Ulster Independent Clinic ordered to tackle litany of failings by watchdog
One of Northern Ireland’s biggest private hospitals is at the centre of enforcement action by regulators.
The Ulster Independent Clinic (UIC) in south Belfast has been given until February 23 to improve procedures to ensure the safety of patients.
It comes after the Regulation and Quality Improvement Authority (RQIA) discovered doctors were working there without providing proof they had insurance or the mandatory training proving it is safe for them to work.
It was one of “a number of areas of significant concern” uncovered by the RQIA during a three-day unannounced inspection in January last year.
The watchdog ordered the hospital to “urgently review and resolve the issue”.
It further said the hospital should stop the practice of allowing doctors to assist with operations without providing evidence of revalidation and indemnity “immediately” during a serious concerns meeting in July.
The hospital said it was working to update records and introduce more stringent administrative processes, and is confident the actions required by the regulator will be completed by the compliance deadline.
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Revalidation is a safeguarding process all doctors must go through to prove their competence, while medical indemnity is insurance for doctors in the event of negligence.
However, following a further inspection in November, the RQIA said it was “not assured that sufficient safeguards were in place to protect the safety and well-being of patients”.
As a result, it put in place a failure to comply notice on the registration of the hospital.
The January inspection highlighted a litany of failings, including the failure of the hospital to alert doctors to the dangers of a treatment involved in the deaths of five children in hospitals across Northern Ireland.
The RQIA team found that the hospital’s fluid management policy was outdated and did not reflect official guidance issued in July 2014, which provides advice on the use of Solution 18.
It came after it was found to have played a part in the deaths of the five children at the centre of the Hyponatraemia Inquiry.
However, the RQIA inspection report said: “We did not find an effective system to consider adoption and implementation of regional and national guidance or Department of Health circulars.
“We identified significant issues relating to the management of fluids for one patient receiving care on ward one in UIC.
“We found that the patient’s medical history and prescribed medications had not been fully considered when managing their fluid intake and output.
“The intravenous fluids prescribed by the Resident Medical Officer (RMO) were not available in Northern Ireland and the fluids administered by nursing staff did not match the prescription written by the RMO.
“In addition, the nursing care records reviewed did not provide evidence of accurate oversight or management of the total fluid intake and output of this patient for each 24-hour period of care.
“We identified immediate learning in relation to the management of fluids as RMOs from outside Northern Ireland working within the hospital may not be aware of practices in fluid management which are unique to Northern Ireland.”
During the inspection in January it also emerged that patients were being sent home with discharge letters that didn’t include details of surgical procedures that had been carried out.
The report said: “For example, a patient who was booked for a planned surgical procedure had an additional procedure undertaken during surgery.
“However, the surgical notes mentioned the original planned procedure only and did not include information relating to the additional procedure and the discharge letter replicated information on the planned procedure only.”
The inspectors also raised concerns that it was not always clear whether patients had given consent for nursing interventions.
They were also worried about the management of medication and found the hospital’s policy for the treatment of infections was out of date. The inspection report continued: “We did not find a robust system for reporting to RQIA medication events which had adversely affected the well-being or safety of a patient, as required by legislation.”
The RQIA team also raised concerns about how the outpatient department was managed.
“This is an area of significant risk for the hospital which will need to be addressed and this potentially exposes the hospital to unsafe practice and other safety risks,” the report added.
The RQIA carried out a series of inspections of the hospital throughout the year, but remained concerned about doctors working without providing proper documentation.
A spokesman from UIC said: “At the Ulster Independent Clinic we take our responsibilities regarding governance extremely seriously and are working with the RQIA to strengthen our existing administrative and governance procedures even further.
“Since the unannounced RQIA inspection on November 4 we have been working closely with our registered consultants and their surgical assistants to update records and introduce more stringent administrative processes around practising privileges to ensure we remain in line with best practice. We are working to implement the actions required by the regulator and are confident that these will be completed by the compliance deadline.”
In 2018 it emerged that UIC is eligible for rates relief because it is a registered charity.
At the time the hospital had an annual rates bill of £839, despite the facility being worth almost £35m.
In addition, as the hospital is a registered charity, all income falls within tax exemption.
The hospital, which is a non-profit making company, has been granted charitable status because the work done there provides a benefit to the public.
This includes the diagnosis of illness and physical injury and the relief of pain and suffering for patients as a result of receiving medical treatment.