• Hospital
  • Independent hospital

Hospital of St John & St Elizabeth

Overall: Good read more about inspection ratings

60 Grove End Road, St John's Wood, London, NW8 9NH (020) 7806 4000

Provided and run by:
The Hospital Of St John And St Elizabeth

Important: We are carrying out a review of quality at Hospital of St John & St Elizabeth. We will publish a report when our review is complete. Find out more about our inspection reports.

Latest inspection summary

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Background to this inspection

Updated 15 November 2021

The Hospital of St John and St Elizabeth is one of the UK's largest independent charitable hospitals, with any profits used to fund the on-site hospice. The hospital was founded in 1856 with Roman Catholic affiliation and is a registered charity. Facilities at the hospital include: a pre-assessment unit, four theatres, a recovery unit, a high dependency unit with level 2 care beds, a day surgery unit, endoscopy unit, a 23 bedded dedicated surgical ward, diagnostic imaging, outpatient department, and a walk-in urgent care centre. The hospice has 17 beds and is located within the main hospital.

The hospital was due to open a new surgical wing in October 2021 shortly after this inspection, the new wing would consolidate the surgical service into one area and add an additional two theatre units. A new area was also planned for urgent care and imaging, opening at a later stage.

The service provides surgery, medical care, end of life care, urgent care, outpatient and diagnostic services. The hospital is registered to provide the following regulated activities:

  • Diagnostic and screening procedures
  • Management of supply of blood and blood derived products
  • Maternity and midwifery services
  • Personal Care
  • Surgical procedures
  • Transport Services
  • Treatment of disease, disorder or injury

The hospital has been inspected two times previously, with the most recent inspection taking place in March 2019. This was a focused inspection of Urgent Care services, as well as two wards and the high dependency unit. A comprehensive inspection took place in 2016. There were no outstanding enforcement actions from these inspections, but a number of areas were identified for improvement, even though a regulation had not been breached.

On this occasion, we inspected Surgery, Urgent Care and End of Life Care using our comprehensive inspection methodology.

The hospital provides day case surgery and inpatient care for private patients. The service offered a range of different surgical specialities, including orthopaedics, ophthalmology, gynaecology, cosmetic, gastro-intestinal and more. A resident medical officer (RMO) and a resident intensive treatment unit (ITU) fellow are on site 24 hours.

The hospital’s private urgent care centre, Casualty First, was launched in 2011. The centre treats patients from the age of one year. The urgent care centre is open from 8am on 8pm on weekdays, and 8am to 6pm on weekends. Patients can be referred to a specialist consultant and if required an admission facilitated.

The hospital's current registered manager has been in post since 31 May 2018.

Activity:

  • Between August 2020 and July 2021, surgical services saw a total of 6752 patients, with the majority of these being day cases (4648) and the rest being inpatients (2077). The most common day cases were endoscopy and colonoscopy procedures.
  • Between January 2021 and July 2021, 2010 patients visited the urgent care centre.
  • Between January 2021 and July 2021, there were 130 admissions to the inpatient hospice, 118 new referrals to the community team and 78 patients seen by the Hospice@Home team.
  • The hospital worked with local NHS trusts as part of the national arrangement with independent healthcare providers during the COVID-19 pandemic.

Overall inspection

Good

Updated 15 November 2021

Our rating of this location stayed the same. We rated it as good because:

  • Staff understood how to protect patients from abuse and managed safety well. The service controlled infection risk well. Staff tried to minimise risks to patients and acted on them. They managed medicines well. The service managed safety incidents well. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and all staff were committed to improving services continually.

However:

  • Some staff across the service did not complete their mandatory training. Within the hospice community team, only 76% of staff has completed life support training at the time of inspection. Porters within the hospital were given some end of life care (EOLC) training at their induction but only 64% had completed this. Following our first site inspection, the hospital began to deliver further EOLC tailored training to the porters, which 81% of these staff had completed by the time of the second site visit. The remaining staff were booked to complete this training.
  • Some minor issues were found with infection prevention control (IPC) within urgent care. There was no handwashing poster displayed by the handwashing sink in the treatment room. No record of cleaning toys was kept. The hospital policy for reception staff dress code within the urgent care centre was not in line with the best infection prevention control practice, as staff were not required to be ‘bare below the elbow’ (BBE).
  • In the hospice day centre and basement areas, there were some environmental issues such as lack of air conditioning and poor wheelchair access. However, the hospital was aware of these issues and were in the process of redesigning the areas with staff input, with plans and concept designs being drawn up.
  • In urgent care, we found some emergency medicines in the resuscitation trolleys were stored incorrectly and did not match the daily stock list. However, the service rectified this immediately on the day of inspection.
  • Not all staff in surgical services completed and updated risk assessments accurately.
  • In the end of life service, staff did not always receive feedback from investigation of incidents. Although staff were aware of incidents that had occurred, we were not always assured that planned actions or recommendations from incident investigations were taken forward. Action plans as a result of incidents were not always clear and responsible people were not always assigned to ensure that learning was fully implemented across the service.
  • There was no safeguarding flagging system in the electronic health records to identify adult patients who may be vulnerable. Senior leaders told us that they were working with the IT software team to incorporate this.
  • There had been a 43% increase in patient contacts to the social work team in the last year due to pressures from the pandemic, leaving the team feeling stretched. There was a feeling amongst staff we spoke with that whilst the team offered excellent support, they perhaps they did not have the capacity to support everyone. Senior staff told us that they were aware of the workload challenges of the team and another post focusing specifically on welfare benefits had been agreed.
  • There were medical vacancies within the end of life care service. This reflected a national shortage of palliative care consultants, and the service had been trying to recruit into these vacancies for some time. The provider had identified insufficient consultant cover as a risk and was working with a local NHS trust to develop a joint consultant post to attract a greater number of applicants.
  • The hospice community and hospice inpatient unit teams used different patient record systems, and IT systems and records across the hospital were not integrated. This led to some duplication, frustration and delays. Electronic patient records in urgent care were not integrated. The hospital was aware of these issues and were working to integrate systems and ultimately the creation of a hospital-wide patient record system.
  • Staff monitored the effectiveness of some care and treatment, but not all audits were carried out in a systematic and meaningful way. They used the findings to make some improvements but action plans were not always clear.
  • There was no separate multifaith room, although the service informed us that alternative quiet rooms were available on request. There were also no prayer mats available for patients.

End of life care

Good

Updated 15 November 2021

Our rating of this service stayed the same. We rated it as good because:

  • Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. They managed medicines well. The service managed safety incidents well. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with patients to plan and manage services and all staff were committed to improving services continually.

However:

  • Porters within the hospital were given some end of life care (EOLC) training at their induction but only 64% had completed this. Following our first site inspection, the hospital began to deliver further EOLC tailored training to the porters, which 81% of these staff had completed by the time of the second site visit. The remaining staff were booked to complete this training.
  • In the day centre and basement areas, there were some environmental issues such as lack of air conditioning and poor wheelchair access. However, the hospital was aware of these issues and were in the process of redesigning the areas with staff input, with plans and concept designs being drawn up.
  • Life support training compliance was 100% for inpatient unit staff, but only 76% for community staff at the time of our inspection. The provider explained this was due to lack of face-to-face training sessions during the COVID-19 pandemic and training was booked for these staff.
  • There had been a 43% increase in patient contacts to the social work team in the last year due to pressures from the pandemic, leaving the team feeling stretched. There was a feeling amongst staff we spoke with that whilst the team offered excellent support, they perhaps they did not have the capacity to support everyone. Senior staff told us that they were aware of the workload challenges of the team and another post focusing specifically on welfare benefits had been agreed.
  • There were medical vacancies within the service. This reflected a national shortage of palliative care consultants, and the service had been trying to recruit into these vacancies for some time. The provider had identified insufficient consultant cover as a risk and was working with a local NHS trust to develop a joint consultant post to attract a greater number of applicants.
  • Although staff were aware of incidents that had occurred, we were not always assured that planned actions or recommendations from incident investigations were taken forward. Action plans as a result of incidents were not always clear and responsible people were not always assigned to ensure that learning was fully implemented across the service.
  • The community and inpatient unit teams used different patient record systems, and IT systems and records across the hospital were not integrated. This led to some duplication, frustration and delays. The hospital was aware of these issues and were working to integrate systems and ultimately the creation of a hospital-wide patient record system.
  • Staff monitored the effectiveness of some care and treatment, but not all audits were consistent. They used the findings to make some improvements but action plans were not always clear.
  • There was no separate multifaith room, although the service informed us that alternative quiet rooms were available on request. There were also no prayer mats available for patients.

Surgery

Good

Updated 15 November 2021

Our rating of this service stayed the same. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff tried to minimise risks to patients, and kept care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and all staff were committed to improving services continually.

However:

  • Some staff across the service did not complete their mandatory training.
  • Not all staff completed and updated risk assessments accurately.
  • Staff did not always receive feedback from investigation of incidents.

Urgent and emergency services

Good

Updated 15 November 2021

This is the first time we rated this service. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs and helped them understand their conditions. They provided emotional support to patients.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

  • There was no handwashing poster displayed by the handwashing sink in the treatment room.
  • Staff told us that the box and toys in the treatment room for children were cleaned daily and after every use, but no record of cleaning of this was kept. We also found a picture book and a squeezable ball within the toy box, which would be difficult to disinfect. Staff were working to rectify this following this inspection and introduced a cleaning checklist.
  • The hospital policy for reception staff dress code within the urgent care centre was not in line with the best infection prevention control practice, as staff were not required to be ‘bare below the elbow’ (BBE).
  • There was no safeguarding flagging system in the electronic health records to identify adult patients who may be vulnerable. Senior leaders told us that they were working with the IT software team to incorporate this.
  • We found some emergency medicines in the resuscitation trolleys were stored incorrectly and did not match the daily stock list. However, the service rectified this immediately on the day of inspection.
  • Electronic patient records were not integrated with the hospital wide health record system.