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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This was the first assessment of this service. We rated this key question good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 the treatment was planned. Staff told us they involved the next of kin in care planning where appropriate and patients and relative’s views were considered during MDT meetings. This meant there was a holistic approach taking into account people’s preferences and patients were clear what to expect.

The mental health support team could provide additional support. Staff told us this was most often to support patients following neurological surgery. The team consisted of four psychologists who carried out assessments that focussed on individual needs of patients. They worked in conjunction with the therapy team, and both were available site wide. This ensured there was the correct support in place throughout the patient’s recovery.

Processes were in place to support patients who were anxious or those with specials requirements. For instance, a patient with known complex pain control needs was reviewed by the multidisciplinary team who developed a plan before, during and after surgery which worked well for the patient. Staff gave an example when they arranged an individualised care for a patient with anxiety by allowing a relative to accompany them to the theatre. The patient’s mental health needs were considered as part of the pre-operative assessment. This meant their individual needs were met.

The global service team work across the hospital providing a support system for overseas patients, ensuring their individual needs were met. Patients we spoke with told us they felt their needs had been met and staff were very supportive. One patient told us staff were good at anticipating what their needs might be post-operatively. Communication aids were used to speak with patients and one patient gave an example of when this was used after they had taken pain medication and their ability to communicate had been impaired.

Policies reflected national guidance and good practice, considering NICE, Department of Health and surgical specialty guidelines. Scheduled audits monitored compliance with NICE standards meaning policies reflected up to date information. The service was supported by regular organisational updates following national bulletins. For example, new guidance on venous thromboembolism(VTE) indicated TED stockings were no longer needed. However, quality outcome monitoring at the hospital identified benefits to patients undergoing orthopaedic procedures and continued to use them following discussion with surgeons.

We observed good practice in theatres and recovery, for instance, the use of normothermia bair huggers, thermometer checks, and diabetic standards.

The service contributed to a number of national audits and registries including patient reported outcome measures (PROMS) and the national joint register, for which they received a bronze award. This allowed the service to benchmark their practice and outcomes with other providers identifying areas for improvement.

There was a quality metrics dashboard which benchmarked a large number of metrics with the performance of each surgical team. The dashboard was used in team meetings and quality and safety governance meetings where actions were monitored. Data could be looked at for closer analysis and filtered by department or procedure, so the information was relevant to local teams.

The provider developed local safety standards for invasive procedures (LocSSIPs). We observed the process and found they had been implemented alongside the World Health Organisation (WHO) surgical safety checklist. These measures were in place to reinforce best practice and improve patient safety. The quarterly audit of compliance with the WHO checklist showed since December 2023 they consistently achieved 100% apart from on two occasions where it fell to 97%. This meant staff were using tools available to them to keep patients safe.

Staff worked well together and with other teams and had good links with all the departments in the hospital. Theatre staff told us they worked well with ward staff and as part of a multidisciplinary team. The multidisciplinary model meant that teams followed the patients through patient pathways and multidisciplinary teams worked as one team. This meant patients had familiarity and consistency with key people throughout their journey and staff were able to get to understand the patients’ individual needs. One patient told us they were aware of the integrated multidisciplinary team and told us ‘They all knew me and understood me. I only had to explain it once and they all knew because they are all speaking to one another’.

The theatre team leader told us they felt looked after, respected and felt supported and that it was crucial they felt part of the multidisciplinary team. The medical director told us they were proud of the good speak up and no blame culture here. The charge nurse on PACU told us they felt they had a strong multidisciplinary team which gave them a good knowledge base helping keep patients safe.

We observed a good culture and effective communication between healthcare professionals throughout the hospital which meant there was an effective transition for patients between services. Staff on surgery wards told us there was excellent communication across teams. For instance, the critical care outreach team were responsive and accessible by sending a message via an electronic platform or by calling them. We were told they followed up patients for 24 to 48 hours and were free to refer patients back to the service if it was necessary.

An advanced nurse practitioner we spoke with told us the technology to see who was on duty was helpful as you could see instantly who was available to call upon for support. They told us that when patients are transitioning between services, there was good specialist support enabling them to provide effective care.

Staff engaged with patients during their pre-assessment appointment and all patient’s health promotion was based on the procedure the patient was having and their pre-operative assessment. Patients could access a digital platform where interactive animations and videos gave procedure specific information in a clear accessible way. While patients were supported throughout their stay, staff could help them to access support once they had been discharged to continue to live a healthier life. For example, finding appropriate physiotherapy care in the community to aid with their recovery and aid them to live a healthier life.

Staff could refer patients for additional support to teams such as the diabetes team to help them 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.

Managers and staff carried out a programme of repeated audits to check improvement over time. Managers told us they used information from the audits to improve care and treatment and they shared and made sure staff understood information from the audits by discussing results with them.

The quality metrics dashboard for surgery covered many indicators of surgery quality. For instance, timings and late starts, surgical site infection rates, top ten surgeons, average length of stay and theatre utilisation. Statistics were broken down by each of the four surgical institutes and gave an overview of quality. Each surgical institute had their own governance structure and monitored quality issues such as post operative infection rates and outcomes. Surgical site infections and theatre readmission rates were reviewed at the quality and safety board and when necessary recommended for escalation to the integrated governance committee. This meant there was oversite of the service, and they were able to track patient outcomes and review or change practice to avoid further infections.

The provider submitted patient reported outcome measures (PROMS) data to NHS England, this was their first year of submission. This was monitored using an online health management tool to track PROMS. 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 used an online health management tool to track PROMS

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.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff worked in line with the provider’s consent policy. Consent was recorded digitally and meant all staff could easily access and see what the patients had consented to. This formed part of the patient’s pre-assessment appointment which took place between two to four weeks before surgery.

Patients had all risks explained to them and were given information to review to help them give informed consent. On the day of surgery, consent was taken again to ensure the patients had not changed their mind. The patient was able to ask any further questions, and staff told us it was very rare for a patient to change their mind on the day of the procedure, but they could if they chose to.

During our assessment we observed a patient have the treatment and process fully explained to them. They were fully engaged with the consent process and there was an electronic screen used to assist the patient in their understanding and be involved in their own assessment of their needs.