At our last inspection in February 2014 we found two issues that we told the hospital to take action on. The purpose of this visit was to check on the hospital’s progress in taking action.

The first was that the World Health Organisation (WHO) surgical safety checklist was only being partially completed and that checks on its completion were not systematically occurring. The intention of the checklist is to ensure that all conditions are optimum for surgical patient safety and that errors in patient identity, site and type of procedure are avoided.

The second was that we found examples where doctors were not observing the hospital’s bare below the elbows policy and not wearing gloves when carrying out cannula insertion procedures.

We found that the hospital had taken steps to ensure that both the surgical safety checklist was being completed and that medical staff observed the hospital’s hand hygiene protocols.

We spoke with 12 people using the service (and some of their relatives, five members of staff and the senior managers. We also spoke with and/or observed 18 staff working within the theatres and recovery rooms at the hospital.

People using the service were happy with the care they received at BMI The London Independent Hospital. People told us they had confidence in the quality of care. One person said, “the staff are so nice, this is a really pleasant place to be unwell.” However, we observed some clinicians did not follow best practice guidelines in some of the theatre procedures.

People said they were involved in decisions and had enough information. We saw staff treating people respectfully and protecting people's privacy. One person told us, “the staff work as a team, if you have a query they all tell you the same thing, it feels like they know you individually.”

The provider had taken steps to ensure that all nursing and administration staff understood how to safeguard children and vulnerable adults. However, they could not confirm that all the consultants working at the hospital were trained to the required standard or knew the services procedures should they suspect someone was at risk of being abused.

Staff members did not report any concerns about staffing levels. Staffing levels and the mix of staff experience were assessed against the requirements of the patients on a regular basis. All the patients we spoke with told us the nursing staff responded quickly to the call bells.

There was a complaints procedure and we saw that any complaints were address appropriately.

We spoke with 12 people using the service (and some of their relatives), eight members of staff and the senior managers. We also looked at the feedback the service had received from patient and staff surveys and how it had responded.

People using the service were happy with the care they received at BMI The London Independent Hospital. People told us they were always treated with respect by staff, the hospital was clean, the quality and choice of food was excellent and they had confidence in the quality of care. People said they were involved in decisions and had enough information. We saw staff treating people respectfully and protecting people's privacy.

Staff members were also positive about the quality of the service with several telling us they would use the hospital for themselves and their own families. Staff reported being well trained and supported for their roles. They said they had opportunities to keep their practice up-to-date and develop professionally.

Staff members did not report any concerns about staffing levels. However, several patients on the wards said they sometimes had to wait too long for the nurses to respond to the call bell. One person reported having to wait for pain relief. The hospital was aware of the issue and was recruiting two additional nurses to the wards.

The managers were able to demonstrate how they monitored the service and addressed any issues to ensure that people received safe, effective care at the hospital.

BMI The London Independent is an acute private sector hospital located in Stepney Green, East London. The hospital is a purpose built 5 storey single building which opened in 1986. The hospital provides services to patients aged 16 years or over. Services are provided by UK registered health care professionals and support teams across a range of specialties including Cardiology; Cardio-Thoracic surgery; Dermatology; ENT; Endoscopy; General Medicine; General Surgery [including upper GI, lower GI and breast]; Maxillo-facial; Ophthalmology; Orthopaedics; Pain Management; Physiotherapy; Plastic Surgery; Podiatry; Renal Medicine [including Dialysis]; Renal Surgery [including live donor transplant]; Spinal; Urology and Vascular.

We inspected the core inpatient services of inpatient medicine, surgery, critical care as well as outpatients and diagnostic imaging.

We rated this hospital as good overall. We rated it good for effective, caring, responsive and well-led. We rated safe as requires improvement. We rated medicine, critical care and outpatients and diagnostic imaging as good. We rated surgery as requires improvement.

Our key findings were as follows:

We found evidence of outstanding practice:

• The endoscopy suite had been recently refurbished and was purpose built with excellent patient and treatment facilities.

We found evidence of the following good practice:

• There was evidence of suitable investigation, learning and dissemination of learning from incidents.
• Hospital infection prevention and control practices were followed and these were regularly monitored by the infection control lead, to reduce the risk of spreading of infections.
• Appropriate equipment was available for patient procedures and tests. Equipment was well maintained and tested annually or in accordance with manufacturers’ guidelines.
• The provider had begun a refurbishment programme of the whole hospital which was recognised as requiring updating in parts.
• Medicines were suitably prescribed, stored and administered.
• We observed suitable infection prevention and control procedures in use, and audit results showed 100% compliance with hand hygiene and bare below the elbow principles.
• There were sufficient nursing and medical staffing levels to enable safe care.
• Staff had undertaken appropriate mandatory training for their role, were up-to-date with training and were well supported to undertake training.

• We saw evidence-based practice in place, compliance with recommendations from the National Institute for Health and Care Excellence (NICE) and other national guidelines according to speciality.
• Patients received care from competent staff who had received the necessary training to undertake their respective roles.
• Staff had good access to patient information and liaised with internal as well as external agencies to plan and deliver patient care.
• Patients received suitable nutrition and hydration, and additional support was available for those with specific dietary requirements.
• Patient outcomes, including mortality, unplanned returns to theatre and unplanned readmissions to hospital, were good.
• Pain was well managed and we observed staff asking patients if they had pain during their routine observations.
• Most staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.
• We observed staff provided care in a compassionate and respectful manner. Patients were treated with dignity and respect.
• Patient feedback forms about their overall experience and their opinions of the nursing and medical staff demonstrated positive results, with scores frequently above 95% satisfaction.
• Patients felt they were fully involved in planning their care and treatment. Staff ensured they listened to and responded to patients’ questions appropriately. Patients commented that they had been well supported.
• Relatives were confident in the care provided throughout the service and told us they were suitably involved in the care of their loved one.

• Access to services for NHS patients and privately funded patients was straight forward and efficient.
• Services were tailored to meet the needs of individual people and there was flexibility in the provision of care.

• Staff demonstrated a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met their needs and promoted equality.
• Support was available for international patients from Kuwait. This included translation support and liaison with the Kuwaiti embassy. The hospital had an international team working closely with ITU in the admission and discharge of patients.
• Services were planned and delivered in a way which met the needs of patients. Patients had timely access to appointments. Clinics were held on weekdays into the evenings and Saturday mornings to suit patients’ preferences.
• Risk registers contained items considered as issues by the leadership team and reflected our inspection findings. Key risks were displayed on posters in staff areas to raise awareness.
• Suitable governance processes were in place with a clear clinical and organisational structure. The Medical Advisory Committee (MAC) were involved in a number of key processes, including performance reviews and quality measure.
• There was a positive culture throughout the hospital, and low sickness rates.
• Staff had a good understanding of the organisation’s visions and values.
• Staff described a visible and approachable leadership team and told us they felt able to raise concerns or report incidents without fear of repercussions.
• There was evidence of some innovative practice and plans for additional service development, with quality, safety and sustainability at the forefront of the decision making process.

However we found evidence of the following poor practice:

• Compliance with the World Health Organisation (WHO) Five Steps to Safer Surgery checklist was variable.
• Theatres did not have access to an uninterruptible power supply UPS, which was not in line with recommendations for surgical estates, and meant theatres could temporarily lose power in the event of a power cut.
• There were no designated hand wash sinks in patient rooms on wards, which meant staff washed their hands in patient basins. This was not compliant with hand hygiene protocols.
• Most clinical staff received level-one safeguarding training, which is not sufficient to comply with recommendations from NHS England.

• We saw that information, including information on how to complain, was in English only. Although staff had access to interpreters, there was no translated literature and no translated signage.
• There was no visitors’ waiting room for ITU or HDU.
• The reception desks in outpatients and in diagnostic imaging did not have lowered areas for accessibility to wheelchair users.
• The changing room in the nuclear medicine area did not have direct access to the consulting rooms. Patients had to wear gowns and walk down the corridor where they could be seen by other patients.
• Importantly the hospital should:
• Review and ensure full compliance with the World Health Organisation (WHO) Five Steps to Safer Surgery checklist by all surgical staff..
• Take steps to ensure that theatres  have access to an uninterruptible power supply (UPS).
• Provide designated hand wash sinks in patient rooms on wards, to  comply with hand hygiene protocols.
• Review and implement  safeguarding training sufficient to comply with recommendations from NHS England.
• Although numbers of patients aged 16-18 are low, review safeguarding, paediatric nurse cover and assessment of suitable patient pathways for these patients.
• Provide information, including information on how to complain, in other languages as well as English.
• Provide a visitors’ waiting room for ITU or HDU.
• Ensure that  reception desks in outpatients and in diagnostic imaging have lowered areas for accessibility to wheelchair users.
• Take appropriate steps to preserve patient dignity in the nuclear medicine area by providing direct access to the consulting rooms from changing areas.
• Take steps to modify the temperature in the OPD sluice room.
• Complete its replacement programme for fire doors.

• Prepare an action plan to address the health and safety audit results for May and June 2016 which recorded that ‘power tools and electrical tools in good working order, free from splits, cracks and deformities’ was rated poor.

• The above list is not exhaustive and the provider should review all elements of the report in order to continually improve the quality of its services to patients.

Professor Sir Mike Richards

Chief Inspector of Hospitals