The Whiteley Clinic London

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• 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 patients and communities had the best possible outcomes because their needs were assessed. We checked that patients’ care, support and treatment reflected these needs and any protected equality characteristics, ensuring patients 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.

At our last assessment we did not have sufficient evidence to rate this key question. At this assessment we have rated the service good. This meant patients’ outcomes were consistently good, and patients’ feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service usually made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff shared key information to keep patients safe. Consultants carried out all necessary risk assessments for patients pre-procedure, including deep venous thrombosis (DVT) risk assessments. The service had a patient concern protocol to provide clear steps for staff members to assess and record patient concerns efficiently and minimise errors, using an electronic patient contact log to record any communication with patients.

Nursing and HCA staff conducted pre-operative telephone calls with patients at least 1 week prior to the patient’s treatment, following set guidelines. Staff reviewed the patient’s medical letter and consent form to verify any special prescription requirements and to confirm the procedure type. Staff would also confirm the patient was able to eat and drink before their procedure, and would check with the patient if there were any special requirements or prescriptions needed from their consultant before their procedure. Staff instructed the patient to take their prescribed medicine as usual, unless they were advised otherwise by their consultant. Staff recorded the details of the call, including any patient concerns, additional instructions provided, and any updates to the patient’s condition or contact information.

Additionally, where applicable nursing and HCA staff would send the post-procedure information leaflet to the patient via email (unless they specified a preference for a paper copy on the day of their procedure). They communicated with consultants to share relevant patient concerns or any outstanding actions (for example, prescriptions) with the consultant who performed the procedure. They also liaised with the rest of the team where needed, in terms of coordination with the team assisting the surgeon to address any special requirements, such as stocking orders or allergy considerations of the patient (for example, latex allergies).

On the day of the procedure, a detailed pre-operative assessment was completed, including consent verification, blood pressure measurement, weight check, anticoagulant review, risk assessment, and a full phlebology checklist. Any concerns identified during this stage were initially raised by nurses or HCAs and were escalated promptly to the consultant for review prior to the procedure commencing.

Staff with appropriate seniority had discussions about the patients’ preferences and wishes if their condition deteriorated. Decisions about care were made with consideration of wishes of the patient and/or their family.

Staff assessed patients’ pain and used recognised tools to do so. Staff gave pain relief in line with individual needs and best practice and assessed how effective this was. Patients’ pain was addressed before they left the operating theatre.

The service planned and delivered patients’ care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation. They worked to develop evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. We reviewed all policies which had review dates and referenced current National Institute for Health and Care and Excellence (NICE) guidance, the Royal College and the College of Phlebology guidelines and saw these reflected in patients’ care records. There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards displaying up-to-date guidance to staff.

We reviewed 4 care records for evidence of completion of care plans and risks assessment of patients. These records contained key documents including patient registration forms, signed and dated consent forms, venous diagnostic test results, DVT risk assessments, phlebotomy safety checklists, letters sent to patients and their GPs confirming the outcome of procedures and recommendations, consultation notes, operation notes from consultants and details of the procedure carried out by the consultant. All records we reviewed were clear and detailed, and contained key information required for each patient. The information was used to inform care planning and delivery.

The service usually worked well across teams and services to support patients. Staff made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

Staff reported healthy working relations across staff groups, including between medical and nursing teams. We saw and heard examples of effective team working which was based on mutual respect and trust.

Plans for discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Discharges were planned at an early stage to ensure they were safe and appropriate for the person’s needs.

Information was shared between teams and services to ensure continuity of care.

Staff worked across health care disciplines and with other agencies when required to care for patients. For example, if the patient wished, the service would write a letter to their GP summarising the procedure undertaken at the clinic and any medication the patient needed as part of discharge planning.

Peoples’ records showed there was input from a range of clinicians and that they shared information to ensure a consistent approach to care and treatment pathways.

Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care. We reviewed clinical governance meeting minutes, which provided evidence of multidisciplinary discussions about patient care and agreed treatment options based on the individual medical needs of the patient.

The service generally supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support. For example, as part of discharge planning, patients were encouraged to mobilise as much as possible after their procedure and to prevent the risk of developing DVT and other complications.

Staff spoke with patients about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health. For example, staff encouraged patients to avoid alcohol post-procedure, and encouraged patients to stay well hydrated. This information was stated in letters that consultants sent to patients confirming the outcome of their procedure and any recommendations.

The service monitored patients’ care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and outcomes met both clinical expectations and the expectations of patients themselves.

Staff monitored the effectiveness of care and treatment through patient audits. The service used the findings from Patient Reported Outcome Measures (PROMs) data to make improvements and achieved good outcomes for patients, through generally low recurrence rates amongst patients following their procedures. The nominated individual of the service was the founder of the College of Phlebology and provided data to the College of Phlebology venous registry dashboard. The College of Phlebology was an international organisation dedicated to promoting excellence in the treatment and management of venous disorders and aimed to provide a platform for sharing best practice, advancing research, and promoting education and training in phlebology. The patient audits enabled the service to monitor and improve the quality of their own care, whilst contributing to the overall goals of the registry. The registry complied with all applicable laws and regulations related to data protection.

The service did not currently contribute data to the Private Health Information Network (PHIN) as they did not have inpatients.

The service reported 15 surgical site infections post procedure within the past 12 months. Appropriate action was taken by the service to treat these infections, including the use of prescribed antibiotics and other medications, such as blood-thinning medication and anticoagulants, to prevent the occurrence of blood clots. The action the service took to treat these infections resulted in patients having generally low recurrence rates of developing complications and infections based on the internal audit data that we reviewed.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

The service made sure patients were supported to give informed consent. Staff followed national guidance and ensured patients understood the risks, benefits and alternatives to treatment. We saw that consent processes were consistently followed, including checks at different stages before procedures. Staff understood how to assess mental capacity and support patients who required additional help.

The service monitored consent through regular audits, with a recent audit showing 96% compliance. Any areas for improvement were identified and addressed through action plans, and learning was shared with staff. This avoided any similar concerns from happening again in the future, and any findings were communicated directly to staff members, as well as in 1:1s and clinical governance meetings.

Patients told us they were given time to ask questions and make decisions about their care. They felt involved in decisions about their care and could describe the information they had been given prior to treatment. Chaperones were provided if requested.

The service used a translation service for patients whose first language was not English, which was used to support patients to give informed consent to the procedure. Where appropriate, interpreters also needed to sign and date patients’ consent forms to confirm they had explained to the patient that they had communicated to them the procedure in their native language, and in a way they believed the patient had understood.