INDEPENDENT
HOSPITAL CARE
1
20 MILLION PATIENTS ALL TREATED
EXACTLY THE SAME WAY – UNIQUELY
ANNUAL REPORT
2012-13
Serious about health.
Passionate about care.
1
CASE STUDY
“They took my health
seriously and their passion
for care was evident in
everything they did”
Miriam Plancey
Miriam Plancey
On the day she was due for a knee
operation in the summer of 2012, Miriam
Plancey noticed a numbness in her foot.
Her condition deteriorated rapidly to the
point where she required a wheelchair
before Consultant Orthopaedic and Spinal
Surgeon Sean Molloy diagnosed the rare
Cauda Equina, a syndrome caused by
compression of back nerves which can
lead to pain, sensory disturbance, bladder
and bowel dysfunction and lower
extremity motor loss. By the time that
Mr Molloy operated on Miriam at BMI
The Clementine Churchill Hospital, she
had progressive paralysis of both legs
which restricted walking to short
distances. Time was of the essence;
without emergency surgery the
neurological loss would have
progressively worsened. Aided by
the hospital’s innovative O-Arm
multi-dimensional imaging system, which
lessened the serious risks of further
neurological loss, Mr Molloy was able
to perform a precise decompression
and fusion of her lumbar spine.
During her six month hospital
recuperation, Miriam worked with our
physiotherapists to progressively restore
her strength and mobility, but she also
became firm friends with her whole care
team of caterers, housekeepers and
nurses. Three weeks after she was
finally discharged, Miriam was back at
BMI The Clementine Churchill for the
long-delayed knee replacement; today
she is back walking independently as
she continues her rehabilitation. A
relationship had been forged and now
Miriam’s husband, Rabbi Alan Plancey,
helps the hospital, acting as the Chaplain.
“Mr Molloy was a fantastic consultant
and without him I don’t know what
would have happened. But everyone at
the hospital was amazing,” said Miriam.
“They took my health seriously and
their passion for care was evident in
everything they did.”
2
CASE STUDY
Dirk Nannes
“Patients should take
this approach to their
own healthcare and
seek to be proactive,
rather than reactive”
Professor Tony Kochhar
4
International cricketers need to be at the
top of their game, and Dirk Nannes is
no exception. “When you rely on your
mobility and your health for your job you
naturally seek out the best experts in
their field,” said the 37-year-old Australian
left-arm fast bowler after consulting
Professor Tony Kochhar, an expert in
sports injuries and a Consultant Shoulder
and Upper Limb Surgeon at BMI The
Sloane Hospital. “Ahead of any major
tournament you need to ensure you are
in peak physical shape. As a sportsman
and a bowler my upper limb strength and
mobility are crucial to me and Professor
Kochhar and his team have truly been an
invaluable asset in ensuring I can continue
with my passion well into the future.”
Professor Kochhar is regularly consulted
by sportsmen including boxers and martial
arts specialists, but also the more routine
patients seeking the highest standards
of care and medical expertise.
“Dirk, like any athlete at the top of their
game, needs to listen to what his body
is saying to him and seek out medical
attention before injuries develop to the
point of damage,” says Professor Kochhar.
“In a lot of ways all patients should take
this approach to their own healthcare
needs and seek to be proactive, rather
than reactive.”
BMI HEALTHCARE
BY NUMBERS
OUR VISION
of adults in the UK who have
private medical insurance live less
than an hour from a BMI hospital2
Percentage of patients giving a rating of ‘very good’ or ‘excellent’. Patient satisfaction survey January – December 2012. Questionnaires
analysed by Howard Warwick Associates. 2 Based on UK PMI penetration within a 60 minute drivetime of a BMI Healthcare hospital.
1
6
7
CONTENTS
Our business
10 Group Chief Executive’s Statement
12 Chief Financial Officer’s Statement
14 The Healthcare Market & Health Policy
17 Financial & Trading Review
Serious about health
26 Major Capital Investments
28 Maximising Operational Efficiencies
30 New Treatments & Services
34 GP & Consultant Relationships
Passionate about care
40 Our People
44 Clinical Governance
A responsible organisation
50 Corporate Social Responsibility
52 Environment
54 Corporate Governance & Business Ethics
58 Our Hospitals
8
OUR BUSINESS
STATEMENT
Stephen Collier
Group Chief Executive
Welcome to the BMI
Healthcare Annual Report
2013. This year we have
tried to focus on what
really matters, highlighting
the high quality care we
aim to provide to our
patients. I hope you like
the new format.
Few in the health world would argue that
the last year has not been a momentous
one for everyone who works in
delivering healthcare. Change has
come thick and fast and I hope that
we illustrate in this document how
BMI Healthcare is a flexible, responsive
organisation capable of adapting swiftly
to change while continuing to pursue
our core strategy.
Whilst two thirds of our work by case
volume remains private, one third is now
National Health Service (NHS), so it
was reassuring that we were fully
prepared for the fundamental changes
to commissioning that came into force in
April. After all the contentious politics
that preceded the transition, in practice
there were no major issues and the
changes occurred smoothly. BMI
Healthcare will continue to support
the NHS, not least through our successful
strategy to increase the acuity of the
publicly-funded work we do, delivered
for patients at the same price as an NHS
trust would charge commissioners. There
remains some political uncertainty with
the election just over a year away, and it
will be interesting to see what the parties’
manifestos have to say on health and how
it will be delivered in future.
The Francis report, which laid plain
the unacceptable and tragic failures at
Mid Staffordshire NHS Foundation Trust,
was a wake-up call for everyone involved
in UK healthcare, public or private,
commissioner or provider. No one in
the health world can be complacent;
and while 98% of our patients rate their
overall care as very good or excellent, the
issues highlighted by the Care Quality
Commission (CQC) at our BMI Mount
10
Alvernia Hospital in Guildford in early 2013
were entirely unacceptable. In response,
with a strengthened hospital management
team supported by our national experts,
dedicated staff and consultants, we turned
the hospital around in short order and
the CQC has now confirmed formally
that BMI Mount Alvernia meets all the
required standards. But Francis and the
CQC Mount Alvernia report also led us
to check standards in our other hospitals
and to make some adjustments to our
regional and corporate clinical governance
structures to try to ensure that no BMI
Healthcare hospital can let standards slip.
The message from both episodes is clear
– providing high quality patient care must
always remain our priority.
Of course we do not operate in isolation
from the general economy, which
remained subdued for most of 2013,
although there were some positive signs
of life emerging in the second half of
the year that could herald firm, sustained
growth in both the number of lives
covered by private medical insurance
and demand for self pay treatment.
Yet despite all these challenges, BMI
Healthcare has returned solid results
showing growth in revenues and profits.
This was in large part based on the success
of our core strategy to raise the acuity of
what we do, a direction we will continue
to pursue in 2014.
Our focus on operational efficiency and
cost rationalisation was also important,
allowing us to invest £40m in our estate
of 66 hospitals and walk-in centres.
Completing an extension to our debt
facilities in August – which was supported
by over 90% by value of our banking
syndicate - provides the group with better
short term certainty and longer term
stability, and we have continued to attract
and retain 6,500 consultants offering
115 specialities who choose to practise
in BMI Healthcare hospitals.
This year we also changed our branding
to better represent what we stand for
and in this annual report we have tried
to capture a number of case studies
that really spell out what we mean when
we say we are “serious about health,
passionate about care”. This articulates
our entire purpose, the reason we come
to work every day; to provide high quality
healthcare to our patients.
It is the threat to our patient offering
that makes us determined to ensure that
the Competition Commission, which at
the time of writing is nearing the end of
its investigation into private healthcare,
does not unintentionally undermine
the independent sector. Whilst we
recognise that some of its provisional
findings published in August are
sensible – notably on the need for better
information for patients and on consultant
incentives – a number are ill-conceived.
The Commission’s analysis is flawed but
we are determined to help it better
understand the market so that its final
prescriptions, due in the spring, do not
damage patient interests.
I hope that when you read this annual
report, and especially the patient
stories, you get a tangible sense of what
BMI Healthcare is all about and how,
if we continue to focus on providing the
highest quality care to our patients,
we can look forward to another year of
success in 2014.
Thank you,
Stephen Collier
Group Chief Executive
11
STATEMENT
CRAIG LOVELACE
Chief Financial Officer
BMI Healthcare delivered
growth in underlying
trading and EBITDA in the
2013 business year, despite
continued challenges in
the UK economy, ongoing
uncertainty arising from
the implementation of
reforms to the NHS and
a significantly enhanced
level of regulatory focus
on the wider private
healthcare sector from the
Competition Commission.
Group revenue from continuing
operations was £851.3 million for the
year, 2.1% ahead of prior year, and group
EBITDA (earnings before interest, tax,
depreciation and amortisation, after rent
payable, but before non-recurring costs)
grew by 14.5% to £56.9 million.
The company saw an overall decline of
1.9% in its caseload compared to the prior
year. This was driven by a continued fall in
private medical insurance (PMI) case
volumes, largely offset by continued
growth in NHS caseload, primarily
NHS Choose & Book activity.
Following growth in the first half of the
2012 financial year, self-pay volumes again
declined through the second half of 2012
and throughout 2013. Self-pay volumes
are heavily influenced by consumer
confidence in the wider economy and,
more widely, waiting list times within
the NHS. The continued self-pay
challenges in 2013 therefore reflected a
continued suppressed level of consumer
confidence, despite some recent
more positive economic sentiment
from the UK.
EBITDA margin grew from 6.0% to 6.7%
in the year, mainly as a result of increases
in case complexity, a reduction in the
rate of the shift from inpatient to day
12
cases, and continued focus on operational
efficiency and cost rationalisation
programmes. These more than offset
the impact of the continued increase
in lower-margin NHS volumes and
year-on-year reductions in NHS tariff.
Capital expenditure (including intangible
assets) amounted to £39.8 million (2012:
£41.2 million), relating mainly to projects
initiated in the year and spending on
enhancing the quality of the existing
hospital portfolio.
In August 2013, BMI Healthcare took
advantage of its strong balance sheet,
efficient working capital management
and the favourable capital markets to
complete an “amend and extend” of its
existing debt. This comprised the early
repayment of c.£45 million of debt which
had been due in October 2013 and the
prepayment of a further £15 million of
debt due in October 2014 and 2015.
In addition, the remaining debt repayment
profile was amended with c.30% of the
amounts due for payment in October
2014 and 2015 extended by 30 months
and c.40% extended by 36 months. Some
90% of lenders gave their support to
the deal. The remaining gross bank debt
at year-end was £145.9 million, down
from £222.5 million at 30 September
2012. Net debt at 30 September 2013
was £90.9 million (2012: £92.5 million).
BMI Healthcare continues to meet all
financial covenants pertaining to its
debt facilities.
The successful execution of the amend
and extend arrangement was further
evidence of our proactive approach to
balance sheet and financial management.
With the repayment of a substantive
balance of our gross debt, it has created
a step-change to a more efficient capital
structure and reduced debt service
costs, all providing longer term stability
and short term certainty.
These are solid results delivered in a
market that remains difficult. Growth in
underlying profits and EBITDA reflects
our continued focus on operational
efficiency, clinical effectiveness and cost
rationalisation programmes. It also shows
early delivery against our stated strategy
of driving up case complexity, including
in our NHS work, which now accounts for
one third of our caseload. We continue to
reinvest in the business, as we have done
for the last six years, with no dividend
having been paid to our shareholders since
they bought BMI Healthcare in 2006.
Craig Lovelace
Chief Financial Officer
13
The healthcare market & health policy in 2013
Healthcare continues to be a
high profile sector given the
importance of the service to
the population of the UK.
Reforms within the NHS have
prompted a political debate
about NHS-commissioned
healthcare. Overlaying this,
fiscal and economic
pressures have added their
own challenges to healthcare
delivery, particularly in the
current era of increased focus
on quality of service. It is clear
that the high profile of the
health sector will be maintained
in 2014 as we enter the run
up to the next election.
The political and regulatory environment for health
In his March 2013 budget, the Chancellor of the Exchequer reiterated the Government’s
commitment to protecting the NHS budget, stating that funding for health in
England will remain frozen in real terms for an additional year (up to March 2016).
Given underlying increases in demand, this settlement is predicated on the NHS
being able to generate sufficient cost-efficiency gain to offset that increasing demand.
Although at a headline level the NHS appears to be achieving its efficiency targets,
both the National Audit Office1 and Health Select Committee2 have raised
concerns about the sustainability and quantum of that efficiency gain. If continuing
cost efficiencies cannot be delivered year on year, the consequence of flat real-terms
budgets will be to create a sizeable gap between funding and demand, and potentially
longer waiting times or even decisions not to treat. A number of informed
commentators3 have already set out the scale of the potential challenge. How the
NHS chooses to address this could affect BMI Healthcare in a number of ways.
In parallel, on 1 April 2013, the structures established under the Health and Social
Care Act 2012 came into being, formally introducing new commissioning and regulatory
arrangements for the NHS in England, including:
nn
The abolition of Primary Care Trusts and Strategic Health Authorities
nn
Changes to commissioning arrangements – NHS England (formerly The NHS
Commissioning Board) and Clinical Commissioning Groups (CCGs) becoming
responsible for commissioning the majority of NHS services, with local authorities
taking on new public health commissioning responsibilities
nn
Changes to system regulation – Monitor, the independent regulator for NHS
foundation trusts, has assumed this role for all NHS-funded services, including those
provided by private hospital groups, with all remaining NHS trusts expected to
become NHS foundation trusts within the next few years.
Competition Commission
The Competition Commission has been undertaking an investigation into private
healthcare. In August 2013 it issued its provisional findings and notice of possible
remedies, with a final report due by April 2014.
BMI Healthcare welcomed some aspects of the Commission’s provisional findings,
such as clarity on the relationships between consultants and hospitals, and the call
for greater transparency of pricing and quality data. We agree that if a sector-wide
approach could be mandated these changes would benefit patients. BMI Healthcare
is already working towards achieving a number of these.
However, we regard a number of the Commission’s provisional findings as incorrect,
being based on a flawed analysis of the real costs of providing high quality private
healthcare. We fundamentally dispute the Commission’s assertions that BMI Healthcare
exercises market power in negotiations with private medical insurers, and makes excess
profits at the expense of patients.
The Commission’s notice of possible remedies included restrictions on the way in which
private healthcare providers can negotiate prices with insurers as well as possible
requirements for certain private healthcare groups to divest themselves of some
hospitals. BMI Healthcare continues to assess the potential impact that all the potential
remedies could have on the company including on its future financial performance.
There is significant uncertainty about the eventual findings and any associated remedies.
However the directors acknowledge that in certain scenarios the potential remedies
could have a material impact on BMI Healthcare.
We continue to respond robustly to the provisional findings and notice of possible
remedies to help the Commission better understand the market for private healthcare.
Should the Commission’s final findings fail to appropriately address the flaws in
its arguments, BMI Healthcare will defend its position against any unnecessary or
disproportionate remedies, considering all options available to it.
The general economy
For most of 2013 the wider economy remained subdued and the recovery fragile
and focused in the south. Only in the second half of the year were there signs of
any material pick-up. Although output, pay and employment grew, real household
disposable income lagged. Most commentators predict faster GDP growth in 2014,
albeit still restrained to some extent by the slower growth in real disposable income.
Private healthcare market overview
There has been no significant change in the key players in the private sector, with
BMI Healthcare remaining the largest private provider by scale and network with
66 hospitals and walk-in centres.
The main activity of the private acute medical care sector is still elective surgery.
Private payers (comprising three broad groupings: those with private medical insurance;
those with non-insured medical expenses schemes run by some employers; and those
choosing to pay out of their own pockets) remain the principal source of funding,
accounting for an estimated 72%4 of the sector’s revenues.
Private payers
NHS referrals
72%
Private acute medical care
– sector revenue breakdown
4%
Percentage of NHS work
carried out in private hospitals
An estimated 28% of the sector’s revenues are derived from patients referred by the
NHS (either directly by GPs under the Choose and Book system, or indirectly by NHS
trusts and foundation trusts). Despite the significant growth of NHS outsourcing to
the private sector, the NHS’s own hospitals remain by far the main supplier of
surgical services to NHS commissioners. In fact of all NHS commissioned patient care
episodes recorded in the Hospital Episodes Statistics (HES) database, only some 4%
are treated in a private hospital. However, in some specialties such as orthopaedics
the percentage is over 14%.
http://www.nao.org.uk/report/progress-in-making-nhs-efficiency-savings/
http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/
news/nhs-efficiency-savings-report/
3
http://www.nuffieldtrust.org.uk/sites/files/nuffield/121203_a_decade_of_austerity_full_report_1.pdf and http://
www.nuffieldtrust.org.uk/blog/houston-we-have-problem
4
Source: Laing and Buisson, Private Acute Medical Care, 2013
1
2
14
15
The healthcare market & health policy in 2013 (continued...)
Private Medical Insurance
The market for private medical insurance (PMI) remained difficult in 2013, with
consequent knock-on impact on BMI Healthcare’s insured caseload. Although the
numbers of lives insured is reported to have stabilised after consecutive years of falls,
BMI Healthcare continued to see a decline in the number of PMI cases treated in 2013
(although as indicated below this was largely offset by increasing amounts of NHS
work). The second half of the year showed a slowing of the rate of decline in PMI
caseload, potentially implying that the bottoming of the insured population may be
beginning to feed through into caseload trends. However, with the number of lives
insured in the UK still close to the lowest level for more than 20 years it remains too
early to call the bottom of the insured caseload market. Despite the reported
standstill in the numbers of those with PMI, we believe that insurers’ current claims
management practices and an increasingly younger insured population will continue
to negatively impact PMI caseload volumes for the foreseeable future.
Self-pay patients
Following growth in the first half of 2012, self-pay caseload has throughout 2013
continued the decline experienced in the second half of 2012. Self-pay caseload is
heavily influenced by consumer confidence in the wider economy and the current
trend reflects a continued depressed level of confidence, despite some recent more
positive economic sentiment. BMI Healthcare continues to carefully monitor waiting
times – another significant factor in self-pay volumes – as the NHS experiences
continued financial constraints and regulatory challenges.
NHS patients
Despite private payers remaining the main source of activity for BMI Healthcare,
caseload referred from the NHS has been rapidly increasing, from less than 5% of
BMI Healthcare’s caseload a decade ago to over a third in 2013. The independent
sector is still experiencing growth in the amount of its NHS-referred caseload and
has seen significant change in the interactions between it and the NHS. At both a
local and central level, BMI Healthcare has been working constructively with NHS
bodies to find solutions to NHS delivery challenges.
Financial & Trading Review
BMI Healthcare achieved
growth in underlying
trading in 20131, despite
the continued challenges
in the UK economy, ongoing
uncertainty arising from
the implementation of the
reforms to the NHS, and an
enhanced level of regulatory
focus on the wider private
healthcare sector from the
Competition Commission.
Trading
Revenue from continuing operations grew by 2.1% to £851.3 million for the year (2012
£834.1m), driven by increased complexity levels in the cases undertaken, particularly
in NHS referred work, and demonstrating the success of our strategy to focus on
high acuity work.
Actual caseload volumes fell by 1.9% compared to the prior year. This reflected a
continued fall in private medical insurance (PMI) volumes, largely offset by continued
growth in NHS caseload, primarily NHS Choose & Book activity. The second half of
the year showed a slowing of the rate of decline in the PMI market. The number of
lives insured in the UK is reported to have increased marginally in 2012, after reaching
the lowest level for more than 20 years in 2011. It remains too early however to call
the bottom of the market, and whilst some signs may point to a muted improvement
in underlying metrics, current claims management practices and an increasingly
younger insured population continue to negatively impact PMI caseload volumes.
Following growth in the first half of 2012, self-pay volumes have continued the decline
experienced in the second half of 2012 throughout 2013. Self-pay volumes are heavily
influenced by consumer confidence in the wider economy and this performance
reflects a continued suppressed level of confidence, despite some recent more positive
economic sentiment. BMI Healthcare continues to carefully monitor waiting times
– another significant factor in self-pay volumes – as the NHS experiences continued
financial constraints and regulatory challenges.
EBITDA (earnings before interest, tax, depreciation and amortisation) from continuing
operations (after all rent payable, but before non-recurring costs) grew by 14.5% to
£56.9 million. The EBITDA margin improved slightly from 6.0% to 6.7% in the period.
This reflected the greater complexity of the caseload in the year – a core part of our
underlying strategy – as well as the impact of programmes undertaken to improve
operational efficiency and control costs.
Whilst BMI Healthcare believes that its NHS caseload will continue to grow in the
run up to the general election in May 2015, the level of growth beyond that point is
less certain. Outsourcing of NHS healthcare delivery is still at a relatively early stage
compared to social care, and is potentially vulnerable to both NHS funding pressures
and political decisions to prefer public supply through NHS trusts and NHS
foundation trusts.
1. All years cited are BMI Healthcare financial years, i.e. October 1 to September 30, unless otherwise stated.
16
17
Financial & Trading Review (continued...)
Financial
In August 2013, BMI Healthcare completed an amend & extend of its existing debt.
This comprised the early repayment of c£45 million of debt which had been due in
October 2013 and the prepayment of a further £15 million of debt due in October
2014 and 2015. The remaining debt repayment profile was amended to remove the
£80 million repayments due in both October 2014 and 2015 and replace these with
a more measured and stable repayment profile of c£22 million in each of 2015 to
2018 and a final repayment in 2019.
As a result of the amend & extend transaction and other scheduled loan repayments in
the year, BMI Healthcare reduced its gross bank debt to £145.9 million at the year
end, down from £222.5 million at 30 September 2012.
At the same time as the amend & extend, BMI Healthcare elected to pay £7.7 million
to reset the interest rate on its ‘out of the money’ swap to a fixed rate of 0.63%
(previously 5.05%).
Overall net financial expenses increased to £19.2 million (2012: £14.7 million).
This increase reflected the swap reset cost noted above which was partially offset by
the reduced interest cost following the scheduled repayments during the year and the
reduced debt level and interest rate following the amend & extend and swap reset.
The tax charge in the year was £1.8 million (2012: £1.3 million credit), the change
largely related to movements in deferred tax resulting from the enactment of the
corporation tax rate change in the year.
BMI Healthcare recorded an overall loss after tax for the year of £45.1 million (2012:
£48.6 million – on a like for like basis, excluding £28.6 million profit from the trading
and sale of discontinued operations in 2012).
Financial Highlights
Results from continuing
operations £m
30 Sep 2012
30 Sep 2013
% change
Revenue
834.1
851.3
2.1
EBITDAR
201.2
208.9
3.8
EBITDA (before GHG
PropCo rent but after
other rental charges)
183.6
193.2
5.2
GHG PropCo rent charge
(133.9)
(136.3)
EBITDA
49.7
56.9
14.5
EBITDA after
non-recurring costs
42.7
46.9
9.8
Operating profit (including
share of associates profits)
(7.4)
1.0
EBITDAR margin (%)
24.1
24.5
EBITDA margin (%)
6.0
6.7
nn
Revenue per inpatient 56.7%
and day case 54.0% reflecting
5% increase in complexity
nn
Caseload 61.9% on weaker
private volumes, offset by
8.6% NHS growth
nn
PMI 56.5%, NHS 32.2%,
Self pay 11.3%
Inclusive of significant legal
and refinancing costs
Operating profit improved via
enhanced acuity, operational
efficiency and cost rationalisation
Widening margins despite
NHS increase in contribution
to caseload from 29.1% to 32.2%
0.1
Operating profit margin (%)
These results exclude the non-cash accounting charge relating to the straight-lining future fixed rental uplifts
However, after adding back the non-cash rent straight lining accounting charge of £24.7
million (2012: £28.8 million), non-recurring costs of £10.0 million (2012: £7.0 million)
and the one off swap reset cost of £7.7 million (2012: £nil) the result would show
a loss after tax of only £2.7 million (2012: £12.8 million loss).
£851.3m
Net debt, including finance leases and deducting cash on hand, was £89.8 million
at 30 September 2013, down marginally from the prior year and reflecting the
debt repayments as part of the wider amend and extend transactions.
Revenue 30 September 2013
(+2.1%)
£834.1m
Revenue 30 September 2012
Caseload by payor group
For a second successive year, working capital continued to be tightly controlled
and the improvements over the prior year were sustained during the period.
Closing cash balances were solid at £49.2 million compared to £142.6 million at
30 September 2012. This was predominantly due to debt repayments of almost
£77 million in the year and the £7.7 million payment to reset the interest rate
swap. In addition, during the year significant expenses have been incurred as part
of the Competition Commission process.
+6.7%
+4.0%
+5.0%
Revenue per
inpatient
Day cases
Increase in
complex cases
1.9%
BMI Healthcare continues to meet all financial covenants on debt facilities.
+8.6%
PMI
18
NHS
Self-Pay
Caseload
NHS cases
19
Financial Highlights (continued...)
Rent charges
EBITDAR
before all rent
but after other
rental charges
2013
£208.9m
£201.2m
2012
2012
£151.5m
2013
£152m
0m
100m
200m
+3.8%
EBITDA
EBITDAR margin
2012
2013
£56.9m
£49.7m
2012
2013
+14.5%
0%
24.1%
24.5%
25%
50%
Widening margins despite NHS increase in contribution to caseload from 29.1% to 32.2%
EBITDA margin
EBITDA
after non-recurring costs
2012
2013
£46.9m
+9.8%
£42.7m
2012
6%
2013
0%
6.7%
5%
10%
Figure is inclusive of significant
legal & refinancing costs
20
21
SERIOUS
ABOUT HEALTH
Financial & Trading Review (continued...)
Investment
BMI Healthcare continued to invest in its infrastructure and facilities, with capital
additions amounting to £40 million (including finance leases, 2012: £41 million), relating
mainly to projects initiated in the year and spending on enhancing the quality of the
existing hospital portfolio and providing advanced diagnostic and other equipment
for patients. Details of major in-hospital capital investments can be found elsewhere
in this document. In addition, the in-house developed PeopleSoft IT system was
completed during the year and rolled out successfully to 50 hospitals, with training
provided to 5,500 staff. PeopleSoft provides BMI with an integrated solution covering
patient administration, charging and billing, pharmacy dispensing, stock control, ward
and theatre management, procurement and financials. The roll out has progressed
smoothly with minimal disruption, on budget, and is expected to be substantially
complete across our network by the end of calendar year 2013.
£40m
2013
Infrastructure
investment total
The year ahead
The recovery in the UK economy remains predominantly focused geographically
on the south at the present time, and outside of this area continues to be muted.
Notwithstanding positive economic messages, consumer incomes and confidence
remain subdued. Coupled with continued underlying economic budgetary constraints,
structural uncertainties in the NHS and continued constraints in the PMI market,
the next 12 months are anticipated to remain challenging for BMI Healthcare.
Whilst the findings of the Competition Commission’s market investigation into private
healthcare remain provisional in nature at this point, their potential ramifications could
also be significant for the independent healthcare sector and will further compound
wider market headwinds in the coming year.
However, with multi-year contracts in place with the majority of PMIs, early signs
of stabilisation in some parts of that market and continued growth in acuity,
particularly in NHS referrals, we remain cautiously optimistic about the medium
and longer term prospects for the business.
22
5,500
2013
Staff trained to use
PeopleSoft across 50 sites
CASE STUDY
John Carmichael
Radiology Manager,
BMI Woodlands Hospital
Without John’s
clinical expertise and
knowledge, this patient’s
condition could have
quickly deteriorated.
John’s quick thinking and tenacity may
well have saved a man’s use of his legs,
if not his life.
When a patient arrived at the hospital
one Friday afternoon for an MRI scan on
his lower back, John noticed something
untoward and asked for a second opinion.
A member of the physio team assessed
the patient and confirmed John’s suspicion
of a very serious back problem, specifically
Cauda Equina Syndrome. As the
physiotherapist confirmed, “You hope to
see this condition no more than 10 times
in your entire career.”
John immediately assumed responsibility
for supporting the patient. First he
attempted to contact the patient’s
consultant who unfortunately was out
of the country. Knowing that the patient
could not afford to wait, John contacted
the A&E Department at James Cook
University Hospital in Middlesbrough
to explain the findings and agree an
appropriate course of action.
Just over 24 hours later John received a
phone call from the patient confirming
that he had undergone very successful
emergency lumbar decompression
surgery and was in recovery.
Without John’s clinical expertise and
knowledge, this patient’s condition could
have quickly escalated to an inoperable
level. For the outstanding care he provided,
John was recognised with a BMI
Healthcare “Above & Beyond” award.
24
Major capital investments
BMI Healthcare made almost
£40m in capital investments
in the year, including the
major projects listed below.
The opening of BMI Thornbury
Hospital’s Aquilion Prime CT scanner.
North Region
Central Region
South region
BMI The Alexandra Hospital
BMI The Priory Hospital
BMI Mount Alvernia Hospital
In 2013 BMI The Alexandra in
Manchester completed a £1.2m
investment in its flagship radiology unit.
The bulk of the investment – £1m –
was for a new SPECT/CT scanner for
its nuclear medicine service, a specialty
that involves administering a small amount
of a radioactive medication into a patient to
deliver a more accurate, focused diagnosis
and treatment. The remaining £200,000
was invested in digital mammography,
which allows for faster examination of
patients and will work hand-in-hand with
the new scanner to deliver women with
a more accurate diagnosis.
The latest development follows an £8m
refurbishment and service upgrade at the
hospital over the last two years, which
included the launch of a new oncology
unit, a minor injuries unit, and state-ofthe-art operating theatres.
BMI Thornbury Hospital
BMI The London Independent Hospital’s
improved outpatients facilities.
The site in Sheffield this year unveiled its
high specification Aquilion Prime 160-slice
CT scanner, a latest generation scanner
which incorporates cutting-edge
technologies that ensure high-quality
images for best possible diagnosis with the
lowest possible level of radioactivity
exposure. The £750,000 scanner helps
the hospital streamline increasing demand
and reduce scan times for patients, and also
upgrades the cardiac diagnostic capabilities
of the hospital’s radiology department.
BMI The Priory Hospital in Birmingham
underwent a £1.8m refurbishment
programme that reaffirms its position as
the market leader for private healthcare
in the West Midlands. The development
encompassed a complete refit of two
wards to enhance the patient pathway.
The oncology inpatient ward was
completed in the first half of 2013,
followed by the cardiac ward, featuring
high specification cardiac monitoring
systems to support increasing volume
and complexity.
BMI The Park Hospital
A £1.4m development to install a high
specification MRI scanner was completed
during the final quarter of 2013. The new
equipment’s additional capability enables
BMI The Park Hospital to offer such
services as liver scanning and neurological
perfusion scanning to support the
growing service to oncology patients in
the Nottingham area provided by the
hospital’s joint venture with Cancer
Partners UK.
London
BMI The Blackheath Hospital
Work has recently begun to complete
a £2.1m refurbishment of the operating
theatres and recovery area. Once it is
complete in March 2014, the hospital will
have three new theatres and six recovery
beds allowing this busy London hospital
to support increased acuity and capacity.
BMI The London
Independent Hospital
The hospital recently completed a
£350,000 project to increase its outpatient
consulting facilities from 12 to 23 rooms,
providing capacity to meet the demand
for accommodation from consultants
keen to provide services at the Stepney
Green hospital.
26
The Guildford hospital has benefited from
a £1.45m investment in its oncology
ward, including a refurbishment of nine
patient rooms and en-suite bathrooms,
the creation of a dedicated chemotherapy
suite with six new “pods” for chemo
delivery, two new consulting spaces, specific
rooms for counselling and complementary
therapies, and refurbishment of the waiting
area. BMI Mount Alvernia has also added
a radiotherapy service in partnership with
Cancer Partners UK, utilising a new
Elekta Versa radiotherapy system.
Decontamination
During the year, four BMI Healthcare
units – BMI Bath Clinic, Somerset, BMI
The Harbour Hospital in Poole, Dorset,
BMI Mount Alvernia Hospital in
Guildford, Surrey, and BMI The
Runnymede Hospital in Chertsey, Surrey
– relocated their decontamination into
off-site facilities. Two further hospitals
– BMI Kings Park Hospital in Stirling,
Stirlingshire, and BMI St Edmunds
Hospital, Bury St Edmunds, Suffolk,
transferred their decontamination
services from third party providers
into BMI Healthcare’s Regional
Decontamination Centres. A total of
£2.8m was invested in providing surgical
instrumentation and for the associated
upgrade of the hospitals.
JAG Endoscopy
BMI Goring Hall Hospital’s
refurbished imaging reception
BMI Goring Hall Hospital
This year the hospital in Goring-by-Sea
completed a £450,000 refurbishment
of its imaging department, creating an
expanded waiting area, and relocated
their recently acquired full-field digital
mammography machine. The project also
integrated the CT and MRI service into the
department and provided a high quality
waiting and reception area.
BMI The Hampshire Clinic
Phase 1 of a £5m development
and refurbishment programme at BMI
The Hampshire Clinic, Basingstoke, was
completed with a new £2.5m imaging
department, a joint venture between BMI
Healthcare and Alliance Medical.
The £3.4m JAG Endoscopy Programme
investment forms the first phase of a
five to seven year programme to enable
hospitals to provide JAG (Joint Advisory
Group on gastrointestinal endoscopy)
accredited services, and to enhance the
technology available for consultants with
the latest Olympus and Pentax equipment.
The investment to date has been focussed
on eight hospitals. Three have benefited
from investment in equipment (BMI The
Esperance Hospital in Eastbourne, East
Sussex, BMI Sarum Road Hospital in
Winchester, Hampshire, and BMI The
Blackheath Hospital in London); five others
have benefited from investment in building
infrastructure (BMI The Chiltern Hospital
in Great Missenden, Buckinghamshire,
BMI The Droitwich Spa Hospital in
Worcestershire, BMI Ross Hall Hospital
in Glasgow, BMI The Alexandra Hospital in
Manchester, and BMI The Cavell Hospital
Full-field digital mammography
in Enfield, Middlesex).
Full-Field Digital Mammography
Five sites have benefited from investment
in full-field digital mammography, each
receiving the latest technology supplied
by Siemens, which can include options for
stereotactic biopsy and tomosynthesis
imaging. A total of £1.2m has been
invested in the new equipment and the
necessary building infrastructure to
support the upgrade. The hospitals in
the programme are BMI Chelsfield Park
Hospital in Orpington, Kent, BMI Bishops
Wood Hospital in Northwood, Middlesex,
BMI Shirley Oaks Hospital in Croydon,
Surrey, BMI The Kings Oak Hospital in
Enfield, Middlesex, and BMI The Alexandra
Hospital in Manchester.
27
Maximising operational efficiencies – the BMI Way
BMI Healthcare recognises
the long term benefits that
a sustainable culture of
continuous improvement
can provide, and this year
embarked on a journey
to nurture excellence and
best practice which we call
“The BMI Way”.
The BMI Way encompasses a defined way of working based on a philosophy
of continuous improvement where our people analyse their working habits and
practices on a daily basis and ask themselves the question: ‘how could I do my
job in a better way today?’.
Impact and results
The BMI Way is positively reinforced every day through the application of five
core principles:
nn
The development of a robust assurance framework, increasing our compliance with
standards, under which individual departments are taking active ownership for
resolution of concerns. This has led to an improvement in the handling of incidents
and complaints; the number of incidents closed within 20 days has improved by 26%
We will understand our customers’ needs better than anybody else and
deliver them better than anyone else
The BMI Way is actively empowering and enabling our people to make a difference
and helping them to focus on the things that really matter. It has delivered tangible,
significant results in 2013. Taking one hospital as an example, we have seen:
Incidents closed in
We will encourage, empower and enable our people to act to help
enhance our company, our ways of working and the patient experience
We will promote transparency of our processes and our performance
to help identify opportunities for improvement
DAYS
We will create a culture of continuous improvement through creative
problem solving at all levels and across all departments
We will continue to seek perfection recognising that The BMI Way
is here to stay
These principles can be brought to life in numerous ways; for example, ‘communication
cell’ meetings where all staff join a ten minute daily session to discuss yesterday’s
performance, the learning from yesterday that will be incorporated into today’s activity,
and a consideration of future plans. Everyone has a voice at these sessions, stimulating
an environment where concerns are dealt with in a timely manner and innovation
is accelerated, all of which promotes our ethos of ‘serious about health, passionate
about care’ in the most efficient and effective manner.
20
nn
An increased focus on care has led to patient care KPIs rising from 88% to 97.7%
and complaints regarding clinical care halving
nn
In addition to improving care, The BMI Way has also realised financial benefits
with both theatre and ward costs reducing by c.8% due to more efficient and
effective processes
Theatre & ward costs
Increased team and self-reflection on ways of working have led to all departments
critically examining their current operations and identifying and implementing
improvements. The theatre bookings team, for example, introduced ‘paperless working’,
halving their processing time and improving their ‘right first time’ quality metric by a
third. The team then turned to how to improve the quality of information they received
from consultants’ secretaries. This led to the introduction of standardised booking
forms, reducing time wasted asking for additional information from the secretaries.
The intention for the 2014 business year is to create at least one BMI Way reference
site in each of our four regions. These will become focal points for the surrounding
hospitals to ‘Go & See & Learn’ about our enhanced ways of working and experience
first-hand the benefits that can be gained, actively supporting the widespread
deployment of The BMI Way across our entire hospital network.
28
29
New treatments & services
BMI Healthcare hospitals
introduced a number
of new and improved
treatment options over
the last year, including:
Intra-Operative Radiation Therapy (IORT)
Nuclear Medicine Service
IORT has multiple benefits for patients including reduced radiation exposure to healthy
tissue and organs. IORT also eliminates the need for external beam radiation treatments
in certain selected patient groups who would otherwise have to return to hospital for
15-25 consecutive days for continued treatment. Patients can return to their normal
life and daily routines more quickly because the surgery and radiation are administered
at the same time.
Live donor transplant service
Two hospitals (BMI Chelsfield Park Hospital in Orpington, Kent, and BMI Bishops
Wood Hospital in Northwood, Middlesex) have successfully started to provide a
new single dose form of intra-operative radiation therapy (IORT) for early stage two
breast cancer patients. The new therapy is being provided by Oncotherapy
Resources Ltd, a subsidiary of Advanced Oncotherapy.
Radiotherapy centre at BMI Mount Alvernia Hospital
BMI Mount Alvernia Hospital recently opened a new radiotherapy cancer centre, the
first of its kind in Guildford, Surrey. Run by Cancer Partners UK, the centre specialises
in providing treatments such as intensity modulated and image-guided radiotherapy.
Its sophisticated equipment uses cutting-edge “linac” (linear particle accelerator)
technology to provide patients with the most precisely targeted external beam
radiotherapy treatment available for the treatment of cancer.
Complete Cytoreduction (The Sugarbaker technique)
BMI The Hampshire Clinic in Basingstoke is the only independent hospital in the UK
that provides for the assessment and treatment of pseudomyxoma peritonei (a rare
type of cancer). Treatment options include Complete Cytoreduction (also known as
the Sugarbaker technique). This involves removing the complete tumour, stripping
the lining of the abdomen known as the peritoneum and operating on the small
intestine, colon, rectum, liver, gall bladder, spleen, omentum, and, in women, the
ovaries and uterus. The abdomen is then washed out with hot chemotherapy drugs
for one hour. The average length of an operation for complete tumour removal is
10.5 hours.
This year BMI The Alexandra Hospital in Manchester introduced a new Nuclear Medicine
Service – a specialty that involves administering a small amount of a radioactive
medication into a patient to deliver a more accurate, focused diagnosis and treatment.
The service also features a new SPECT/CT scanner which reduces patients’ exposure
to radiation, and digital mammography, which allows for faster examination of
patients and will work hand-in-hand with the new scanner to deliver women with
a more accurate diagnosis.
The Human Tissue Authority has recently licensed BMI The London Independent
Hospital in Stepney Green for organ donation and transplantation.
O-Arm imaging system
BMI The Clementine Churchill has become the first hospital in the UK to use
Medtronic’s spinal O-Arm imaging system. The device improves patient outcomes
and raises the complexity of procedures offered at the hospital in Harrow, London.
The O-Arm imaging system as used at
BMI The Clementine Churchill
The O-Arm device provides surgeons with real-time, 3D images, as well as multi-plane,
2D and fluoroscopic imaging of a patient during their operation. Most spinal patients
undergo imaging procedures, such as CT scans, MRI and X-rays before surgery.
With the new imaging device, spinal surgeons can view the patient anatomy in the
operative position, monitor the status of the surgery and verify surgical changes
made during operations. The ability to obtain live, accurate images during surgery
reportedly provides a benefit to the surgeon and the patient and reduces the risk
of complications.
Following surgery, patients are nursed in the newly commissioned Level Three
intensive care unit before returning to the ward. The stay in hospital is approximately
three weeks. Patients are referred to the unit for assessment and treatment from
all over the United Kingdom.
30
31
CASE STUDY
“Traditional treatment irradiates the
whole brain. With our technology
we can keep the focus of the
radiation to the tumour”
Andras Kemeny
Andras Kemeny
Mr Andras Kemeny is the lead Consultant
Neurosurgeon for the high specification
gamma knife at BMI Thornbury Hospital
in Sheffield, one of only a handful of such
devices in the UK.
“The gamma knife is the gold standard
high-precision radiation delivery tool to
treat a very wide range of pathologies
in the brain. The conditions include
trigeminal neuralgia, a common painful
condition in the elderly, and both
benign and malignant brain tumours,”
said Mr Kemeny, President of the British
Radiosurgery Society.
“When cancer spreads to the brain, the
traditional treatment irradiates the whole
brain. With our technology we can keep
the focus of the radiation to the tumour,
avoiding the damage, including dementia,
that whole brain therapy would cause.”
The gamma knife can also treat less
common conditions, for example acoustic
neuroma, which usually presents with
one-sided hearing loss, tinnitus or balance
problems. Traditional treatment for that
tumour is a complex operation lasting
up to ten hours; using the gamma knife,
Mr Kemeny can perform the surgery as
an outpatient procedure.
“The unit at Thornbury treats both
insured and self pay patients but also now
there is a contract for NHS patients
to be able to access the benefits of the
treatment,” added Mr Kemeny. “Both
the gamma knife team and the ward
staff provide a fantastic environment
for patients.”
32
GP & Consultant Relationships
BMI Healthcare’s ability
to offer patients the
greatest choice and quality
is reliant on the strength
of our relationships with
GPs and consultants.
Our strategy continues to focus on these key relationships and we have a
multi-disciplinary group of senior managers to highlight areas for improvement in our
engagement and discuss relevant topics in a timely fashion. The group met regularly
throughout 2013, encouraging and supporting our hospitals’ relationships with
consultants and GPs.
Consultant relationships
Each hospital has a Medical Advisory Committee (MAC), made up of representatives
from different specialities, which meets monthly or bi-monthly to discuss clinical
issues, nursing, and other hospital matters. To encourage further collaboration, BMI
Healthcare hosts an annual NMAC (National Medical Advisory Committee) meeting
where the chairs of each MAC are invited to discuss clinical issues and participate in
workshops with senior group management to discuss hospital issues. The most recent
NMAC was held in June 2013.
BMI Healthcare provides all consultants (and local GPs) with an opportunity to discuss
issues with Executive Directors and Regional Directors at an Annual General Meeting
at their local hospital, where management are available to answer questions, feedback
on the performance of their hospitals, and explore opportunities to develop
services for the local community. BMI Healthcare continues to support individual
consultants with development of their private work by carrying out formal business
reviews to enable Executive Directors and individual consultants to talk about patient
caseloads, new procedures, timetabling, specialist staff, equipment or facilities. We
include data on clinical measures and outcomes for individual consultants as part of
these reviews.
BMI Healthcare supports the annual appraisal and revalidation of all consultants and
has additional responsibility for those consultants who have a Prescribed Connection
with us who work entirely in private practice, either mostly or solely in BMI Healthcare
hospitals. We have designated Professor Duncan Empey as our Responsible Officer for
this group of nearly 300 consultants. We have introduced an IT-based appraisal and
revalidation management system, together with a scheme to allow feedback from a
variety of sources to support the processes for all of these colleagues. For the majority
of our consultants who have a Prescribed Connection with an NHS Designated Body
(usually an NHS trust), BMI Healthcare will routinely provide all consultants with data
on their activity levels, any complications and other information on their practice
which is available, for them to submit as part of their supporting information for
their annual appraisal.
We remain committed to encouraging a two-way communication with our consultants.
Since last year, we have extended the Consultant Reference Group (CRG) to include
representatives from the majority of the specialties active in our hospitals. This group
meets two to three times a year to discuss topical issues and to advise senior managers
at BMI Healthcare on issues of best practice and future strategic direction.
Our annual consultant survey remains a key tool in understanding how our consultants
feel about both BMI Healthcare as a whole and our individual hospitals, and is used
to assess which areas they rate as our strengths or weaknesses. Results from the
consultant survey are discussed in detail by BMI Healthcare’s Leadership Team, with
34
35
PASSIONATE
ABOUT CARE
GP & Consultant Relationships (continued...)
individual hospital results fed back to Executive Directors for action.
GP relationships
A nationwide team of Primary Care Managers (PCMs) ensure that GPs and their teams
are fully informed of developments in our services and also the wider clinical field. By
travelling to GP surgeries, PCMs are able to spend time with practice staff to understand
where they can be of assistance; this often results in new training programmes
for practical developments such as the NHS Choose and Book system and
mandatory training subjects.
Revalidation is necessary for all GPs, who must undergo continual professional training
in order to stay abreast of clinical developments and retain their rights to practice.
The PCMs work closely with consultants to bring educational meetings to GPs’ practices,
enabling them to participate in continued professional development (CPD) activities
to earn accreditation points towards their revalidation. These ‘Lunch and Learn’ sessions
have proven to be very popular, partly due to the convenience of being able to attend
seminars at their own practice.
In addition to the Lunch and Learn programme, local area GP tutors run educationallyrelevant meetings according to GP need within our hospitals. These regular
consultant-led GP education events are free and open to GPs throughout the country.
Over the year GPs have earned thousands of CPD points towards revalidation through
BMI Healthcare education initiatives. GPs are also able to reflect on this learning
and implement the knowledge gained in practice, making a real difference to their
patients’ care.
In some parts of the country, our hospitals host large educational symposia, attended
by hundreds of GPs keen to take advantage of a day of lectures and learning from
senior consultants within various specialties. Each location’s symposia is adapted by
the local GP tutors to ensure that the day meets the needs of local practices.
Each year, every hospital publishes a directory of consultants in print and online to
aid GPs when making referrals. Over 60,000 copies are delivered to GP’s surgeries.
Many of the consultants listed in these directories are also on hand to support GPs
with queries around when it is clinically appropriate to refer patients.
The BMI Healthcare website has a separate section for GPs with downloadable
consultant directories, referral information, and online capability for referring to
consultants, physiotherapy, imaging and pathology services.
For those who prefer the telephone, the GP Hotline is a dedicated service with a
Freephone number, email address and fax number for GP surgeries to refer private
patients to a BMI Healthcare hospital. Our GP Hotline advisors are specifically trained
to receive dictation from GPs and issue referral letters on behalf of their practice. The
letter is typed and faxed or emailed through to the practice for approval. The team
then contact the patient within one hour of the referral being received to arrange a
suitable time and date for an appointment with the consultant. A confirmation of the
appointment and referral is then sent to the GP.
36
CASE STUDY
Sammy Messadh
Porter at BMI The London Independent Hospital
When Sammy met a long term patient
who was being treated for injuries
sustained in the unrest in Libya, the porter
at BMI The London Independent Hospital
happily offered his services as translator,
but also extended the hand of friendship.
Sammy visited him every day, without
fail, for nine months. Such prolonged
separation from friends and family was
not easy for the patient and Sammy took
great pains to make life a little more
bearable. He brought in familiar food
from the patient’s home country and
over time struck up a great friendship
with the patient.
Sammy’s thoughtfulness extended beyond
care in the hospital; for the patient’s
birthday he and a number of his
colleagues organised a trip to the London
Eye followed by a celebratory dinner.
For his fine example of outstanding patient
care Sammy (centre) was awarded the
BMI Healthcare Carer of the Year Award
in November 2012, presented by CEO
Stephen Collier and Olympic rowing gold
medallist Sophie Hosking.
38
Our People
To support our mission to
make BMI Healthcare a great
place for great people to
work, we continue to focus
on the five pillars of the
strategic human resources
(HR) roadmap: talent,
performance, engagement,
workforce management and
HR service excellence.
In 2013 BMI appointed a new People Director, Keith Luxon, who will play an
instrumental role in driving the people agenda.
“Developing our own staff is a key
component of our long-term
labour planning strategy”
Talent and leadership
During 2013, we developed and launched Moments of Truth, a leadership development
programme for hospital Executive Directors, Directors of Nursing and Clinical
Services, and corporate senior managers. The programme was piloted with BMI
Healthcare’s senior leadership team and began rollout across the group in August 2013.
BMI Healthcare also continued to partner with Ashridge Business School, which provides
a more extensive and formalised one-year management development programme to
high-performing hospital Executive Directors and high-potential Directors of Operations
who are earmarked as potential future hospital Executive Directors.
Our clinical talent agenda remains pivotal, as competition to attract and retain the best
highly skilled workers shows no signs of abating. Competition is also amplified as the
number of nursing degree places in the UK education landscape shrinks to match
current labour demand. In response, BMI Healthcare has redeveloped its clinical
resourcing strategy, with some notable successes in recruiting from other European
Union countries where high unemployment rates are driving skilled nurses to move
to the UK.
In addition, developing our own staff is a key component of our long-term labour
planning strategy, to be achieved through clinical skills development and offering
National Vocational Qualifications to help healthcare assistants transition to more
qualified nursing roles.
Keith Luxon, BMI Healthcare’s
new People Director
In April 2013 BMI Healthcare launched a pilot graduate theatre nursing programme
to get newly qualified nurses into operating theatres and ready to act as scrub
practitioners after an intensive training programme. The first participants completed
the programme in early September; given the success of the pilot, a wider rollout is
planned in 2014.
During 2013, 169,371 e-learning modules were delivered, up from 146,195 in 2012,
and 43,178 training days (2012: 32,080) were delivered.
40
169,371
43,178
+14%
+26%
E-Learning modules delivered in 2013.
Percentage increase over 2012 figure.
Training days delivered in 2013.
Percentage increase over 2012 figure.
41
Our People (continued...)
Performance management and driving a high performance culture
BMiLearn, our learning management system, serves as the platform for performance
tools and development plans. It supports our move to a standardised performance
management system across the business. In 2013 people in the 700 roles covered by
our Balanced Score Card system were able to view their objectives online for the
first time and complete mid-year and year end performance reviews online. In 2014
we aim to move the rest of the business on to the system.
We re-launched our staff recognition programme in October 2013, moving from the
annual gala award programme, Night of the Stars, to the more local and accessible
Above & Beyond recognition programme. This also takes into consideration patient
feedback and links to BMI Healthcare’s behavioural framework which establishes a
set of behaviours that we expect our employees to demonstrate and which are also
built into our performance management tools and bonus arrangements.
An example of employees going “Above & Beyond” was at BMI The Droitwich Spa
Hospital. Jenny Liggitt, the hospital’s Executive Director, recognised the exceptional
efforts of employees following a flood which damaged three theatres and the
outpatient department. Staff already on duty sprang into action to try limit the
damage and they were soon joined by employees not on duty who came in to
work in their own time to help out.
Engagement and insight
BMI Healthcare’s annual staff survey, BMiSay, was carried out in February and
March 2013. It was undertaken by an external provider for the first time to improve
confidentiality and provide a robust external benchmark for survey results. We scored
in the upper quartile of health and life sciences businesses.
BMI Healthcare had an extremely high response rate, with 71% of the workforce
completing the survey. Encouragingly, 91% of the workforce agreed that they were
committed to doing their best. The business has started a planning process to deal
with areas where scores were lower.
71%
91%
Response rate of workforce
completing BMiSay survey
Percentage of workforce
“committed to doing their best”
Shaping the workforce
Matching labour supply to caseload demand continues to be a priority, which is reflected
in our ongoing reliance on flexible labour. We initiated a three-year programme, BMI
Harmonise, to align and consolidate job titles, provide greater transparency of pay
bandings, and develop standardised structures across hospitals with different operating
models and sizes. We will continue to use annual pay reviews to help address reward
imbalances across clinical roles.
42
Karen Montero, Novela Merchant and Anne Bollen,
all from BMI Ross Hall Hospital Glasgow, the first to
graduate from BMI Healthcare’s 12-week scheme
to provide qualified nurses with the hands-on
experience, skills and knowledge to work in theatre
Employee turnover
2013
2012
Permanent employees at the beginning of the year
Appointments
Decreased:
Resignations
Retirements
Dismissals
Deaths
Redundancies
Other
Permanent employees at the end of the year
Annual employee turnover (%)
7791
1233
1264
957
67
74
5
112
49
7761
16.3
8376
1088
1673
1153
102
106
12
128
172
7791
22.5
Employee distribution
Employee numbers have remained largely stable during the year, decreasing marginally
by 0.4% to 7,761. This is partly in line with our approach to manage headcount down
organically by reviewing each vacancy following a resignation to ensure that, where
sensible, teams are restructured or existing staff are developed to fulfil requirements.
In addition, localised structural reviews have resulted in some redundancies.
Staff turnover decreased to 16.3% (2012: 22.5%), which reflects both our efforts to
engage staff and the continued weakness in the UK employment market, although we
have faced some challenges given renewed activity in the UK healthcare employment
market as the newly-created Clinical Commissioning Groups seek to recruit.
HR service improvement
A structural change to the HR function has been carried out to improve the balance
of workload between roles and support development for high performers. We have
also introduced an HR Projects and Business Partner role in the corporate HR team
to give greater reach and support to initiatives. The split of organisational development
from talent and learning is providing greater focus on the change management issues
flagged by staff in the BMiSay staff survey.
The delivery of HR administration is also under review, and critical steps have been
taken to implement a more efficient automated process. Our fully outsourced
electronic reference checking is already enabling more effective processing and
improved compliance.
Looking ahead
Our focus areas for the year ahead:
nn
Finalising the pensions auto-enrolment project, where every employee must
automatically be enrolled into the pension scheme
nn
Delivering the core focus on developing talent and meeting recruitment challenges
nn
Driving employee engagement and commitment across the business
43
Clinical governance
BMI Healthcare works
within a robust clinical
governance framework,
which covers standardsetting, implementation
and monitoring for all our
hospital and site activity.
The framework is overseen
by national, regional and
local clinical governance
boards and Medical
Advisory Committees.
The Francis Report – which reviewed the significant failings at Mid Staffordshire NHS
Foundation Trust – recommended that all UK healthcare organisations should consider
its findings and recommendations and decide how to apply them. BMI Healthcare
reviewed the Francis Report and its recommendations and is committed to continuing
to put patients first, making them our first priority in everything we do.
In particular, we have committed to:
nn
Continued improvement and expansion of quality metrics to support our
ongoing commitment to putting patients first and ensuring patient safety
nn
Expanding the quality metrics to corporate, regional and individual scorecards
nn
R aising awareness of these quality metrics by adding a quality dashboard for
monthly review by senior management
nn
Reinforcing clear policies and procedures for reporting concerns so that early
actions can be taken and support given to the individual to remedy the situation
nn
Reinforcing the internal whistle-blowing policy and procedure
nn
Reinforcing visible clinical leadership in all clinical departments
BMI Healthcare’s clinical governance framework
While “clinical governance” does not mandate any particular structure, system or
process for maintaining and improving the quality of care, the designated responsibility
for clinical governance exists at Board level. It is the role of the BMI Healthcare
Leadership Team supported by the BMI Healthcare Clinical Governance Board to
assure the Group Board of the quality of care in our hospitals by interpreting the
principle of clinical governance into locally appropriate structures, processes, roles
and responsibilities.
Every hospital has a Medical Advisory Committee (MAC), the membership of which
includes representatives from the majority of specialities represented in the
hospital. These committees advise hospital management on clinical standards,
consultant performance and on the granting, retention and, where appropriate, the
suspension and withdrawal of consultants’ practising privileges. They also receive
reports from the Hospital Clinical Governance Committee which in turn receives
reports from the Hospital Infection Prevention and Control and Resuscitation
Committees, and reviews all other incidents, near misses and complaints. They also
review information provided by the corporate Clinical Governance Board and
support the implementation of any changes required from shared learning.
At a regional level, BMI Healthcare has four Regional Quality Assurance Groups.
These multidisciplinary committees, which include HR and finance representation,
and are chaired by the respective Regional Directors, provide regional governance
and operational oversight, ensure cross-departmental discussion, and act as the
conduit for upward and downward communications between a hospital and the
Group Clinical Governance Board. Their responsibility is also to ensure operationally
that actions have been implemented.
At a corporate level the Clinical Governance Board is chaired by BMI Healthcare’s
Responsible Officer, assisted by the Group Medical Director. All clinical departments
are represented by the corporate leads as well as the Managing Director – Hospitals,
and the General Counsel. The Board meets monthly and reviews regulator activity,
trends and serious issues, and ratifies corporate policy, as well as monitoring
completion of appropriate action plans to address issues identified. This group arranges
regular bulletins to all hospitals to facilitate corporate learning. It in turn reports to
the Group Quality and Risk Committee, which is chaired by one of the Non-Executive
Directors and feeds into the Group Board of Directors.
Each hospital has both an Executive Director (ED) and a Director of Nursing/Clinical
Services. The former is the Registered Manager of the hospital and has overall
responsibility for the hospital’s compliance with regulatory standards. The ED is also
responsible for managing consultants at the hospital and for their practising privileges.
The Director of Nursing/Clinical Services is responsible for clinical standards and
clinical governance at the hospital with support from the hospital Clinical Governance
and Medical Advisory Committees. In some of the larger sites, this role is fulfilled
separately by a dedicated Quality & Risk Manager who supports the Director of
Nursing/Clinical Services.
44
45
Clinical governance (continued...)
Setting standards
Our standards are based on:
Hospital attributable infection rates
(June 2012-June 2013)
nn
Regulatory standards set by the Care Quality Commission (England),
Healthcare Inspectorate Wales and Health Improvement Scotland
nn
Evidence-based practice which is underpinned by appropriately-referenced
policies and procedures, including those from NICE (National Institute for
Health and Care Excellence)
nn
National guidelines, which are assessed for applicability and communicated to our
hospitals for implementation through well-established communication structures
C Diff
MRSA
1.8
NHS
nn
Information security and governance. BMI Healthcare continues to hold
ISO27001 accreditation (information security) which ensures that all patient
and other data is managed securely at all times
0
16
NHS
BMI
5.25
BMI
Rate per 100,000 bed days
Rate per 100,000 bed days
nn
O ther relevant legislation and contractual obligations, for example with
the Department of Health for provision of care to NHS patients
Monitoring performance and outcomes
Planning and driving continuous improvement requires the perpetual and consistent
measurement and monitoring of all incidents, near misses and quality outcome metrics.
In addition to the external reporting requirements in place for BMI Healthcare’s
principal regulator, the Care Quality Commission (CQC), we provide regular quality
reports to other agencies such as the Health Protection Agency and also to health
insurers whose patients we treat.
BMI Healthcare has been an active member of the Private Healthcare Information
Network (PHIN) which, as it continues to develop, will provide the opportunity for
independent providers to report as a sector and to benchmark both against each
other and against the NHS. Our performance monitoring covers the key areas of
safety, effectiveness and patient experience.
Unplanned return to theatre rate
Per 100 theatre cases
0.129
2012-2013
0.136
2011-2012
0.177
2010-2011
0
0.05
0.1
0.15
0.2
Safety: infection prevention and control
Infection rates, especially MRSA (methicillin-resistant staphylococcus aureusis) infection
rates, remain an important benchmark of quality for the media and public at large.
The Health Protection Agency has mandatory surveillance of MRSA bacteraemias
and clostridium difficile rates and BMI Healthcare continues to demonstrate the
effective pre-admission assessment and the high standard of clinical care delivered
during and after surgery in our hospitals, with not a single hospital-attributable MRSA
bacteraemia in the period June 2012 to June 2013.
Effectiveness
As medical technology and clinical quality continue to advance, the average length
of hospital stay for BMI hospital patients gets shorter. All surgery carries a risk of
complications which can potentially result in an unplanned return to theatre for
affected patients. The decline in total number of unplanned returns to theatre is
indicative of fewer complications, which is a measure of both the quality of care
and effectiveness of hospital staff and standard processes.
Unplanned readmissions within 31 days
Per 100 admissions
0.192
2012-2013
0.189
2011-2012
0.228
2010-2011
0
0.05
0.1
0.15
0.2
0.25
The rate of unplanned readmission to BMI Healthcare hospitals due to clinical
complication within 31 days has remained low over the past year.
46
47
A RESPONSIBLE
ORGANISATION
Clinical governance (continued...)
Patient experience
BMI Healthcare continuously monitors the satisfaction of its patients using selfcompletion questionnaires which cover all of the important aspects of their treatment.
The largest survey – of inpatients and day cases – is generally completed by around
one in four patients, giving us around 61,000 responses per annum. The results are
analysed by an independent research organisation and there has been a steady focus
on increasing the response rate. Results are analysed at both group and hospital
level, with each hospital implementing appropriate action to address any issues of
dissatisfaction or areas that have scored lower than others.
Our rating for overall quality of care remains exceptional at 97.2%, we met or
exceeded the expectations of 98.3% of our patients, and 97.9% of our patients would
recommend us to others (all data based on the three months July to September 2013,
compiled by independent research organisation Quality Health).
Patient safety
61,000
Approx. responses per annum
to Inpatient and day case
patient satisfaction survey
97.2
%
In line with the aims of our clinical governance framework we have worked on a
number of initiatives through the year. These include:
Venous thromboembolism (VTE) prevention
Our policy and risk assessment has been reviewed in line with the latest national
guidance and BMI Healthcare is the first national private healthcare provider in the
UK to be awarded VTE Exemplar Centre status across its whole network of hospitals
and clinics by the Department of Health. In addition BMI Healthcare’s clinical and
strategic implementation and on-going development has earned the award of Best
VTE Education Initiative at the Lifeblood National VTE Awards. Awarded by the
thrombosis charity Lifeblood, the All-Party Parliamentary Thrombosis Group, and
the NHS VTE Prevention Programme, it recognises the role BMI Healthcare has played
in sharing best practice with the NHS.
Reduction in number of patient falls
Preventing patient falls remains a challenge as patients are all accommodated in single
rooms and are therefore not within sight of staff at all times. A multidisciplinary falls
working group contributed to the completion of a new falls risk assessment with
explicit actions to be taken for high risk patients. This was implemented in late 2011
and we have since seen a marked reduction in total patient falls.
98.3
%
Met or exceeded expectations
97.9
Total patient falls
Per 1000 bed days
%
0.92
2012-2013
1.097
2011-2012
0.8
48
Overall quality of care
0.9
1
Would recommend us to others
1.1
Corporate social RESPONSIBILITY
Both at a corporate and
an individual level, BMI
Healthcare supports a
wide range of healthcare
education and outreach
programs, charities, and
fundraising events.
Industry sponsorship
BMI Healthcare was a sponsor of the 2013 Laing & Buisson Independent Healthcare
Awards. The awards highlight excellence in the independent healthcare sector,
acknowledging individuals and organisations whose dedication and commitment helps
make the UK independent healthcare sector truly world-class. Ian Jenkins, a colorectal
consultant surgeon who practices at BMI The Clementine Churchill Hospital, won the
Outstanding Contribution Award.
National initiatives
BMI Healthcare launched the Big Health Pledge, a community outreach campaign
encouraging and supporting people throughout the UK to take small steps to see big
changes to their health and lifestyle. People are asked to make one of five pledges:
quit smoking, improve their diet, drink less alcohol, move more, or be health aware.
The campaign also includes information on the steps people can take to address issues
associated with the big health killers, such as cancer, heart disease, liver disease,
stroke and lung disease. The health message was taken into the community via
road shows in local shopping centres.
BMI Healthcare supported a medical mission to the City of Tacloban, in the province of
Leyte in the Philippines, with Medical Missions for Children. During the visit, a team of
13 volunteers provided urgent medical care to more than 40 infants born with cleft lips
and palates. The team included a consultant and theatre nurse from BMI The Blackheath
Hospital. A second nurse from BMI The Alexandra Hospital joined the team in Batangas
in the Philippines in February 2013.
BMI Healthcare sponsored Spring Online, a digital inclusion campaign which helps
empower older people to make use of online resources.
Hospital initiatives
BMI Healthcare hospitals supported healthcare events throughout the year to raise
awareness of specific health conditions. Some events also provided early diagnosis
screening opportunities for local communities.
BMI Healthcare hospitals also support charities and local initiatives on an individual basis.
As an example, Cura is a breast cancer charity set up by consultants at BMI Bishops
Wood Hospital. It supports patients suffering from breast cancer by offering financial
support to help cater for their physical and psychological needs, with modest grants
provided for items such as wigs, custom made arm hosiery and bras, assistance with
custom made breast prostheses, and equipment hire.
BMI Bath Clinic worked with the local Bath Chronicle newspaper on Wish Cash for
your Community (a community competition open to all not-for-profit groups, projects,
schools and organisations across Bath and Somerset) and the Pride in Bath Awards
(that recognise achievements of individuals in the local community).
Patient support groups & ad hoc support
Some BMI Healthcare hospitals run support groups for patients who have undergone
cancer treatments and obesity surgery. BMI Healthcare hospital employees participate
in fundraising events to provide ongoing and ad hoc support to schools, children’s
hospices, charities supporting vulnerable children and families, local community
initiatives, and certain campaigns abroad.
50
51
Environment
During 2013, we focused
on updating our waste and
environmental policies to
improve our systems and
maintain alignment with UK
environmental regulations.
The updated policies are
close to final ratification and
will be implemented during
the second quarter of the
2014 financial year.
The Environmental Sub-Committee continued to meet regularly during the year.
It recently approved the creation of a Waste Steering Committee and will develop
guidelines to address specific functional waste management issues, as well as identify
opportunities to secure business and environmental benefits from emerging waste
management technologies. It will report to the Environmental Sub-Committee.
Energy and carbon management
Overall reported carbon emissions are estimated to have reduced 1.1% to 48,6631
tonnes of carbon dioxide equivalent (CO2e), driven by a reduction in the consumption
of fuel, coal and water. This also takes into account the UK Government’s revised
guidance for CO2 emissions from electricity generation that have reduced reported
emissions by some 14% per kilowatt-hour.
Water usage
49,284
2013
47,594
2012
+0.9%
Our general waste recycling rate has increased marginally to 45% (2012: 44%) in
the year, slightly reducing indirect CO2e emissions from landfill due to reduced
methane generation.
In 2013, our carbon emissions reported to the UK Government for the Carbon
Reduction Commitment (CRC) Energy Efficiency Scheme were 49,284 tonnes of
carbon dioxide (CO2) (2012: 47,594 tonnes CO2). As legislated by this scheme, we
were required to purchase carbon allowances at a cost of £591,408 (2012: £571,000) to
cover regulated emissions. The CRC requires qualifying organisations to report annually
on their electricity and gas consumption from buildings’ energy use only. The UK
Government converts this energy consumption into CO2 emissions and requires
participants to pay for allowances for these emissions at a cost of £12/tonne of CO2 .
Going forward, the business will have to register for the second phase of the CRC (for
2014 to 2016) by January 2014.
+7.9%
We entered the second year of working with a specialist water services consultancy
to review our water supply and treatment arrangements. Negotiations with suppliers
and a combination of tariff negotiations and leakage reduction continues to deliver
environmental and financial benefits, with annual savings of £11,600 and a reduction
of 4,360m3 in consumption achieved.
Waste reduction
Reported carbon emissions to Carbon Reduction
Commitment (CRC) Energy Efficiency Scheme (in tonnes)
–2.6%
154,388
(MWh)
Overall gas and electricity consumption is estimated at 154,388 megawatt hours
(MWh), an increase of 4.9% over 2012. While core electricity consumption reduced
by 2.6% across BMI Healthcare, the overall increase is largely due to a 7.9% increase
in gas consumption.
52
Capital constraints continue to prove challenging and alternative funding mechanisms
are being explored with several major building services companies. However, we
continued investing in specific energy efficient technologies with the installation of
light emitting diodes (LED) in our re-lamping activities.
We are currently investigating the opportunity to substitute off-site disposal of some
clinical waste for on-site management of waste via small-scale pyrolysis technology.
Subject to local site constraints, this technology may offer significant financial savings,
while meeting regulatory standards for emissions and waste management.
Looking ahead
Our key environmental focus areas for 2014 are:
nn
Launch the new environmental and waste policies with related training
nn
Undertake an audit against the policy criteria to identify any compliance actions
and investment necessary to ensure that statutory requirements are met
nn
Continue with the rollout of energy efficient technology, encompassing many
common types of compact fluorescent lights and fittings, to deliver further
electricity and carbon savings
Carbon Footprint
Metric tonnes CO2e
2013
2012
% change
19,005
18,965
0.2
26,255
26,448
(0.7)
Indirect (Scope 3) 4
3,404
3,793
(10.3)
Total emissions
48,663
49,206
(1.1)
Carbon emissions 1
Direct (Scope 1) 2
Indirect (Scope 2)
3
1. Carbon emissions are reported as per the
GHG Protocol.
2. Scope 1 emissions are as defined in the GHG
protocol and include all “direct” emissions from
greenhouse gas sources such as combustion
facilities. This includes emissions from gases used
(nitrous oxide, carbon dioxide, LPG, natural gas)
as well as emissions from diesel, petrol and Jet
A1 usage.
3. Scope 2 emissions are indirectly incurred through
the consumption of electricity, heating and cooling,
commonly referred to as “purchased electricity”.
4. Scope 3 emissions are indirectly caused through
services provided on behalf of a company.
Non-clinical waste is regarded as the most
common source of Scope 3 emissions.
53
Corporate Governance & Business Ethics
General Healthcare Group
(GHG) and its operational
subsidiaries – including BMI
Healthcare – understand
that they must conduct their
business within the ambit of
stakeholder expectations
and local regulations.
GHG strives to maintain the highest standards of discipline, integrity and transparency,
combining the twin requirements of compliance and performance to support an
appropriate legal, regulatory and institutional foundation.
Overall structure
Constitution and function of the Board committees
Committee
Chair
Responsibilities
Audit
Non-Executive Director
nn
Appointment and remuneration of external auditors
The Board of GHG leads corporate governance in GHG, encompassing the business,
service, safety and quality aspects of BMI Healthcare’s activities. Committees of the
Board have been established to deal with specific components of governance.
nn
Oversight of internal and external audit of GHG’s
financial activities and financial reporting
The Board comprises Executive and Non-Executive Directors. The 11 Non-Executive
Directors are generally appointed by and drawn from GHG’s investors, although there
is scope for a Non-Executive Chairman, independent of shareholders.
nn
Oversight of other financial and business risk issues,
including specific compliance functions
Two Executive Directors sit on the GHG Board: the Chief Executive Officer (CEO)
and the Chief Financial Officer (CFO). The General Counsel is not a director but
attends GHG’s Board meetings and ensures proper records are kept. The CEO is
responsible for day-to-day operations and BMI Healthcare’s strategic development,
and the CFO is responsible for its financial management. The General Counsel is
responsible for advice to the Board and the executive, GHG’s compliance with its
responsibilities, and relations with external regulators.
REMUNERATION
nn
Oversight over BMI Healthcare’s internal controls
Remuneration
Non-Executive Director
nn
Review and set BMI Healthcare’s remuneration strategy and
salary and benefit levels to ensure competitive remuneration
nn
Monitor the management of equity and any other management
incentive arrangements
Quality & Risk
Senior Netcare Director
(independent of the Board)
nn
Monitor the safety, effectiveness and quality of BMI Healthcare’s
operational activities
nn
Monitor BMI Healthcare’s regulatory compliance, clinical operational
conformity to internal policy and, in conjunction with the Audit
Committee and Board, the level of risk retained by GHG
Finance & Investment
Non-Executive Director
nn
Review potential capital investments and capital projects,
and undertake follow-on post acquisition reviews
Leadership
CEO
nn
Focus on corporate, commercial and operational matters
including through appropriate sub-boards
nn
Address all BMI Healthcare operational matters, and act as the
principal executive decision-making body within BMI Healthcare
Leadership
AUDIT
nn
Oversight of other specialist boards – including a Clinical Governance
Board and a Health & Safety and Non-Clinical Risk Board
GHG Board
committees
Finance &
Investment
54
Quality
& Risk
55
Corporate Governance & Business Ethics (continued...)
Ethics
BMI Healthcare’s Code of Business Conduct, to which all staff are expected to adhere,
sets out standards to prevent any illegal or unethical behaviour. This has been
supplemented by BMI Healthcare’s Anti-Bribery and Corruption Policy that provides
further guidance. There is also a Whistle-Blowing Policy that guides staff on how they
can confidentially raise any concerns about the conduct of others in the business,
or the way in which the business is run. When issues are raised, immediate action is
taken to investigate and address the matter, with BMI Healthcare’s disciplinary policy
being applied where appropriate.
BMI Healthcare’s basic values are honesty, directness and openness in dealing with
others, and these values encompass our relationships with employees, shareholders,
customers, suppliers and local communities. Our Business Conduct Policy sets out
our policy with regard to:
nnBasic values
nnConfidential information
nnEquality and diversity
nnGifts and entertainment
nnAccuracy and integrity
of books and records
nnHealth and safety standards
affecting employees and customers
nnOutside interests
nnMaladministration
nnMonitoring and compliance
Our whistleblowing policy also provides details of a mechanism to allow staff to report,
either by email or telephone, concerns about fraud or issues of any other nature
across any area of the business.
Fraud and Ethics Hotline statistics
General fraud cases
“BMI Healthcare’s basic values are
honesty, directness and openness
in dealing with others”
Hotline
Non-fraud
(including clinical)
via whistleblowing
email or hotline
6
7
2013
2012
3
2
2013
2012
11
2012 figures
not available
2013
56
57
OUR HOSPITALS and clinics
1. BMI Albyn Hospital
23.BMI Goring Hall Hospital
45.BMI The Shelburne Hospital
2. BMI The Alexandra Hospital
24.BMI The Hampshire Clinic
46.BMI Shirley Oaks Hospital
3. BMI Bath Clinic
25.BMI The Harbour Hospital
47.BMI The Sloane Hospital
4. BMI The Beardwood Hospital
26.BMI The Highfield Hospital
48.BMI The Somerfield Hospital
5. BMI The Beaumont Hospital
27.BMI The Huddersfield Hospital
49.BMI South Cheshire Hospital
6. BMI Bishops Wood Hospital
28.BMI The Kings Oak Hospital
50.BMI St Edmunds Hospital
7. BMI The Blackheath Hospital
29.BMI Kings Park Hospital
51.BMI The Garden Hospital
8. BMI Carrick Glen Hospital
30.BMI The Lancaster Hospital
31.BMI The Lincoln Hospital
53.BMI Thornbury Hospital
10.BMI The Clementine
Churchill Hospital
32.BMI The London
Independent Hospital
54.BMI Three Shires Hospital
11.BMI The Chaucer Hospital
33.BMI The Manor Hospital
12.BMI Chelsfield Park Hospital
34.BMI The Meriden Hospital
13.BMI The Chiltern Hospital
35.BMI Mount Alvernia Hospital
14.BMI Coombe Wing
36.BMI The Park Hospital
15.BMI The Droitwich
Spa Hospital
37.BMI The Princess
Margaret Hospital
16.BMI The Duchy Hospital
38.BMI The Priory Hospital
17.BMI The Edgbaston Hospital
39.BMI Ross Hall Hospital
40.BMI The Runnymede Hospital
19.BMI Fawkham Manor Hospital
41.BMI The Sandringham Hospital
20.BMI Fernbrae Hospital
42.BMI Sarum Road Hospital
21.BMI The Foscote Hospital
43.BMI The Saxon Clinic
22.BMI Gisburne Park Hospital
44.BMI Sefton Hospital
55.BMI Werndale Hospital
13
20
52.BMI The Ridgeway Hospital
9. BMI The Cavell Hospital
18.BMI The Esperance Hospital
01
06
45
29
37
39
40
28
09
51 62
10
32
56 60
61
66
07
14
47
12
46
19
08
35
56.BMI The Winterbourne Hospital
57.BMI Woodlands Hospital
58
58.BMI Southend Hospital
59.BMI City Medical
30
60.BMI Fitzroy Square Hospital
44
61.Heath Lodge Clinic
27
05 26
02
53
36
41
65
17 38
34
63
15
63.Oaklands Health Centre
64.BMI The Paddocks Clinic
66.BMI Syon Clinic
31
49
62.Kenilworth Road
Diagnostics Centre
65.BMI Sutton Medical Centre
16
22
04
54
21
55
50
33
43
64
52
59
London
03
48
24
11
42
57
25
23
18
of the insured adult
population live within
an hour of a BMI facility
58
59
CASE STUDY
Sachin Khurjekar
“The hospital was fantastic
from start to finish”
Sachin Khurjekar
Dr Sachin Khurjekar had tried numerous
ways to lose weight, from commercial
diets to strenuous exercise regimes, but
the result was always the same. “They are
good for the short term but as soon as
the programme stopped my weight would
yo-yo back up again,” said the GP partner
who practices in north west London.
Having had issues with food since
childhood, Dr Khurjekar knew in 2011 he
needed to act. His weight had led to him
developing high blood pressure, gout, and
type two diabetes. He had previously
referred a number of patients to the
nearby BMI The Clementine Churchill
Hospital – which he describes as “the
local private hospital of choice” – and
decided to self-pay for a gastric bypass
operation performed at the hospital by
Consultant Surgeon Guy Slater.
Today he is a trim 70 kilos, less than
half his highest weight. “The hospital was
fantastic from start to finish, from being
greeted at the door on the day of my
operation to the physio follow up.”
Dr Khurjekar was back behind his desk
at The Honeypot Medical Centre in
Stanmore within a week of surgery and
after acclimatising to his new diet is having
some success controlling his diabetes,
a chronic condition which can have
devastating consequences if not well
managed. “I have now reduced my blood
sugars and developed a much more
healthy relationship with food,” said
Dr Khurjekar.
60
CASE STUDY
“The staff at Goring Hall were
fantastic and the treatment
couldn’t have gone better”
Alan Ramsay
Alan Ramsay
When retired finance director Alan
Ramsay began to suffer persistent pain in
his knee, he feared his ballroom dancing
days might be over. Investigations showed
that the discomfort, which made it a
struggle to walk more than fifty yards,
stemmed from a wearing away of the
bones in his knee; two were rubbing
painfully together, preventing him from
playing golf, mowing the lawn or even
hobbling around the supermarket.
Under the care of Consultant Knee
Surgeon Mr James Lewis, 76-year-old Alan
had a partial two-thirds knee resurfacing
at BMI Goring Hall Hospital. This
custom procedure avoids the usual
need to remove some of the ligaments,
treating only the affected area, and was
undertaken as day surgery,
circumventing the need for a stay in
hospital. A CT scan was used to form
a template for an implant specifically
designed for Alan. “It gives a knee that
feels like the patient’s very own,” says
Mr Lewis. “The technology is a quantum
leap from off-the-shelf replacements.”
“The operation took an hour and a half
and Mr Lewis visited me before and after
surgery to both assure me and make
sure I was recovering well,” said Alan.
“In fact all the staff at Goring Hall were
fantastic and the treatment couldn’t have
gone better. I went home at 6pm that
evening and could get out of the car and
climb upstairs.”
Five weeks later, Alan was walking without
crutches, and today, 18 months on, he is
taking the family’s King Charles Spaniel for
long walks again and is back on the dance
floor with wife Jean. “My knee feels just
like it’s my own,” said Alan.
62
BMI Healthcare House, 3 Paris Garden, Southwark, London SE1 8ND
T 020 3283 6600 F 020 3283 6601 E [email protected]
bmihealthcare.co.uk
BMI internal data as at March 2013 – CDS07205 – © BMI 2013-2014
1