We found the following areas of outstanding practice:

• The hospital had a clear ‘digital inclusion’ focus and used information technology in a therapeutic way to help patients improve their cognitive function and problem solving skills.
• Staff provided additional support for patients, beyond clinical care. Staff had a detailed, holistic understanding about their patients’ lives and needs. Staff advocated for and ensured the best interest of the patient when liaising with external organisations.
• There was extensive recognition of and provision for the emotional support and wellbeing of patients, with inclusive and personalised spiritual and social support.
• Patients could participate in a comprehensive planned timetable of therapeutic activities, and staff supported them to do so in an inclusive and personalised way.
• The hospital provided comprehensive rehabilitation training and support to help patients maintain or regain independence in their daily lives.
• There was a comprehensive volunteer support programme to provide one-to-one social time and support to patients to reduce their risk of social isolation.
• The hospital board had representation from two HIV positive individuals, including a former patient. This helped ensure the voice of HIV positive people was included in decision making.
• Patients were involved in service design and staff sought patients’ suggestions on how they could better support them and meet their rehabilitation needs.

We found the following areas of good practice:

• There was a good overall safety performance across the hospital and effective processes for identifying and managing risks. There were very low levels of reported serious incidents and incidents resulting in harm. Learning from incidents was shared with staff.
• Patient records were comprehensive and clearly documented person-centred care.
• The hospital could evidence positive patient outcomes including improved medication adherence, cognitive function and greater independence.
• Patients’ nutrition and hydration needs were managed appropriately. Staff demonstrated a consistent focus in supporting patients to achieve and maintain healthy eating standards.
• There was good multi-disciplinary working between staff within the hospital and with external partners such as social workers.
• Staff adapted their communication and approach for each individual patient. They ensured care and activity sessions were delivered in a relaxed, inclusive and supportive way.
• The hospital had procedures in place to ensure patients experienced a dignified death.
• Patients were routinely involved in their care planning. Staff tailored their clinical approach accordingly so patients could take ownership of their care and work at a pace they felt comfortable with.
• The hospital provided a very comprehensive range of inpatient and day services to support and care for patients living with HIV acquired neuro-cognitive impairment, including those needing complex physiological and psychological support.
• The hospital had clearly embedded equalities objectives to improve inclusivity and prevent discrimination. Patients of all faiths and those of no faith were welcomed and treated equally. Staff supported patients of other faiths to practise their faith and had good local links with religious organisations to facilitate support for patients with specific religious and cultural needs.
• The hospital’s social work team supported vulnerable patients, some with very wide ranging and complex social, legal and financial needs.
• There were no waiting lists to access services and there were no delays in accepting new patients.
• There was a clearly defined organisational culture at Mildmay Mission Hospital, based on Christian values and the charitable history of the hospital. The whole hospital team demonstrated a strong sense of community to celebrate achievements.

However, we also found the following issues that the hospital needs to improve:

• There were a number of nursing vacancies and the hospital was heavily reliant on agency and bank nurses to cover rota gaps.
• Some hospital policies were very out of date and needed to be updated.
• There were isolated examples of do not resuscitate orders (DNAR) not recorded or applied correctly.
• There were some isolated examples of patient records which did not have clearly documented consent forms.
• Some nurses perceived a disconnect between staff groups and felt intimidated by certain individuals in the therapies team. They felt there was limited understanding of what nurses did amongst therapies staff.

Following this inspection, we told the provider that it should make some improvements, even though regulations had not been breached, to help the service improve. These are recorded at the end of the report.