During this inspection we visited an orthopaedic ward and a general surgical ward. We spoke with 13 people using the service, eight members of ward staff, the registered manager for the service, the director of clinical services and the governance and risk manager.

People using the service told us they were happy with the care, treatment and advice they had received. Comments included, "I am very happy with the care and cannot ask for more,” “The staff are very good, I cannot fault them” and “I feel better and less anxious because staff always give me an update regarding my wound.”

People told us they enjoyed the food. Comments included, "Meals are beautifully presented which increases my appetite,” “The food is superb” and “When I have little or no appetite I am always encouraged to have some soup, which is always very tasty.”

There were sufficient skilled and experienced staff to meet people's needs. One person said “Staff are great they are always available.”

Staff had access to 'safeguarding' and 'whistle blowing' procedures and had received training to help them recognise and respond to any signs of potential abuse or neglect. We were told that people felt safe and staff were described as polite and knowledgeable. One person said “It gives me an assurance of safety because staff are well organised and experienced.”

We spoke with four people who used the service and one visiting relative. They all told us that they were they were happy with the services they received. They said they had been asked for written consent prior to receiving any treatment. They also told us that they were offered a choice and their treatment options were fully explained to them by staff.

One person told us they felt comfortable because they were seen by the same consultant during each visit.

The people we spoke told us they were happy with the staff and care received. One person told us the staff were knowledgeable and that the nursing staff responded quickly when they were called.

People spoken with also told us they did not have any concerns about the service they received but were aware of how to raise a complaint if they did have any issues.

During this inspection visit we spoke with six members of staff. Staff told us they were happy working at the hospital. One person said she “Really enjoyed the job.”

Staff spoken with were able to clearly explain the process for obtaining patient consent prior to treatment and knew the process if a patient had a complaint or a concern.

We found there were various information leaflets on display around the hospital for people to take.

“The staff are very good and I am very happy with my treatment so far.”

“It has been a fantastic experience; the consultant gave me information about what the surgery entailed, the risks involved and how long I should expect to be away from work afterwards.”

“The nurses and healthcare assistants are helpful and caring and always explain whatever they are doing in a way you can understand.”

“The staff are very efficient.”

“They are well trained and always know what they doing.”

BMI The Alexandra Hospital in Cheadle is part of BMI Healthcare, the UK’s largest provider of independent healthcare. BMI Alexandra Hospital is registered to provide the following regulated activities:

Diagnostic and screening.

Surgical procedures.

Treatment of disease, disorder or injury.

Our inspection was undertaken as part of our on-going programme of comprehensive Independent Health Care inspections. We carried out an announced inspection visit of BMI Alexandra Hospital on 5th and 6th July and an unannounced inspection on 13th July 2016.

We inspected the core services of Surgery, Medicine, Urgent and Emergency Care, Critical Care services for Children and Young People and the Outpatients and Diagnostics service.

 Are services safe at this hospital:

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.

Senior staff were aware of their responsibilities relating to duty of candour legislation and 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.

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.

Staff assessed and responded to patient’s risks and used recognised assessments. We found these had been fully completed.

There were systems in place for reporting risk and safeguarding patients from abuse. Staff were aware of how to report incidents that took place in the departments and we saw evidence of incidents being investigated and learning being shared within the team.

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.

Staff had completed their mandatory and specialist training.

Resident registered medical officers [RMOs] were employed to provide medical cover when the named consultant was not available.

 Are services effective at this hospital:

Patients received care and treatment according to national guidelines such as National Institute for Health and Clinical Excellence (NICE) and the Royal Colleges.

The hospital monitored patient outcomes through surveys to ensure that patients were

satisfied with the service they received.

BMI corporate policies based on national institute for health and care excellence (NICE), national and royal college guidelines were available to staff on the intranet.

Care and treatment was provided by suitably trained, competent staff that worked well as part of a multidisciplinary team.

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

Are services caring at this hospital:

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 97% of patients were positive about recommending services to friends and family.

Staff provided emotional support to patients and chaperones were used across the departments at the request of patients or for intimate examinations or procedures.

All of the patients we spoke to during our visit told us that they had been treated exceptionally well by staff.

We observed that staff were sensitive and understanding of the emotional impact of care and treatment. Staff told us that they put the needs of patients first.

Patients consultants, named nurse looking after them. This was to ensure continuity of care. Patients we spoke with said that staff always introduced themselves and made them feel that they were involved.

Are services responsive at this hospital:

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.

Staff had attended equality and diversity training, the cultural needs and specific requirements of patients were taken into account when planning and delivering services. For example, patients attending the wards were asked about their religious beliefs and dietary requirements, in case these affected their treatment options or meal choices. 

 The services accessed translation services for those patients whose first language was not English, and information was available to patients in differing formats if required.

Are services well led at this hospital:

There were governance structures in place. The hospital’s vision and values had been cascaded across the services and staff had an understanding of what these involved.

There was clearly visible leadership within the services staff were positive about the culture within the services overall and the level of support they received.

All staff were committed to delivering good, compassionate care and were motivated to work at the hospital.

On the whole, staff across the departments spoke positively about the leaders and the culture within the hospital.

Our key findings were as follows:

There were systems in place for reporting risk and safeguarding patients from abuse. Staff were aware of how to report incidents that took place in the departments and we saw evidence of incidents being investigated and learning being shared within the team. Staff completion of mandatory training for their roles was high.

Equipment was maintained, appropriately checked, and visibly clean. Medical equipment was checked and maintained by an independent company. We saw records to confirm that electrical equipment had been tested.

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 Clinical Excellence (NICE) and the Royal Colleges. Surgery services participated in national audits.

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.

Complaints about the services were resolved in a timely manner and information about complaints was shared with staff to aid learning.

Staff treated patients with dignity and respect and patients were kept involved in their care. Patients and their relatives we spoke to told us they were supported by staff that were caring, compassionate and supportive to their needs.

There were governance structures in place which included a risk register. 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.

 All staff were committed to delivering good, compassionate care and were motivated to work at the hospital.

Patient records were stored securely, and access was limited to those who needed to use them. This ensured that patient confidentiality was maintained at all times.

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.

Procedures were in place to ensure that consultants holding practicing privileges were valid to practice. We saw there were procedures in place to ensure all consultant requests to practice were reviewed by the Medical Advisory Committee (MAC).

Staff felt appreciated and valued, they discussed with us the different ways BMI recognised staff for their hard work. At a corporate level BMI championed the ‘Above and Beyond’ nominations, senior staff were asked to nominate staff in for this award.

There were some areas where the provider needs to make improvements.

Action the hospital SHOULD take to improve

The hospital should ensure that appropriate procedures are in place to ensure children using the diagnostic imaging department received appropriate images.

The outpatient department should ensure that sufficient action is taken when the fridge containing medication lays outside of the acceptable temperature range.

The hospital should ensure that patient temperatures and visual infused phlebitis (VIP) scores were not being recorded in theatres in line with evidence-based practice in the prevention of surgical site infections.

The hospital should ensure the development of multidisciplinary working, for all teams across the hospital. For example teams should attend multidisciplinary meetings to discuss the care of patients with complex cases.

The hospital should consider including the ‘cool off’ period for cosmetic surgery in the consent policy.

Professor Sir Mike Richards

Chief Inspector of Hospitals