Harley Street Specialist Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that patients were properly assessed and treated according to their needs. We were assured that premises and equipment were safe, clean and fit for purpose. We reviewed records and checked there were enough suitably qualified staff.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 56 (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 proactive and positive culture of safety, based on openness. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Steps had been taken to nurture a culture of transparency and inclusivity. The daily morning meeting was now open to all staff, who were encouraged to raise emerging concerns, themes or issues. A daily bookings meeting was held at 2pm to prepare and plan for future procedures where all key staff were encouraged to attend and contribute.

The director of clinical services and chief operating officer had moved out of their offices to sit at desks in communal areas to increase visibility and accessibility. The human resources lead had an open-door policy 5 days a week, 2 of which were on-site.

Freedom to speak up (FTSU) guardians were accessible to all staff. One of the FTSU guardians chaired the staff forum and brought issues raised to the senior leadership team meeting. We were shown examples of what had been raised and how it had been acted on. This included dealing with consultants, visitor passes, staff breaks and wellness room.

The service learnt from incidents and near misses. Staff reported incidents on a digital reporting system which alerted relevant members of staff. Incidents were graded for severity and investigation. Governance meetings reviewed incidents and complaints. Learning was communicated in staff meetings, regular staff bulletins and a monthly all staff meeting where the chief operating officer presented performance data which included learning from incidents and complaints. Staff had recently received refresher training on how to raise and investigate incidents as it was acknowledged by leaders that they wanted to increase reporting rates. In the last year here had been no never events and two incidents categorised as serious. Both incidents related to deteriorating patient episodes.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care.

There was collaborative, joined-up care that involved patients, staff and other partners in their care. There were two lines of entry into service. One was consultant led where the service initiated and carried out initial consultation. The other was patients contacting the service directly. Initial consultation preceded the pre assessment process. A senior nurse was the pre assessment lead and was responsible for ensuring that risk was effectively assessed and managed across the care journey.

The daily multidisciplinary bookings meeting reviewed pre assessment information and theatre scheduling. Eligibility and suitability for surgery depended on patients fitting a day case profile. The admission and exclusion policy clearly stated the criteria by which patients were not suitable. The service used the American Society of Anaesthesiologists physical status classification system; a grading system used to assess a patient's health before surgery (ASA score). Only patients with an ASA 1 and 2 profile were eligible to be admitted to the service.

Discharge criteria ensured that care and support was organised with patients, relatives and partners to ensure continuity. The outpatient's department followed up patients to ensure post discharge consultations, wound check appointments and physiotherapy appointments occurred. Dedicated aftercare support was provided through a triaging system. Patients were able to contact the service's RMO directly if there were any concerns. They were also to contact the service's pharmacist directly. There had been zero return to theatres for the year before our visit, February 2024-25.

The views of people who use services were taken into account. We reviewed four months of data which had response rates of between 72 and 84%, with the average numbers of patients contacted between 50 and 60 per month. Peoples' views of the service were overwhelmingly positive. Feedback contributed to quality improvement themes and was included in the monthly staff update.

We did not look at Safeguarding during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

The service worked with people to understand and manage risks. Staff provided care to meet people's needs that was supportive and enabled people to do the things that mattered to them.

Risks were assessed, and people and staff understood them. There was a thorough pre assessment process that included assessing eligibility for day case surgery. The booking form ensured that all basic details and prospective care needs were recorded. The pre assessment form was a comprehensive health assessment which met the needs of the types of procedures being carried out.

Daily morning meetings ensured the service understood and managed safe practice. Completed forms showed daily checks of who was on call, including 3 ILS trained and 1 BLS trained bleep holders. Bleeps and radios were checked, confirmation of the consultants in on the day and the following day was confirmed. Theatre packs and the rooms in use were checked and confirmed.

In recovery, the service used NEWS2, a nationally recognised risk assessment tool to respond to clinical deterioration. In recovery, nursing was provided on a one-to-one basis and patient observations were recorded every 5 minutes. Staff told us that any deterioration was reported to the resident medical officer (RMO) who was medically responsible for patient care. A nationally recognised pain assessment tool was also used.

When assessed as stable patients were moved to the recovery pods; a more private area located within the recovery area and within proximity of the nurses. The frequency of observations were reduced according to care needs and risk, until patients were discharged. Clear discharge criteria ensured safe discharge. The recovery area and pods had `day case steps to discharge' checklist posters, providing staff with a visual guide of tasks to complete before discharge.

The RMO and nursing staff stayed until all patients had been discharged. Staff worked 7am till 6pm and could recall 3 examples in the past year when a late stay was required. There was one example where a patient's blood pressure was high, and the patient stayed overnight for monitoring before transfer to A&E. We were told during this time nursing staff were with the patient and the consultant and anaesthetist were within twenty minutes and on call. Leaders told us overruns were discussed in governance meetings regarding what could have been done to prevent it.

The management of deteriorating patients policy stated that in the event of a critically unwell patient, they would be transferred to an appropriate NHS facility; the nearest A&E by dialling 999. The consultant or RMO would liaise and update the ambulance service according to the patients' medical condition. In the event where a consultant wants to arrange admission to an appropriate private hospital where they had practicing privileges, it would be the responsibility of the patient's consultant to arrange this.

Staff told us they could recall 1 patient transferred to A&E in the last year, adding this was not a recent event. Leaders confirmed the same thing to us and explained the process which involved stabilising the patient prior to transfer to the nearby NHS hospital which they had good links with through their consultants.

The use of the World Health Organisation (WHO) five steps to safer surgery checklist was embedded in practice. The service used an electronic WHO checklist and swab boards were located in each theatre, providing visual management tools to document and track swabs, sharps, and instrument counts to ensure compliance and ease of use. This was a small service with one theatre team on the day of our inspection. We observed one WHO sign in. All staff understood their roles and the process appeared embedded into practice. WHO audits took place and sampled ten procedures a month. Results showed good compliance.

The service detected and controlled potential risks in the care environment. Staff made sure equipment, facilities and technology supported the delivery of safe care.

Surgical activity was located on the lower ground floor (1 operating theatre, anaesthetic room, 2 recovery bays and 4 daycase pods) and the ground floor (1 theatre, 1 patient room, 3 bedded recovery bay). We found environments were safe and designed to meet people's needs. For instance, the operating theatres were bright, clean and in good order. There was an anaesthetic room with an integrated theatre scrub area. There was a separate setup/ preparation room. Both theatres had laminar flow equipment in situ. All areas were secure and accessed by swipe card.

There was adequate facilities and equipment in recovery and pods including beds and trolleys. Sharps bins were wall-mounted and not over filled/overflowing. Patient equipment such as gowns and an ample supply of TEDs and nonslip socks, were stored in a clean drawer within the recovery area.

We found there was suitable heating in each room. Each pod had its own radiator, and the recovery area had central air conditioning which was switched on by staff prior to any patient arrival and was controlled by staff. There was specialist equipment available to help maintain or restore a patient's core body temperature after surgery if required.

Facilities, equipment and technology were safe and well-maintained. For instance, maintenance of equipment was carried out under a service level agreement with a suitably qualified company. They carried out asset tagging and systematically went through each theatre and recovery room providing checks on all equipment, with a report provided following each visit. Equipment we checked had been serviced and was within date. Staff told us that maintenance issues were responded to in good time. There was one anaesthetic machine in theatre and one in the anaesthetic room. Each machine was checked and recorded in a logbook in accordance with the Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommendations.

The controlled drugs cupboard was fixed to the wall in the anaesthetic room. It was locked and secure which followed national guidelines.

In the pack room, items were stored on racks off the floor in accordance with good practice. The procurement manager rotated and ordered stock as appropriate. It was noted that irrigation bags were stored on the floor by the pack room. Managers were informed of this and made immediate changes. There was a cupboard identified for control of substances hazardous to health. It was secure and locked as per national guidelines. Fridges were checked daily when theatres were in use.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people's individual needs.

Daily meetings identified staffing needs in advance, according to numbers and types of procedures. Staffing rotas were provided a month in advance. Staff explained they used to receive weekly shift rotas at short notice but were now receiving their rotas in a more timely manner.

In recovery, one to one nursing was always used. On the day of our visit, we found there were three qualified nurses and one healthcare assistant (HCA) on duty. Because only one theatre was in use, the service was more than meeting best practice recommendations. Nursing staff and the RMO stayed until the last patient was off site. Staff worked 7am till 6pm and could recall 3 examples in the past year when a late stay was required. We were told it was accepted that it sometimes happened, sometimes to tidy and clean up and sometimes they finished early. Staff told us felt supported by each other, including the recovery RMO. The RMO stated there were bank or agency workers available should a patient need to stay overnight, and a handover would take place. Bank staff were either full time staff doing extra shifts or staff who the service had known for a while, so were familiar with work practices.

We found that theatres were staffed in accordance with the the Association for Perioperative Practice (AFPP) and AAGBI guidelines: one scrub practitioner, one anaesthetic practitioner, one circulating practitioner, one healthcare assistant and one recovery practitioner. This included one agency member of staff who had been working at the service filling a vacancy. The same person was used for consistency.

Managers had been working to retrospectively catch up with staff annual appraisals and all staff who had worked at the service for more than a year had an up to date appraisal. Staff reported their induction period included completion of their mandatory training courses, which amounted to 20 modules for an HCA and 30 for a nurse. Staff were supernumerary during induction, shadowing, for the first two weeks and continued with buddying. The length of time this lasted was based on individual staff need.

Medical staff worked at the service under practising privileges. The granting of practising privileges is a process within independent healthcare when a medical practitioner is granted permission to work at a service. Due diligence for the granting of practising privileges included a referral process, documentation gathering and meeting the chief operating officer to ensure they were the right profile for the culture of the service. This information was then presented to the medical advisory committee. The dashboard for practising privileges demonstrated that mandatory training, employment checks, practising credentials, background checks, indemnity insurance and appraisals were audited regularly and were in place for each person granted practising privileges at the service.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Premises and equipment were kept clean and hygienic. We found all areas to be clean, hygienic and free of dust on high and low surfaces. This included the two operating theatres, the preparation room, anaesthetic room and recovery area. Cleaning schedules had all been completed daily and noted when theatres were closed.

There were enough hand wash basins and hand gels located in every area. Staff we observed were all bare below the elbows. Cleaning occurred between patients and at the end of each day. Cleaners were employed directly by the service and visited every morning and evening. Deep cleans occurred quarterly. This had been increased from half yearly following a new infection prevention and control consultant auditing the service for best practice.

Sterile supplies were outsourced to a local NHS trust under service level agreement, ensuring reusable medical devices were cleaned, disinfected, inspected, packed, and sterilised for safe reuse. Instruments were collected at 7am daily and returned the following morning unless fast tracked, which ensured return at 6pm the same day. There was a tracking system in place for surgical instrument tray sets for audit of potential infection; a legal requirement.

Clinical waste was kept in yellow locked bins as per local and national policy and kept in a basement room with locked access to outdoors for collection.

There were regular infection control audits such as cleaning audits, monthly hand hygiene, quarterly legionella testing. The service produced an annual report. Quarterly IPC governance meetings reviewed performance. There had been no post operative surgical site infections within the last year. There had been no healthcare associated infections such as MRSA, Clostridioides Difficile and Pseudomonas within the last year.

We did not look at Medicines optimisation during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.