We visited BMI Runnymede Hospital as a responsive review and looked at the care and welfare of people who used the service. A theatre specialist advisor and a paediatric specialist advisor attended the inspection with us.

We spoke to 12 patients, nine members of staff and the registered manager. All patients that we spoke with were complimentary about the care and treatment they had received. One person told us “Staff are wonderful. They really helped me and were supportive.” Another said “Staff are very attentive, pleasant and everyone is very nice.”

We saw that there were arrangements in place for obtaining consent from people. One person told us “I completed a consent form when I was admitted. The pros and cons of the procedure were also fully explained.”

People received care and treatment that met their needs. All the people that we spoke with told us they knew the details of procedure they were going to have. The provider had systems in place for managing cleanliness and infection control. We looked at the procedures in place in the operating theatre and no concerns were identified.

The staff we spoke with told us they felt supported to do their job. Staff told us that they enjoyed working at the hospital and BMI provided them with the training they required.

The hospital had a complaints policy and staff knew what to do if a patient complained. One person raised an issue during our inspection. We spoke with the manager and this was actioned.

On the day of inspection the manager told us that there were only 21 patients in the hospital. We spoke to three patients on the longer stay ward, the registered manager, the Director of Clinical Services, the Quality and Risk Manager and six members of staff.

We talked with the patients about their experience at the hospital. Patients confirmed with us that their consultants had been very attentive and they had been seen everyday since their admission.

Patients told us how caring the nurses were. One patient said “The staff are stupendous. I have been to other independent hospitals and this is the best.” Another patient told us “The staff know me and my condition very well. They are very good here, nurses, consultants everyone.”

We looked at care plans for patients admitted to the hospital and could see they contained information that was relevant to the patients diagnosis.

Patients that we spoke to told us that staff gave them choices. We were told that the explanations by the consultants prior to surgery were very good.

Staff told us that the hospital were very supportive and provided them with training. Other staff told us that regular training took place either via a computer or face to face training with a practical element.

We were told that regular audits take place at the hospital to ensure patients health and safety. Audits were also undertaken to ensure that systems put in place by management were being carried out by staff.

Our visit involved two compliance inspectors and took place between10.30 and 16.00 hours. We gave the service short notice of our intended visit to ensure that senior personnel would be available to talk to us. The service displayed notices about our visit to inform patients, visitors and staff. We spoke with eight people who were using the service during our visit. We also spoke to a further four people via telephone post site visit, who had used the service previously. We also consulted ten staff members.

Our visit was part of the Commissions inspection programme of providers offering cosmetic and breast enhancement surgery. The programme of inspection was set up following recent media attention regarding complications with the use of PIP implants for certain types of breast augmentation procedures. CQC agreed with the Department of Health to undertake targeted inspections to review compliance against specific essential standards, with a percentage of providers who carry out elective breast augmentation procedures and may have used PIP implants.

On the day of our visit there were twenty six people accommodated across the two wards. Ten patients were accommodated on the short stay ward and sixteen on the longer stay ward. We consulted a mixture of surgical and medical patients who were independent fee paying and some NHS referred patients.

All of the people we consulted spoke positively about their experiences at the hospital and of the care and treatment they had received. Their comments included, “I felt fully involved every step of the way” “There’s nothing you can say, except that it is simply exemplary.” and “So calm and quiet, gives you huge confidence”. People told us that they were treated with dignity and respect at all times. Staff listened carefully to their opinions and answered their questions in full.

A person told us that they were given time to reflect before they consented to their treatment and several people told us that they had not been put under any pressure to consent to interventions. A person told us that, “Risks were explained to me, I was even given a percentage as to the likelihood of things that could go wrong, it was very reassuring”.

People admitted for day surgery only confirmed that before treatment they were asked questions about their present health, previous medical history, and any medication they were currently taking.

Without exception people spoke positively about their experiences with staff. Their comments included “Staffing levels are high. If you call for help, they are there before you even put down the call bell” and “All the staff were excellent from the receptionist to the housekeeper to the doctors and the nurses, you don’t want for anything” “Staff are well trained and show a high level of expertise”.

Some people told us that they were aware of quality assurance leaflets located around the hospital, which gave them the opportunity to feedback about their experiences of the service they had received. People we spoke with also said they had been able to raise any concerns they had about their care and treatment quite freely with staff.

We carried out a comprehensive inspection of BMI The Runnymede Hospital on 1-3 August 2016 as part of our national programme to inspect and rate all independent hospitals. We inspected the core services of medical care, surgery, and outpatients and diagnostic imaging as these represented the activity undertaken by the provider, BMI Healthcare, at this location.

We rated medical care, surgery and outpatients and diagnostic imaging as good.

Are services safe at this hospital?

• We saw evidence of comprehensive and detailed investigations into incidents and complaints with learning appropriately shared throughout the hospital to improve standards of care and avoid recurrence. Staff understood the duty of candour and we saw evidence of this in practice.
• Staff recognised and responded to changing levels of risk for the patient in line with current guidance and best practice.
• There were clearly defined and embedded systems to keep patients safe, with staff demonstrating knowledge of safeguarding and an understanding of referral processes. The Director of Clinical Services was the safeguarding lead for adults and children.
• There were effective handovers between shifts with information about patients being shared appropriately to ensure continuity of care. Nursing handovers took place three times per day and there was a formal handover between the RMOs who undertook regular ward rounds.
• There was a service level agreement with the local NHS hospital which allowed for the transfer of patients who needed additional care.

Are services effective at this hospital?

• Staff worked to national guidance and followed best practice standards to deliver consistently good quality care to patients, which the hospital monitored to ensure consistency of practice.
• The role of the medical advisory committee was clear, with comprehensive paperwork circulated in advance so that members could be fully prepared. We saw minutes which demonstrated robust discussions of policy, shared learning and appropriate challenges
• Mandatory training compliance was high across the hospital, with staff able to access additional training for personal development with the support of their line manager.
• Although there was no dedicated pain team, staff had received specialist training and were able to discuss anticipated pain levels with patients in advance of their surgery. Patients told us their pain had been well managed.
• There was a thorough system for managing the review and granting of practising privileges which ensured there was appropriate clinical and managerial oversight of this.
• We reviewed patient records and noted that informed consent was clearly documented, with details of risks and benefits being discussed with patients in a manner which could be easily understood.

Are services caring at this hospital?

• Patients and their relatives described the care they received at the hospital in very positive terms, with both clinical and non-clinical staff understanding the need for privacy and dignity and taking steps to ensure this.
• Patients knew the name of the nurse who was looking after them, and we saw how staff made the effort to include relatives in the care of patients and explained to them what was happening.
• The hospital made arrangements to allow parents to stay with their child overnight, and we observed staff being particularly gentle and reassuring with children undergoing procedures.

Are services responsive at this hospital?

• Appointments were offered promptly to patients with flexibility to suit their preferences as far as possible. Patients told us they were seen on time.
• Although the hospital saw very few patients with dementia, all staff had been trained in dementia awareness and were sensitive to the needs of patients living with dementia.
• There was a clear process for managing urgent admissions which allowed for better planning and a more effective use of staff time.
• The complaints process was well publicised and patients who chose to complain were treated compassionately throughout the process. Senior managers would invite the patient in to the hospital for a meeting, and we saw evidence that managers had visited a patient in their home when the patient did not wish to return to the hospital.
• Provision was made to meet the individual needs of patients, including a hearing loop at reception for patients with a hearing disability, a list of languages that different staff members spoke, an interpreting service and careful planning of theatre lists to reduce anxiety for patients with a learning disability.

Are services well led at this hospital?

• Staff were aware of the overall BMI strategy as well as the local mission statement and understood how it applied to their role and work in the hospital.
• The senior management team was highly regarded by staff who told us they found them visible, approachable and supportive.
• The registered manager was on annual leave at the time of the inspection but this did not impact upon the smooth and effective running of the hospital. The overall leadership and culture was not dependant on a single individual but continued to be demonstrated by the management team in the director’s absence.
• The management team had taken steps to address the difficulties around recruitment and retention of staff by researching salaries across their independent competitors and NHS trusts and ensuring there was pay parity, and by providing training and development opportunities to retain experienced staff.
• There was an effective system of governance with departmental meetings and a clinical governance committee with oversight by a well-managed and well attended medical advisory committee.
• There was a culture of transparency and honesty amongst staff, who told us that managers actively encouraged them to report incidents. Staff told us they felt valued and respected by their leaders.
• There were plans to develop medical services with the provision of four dedicated medical beds.

Our key findings were as follows:

• There were effective systems to keep patients safe and to allow staff to learn and improve from incidents.
• The hospital was visibly clean and we saw evidence that policies were implemented and monitored to prevent the spread of infection. Where audits had shown the need for improvement (for example, clinical staff being bare below the elbows), we saw measures had been put in place to improve performance.
• The process for obtaining consent from patients was clear and ensured that staff followed national guidelines and met legal requirements.
• Appointments were arranged so that patients could access care when they needed it.
• Care was delivered in line with national guidelines and BMI corporate policy.
• Staffing levels were adequate, with some vacancies which were managed through the use of bank or agency staff to ensure that there was no impact on patient care. There were robust arrangements to ensure that staff had the required training and skills to do their jobs.
• The leadership had the confidence and respect of their staff, who felt supported and motivated by them to provide the best possible care for patients.
• There was appropriate management of quality and governance through departmental meetings and committees with regular reports to the medical advisory group for comment, debate and decision. Managers were able to identify risks and challenges within the hospital and were able to escalate and take action as required.

We saw several areas of outstanding practice including:

• The working of the medical advisory committee, with engagement from members, strong leadership from the chair and an effective working relationship between the chair and both the executive director and director of clinical services.

However, there were also areas where the provider needs to make improvements.

Importantly, the provider should:

• Ensure that the flooring in all clinical areas is fit for purpose.

• Ensure clinical staff who assess children are trained in safeguarding children level three.

• Ensure that the governance policy is up-to-date.

• Consider improving the environment for children in the outpatients department so that it is child-friendly.

• Consider providing written information to service users for whom English is not their first language

Professor Sir Mike Richards

Chief Inspector of Hospitals