Thornbury Radiosurgery Centre Limited

Updated 5 August 2019

The Thornbury Radiosurgery Centre is located at a local private hospital in Sheffield and is a partnership with Medical Equipment Solutions Limited (MESL) providing a radiosurgery service treating brain tumours and other intracranial conditions. The service works in partnership with the local NHS Foundation Trust to provide treatment for NHS patients from all over the UK and offers a worldwide service for private patients. The host hospital provides various support services including diagnostic imaging under a service level agreement.

The centre is a sub-contractor to the local NHS Foundation Trust and treats tier one to four patients as a Supracentre. This means that the centre was awarded the NHS England contract to treat tier one to four patients for secondary brain and skull-based tumours (tiers 1 and 2) and also for rarer/complex clinical conditions including vascular and functional (tiers 3 and 4). Tier three and four patients generally have more complex conditions and the NHS England service specification for this treatment sets out the precise requirements. The service is not contracted to treat children.

A total of 301 patients were treated from March 2018 to April 2019. Of these, 280 were NHS funded patients and 21 were self-funded.

This service’s registered manager has been in post since December 2018. The registered manager has combined experience as a specialist stereotactic radiosurgery (SRS) treatment radiographer and is responsible for the day to day operations. The service is supported by management resources from MESL, the parent company. The clinical lead (also chair of the medical advisory committee leads the consultant team and is also clinical lead for the local NHS Foundation Trust.

Updated 5 August 2019

Thornbury Radiosurgery Centre Ltd Limited is an independent health care service providing stereotactic radiosurgery (SRS).

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on the 29 April 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Thornbury Radiosurgery Centre Limited was last inspected in 2016. We rated the service as requires improvement overall. We rated safe, responsive and well-led as requires improvement, and effective and caring as good. As part of this inspection we reviewed the actions we had told the service they needed to take to prevent any future breaches of regulation.

We found that the service had taken action to address all of the concerns from our last inspection.

We rated this service as Outstanding overall.

We found good practice in relation to:

• The service had enough staff with the right qualifications, skills, training and experience to provide the right care and treatment. All staff were up to date with mandatory training.
• The service had suitable premises and equipment, and this was well maintained.
• Staff had received training regarding safeguarding children and vulnerable adults, which included mental capacity and consent. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Patients were consented for treatment appropriately.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• Staffing was managed using professional judgment alongside daily and monthly planned patient activity.
• The service was planned and provided in a way that took account of patients and service users’ views and feedback. The service monitored the effectiveness of their service and used the findings for improvement.
• Staff were competent, had clear objectives and received regular reviews and appraisals.
• Staff worked well together as a team and with service users, patients and suppliers to benefit patients and provide a good service.
• The centre met Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) safety requirements for staff skills and practice and for equipment.
• The service had suitable premises and equipment and looked after them well. We found the hospital was accessible to wheelchair users, with clear signage. Access to all areas was controlled using magnetic door locks and by use of reception areas staffed by administration staff.
• The environment was visibly clean, cleaning schedules were followed, and we observed staff following infection prevention and control practices. The service completed monthly infection control audits, results were collated and disseminated to the wider team.
• We observed that all staff were polite and courteous to patients from arriving at the department to when they left. Patients told us they were happy with the service and that they had been talked through what to expect at every stage of the process.
• Patients told us the service was easy to access. There was no waiting list for patients requiring treatment.
• An interpreter service was available for patients if required; health promotion leaflets were available for service users.
• The service had a vision for what it wanted to achieve and identified actions developed with the views of staff, patients and service users taken into consideration.
• The service had not received any complaints in the last 12 months and was responsive to patient feedback.
• The service had systems and processes in place to minimise risks and manage issues and performance.

However, we also found the following issues that the service provider should improve:

• The provider should review the management surrounding the storage of medicines to ensure visibility and effective stock control.
• The provider should review the systems and processes surrounding the sharing of information with staff to ensure they are aware of company performance and updates.

Ann Ford

Deputy Chief Inspector of Hospitals (North Region)

Updated 5 August 2019

We rated this service as outstanding overall with ratings of outstanding for effective and caring and good for safe, responsive and well-led. There were areas of good practice and a small number of things the provider must do to improve. Details are at the end of the report.