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. People always had enough to eat and drink to stay healthy. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. They monitored people’s health to support healthy living. 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.

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.

The service had a person-centred approach to assessing and reviewing patients’ healthcare and communication needs. Care plans were developed based on assessments carried out by staff when the patient was admitted ensuring all their needs were met. Assessments were continuously updated throughout each shift, with clear time stamps to make sure staff could recognise the most up-to-date care needs.

During the assessment we reviewed three sets of notes. We found they were complete, covering all aspects of care. The electronic system prompted staff to include information and automatically opened additional sections if specific responses required further details. This made sure no information was missed or overlooked. The system alerted staff when care plans or risk assessments needed to be updated, helping maintain up-to-date and relevant care planning.

Staff told us they involved patients and families in the care planning process. They took time to gather as much information as possible from patients and their families or carers to ensure that individual needs were understood. Patients could be referred for additional support if needed, such as a dietitian if dietary needs were identified.

The case manager responsible for discharge planning played a crucial role in liaising with families to ensure that appropriate support was arranged for patients once they returned home. This included assisting with applications for Continuing Health Care (CHC) funding where necessary, ensuring that patients and their carers were equipped to provide safe and effective care post-discharge.

The service worked collaboratively with other areas of the hospital to maintain an effective joined up approach and continuity of care, particularly during transitions, referrals and discharges. Junior doctors and clinical fellows were involved in taking a medical history from patients and received regular training during the Friday morning medical rounds as well as at monthly grand rounds. Clinical fellows worked in rotating 24-hour shifts to ensure there was always medical cover. Consultants were available on call ensuring patients received uninterrupted care. Staff we spoke with told us consultants were easily accessible and approachable.

The organisational structure allowed for direct discussions between clinical fellows and consultants regarding patient care. The skill mix and staffing levels were designed to ensure more experienced clinical fellows worked alongside less experienced ones, providing mentorship and support. This teamwork ensured that patients received appropriate treatment, with fellows liaising with consultants regularly and a high standard of patient care maintained.

Technology was used to support communication between teams and external partners. Secure chat functions facilitated sharing information such as referring doctors. The online platform for patient notes meant medical and nursing staff could access patient records and stay updated on developments. Communications were attached to patient records supporting continuity of care when team members were absent.

Clinical huddles took place three times a day and facilitated the multidisciplinary team (MDT) to discuss patient care, plan follow-up care, and prepare for discharges. This meant all relevant staff were updated on the patient’s progress. The handovers between clinical fellows at shift changes reinforced continuity, as did the consultant handovers every Sunday evening. These systems assisted in ensuing staff across all shifts and roles were informed and able to deliver consistent care.

Staff engaged with patients when discussing their medications to make sure they understood how to take the medication and why it was important. They could refer patients for additional support to teams such as the diabetes team to help patients manage 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. This meant patients were able to ask questions about what the results meant and how to manage them at the time rather than wait for medical rounds or consultations.

The clinic consistently monitored and evaluated patient care and treatment to ensure positive outcomes aligned with clinical expectations of patients. The service used an online platform to collect data such as, falls, discharge and readmission rates. Staff told us technologists made sure data was accessible so it could be used to monitor care. This allowed for continuous evaluation of clinical outcomes and identify areas to improve. High readmission rates was identified for improvement. When the data was reviewed the data showed that rather than readmissions, patients were returning for a follow up as part of their post discharge monitoring.

The provider’s safety and quality improvement plan included how outcome data was monitored and shared with staff, for example at weekly senior staff huddles. Learning was cascaded to other staff through departmental huddles. We observed the senior staff huddle and found, routine updates covered scheduled audits, complaints and discharges.

The provider submitted patient reported outcome measures (PROMS) data to NHS England and this was their first year of submission. At the time of our assessment, data for this first year of reporting was not publicly available. Once published, the provider would be able to benchmark outcomes against other services.

The provider was a member of the 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, and 97% of respondents stated their care was good or very good, although these were not broken down by ward. Leaders told us being part of this network helped create a transparent service for patients.

The provider was a member of ISCAS Independent Sector Complaints Adjudication Service (ISCAS) providing patients with an independent body to review complaints. At the time of our assessment there were no complaints for the service being reviewed by ISCAS.

The service made sure people were informed about their rights regarding consent to care and treatment, considering their views and wishes when planning their care. Information about care and treatment was provided in a way that patients were able to understand, and staff could access interpreters if required. Electronic tablets were used to sign consent forms for invasive procedures such as endoscopies and biopsies. For non-invasive procedures verbal consent was obtained. Staff told us patients were given time to make decisions.

Staff were aware of the importance of obtaining consent before delivering care or treatment. In cases where a patient lacked capacity to consent, the clinic followed the Mental Capacity, Deprivation of Liberty Safeguards (DoLS) and Liberty Protection Safeguards (LPS) policy. It referenced the Mental Health Act and national guidance and set out the statutory principles for staff to follow. Best interest meetings were held regularly, and patients were continually reviewed to assess capacity.

For patients who lacked capacity, family members and carers were consulted, and an independent mental capacity advocate (IMCA) was appointed to act on their behalf making sure the patients’ best interests were at the centre of the treatment plan.