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

Staff provided excellent care and treatment, delivered by highly trained, professional staff who undertook specialist development. 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 flexibly and at short notice.

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.

Consultants assessed needs on an individual basis and depending on whether they were seeing a patient for a one-off review or as part of ongoing care. They worked closely with surgeons, GPs, and diagnostic imaging to ensure assessments were complementary to other treatment underway. Each specialty used assessment tools in line with good practice guidance of professional bodies.

Pain management services were comprehensive and available as part of multidisciplinary care. Staff used a range of evidence-based assessment tools and guidance to effectively manage pain. For example, staff based wait times for pain treatment on national and the faces pain rating scale to measure pain levels. They the used the tool most appropriate to the patient’s individual needs, such as if the patient had chronic pain or experienced pain from comorbidities and used a recognised national tool to help communicate with patients who found it challenging to express their level of pain. A pain clinical nurse specialist and chronic pain consultant was available in the hospital and consultants referred to them for support on demand.

Staff used a multidisciplinary approach to meet the needs of patients who presented with complex needs. For example, they worked with colleagues in surgery to facilitate access to care for a patient experiencing addiction by providing weaning and detoxification care ahead of planned treatment. The patient received continuous support from the clinical psychologist and the multidisciplinary team, which ensured a holistic approach to care that avoided the needed to refer the individual back to NHS services.

Care and treatment were based on the most up to date national and international guidance. Governance structures, staff training, and policies were underpinned with a continuous understanding of changes to practice from key organisations such as the National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare products Regulatory Agency (MHRA). Institute chairpersons reviewed updates to guidance issued by NICE and MHRA weekly and applied them to internal policies.

Staff monitored internal standards of care through a programme of 10 quarterly, bi-annual, and annual audits common to each of the provider’s London locations.

Policies, standard operating procedures (SOPs), training, and staff practices were based on up-to-date guidance from professional bodies and organisations including the Royal College of Obstetricians and Gynaecologists (RCOG) and the Association of British Neurologists.

The senior team recognised the need for greater benchmarking in the independent sector as a tool to measure patient outcomes and identify good practice as well as areas for improvement. The provider had completed accreditation with an international quality programme, operating at the level of ISO quality management systems, that required the service to demonstrate how they created positive change amongst staff. The outpatient team used a clinical compliance measure to identify how interventions improved patient outcomes.

Staff used a series of audits to establish benchmarks for standards of practice. Each audit had a named champion who reported results to the rest of their team and performance was consistently good. In the previous 12 months, the service achieved 100% compliance with the provider’s falls prevention processes and over 99% compliance with the requirement for daily safety checks in the department. This audit was undertaken at location level and the overall results were the same as those achieved at the Moorgate Outpatient location.

Advanced nurse practitioners worked with consultants to identify opportunities to develop nurse-led care. This process reflected a continuous, inquisitive approach to improvement.

The provider operated a structure that promoted agility in decision-making that supported staff to contribute ideas for improvement. For example, there were few steps needed for staff to speak with a decision-maker, which meant issues were resolved quickly and staff could test ideas with senior colleagues without delay.

Staff had the opportunity to shadow colleagues in other departments as part of their ongoing development. This helped improve understanding of other roles and specialties and identify areas in which training would be beneficial.

A wide range of clinical and allied health professional services were available across the provider’s care provision. Consultants worked with them to develop care plans. For example, dieticians worked with patients under the care of gastroenterologists to plan care to meet long term health goals.

Multidisciplinary working was embedded throughout the service and provided expanded access by incorporating seamless care between all 3 London locations. Staff convened multidisciplinary meetings across clinical specialties and departments, which enabled staff to effectively review patients with complex needs.

The service had service level agreements (SLAs) in place with other providers in the event a patient could not be treated in outpatients. This included a rapid referral process to an oncology provider and a similar process to refer patients experiencing poor mental health. We saw evidence the SLAs were effective for supporting patients, and staff could refer them quickly, including on the same day. In 1 instance a patient was seen by a cancer specialist at another provider within 4 hours of referral by the consultant. Staff provided referrals to NHS services on request.

Staff provided health promotion guidance and signposting based on individual needs relating to the clinical specialty. For example, staff in orthopaedics provided guidance and referrals to physiotherapy and occupational therapy. Staff had access to a wide range of in-house or partner services including for sexual health, alcohol dependency, and dietetics.

The provider subscribed to a third-party organisation to provide procedure-specific patient information documents. Information was available digitally and included interactive formats such as animations and videos, adapted for optimal viewing on smartphones, computers, and tablets. Patients accessed this information through the digital health record system, which meant they had on-demand access to specialised information.

The provider worked with other organisations to source highly trained specialist nurses to support patients to live healthier lives where this was outside the usual scope of the department. For example, the colorectal clinical nurse specialist worked with external stoma nurses who met with patients in the department to provide long-term care and guidance on daily health. The provide had training, support, and leadership structures in place for stoma nurses that closely matched employed staff, which provided assurance of high standards care. This multidisciplinary service was in place at each of the provider’s 3 outpatient sites and patients accessed it on demand and at the location most convenient to them.

Patient outcomes were monitored by medical specialty rather than at an outpatient department level. For example, dieticians worked with patients to assess their needs and identify care and treatment goals. A psychologist was dedicated to the bariatric service and worked with patients to establish post-operative, long term goals and care managed through outpatients.

Staff used audits to measure outcomes. For example, in the previous 12 months the service achieved 100% compliance with a monthly pain audit and 96% compliance with a quarterly documentation audit.

The provider had a clear focus on staff development as a strategy to drive continuous improvement in patient outcomes. This was reflected in the wide range of achievements amongst the team outside the scope of required training. For example, 2 healthcare assistants had successfully gained registration with the Nursing and Midwifery Council and a nurse had completed a Masters in women’s health. In addition, 2 nurses had attended the NHS national outpatient conference and presented learning and opportunities for innovation. Staff worked across outpatient’s services and as such their achievements reflected the broader development of the team.

Staff valued patient-defined outcomes highly and sought feedback regularly to measure each person’s satisfaction with the outcome of their care and treatment. In the previous 12 months, 93% of patients said they were satisfied with their experience.

The service had reduced blood sampling errors since 2023 through new training and streamlined processes for staff to send samples to the on-site laboratory. In 2024 staff reported an average of 1.7 blood sampling errors per month, compared with 3.9 per month in 2023.

The service used patient-reported outcome measures (PROMS) during post-operative outpatient appointments in 7 clinical specialties. Patients reported their progress using the digital platform and clinicians monitored results to maximise recovery.

The consent process included a discussion of each patient’s medical history so that staff could identify risks or barriers to treatment. Staff were skilled in supporting patients in sensitive discussions and knew how to gain appropriate consent when treatment involved multiple services. Consultants delivering long-term treatment obtained consent at the beginning of treatment and checked with the patient at each subsequent appointment.

We saw the consent process in practice during our onsite assessment. Staff gave patients time and space to ask questions and made sure they fully understood their planned treatment. For example, nurses discussed the potential risk of fainting before removing a plaster cast.

The provider’s minor operations policy required staff and patients to countersign an electronic consent form before treatment proceeded. Staff discussed the potential risks of treatment and made sure patients understood how they could support their own recovery afterwards.