BMI Healthcare is the UK's largest private hospital group and was formed in 1970. In 1993 after various changes, the group was renamed BMI Healthcare, and its new corporate group became General Healthcare Group (GHG). In 2006 GHG was acquired by a consortium led jointly by Netcare Limited, a South African healthcare company.

This was the second follow up inspection to review progress made on outstanding actions. These were developed in response to our comprehensive inspection in August 2016. They related to the use of translation services and consent processes.

We found further improvement had been made for the identified actions on this follow up inspection. There was improvement in the use of translation services, with a noticeable increase in the number of times the service was used for people whose first language was not English. Consent form audits showed an improvement in completion rates. There remained some concern regarding the legibility of written entries on consent forms, which still needed to be improved.

Patients in the outpatients department who had undergone a minor operation now received a copy of their consent form, which included the type of operation and associated risks identified. This was an improvement since our last review.

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals (South London)

BMI The Shirley Oaks Hospital is registered with the commission to provide the following regulated activities;

Diagnostic and screening procedures

Family Planning

Surgical procedures

Treatment of disease, disorder or injury

The hospital is registered for 50 beds. All ward rooms offered privacy and comfort of en-suite facilities, satellite flat screen TV, a telephone and Wi-Fi guest internet service.

The hospital has two theatres, one of which has ultraclean airflow (laminar flow). The outpatients department provides a wide range of services and is open until 9 pm week days and 1pm Saturdays. The Endoscopy Suite is Joint Advisory Group (JAG) accredited, and offers diagnostic services within a discrete unit with a dedicated procedure room. The Extended Recovery Unit is used for planned Critical Care Level 1 patients who require additional extended recovery post-surgery or for patients who become unwell and need increased care for a short period.

Patient services are supported by Pharmacy, Physiotherapy and Radiology services. Wide bore MRI and CT scanning are available on site.

BMI The Shirley Oaks Hospital attracts over 100 Consultants, who provide consultation services to patients who require elective surgery or other diagnostic procedures. Elective adult surgical procedures included; orthopaedic, gynaecology, ophthalmic, and general surgery.

Surgical services are provided to both insured and self-pay private patients and to NHS patients through both GP referral and hospital referral.

We inspected this service as a focused follow up inspection. The purpose of this was to review progress made on action taken to address the requirement notice issued to the hospital following the comprehensive inspection which took place in August 2016.

We carried out the unannounced inspection on 29 June 2017. The requirement notice issued was in relation to a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to regulation 11 of the Health and Social Care Act – Need for Consent.

Our inspection included a review of the completion of consent forms in line with hospital policy, and the procedure of gaining consent. This included the discussion of the risks of surgery using both general and local anaesthetic. The use of translation services in the consenting process for those for whom English is not their first language and audits of the consent forms were also reviewed.

BMI Healthcare is the UK's largest private hospital group and was formed in 1970. In 1993 after various changes, the group was renamed BMI Healthcare, and its new corporate group became General Healthcare Group (GHG). In 2006 GHG was acquired by a consortium led jointly by Netcare Limited, a South African healthcare company.

We inspected the hospital as a follow up inspection to review progress made on the action plan developed in response to our comprehensive inspection in August 2016.

We found improved completion of consent forms. However further improvement is required to ensure that patients are given legible information regarding their procedure and any associated risks.

We saw information which indicated the use of translation services had increased since our last inspection. However, on the day that we inspected, we again witnessed a patient for whom English was not their first language not having a translator provided for them but a family member translating.

In the outpatients department (OPD), we saw considerable improvement in the completion of the right consent forms. These were found to be legible and had detailed descriptions of the surgery and associated risks. However patients weren’t given a copy of the consent form which detailed the surgery and associated risks.

Professor Edward Baker

Chief Inspector of Hospitals

During our inspection we spoke with the hospitals registered manager who was the Executive Director; the health and safety officer; the manager for housekeeping services; the infection control lead; six nurses, including three ward/department sisters; and two non-clinical members of staff. We also spoke with six patients and three of their relatives who were on the inpatient ward or waiting in the outpatients department. All the patients we met told us the staff who worked at the hospital were kind and compassionate, and that they were happy with the care and treatment they had received. One patient said “The service is excellent and the hospital remains my first choice”. Another patient told us “The staff are top notch here…they are all very helpful and kind. Nothing is too much for any of them”.

There were effective systems in place to reduce the risk and spread of infection. Patients and relatives told us the hospital always looked clean. One patient said “the ward is kept very clean. Staff wore gloves when they need to and deal with spillages straight away”. Another patient told us “every day staff change the bed sheets and give the ward a good wipe down”.

We found patients received safe and appropriate care and treatment from sufficient numbers of suitably experienced and qualified staff. We saw staff treated patients with respect and dignity, and staff involved them in discussions about their care and treatment. The environment was kept hygienically clean. Patients were given their medicines when they needed them, and in a safe way. The hospital had effective systems in place to monitor the quality of the care and treatment patients received.

People were made aware of the complaints system. We saw ‘welcome packs’ contained detailed information about the hospital’s complaints system. The people we spoke with told us they did not have any concerns about the service they received. They said the Consultant and nursing staff had explained if they had any concerns they were available to discuss them. One patient told us “I cannot fault the place, but if I did have any concerns I’m pretty confident it would be dealt quickly with by the nursing staff”.

BMI Shirley Oaks is a private hospital registered to provide inpatient care for up to 50 people and a range of outpatient facilities. On the day that we visited there were 16 inpatients. We were able to talk to eight of them. We also spoke with eight members of staff, the executive director of the service and the director of nursing.

All of the people using the service told us how happy they were with everything. They said staff were” very kind” “welcoming” “really polite” and “so nice, really beautiful”. They said that they felt that they had been involved in discussions about their treatment and that the consultants and nurses had answered all of their questions. Those people who had required surgical procedures said they had been given written information prior to their operation. Those waiting to go home told us that they had information about what they could expect, anything that they should or should not do. Outpatient appointments had been made for them and they had a contact number to ring if they had any concerns.

People told us that they enjoyed the meals that were served and that and that they could request a drink at any time.

Information about the services provided, including how people could make a complaint, had been left in people's rooms. This information was also on the hospitals website. People we spoke with said they were not aware of the formal complaints procedure but they didn’t have any concerns.

All of the patients we spoke to told us that they would recommend the hospital. They talked about being made to “feel welcome” described their experience as “smooth and relaxed” and described staff as “absolutely spot on”.

One person had been coming to the hospital for many years. They described Shirley Oaks as “lovely and friendly”, “a good atmosphere where care is good”, and said they were “relaxed the whole time”.

Overall, we rated the services at this hospital as requires improvement.

• We had concerns around consent processes in outpatients and for patients undergoing surgical procedures, particularly where patients did not have English as their first language. Information leaflets were not available in alternate languages. Family members were used to translate for patients, and the interpretation services were not routinely used.

• Safety checks, including the recommended World Health Organisation (WHO) surgical checklists were not always fully completed.

• For the time period April 2015 to March 2016, the assessed rates of clinical incidents in surgery, and inpatients per 100 bed days was higher than the average of other independent acute hospitals we hold this type of data for.

• Some staff had not been trained to the required level of safeguarding vulnerable children.

• Despite the provision of training, staff knowledge of the principles of the Mental Capacity Act 2005 and deprivation of liberty safeguards was variable.

• Although there was evidence of local audits and action plans in most clinical department, the OPD did not have a formalised audit structure. We were unable to view completed action plans for the OPD audits.

• Screening rates for the risk of developing a Venous Thromboembolism (VTE) were far below the 95% in all four quarters of the period April 15 - March 16. Ranging from 64% to 71% over the four quarters. Further, an assessment of patient risk was not always completed in the OPD. Nursing staff rarely undertook and recorded clinical observations for patients undergoing minor procedures.

• There was unsecured access to the theatre environment, and equipment servicing data was not readily available in theatres. Some medical items stored in a temperature controlled environment in theatres were not suitably labelled. 

• Patient identifiable information was not always managed safely or in accordance with confidentiality and data protection guidance. 

• Patients reported experiencing long waiting times for follow up appointments, and long waits once they had arrived at the clinic. Further, clinics in the OPD were cancelled as little as 72 hours beforehand.

• There was a lack of risk register in the OPD and staff were not aware of the local risks impacting on their patients. 

However;

• Incidents were reported, investigated and lessons learned were shared with staff. Staff understood the requirements of the duty of candour, including informing people about the incident, providing reasonable support, providing truthful information and an apology when things go wrong.

• We observed good infection prevention and control (IPC) practices. There were arrangements to update the patient rooms where carpeting was used, as this did not meet IPC standards.

• Medicines were managed safely and clinical equipment was readily available, appeared clean and was functional. Emergency resuscitation equipment checks were regularly undertaken.

• The training information provided showed most staff had attended mandatory safety training. All staff had a minimum of basic life support training and there were paediatric-trained staff to care for children under the age of 18 when children’s clinics were running.

• We saw use of evidence based practice and national guidelines in all departments. This included care of patients with respect to nutritional needs and pain management.

• There were sufficient levels of staff, with appropriate skills and experience to care for patients. These individuals provided dignified, compassionate and respectful care. Patients and their families were positive about the care they received at BMI The Shirley Oaks Hospital. Such care took into account their cultural and religious needs, as well as individual choices.   

• Access and flow was generally good, with low cancellations of surgical procedures. The service was meeting the 92% target for NHS referral to treatment time of 18 weeks most months. Privately funded patients rarely waited to see a consultant for an initial consultation.

• Patients views were sought and where complaints were raised, these were investigated and responded to. Staff understood the hospital’s aim to continuously improve quality and enhance patient experience. Staff felt the ongoing refurbishment plans would further enhance the patient’s experience.

• There was effective and responsive local leadership at the executive level, and staff commented favourably on the senior staff. The executive team were very visible and staff said they were approachable. The size of the hospital helped staff to know one another and contributed to a feeling of ‘family’.

• A local business plan underpinned the broader organisational vision to provide the best patient experience, best outcomes and the most cost effective. The local vision was understood and applied in practice by staff in their interactions with patients.

• There was a culture of transparency and honesty amongst staff. Staff told us managers encouraged and supported them to report incidents.