The Hampshire Clinic is operated by BMI Healthcare Ltd. The hospital has 62 beds. Facilities include four operating theatres, a three-bed level three care unit, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We focused our inspection in two areas, namely surgery and medical care.

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.

We carried out an unannounced focussed inspection on 23 January 2019, to assess compliance against three warning notices which were issued to the provider on 06 July 2018. 

Our inspection targeted the key concerns identified in the warning notice.

At our inspection we found the provider had made considerable progress on all issues identified in the warning notice. For example, we found the following:

• There was evidence of audit being carried out to confirm the effectiveness of infection control procedures and practices. All audits were dated and each had a separate action plan to address issues highlighted.

• The hospital ensured staff followed the pathway and guidance for assessing deteriorating patients.

• To support staff in the safe delivery of care, policies and procedures were reviewed regularly.

• The service undertook observational audits of the World Health Organisation surgery checklists.

• Staff were aware of the sepsis policy for sepsis management and the provider's sepsis care pathway. The sepsis screening tool made reference to the 2017 NICE guidance.

• There was an overall corporate risk register and specialty level risk register. The specialty level risk register accurately reflected current risks at the service. The senior leadership team were aware of the five top risks the hospital faced.

• There were effective processes developed for incidents that affected the health and safety of people using the service.

• In the endoscopy unit, there were arrangements in place for the management and control of spread of infection.

• Venous thromboembolism assessments (VTA) were fully completed. There was evidence these assessments were always reviewed when patients' risks were identified.

The hospital was compliant to the warning notice.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (South and South West)

People who used the Hampshire Cline we spoke with told us they were well informed by staff about the treatments or procedures they were undergoing. Patients were required to sign consent forms prior to receiving any treatment. People we spoke with said that staff were friendly and professional and treated them with respect. People were positive about their care and treatment.

The hospital required that all staff were trained in adult and child protection to ensure that a safe environment was promoted.

We found that there safe systems and procedures in place for the storing and administering of medication. Patients were provided with appropriate information about their medication by the hospital staff.

The hospital had systems in place to monitor and manage risks and also the quality of care and treatment provided. Regular feedback was sought from patients and the information circulated to the staff. Patients were made aware of how to raise a concern or make a complaint. The hospital responded promptly to complaints that were made.

We met and talked with nine people staying at the hospital. They were all positive about the care they were receiving and many told us they had stayed at the hospital before. One person told us "You couldn't fault any of the nurses here”, and another told us "My stay here has been A1." This was supported by our own observation that the staff were polite, professional and respectful in their dealings with people.

All of the care records we looked at were well completed and indicated a person centred approach to care. There were procedures in place to keep records secure and confidential.

The provider had enough skilled and experienced staff to meet people’s needs and the nursing teams were supported by health care assistants and agency nurses.

We found that overall the premises provided good standards of general cleanliness and comfort and were being appropriately maintained.

We found that there were large numbers of items of portable electrical equipment which the provider had not regularly inspected and we asked them to take action to address this.

There were systems in place to audit and monitor the quality of the services being provided.

We previously visited the hospital on 22 September 2011 and identified non-compliance with Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010, relating to safeguarding people using the service. We also said improvements needed to be demonstrated for Regulation 9 (care and welfare) and Regulation 23 (supporting workers). We returned to the hospital in January 2012 to assess whether compliance had been achieved for these regulations and to review arrangements for handling complaints.

On this occasion, we did not talk to people who used services during our visit, so we cannot report on people’s comments and experiences.

We spoke to six patients during our visit, both inpatients on wards and patients waiting to attend clinics. People told us that they were satisfied with the way they were cared for and spoken to. They said that staff treated them with respect and dignity although some consultants could be brusque at times. Inpatients told us that the catering was good and they appreciated the choice and quality of food. People said they felt safe at the hospital.

BMI The Hampshire Clinic is operated by BMI Healthcare Limited . The hospital has 62 registered beds. Facilities include four operating theatres, a three-bed level three intensive care unit, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care including endoscopy and oncology, services for children and young people, and outpatients and diagnostic imaging.

We carried out a responsive inspection to follow up on concerns relating to a number of recent incidents at the hospital. We also had concerns that governance systems and processes were not operating effectively. We carried out the unannounced part of the inspection on 24 and 25 April 2018, with an announced visit to the hospital on 16 May 2018 as part of our well- led inspection.

During this inspection we looked at the core services for surgery including, surgical intensive care, children and young people services, and medical care which included endoscopy and oncology. Children and intensive care are small services, please refer to the main Surgery report for further information.

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

We rated this hospital as requires improvement overall.

• The intensive care unit did not manage medicines including controlled medicines and intravenous drugs effectively which could impact on patients’ safety.

• The service did not manage incidents effectively as these were not investigated in a timely way for improvement and learning.

• There was a National Early Warning System (NEWS) in use however; the patients’ notes we reviewed included scores that were inconsistent. There were gaps in the observations on NEWS records as not all parameters were completed.

• The sepsis screening tool was out of date and did not reflect 2017 national guidance. Staff had not received updates on the management of sepsis in line with recent guidelines.

• The systems and processes for ensuring patients ‘safety prior to surgery was not consistently followed. We were not assured safety briefings and debriefings were being completed in the operating theatres to safeguard patients.

• Not all the theatre team were in attendance at the safety briefings.

• Governance systems and processes for the management of incidents and never events were not operating effectively.

However;

• There was a process for safeguarding children and adults which staff were confident in using.

• The Intensive Care Unit (ICU) doctors reviewed patients who had been recently discharged to the ward, identifying deterioration and providing support and guidance to the ward nurses. Staff from the ICU also worked on the wards if there were no patients in ICU, this enabled patients discharged from ICU to be provided with 1:1 care when needed.

• All paediatric patients who were under five had the ‘red books’ which contained their current health records. The paediatric nurses ensured these were available at the pre -admission assessments stage.

• There were designated paediatric nurses when children were admitted for care and treatment.

• Staff told us they had adequate staff to meet the patients’ needs and they used their bank system and could access agency staff to cover for staff’s shortages.

Following this inspection, we served the Hampshire Clinic with a Warning Notice under Section 29 of the Health and Social Care Act 2008, on July 2018. The notice required the provider to make significant improvements by 3 August 2018.

We told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with requirement notices and two warning notices that affected BMI the Hampshire Clinic. Details are at the end of the report.

Name of signatory

Amanda Stanford

Deputy Chief Inspector of Hospitals