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The Harley Street Clinic Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 4 January 2017

The Harley Street clinic is part of HCA International group, who also provide care at five other hospitals in London.

We carried out this inspection as part of the CQC's ongoing programme of comprehensive, independent healthcare acute hospital inspections under the new methodology.

The Harley Street Clinic undertakes a range of surgical procedures and provides medical and critical care, to adults. The hospital also provides services to children and young people, carries out outpatient consultations and provides critical care services to children. The hospital has the largest independent healthcare paediatric intensive care unit (PICU). The hospital therefore provides five of the eight core services that are inspected by the Care Quality Commission as part of its new approach to hospital inspection.

The Harley Street Clinic has 103 beds, four operating theatres, three catheter laboratories and six treatment rooms. The hospital provides 93 inpatient and ten day case beds. Specialities treated include oncology, cardiac and neurosciences for both adults and paediatrics. At the time of the inspection the hospital was not providing any NHS funded care.

We inspected the Harley Street Clinic as part of our planned inspection programme, visiting 3-5 August 2016 followed by an unannounced visit 17 August 2016. This was a comprehensive inspection and we looked at five core services provided by the hospital: medical care, surgery, critical care, services for children and young people and outpatients and diagnostic imaging.

We rated the safety, effectiveness and responsiveness of this hospital as good. We found the leadership and caring aspects of this hospital to be outstanding. Overall, we have rated The Harley Street Clinic as ‘outstanding’.

Are services safe at this hospital?

By safe, we mean that people are protected from abuse and avoidable harm.

  • There was a hospital wide electronic incident reporting system and staff were aware of how to report incidents. Staff reported incidents and openness about safety was encouraged. Incidents were monitored and reviewed and staff clearly demonstrated examples of learning from these. Senior management understood and adhered to the duty of candour appropriately.

  • Clinical areas were visibly clean and tidy. Hospital infection prevention and control practices were followed and these were regularly monitored, to reduce the risk of spread of infections.

  • Staff had access to a range appropriate equipment to care for patients safely. Equipment was safety tested and well maintained, in line with manufacturer’s guidance.

  • Medicines were stored securely and managed safely. Pharmacy staff were actively involved in the pre-admission, admission, inpatient and discharge processes.

  • Records were managed safely, securely stored on site and available when needed. The radiotherapy departmenthad implemented a fully paperless system of working. This system mitigates the paper based system risks and is also better for the environment. The department has assisted other independent and NHS departments in the implementing the system.

  • Staff were knowledgeable about the hospital’s safeguarding policy and clear about their responsibilities to report concerns.

  • Patients were appropriately risk assessed, their condition was monitored throughout their stay, and there were appropriate procedures and protocols for responding to any deteriorating condition.

  • We had concerns that staffing in the paediatric intensive care unit (PICU) did not meet Royal College of Nursing (RCN) guidance, as the majority of nurses were not trained specifically in paediatrics. In all other areas, staffing levels and skill mix were planned, implemented and reviewed to ensure patients received safe care and treatment at all times.

  • Staff received appropriate training to perform their role safely and were supported to keep their skills up to date.

  • Plans and arrangements were in place to respond to emergency situations.

Are services effective at this hospital?

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

  • Patients care and treatment was planned and delivered in line with current best practice, evidence based guidance and legislation. Performance was monitored and improved in line with national guidance from organisations such as the National Institute for Clinical Excellence (NICE) and the Royal Colleges.

  • Patients’ pain was monitored and the effectiveness of pain management evaluated. Patients had access to different methods of pain relief.

  • The hospital offered a range of meals and drinks and hospitality team were always available. Patients had comprehensive assessments of their needs, which included assessment of their clinical needs, physical health, nutrition and hydration needs.

  • Oncology patient outcomes were monitored at cancer multi-disciplinary (MDT) meetings

  • The hospital surgery participated in a range of national audits and benchmarking, including: the Public Health England (PHE) surgical site surveillance for benchmarking for coronary artery bypass grafting (CABG) and total abdominal hysterectomy (TAH). We found the hospital had performed better than the national average for CABG. For example, the PHE SSI audit from April 2015 to March 2016 indicated that there had been 0% infections compared to the five year average for all hospitals of 4.3%.

  • The Adult intensive care unit (AITU) contributed to the Intensive Care National Audit Research Centre (ICNARC), which meant that the outcomes of care delivered and patient mortality could be benchmarked against similar units nationwide. The hospital performed better than similar units in unplanned readmissions and non-clinical transfers out of the unit in 2015/16.

  • The National Congenital Heart Disease Audit Report 2012 -15 demonstrated the hospital had a 98.8% survival rate for patients admitted with this condition. This was better than the expected predicted survival rate of 97.3%.

  • The hospital published the Breast Quality Framework Report; containing outcome data collected as a retrospective audit of breast cancer patients treated in the period of 2010 to 2014. The hospital is working collaboratively with Public Health England to collate and publish patient survival rates.

  • Consultants were granted practicing privileges after a lengthy application process supported and verified by the medical advisory committee (MAC). Those privileges were then reviewed once a year. The MAC also reviewed policies and guidance and advised on effective care and treatment.

  • There was good communication between the MAC and hospital medical directors and this was maintained through coordinated consultant engagement.

  • Practice facilitators and educators ensured that nursing staff were supported through the revalidation process.

  • Staff worked well within teams and across different services to plan and deliver patients' care and treatment in a coordinated way.

  • The consent process for patients was well structured, audited and reviewed to improve how people are involved in making decisions about their care and treatment.

  • Staff were trained in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs), although rarely used as the vast majority of patients treated had capacity to give their informed consent.

Are services caring at this hospital?

By caring, we mean that staff involve and treat patients with compassion, dignity and respect.

  • Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity and were willing to go the extra mile to meet individuals’ needs. We saw incidences of staff changing their shifts or working additional shifts in order to offer anxious patients continuity of care. We saw examples of pro-bono patient care to accommodate individual needs.

  • Staff always took people’s personal, cultural, social and religious needs into account. For example, care plans for patients observing Shabbat included instructions on how staff could support them to avoid use of technology such as call bells by increasing the frequency of checks. We saw examples of ‘weddings’ that had been organised on the ward to accommodate immobile patients’ last wishes and hosting an event so one patient could fulfil their role as 'mother of the bride' at their daughter's wedding.

  • People’s emotional and social needs were highly valued by staff and are embedded in their care and treatment. For example, the ‘rainbow beads’ project provided an opportunity to recognise the courage and strength of children and young people who were accessing the hospital for long term treatments. Children and young people were rewarded with a bead for each treatment or intervention.We saw examples of patients supported to have visits from loved pets.

  • Patients understood the care and treatment choices available to them and were given appropriate information and support regarding their care and treatment.

  • The hospital used patient feedback to ensure they were addressing patients’ needs.

Are services responsive at this hospital?

By responsive we mean that services are organised so they meet people’s needs.

  • The complex and differing needs of patients were central to the planning and delivery of the tailored service that the hospital provided. Pre-assessment nurses pro-actively provided individual patient-centred care before admission and after discharge.

  • The provider approached care and treatment for their patients in a truly holistic and individualised way. We found excellent multidisciplinary team (MDT) working with close collaboration between all staff. National experts in their field with access to latest diagnostic and treatment methods attended regular MDT meetings. We saw the multidisciplinary team working together to provide the best care available and working to ensure all needs of patients were met.

  • Patient admissions were arranged in a timely manner, with minimal delays. The outpatient service ensured that waiting times were kept at a minimum.

  • There were allocated appointment slots for patients that wanted same day diagnostic procedures.

  • All radiological imaging results were available within 24 hours or earlier if requested.

  • There were facilities in place and readily available for patients from different cultural backgrounds and for whom their first language was not English.

  • The hospital did not treat many patients with dementia or complex mental health needs but staff were aware of who to escalate concerns to regarding these patients.

  • Complaints were dealt with by the CNO and CEO and the service ensured that complaint responses were timely and well managed.

  • Learning from complaints was assessed and shared with staff via both email and monthly ward meetings.

Are services well led at this hospital?

By well-led, we mean that the leadership, management and governance of the organisation, assure the

delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and

fair culture.

  • We found approachable and motivational leadership that promoted staff development and career progression, teamwork and high-quality patient-centred care.

  • Staff were aware of the corporate vision and all staff were aware of their unit vision and strategy. The vision and strategy of the service was embedded into practice by staff.

  • The corporate governance structure ensured that there was a vast amount of cross over in-between key groups.

  • The governance team had hired new members of staff to maintain the risk register and oversee other areas. The handover process was sound and the reporting mechanisms in place were of a high quality.

  • Service managers had monthly meetings with the CEO where issues were actively discussed and best practice was encouraged to be implemented. Staff felt they could engage with the CEO and felt they managers could raise issues on their behalf and they would be listened to.

  • All staff were able to name the CEO and reported that the senior management team were visible and accessible. Staff felt as though there was an open ‘family’-like culture.

  • We saw new leaders and managers in the paediatric services who were driving forward change to improve staff development and patient care. We saw and heard about the improvements to the working culture and how staff satisfaction had improved. New ways of working had been introduced to promote safe and effective patient care.

  • A “Nurse in charge” work initiative was in place in the outpatients department specifically tailored to encourage junior staff nurses to develop leadership skills. This initiative contributed to the five new outpatient senior nurse roles and has allowed the department to promote internally.

  • There were world class, first of their kind innovations taking place at the hospital and staff were proud to say they worked there.

  • The radiotherapy department in collaboration with a London NHS trust has lead a unique scalp sparing technique study. The study is aimed at improving the quality of life of patients requiring whole brain radiotherapy treatment, by trying to remove the side effect of hair loss at such an emotional time in the patient’s life. The study was the winner of the LangBuisson 2015 award for Innovation in Care.

  • The cancer service offered innovative patient-centred care through access to latest diagnostic and therapeutic methods and by seeking out new treatment options and taking a holistic approach to patient care. This high quality care included psychological support and complementary therapies such as relaxation or aromatherapy for example. Patients were given access to early phase clinical trials for new cancer drugs through partnership with a cancer research institute.

However, there were also areas where the provider needs to make improvements.

Importantly, the hospital must make the following improvements:

  • The provider must take action to ensure the skill mix of staff in the paediatric intensive care reflects current recommendations.

In addition the hospital should:

  • Ensure that the multi-faith rooms are appropriate to meet patients’ spiritual needs.

  • Provide more adequate storage space in theatres.

  • Ensure that the theatre doors fully close and do not overlap one another.

  • Ensure all staff that have contact with patients under the age of 18 are trained to a minimum of level 3 safeguarding training.

  • Ensure all staff are up to date with mandatory training requirements.

  •    Ensure all department risk registers reflect the current risks to their service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 4 January 2017

There was a hospital wide electronic incident reporting system and staff were aware of how to report incidents. Staff reported incidents and openness about safety was encouraged. Incidents were monitored and reviewed and staff clearly demonstrated examples of learning from these. Senior management understood and adhered to the Duty of Candour appropriately.

Clinical areas were visibly clean and tidy. Hospital infection prevention and control practices were followed and these were regularly monitored, to reduce the risk of spread of infections.

Staff had access to a range appropriate equipment to care for patients safely. Equipment was safety tested and well maintained, in line with manufacturer’s guidance.

Medicines were stored securely and managed safely. Pharmacy staff were actively involved in the pre-admission, admission, inpatient and discharge processes.

Records were managed safely, securely stored on site and available when needed. The radiotherapy department had implemented a fully paperless system of working. This system mitigates the paper based system risks and is also better for the environment. The department has assisted other independent and NHS departments in the implementing the system.

Staff were knowledgeable about the hospital’s safeguarding policy and clear about their responsibilities to report concerns.

Patients were appropriately risk assessed, their condition was monitored throughout their stay, and there were appropriate procedures and protocols for responding to any deteriorating condition.

We had concerns that staffing in the paediatric intensive care unit (PICU) did not meet Royal College of Nursing (RCN) guidance, as the majority of nurses were not trained specifically in paediatrics. In all other areas, staffing levels and skill mix were planned, implemented and reviewed to ensure patients received safe care and treatment at all times.

Staff received appropriate training to perform their role safely and were supported to keep their skills up to date.

Plans and arrangements were in place to respond to emergency situations.

Effective

Good

Updated 4 January 2017

Patients care and treatment was planned and delivered in line with current best practice, evidence based guidance and legislation. Performance was monitored and improved in line with national guidance from organisations such as the National Institute for Clinical Excellence (NICE) and the Royal Colleges.

Patients’ pain was monitored and the effectiveness of pain management evaluated. Patients had access to different methods of pain relief.

The hospital offered a range of meals and drinks and hospitality team were always available. Patients had comprehensive assessments of their needs, which included assessment of their clinical needs, physical health, nutrition and hydration needs.

Oncology patient outcomes were monitored at cancer multi-disciplinary (MDT) meetings

The hospital surgery participated in a range of national audits and benchmarking, including: the Public Health England (PHE) surgical site surveillance for benchmarking for coronary artery bypass grafting (CABG) and total abdominal hysterectomy (TAH). We found the hospital had performed better than the national average for CABG. For example, the PHE SSI audit from April 2015 to March 2016 indicated that there had been 1.9% infections compared to the five year average for all hospitals of 4.3%.

The critical care unit contributed to the Intensive Care National Audit Research Centre (ICNARC), which meant that the outcomes of care delivered and patient mortality could be benchmarked against similar units nationwide. The hospital performed better than similar units in unplanned readmissions and non-clinical transfers out of the unit in 2015/16.

The National Congenital Heart Disease Audit Report 2012 -15 demonstrated the hospital had a 98.8% survival rate for patients admitted with this condition. This was better than the expected predicted survival rate of 97.3%.

The hospital published the Breast Quality Framework Report; containing outcome data collected as a retrospective audit of breast cancer patients treated in the period of 2010 to 2014. The hospital is working collaboratively with Public Health England to collate and publish patient survival rates.

Consultants were granted practicing privileges after a lengthy application process supported and verified by the medical advisory committee (MAC). Those privileges were then reviewed once a year. The MAC also reviewed policies and guidance and advised on effective care and treatment.

There was good communication between the MAC and hospital medical directors and this was maintained through coordinated consultant engagement.

Practice facilitators and educators ensured that nursing staff were supported through the revalidation process.

Staff worked well within teams and across different services to plan and deliver patients' care and treatment in a coordinated way.

The consent process for patients was well structured, audited and reviewed to improve how people are involved in making decisions about their care and treatment.

Staff were trained in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLs), although rarely used as the vast majority of patients treated had capacity to give their informed consent.

Caring

Outstanding

Updated 4 January 2017

Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity and were willing to go the extra mile to meet individuals’ needs.. We saw incidences of staff changing their shifts or working additional shifts in order to offer anxious patients continuity of care. We saw examples of pro-bono patient care to accommodate individual needs.

Staff always took people’s personal, cultural, social and religious needs into account. For example, care plans for patients observing Shabbat included instructions on how staff could support them to avoid use of technology such as call bells by increasing the frequency of checks. We saw examples of ‘weddings’ that had been organised on the ward to accommodate immobile patients’ last wishes and hosting an event so one patient could fulfil their role as 'mother of the bride' at their daughter's wedding.

People’s emotional and social needs were highly valued by staff and are embedded in their care and treatment. For example, the ‘rainbow beads’ project provided an opportunity to recognise the courage and strength of children and young people who were accessing the hospital for long term treatments. Children and young people were rewarded with a bead for each treatment or intervention.We saw examples of patients supported to have visits from beloved pets.

Patients understood the care and treatment choices available to them and were given appropriate information and support regarding their care and treatment.

The hospital used patient feedback to ensure they were addressing patients’ needs.

Responsive

Good

Updated 4 January 2017

The complex and differing needs of patients were central to the planning and delivery of the tailored service that the hospital provided. Pre-assessment nurses pro-actively provided individual patient-centred care before admission and after discharge. Staff were aware of the processes to

The provider approached care and treatment for their patients in a truly holistic and individualised way. We found excellent multidisciplinary team (MDT) working with close collaboration between all staff. National experts in their field with access to latest diagnostic and treatment methods attended regular MDT meetings. We saw the multidisciplinary team working together to provide the best care available and working to ensure all needs of patients were met.

Patient admissions were arranged in a timely manner, with minimal delays. The outpatient service ensured that waiting times were kept at a minimum.

There were allocated appointment slots for patients that wanted same day diagnostic procedures.

All radiological imaging results were available within 24 hours or earlier if requested.

There were facilities in place and readily available for patients from different cultural backgrounds and for whom their first language was not English.

The hospital did not treat many patients with dementia or complex mental health needs but staff were aware of who to escalate concerns to regarding these patients.

Complaints were dealt with by the CNO and CEO and the service ensured that complaint responses were timely and well managed.

Learning from complaints was assessed and shared with staff via both email and monthly ward meetings.

Well-led

Outstanding

Updated 4 January 2017

We found approachable and motivational leadership that promoted staff development and career progression, teamwork and high-quality patient-centred care.

Staff were aware of the corporate vision and all staff were aware of their unit vision and strategy. Staff embedded the vision and strategy of their services into practice.

The corporate governance structure ensured that there was a vast amount of cross over in-between key groups.

The governance team had hired new members of staff to maintain the risk register and oversee other areas. The handover process was sound and the reporting mechanisms in place were of a high quality.

Service managers had monthly meetings with the CEO where issues were actively discussed and best practice was encouraged to be implemented. Staff felt they could engage with the CEO and felt their managers could raise issues on their behalf and they would be listened to.

All staff were able to name the CEO and reported that the senior management team were visible and accessible. Staff felt as though there was an open ‘family’-like culture.

We saw new leaders and managers in the paediatric services who were driving forward change to improve staff development and patient care. We saw and heard about the improvements to the working culture and how staff satisfaction had improved. New ways of working had been introduced to promote safe and effective patient care.

A “Nurse in charge” work initiative was in place in the outpatients department specifically tailored to encourage junior staff nurses to develop leadership skills. This initiative contributed to the five new outpatient senior nurse roles and has allowed the department to promote internally.

There were world class, first of their kind innovations taking place at the hospital and staff were proud to say they worked there.

The radiotherapy department in collaboration with a London NHS trust has lead a unique scalp sparing technique study. The study is aimed at improving the quality of life of patients requiring whole brain radiotherapy treatment, by trying to remove the side effect of hair loss at such an emotional time in the patient’s life. The study was the winner of the LangBuisson 2015 award for Innovation in Care.

The cancer service offered innovative patient-centred care through access to latest diagnostic and therapeutic methods and by seeking out new treatment options and taking a holistic approach to patient care. This high quality care included psychological support and complementary therapies such as relaxation or aromatherapy for example. Patients were given access to early phase clinical trials for new cancer drugs through partnership with a cancer research institute.

Checks on specific services

Medical care (including older people’s care)

Outstanding

Updated 4 January 2017

The leadership promoted an open and approachable culture with emphasis on integration and collaboration of all staff, driven to improve high quality patient care. Staff felt comfortable to express their views and approach managers with their concerns. The management actively encouraged staff to learn and improve. Staff satisfaction surveys showed that staff felt committed to give their best.

There was a clear governance structure and well executed quality management. The hospital’s risk register was up-to-date and proactively managed.

Patients were cared for compassionately and holistically and were kept informed of their treatment plan and progress. There was an ethos of staff going above and beyond their duty to support patients’ emotional and social needs.

An in-house psychology team was available for patients, relatives and staff. Emotional support for patients was well considered and provided through the easily accessible psychology team, Macmillan Cancer Centre and support groups. Alternative therapies were offered to improve well-being. A make-up and skincare workshop was aimed to help women living with cancer improve their self-confidence and self-esteem.

There was an established process for reporting and investigation of clinical incidents. Staff were aware of their responsibilities to report incidents and be open with patients in the event that things went wrong. Learning from incidents and complaints were shared across the teams and the hospital.

We found excellent multidisciplinary team (MDT) working with close collaboration between all staff. National experts in their field with access to latest diagnostic and treatment methods attended regular MDT meetings.

The cancer service offered innovative patient-centred care by seeking out new treatment options and taking a holistic approach to patient care. Patients had access to latest diagnostic methods and new cancer drugs through early phase clinical trials.

The complex and differing needs of individuals were central to the planning and delivery of the tailored service that the hospital provided. There was no evidence of any long waiting times or delays. Staff were aware of the processes to facilitate admissions and complex discharges. A pre-assessment nurse and a discharge liaison nurse provided individual patient-centred care.

Services for children & young people

Good

Updated 4 January 2017

Staff took time to ensure that children and their parents understood their treatment and went above and beyond in caring for patients.

The emotional and social needs of patients were highly valued and excellently considered in terms of treatment planning.

The 'rainbow beads' project provided an opportunity to recognise the strength and courage of long term children and young people. Patients were also supported to have visits from beloved pets.

Staff were open and transparent, and fully committed to reporting incidents and ‘near misses’. Learning from incidents was demonstrated to be a high priority within the service. We saw thorough analysis and investigations completed when things went wrong and saw that learning was shared appropriately amongst staff.

All clinical areas were clean and well organised. All equipment was safety tested and cleaned.

Medicines, including controlled drugs (CD’s) were stored and managed appropriately. Fridge temperatures were monitored daily.

The staffing ratios were better than most comparable units according to the paediatric intensive care audit data (PICANet). Data was also submitted to the National Congenital Heart Disease Audit (NCHDA).

Not all nurses were paediatric nurses and this did not comply with Royal college of Nursing (RCN) standards.

Nurses had a 26 month learning and development pathway and informed us that they had good opportunities for growth.

There were daily RMO ward rounds and MDT safety huddles.

Support groups were set up for families who had come abroad for treatment. These meetings were well attended by clinical psychologists to provide additional patient support.

Staff were aware of the unit vision and strategy and there were clear governance arrangements in place.

Critical care

Good

Updated 4 January 2017

There was a clear system of incident reporting in place and staff were aware of their responsibilities to report incidents.

Clinical areas throughout the hospital were visibly clean and patient risks were identified and acted upon swiftly.

Staffing in the unit was compliant with Intensive Care Society (ICS) guidance with a suitable number of qualified and registered staff.

Care was provided in accordance with national guidance including NICE guidelines.

The unit contributed to the Intensive Care National Audit & Research Centre (ICNARC) for critical care patients. The rates of early deaths on the unit was below the national average for similar units.

The unit participated in local and national audits to demonstrate patient outcomes.

Nurses received regular supervision and 100% of nurses had undergone an appraisal in the last year.

We observed good working relationships between all grades of staff and all professional disciplines. MDT meetings were well attended.

We reviewed comment slips and ‘thank you’ cards and spoke with patients who found the staff to be very caring and respectful.

The complaint handling process was clear and speedy.

There were arrangements in place for governance, risk management and quality measurement associated with intensive care patients.

There was a comprehensive audit programme and senior staff maintained the risk register.

We observed strong leadership and lines of accountability in the unit were coherent.

Outpatients and diagnostic imaging

Good

Updated 4 January 2017

Staff felt encouraged to move up the career ladder by their managers. All staff we spoke to confirmed this taking inspiration from the CEO and other colleagues who all progressed from junior roles within the hospital.

All staff were aware of the corporate provider’s vision and embedded the strategy into everyday work.

The radiotherapy department in collaboration with a London NHS trust lead a unique scalp sparing technique study aiming to improve the quality of life of palliative brain patients preventing hair loss during such an emotional time. The study won the LangBuisson 2015 award for Innovation in Care.

There were processes in place to investigate incidents and staff were aware of how to report incidents.

All clinical areas were visibly clean and patient areas had enough seating.

Staff complied with the hospital bare below the elbows (BBE) policy and we observed staff using personal protective equipment (PPE) where necessary.

Diagnostic and imaging staff followed national guidance and equipment was appropriately cleaned, tested and maintained.

Both radiology and radiotherapy used the Ionising Radiation (Medical Exposure) Regulations (IR(MER)(2000) where necessary.

There were appropriate numbers of nursing staff and consultants. There was low use of agency staff.

Performance and competence was continually assessed and staff we spoke with confirmed that they were encouraged to undertake continued professional development (CPD).

Complementary therapies were available free of charge to patients and we saw that staff were caring and maintained patients dignity and privacy at all times.

Delays to treatment were dealt with as efficiently as possible. This was confirmed by patients.

The radiotherapy department used a paperless system of working mitigating paper based risks whilst also being environmentally superior. The department has guided other independent and NHS departments who have then implemented the same system.

 

Surgery

Good

Updated 4 January 2017

Senior management were accessible to staff and were reported to be supportive in their approach.

The governance processes in place ensured a vast amount of collaborative working.

The service were using outstanding cutting edge technology including non-invasive robotic radiosurgery, laser therapy and brachytherapy.

There were processes in place to reduce the risks associated with surgical procedures.

Nurses monitored patients after their operation and medical staff were available if there were any concerns.

Automatic alerts were sent to the resident medical officers (RMOs) if a patient's observations were of concern. This was facilitated via the electronic National early warning scoring tool (NEWS).

Pre-operative assessment was undertaken by qualified staff in line with the NICE guidelines.

There were sufficient numbers of staff to care for patients.

Patients provided positive feedback about their care and treatment.

There were regular MDT meetings to discuss patients’ care and treatment.

The pharmacy department provided support for ward staff.