LHM Healthcare

Updated 2 February 2018

The LHM Hyperbaric Unit is based at Whipps Cross University Hospital, Leytonstone, London. The service has been provided by LHM Limited since 2001 on behalf of NHS England. Referrals are taken from London and the surrounding areas. It also accepts patient referrals from outside this area. The service is delivered in partnership with Whipps Cross University Hospital, and is integrated with the hospital’s intensive care unit.

Hyperbaric oxygen treatment involves breathing pure oxygen at higher than atmospheric pressures in an enclosed chamber. The hyperbaric unit contained a category one multiplace hyperbaric chamber. The facility had a dedicated reception area, one changing room, two clinical examination rooms and a multi-purpose training room. Oxygen supplies were made directly to their own liquid oxygen tank.

A registered manager, Mr Philip Sayers, was in post when we inspected the hospital. Regulated activities provided by the service are treatment of disease, disorder or injury.

The unit provided hyperbaric (high-pressure) oxygen therapy for a range of conditions. This included emergency treatment for diving disorders and emergency treatment for patients with gas embolism, necrotising soft tissue infections and carbon monoxide poisoning. Elective hyperbaric treatments were also provided for patients with a range of conditions including osteoradionecrosis, radiation proctitis, problem wounds and diabetic foot ulcers. The service was available to NHS and private patients of all ages.

The service was previously inspected in February 2013 when it was found that staff were not supported to deliver care and treatment safely and to an appropriate standard in that some staff had not received appropriate supervision, appraisal and training. The provider was told to take action. A further inspection was carried out in October 2013 where we found that the provider had taken steps to support staff and was meeting the appropriate standard. During this inspection we found that the improvements had not been sustained, as some staff had not received appropriate training and up-to-date appraisals.

Updated 2 February 2018

London Hyperbaric Medicine (LHM) Healthcare is operated by LHM Limited. The hyperbaric unit was located within the grounds of Whipps Cross University Hospital, Leytonstone, London. The service provided hyperbaric (high pressure) oxygen therapy for a number of conditions. .

We inspected this service using our comprehensive inspection methodology. We carried out our announced inspection on 26 September 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate  hyperbaric oxygen therapy services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Staff were aware of their responsibilities for reporting incidents. We saw that lessons from incidents were shared, and actions put in to place to reduce the risk of them happening again.
• Standards of cleanliness and hygiene were high throughout the unit. Infection control procedures were in place to prevent the spread of infection.
• The service was fully staffed. Staff had appropriate skills and experience to provide care and treatment to patients at their level of need.
• Patient audits for decompression illness and severe carbon monoxide poisoning had been implemented by the unit. The service followed up on patient progress after their treatment.
• Patients told us they felt fully informed about the treatment being offered. Appropriate processes were in place for obtaining consent.
• All patient feedback we received was positive. Patients told us that staff were professional and provided an excellent quality of care.
• The service responded rapidly to emergency patients, with the unit open and ready to treat within an hour.
• Staff tried to be flexible when scheduling appointments. Treatment was usually commenced promptly following initial assessment. Cancellations were infrequent, at which time treatments were quickly rescheduled.
• There was clear direction from the managing director and medical director. Managers were regularly visible at the unit, and advocated an ethos of open communication and feedback.
• We observed a staff team that worked well together. Staff turnover and sickness rates were low.

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

• Mandatory training was out of date for a number of the medical staff.
• Not all staff were trained to level two for safeguarding children and adults.
• Medication that was close to its expiry date was not clearly marked and we found some medication that was out of date. Medication stocks were not checked in the absence of the senior hyperbaric nurse.
• Not all nursing, technical and administrative staff within the unit had received a regular appraisal.
• Whilst there were formal arrangements for the use of interpreting services through the host hospital, the unit often used friends or family to translate information.
• There were limited arrangements for information to be provided in different languages other than English, or alternative formats such as braille or large print where required.
• Staff meetings were held at the unit, but not all staff members were able to attend. Staff told us a meeting that included all unit staff would help with sharing of ideas and good practice.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements to help the service improve. We issued the provider with a Requirement Notice. Details are at the end of the report.

The service must:

• Take all reasonable steps to ensure doctors are up-to-date with mandatory training.
• Ensure appropriate staff are trained to a minimum level two for safeguarding children and adults.
• Ensure all nursing, technical and administrative staff receive timely and regular appraisals.

The service should:

• Put in place procedures so that medication close to expiry can be identified and appropriately disposed of.
• Use formal interpreting services for patients whose first language is not English.
• Ensure that all patient information can be accessed and that there are arrangements in place for information to be provided in different languages or alternative formats when required.
• Encourage all unit staff to attend team meetings, in person or by teleconference, so that best practice can be shared.

Amanda Stanford

Deputy Chief Inspector of Hospitals (London)

Updated 2 February 2018

We regulate this service but we do not currently have a legal duty to rate it. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary .

The unit provided hyperbaric (high-pressure) oxygen therapy for a range of conditions. The service was provided in partnership with Whipps Cross University Hospital.