Cleveland Clinic London Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity. Staff worked with other care providers involved in people’s care for the best outcomes and smooth transitions when moving between services. People always had enough to eat and drink to stay healthy. They monitored people’s health to support healthy living.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During the admission process, staff discussed people’s needs with them and how their treatment was planned as this was not always possible once patients were admitted to the critical care unit. Staff told us they involved the next of kin in care planning where appropriate and patients and their families’ views were considered during MDT meetings.

The service used various tools to help care for patients for example MUST scores to ensure patient’s nutrition needs were reviewed and appropriate interventions put into place. The critical care unit’s nutrition guidelines referred to national guidance and provided protocols for staff to follow, ensuring best practice was followed. The enteral nutrition policy outlined how dieticians would assess patients to determine what type of feed would meet each person’s individual needs.

The global patient services team worked throughout the hospital providing support to patients from overseas. Their individual needs were assessed, identified to ensure their medical and cultural needs were met. Staff could access interpreting services when required making sure patient and staff could communicate well and be understood.

Patients felt comfortable speaking to staff about their treatment and received information when they requested it. One patient we spoke with told us they felt staff knew and understood them and they only had to explain their needs once as staff shared information and communicated well. Care was coordinated, and everyone involved in the patient’s care worked well with them. Information was displayed encouraging patients to provide feedback on the care they received which helped the service identify areas for improvement.

The staff on a surgical ward we spoke with told us they could access the critical care outreach team easily. They could request support when needed and they felt supported when patients were stepped down from critical care to the ward. There was good communication between healthcare professionals throughout the hospital which meant effective assessment and transition between critical care and other wards.

Online systems were used to show who was on duty and available to provide support. This system was linked to the mobile device of critical care staff meaning they could be contacted immediately. In the event of a system failure, a telephone extension list was available by the telephone.

Patients could access support to improve their health and wellbeing from staff, for example if they needed to stop smoking. During the pre-admission appointment patients were advised of the effects of smoking and possible complications for example, when undergoing treatment that required anaesthesia. Referrals could be made for smoking cessation assistance and support teams such as the diabetes team, who could provide help and support to patients in managing their condition.

Point of care testing allowed clinicians to carry out tests close to the patient and be able to discuss the results with them immediately, for example glucose testing. Staff could support patients and discuss ways to improve and maintain a health blood sugar level.

The provider used an online system to collect and analyse data including, staff levels, incidents and audits. The data was sent to local teams to be discussed at team meetings and review performance with staff. The critical care quality and safety board minutes showed data collected by the online system was discussed, and action plans implemented to improve the service.

The provider had an audit schedule showing when audits should take place and how often, for example the critical care documentation audit which reviewed clinical notes of 10 patients. Data from audits was fed back to the critical care quality and safety board.

The department had completed the first year of submitting data to ICNARC to benchmark their performance against other units. We reviewed the quarterly report and found the service was benchmarked against 17 units of a similar size and in most metrics performed as well as, or better than other services.

The provider was a member of Private Healthcare Information Network (PHIN). PHIN is an independent source of information for patients helping them make informed choices. There were just under 1500 reviews for the hospital, with 97% of respondents stating their care was good or very good. This data was not available at service level. Senior leaders told us being part of this network helped create an open and transparent service providing assurance to patients.

The provider was a member of Independent Sector Complaints Adjudication Service (ISCAS). Patients who were not happy with the hospital’s response to their complaint could ask ISCAS to review the complaint and help achieve a satisfactory outcome. At the time of our assessment no complaints regarding critical care were being reviewed by ISCAS.

Data was available from the parent company in the United States. As some metrics differed to standard UK metrics, the service was able to benchmark performance against additional standards of international care helping to improve care.

Patients signed consent forms for the procedure they were to have at the point of admission. Where known, this would include their admission into the critical care service as part of their pathway. Where they were unable to do so due to their medical needs, family members and medical professionals would discuss what was in the best interest of the patient.

Best interest meetings were held regularly to review patients who lacked capacity, and patients without capacity were continually reviewed and assessed. An independent mental capacity advocate (IMCA) was appointed to act on behalf of the patient and ensure their best interests were at the centre of any treatment plan. Staff told us relatives’ involvement was crucial to how patients were treated. Patients and relatives wishes were discussed at the MDT meeting. We observed staff discussing different care options for a patient and agreed to set a time to discuss this with the family before the decision was made.

Involving patients in their care was an important part of the patient pathway. Patient preferences were recorded for example, if the patient required a female caregiver, and interpreters could be requested and booked.

The Mental Capacity, Deprivation of Liberty Safeguards (DoLS) and Liberty Protection Safeguards (LPS) policy referenced the Mental Health Act and national guidance and set out the statutory principles for staff to follow. This policy was accessible to all staff on the provider’s internet. All clinical staff received Mental Health Act training as part of their mandatory training on induction.