevention and control measures.

• Staff knew how and when to record incidents and there were systems to identify, monitor and share learning from incidents.

• Risk assessments were appropriately completed for people who used the hospital and staff protected confidentiality with well organised and managed individual care records.

• Outpatient contemporaneous consultation records were completed on triplicate forms and staff ensured there was always a copy in the patient records. This was a significant improvement since our last inspection.

• The hospital had comprehensive internal audit programmes in place to monitor services and identify areas for improvement and the hospital participated in national audits where applicable.

• Patient care and treatment was delivered in line with national guidance.

• Staff were competent for their roles and were encouraged to develop further. This was an improvement since our last inspection.

• Staff treated patients with care, kindness and compassion.

• Patients were appropriately assessed prior to surgery and there were processes in place to transfer patients should they require a higher level of care.

• Complaints and concerns were taken seriously, responded to in a timely way and managed with face to face meetings with the complainant where needed.

• Managers were visible, approachable and performed well. This was an improvement since our last inspection.

• Staff we spoke with enjoyed their work and were proud to work at the hospital. They described an open culture and felt supported and listened to by their immediate managers.

• There were clear and effective processes for managing risks, issues and performance.

And some areas for improvement:

• Although overall mandatory compliance was generally good some courses showed poor compliance such as; manual handling on the ward (42.9%).

• Records showed that patients were fasted for longer than necessary to accommodate operating theatre list changes.

• Consent forms were sometimes completed on the day of surgery which did not follow best practice guidance.

• Consultants did not always record post-operative reviews in inpatient notes.

• There was inconsistent governance of consultant practising privileges in ensuring appraisals were submitted in line with the practising privilege policy.

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.

Amanda Stanford

Deputy Chief Inspector of Hospitals