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The CyberKnife Centre London Outstanding

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Outstanding

Updated 27 April 2017

The CyberKnife Centre London is operated by Robotic Radiosurgery LLP. Robotic Radiosurgery LLP is an independent health care service and is part of HCA Healthcare UK. The CyberKnife Centre is located within The Harley Street Clinic, also part of HCA, but it is registered separately with CQC.

The CyberKnife Centre London provides stereotactic radiotherapy or radiosurgery treatments for privately funded patients with a wide range of benign and malignant conditions. Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy used to treat functional abnormalities and small tumours of the brain. It can deliver precisely targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection of this service on 15 and 16 December 2016. We inspected this service under the medical care core service.

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.

We rated this service as outstanding overall because:

  • We found that staff were actively engaged in activities to monitor and improve quality and outcomes and that opportunities to participate in benchmarking, peer review, accreditation and research were proactively pursued.

  • We saw many examples of innovative practice and staff could tell us about the research being undertaken by the centre and how outcomes were being embedded within clinical practice to benefit patients.

  • We found excellent multidisciplinary team working. Staff, teams and services worked collaboratively to find innovative and efficient ways to deliver more joined-up care to patients.

  • Feedback from people who use the service and those who are close to them was consistently positive about the way staff treated people. People told us that staff went the extra mile and the care they received exceeded their expectations.

  • There was a strong, visible, person-centred culture and patients were active partners in their care. Patients’ individual preferences and needs were always reflected in how care was delivered.

  • We found approachable and motivational leadership that promoted staff development and career progression, teamwork and high-quality patient-centred care.

  • Governance structures were well organised and well embedded and worked effectively to ensure there were clear lines of communication between key groups.

  • The service had a clear vision and strategy. Staff were aware of the corporate vision. The vision and strategy of the service was embedded into practice by staff.

  • Staff told us they were well supported, and felt valued, by management and felt proud of the organisation as a place to work and spoke highly of the positive and open culture.We found there were high levels of staff engagement and that staff at all levels were actively encouraged to raise concerns.

However, we found areas of practice that required improvement:

  • The risk register did not reflect all risks identified by recent incidents and near misses; managers told us that all risks identified by incidents and near misses should be recorded as risks on the centre’s risk register.

  • Patient experience survey response rates were variable and were on average 17% for the 12 months prior to our inspection. Only 16 of 92 patients provided with the survey had returned it. We were told action was being taken to try to improve this.

  • It was unclear how the results of the patient experience survey were used. We were not provided with any examples of where patient feedback had been used to improve services.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 27 April 2017

We rated safe as good because:

  • Equipment was well maintained and checked regularly with appropriate maintenance contracts in place.
  • The environment was visibly clean and we observed staff adhering to infection prevention techniques.
  • There was a clear incident reporting process in place and staff could describe feedback shared from recent incidents and lessons learnt.
  • All staff were compliant with their mandatory training requirements.
  • Patient records were clear and comprehensive.

However:

  • The centre did not have a staff representative at the hospital’s infection prevention and control (IPC) meetings, although we were assured information was provided by the meeting minutes.
  • The risk register did not reflect all risks identified by recent incidents and near misses. Managers told us that all risks identified by incidents and near misses should be recorded as risks on the centre’s risk register.

Effective

Outstanding

Updated 27 April 2017

We rated effective as outstanding because:

  • We found that staff were actively engaged in activities to monitor and improve quality and outcomes and that opportunities to participate in benchmarking, peer review, accreditation and research were proactively pursued.
  • We saw many examples of innovative practice and staff could tell us about the research being undertaken by the centre and how outcomes were being embedded within clinical practice to benefit patients.
  • We found excellent multidisciplinary team working. Staff, teams and services worked collaboratively to find innovative and efficient ways to deliver more joined-up care to patients.
  • Regular audits were carried out and outcome measures collated and shared both locally and nationally where appropriate.
  • Policies and procedures were developed using relevant national best practice guidance and were adapted in response to latest evidence. Staff were suitably trained and developed to improve their practice. Staff told us they were encouraged and supported to undertake further academic qualifications.

Caring

Good

Updated 27 April 2017

We rated caring as good because:

  • We observed staff delivering good patient care and responding to individual patients’ needs. We observed a supportive team approach to patient care. There was a well-embedded patient centred culture.
  • Feedback we received from patients and relatives about the service was consistently positive. Patients we spoke with were very happy with the care they had received. All of the patient comment cards completed prior to the inspection were positive about the care and treatment.

  • We saw that patients’ privacy and dignity was maintained and respected by kind, caring and compassionate staff.
  • We observed staff providing patients with information on the procedure they were undergoing. Patients were given the opportunity to ask questions and staff responded to provide further explanations where needed.

Responsive

Good

Updated 27 April 2017

We rated responsive as good because:

  • International patients were well supported to access the service via the hospital’s dedicated international patient centre staffed by liaison officers.
  • Staff within The CyberKnife Centre had access to HCA employed interpreters, based within the main hospital, who spoke Arabic, Greek and Russian, and a telephone language line for all other languages was also available. All patients were provided with a point of contact following their treatment should they have any concerns or need advice.
  • Although not required to use national cancer waiting time targets, the department chose to benchmark themselves against the national targets to measure their performance. Referral to treatment time was monitored via an audit and any breaches were investigated.
  • A service level agreement was in place for a nearby CyberKnife service to ensure continuing of service for patients should equipment breakdown.
  • Patients had access to the hospital’s Macmillan accredited information centre which provided specialised information in the forms of booklets, CDs, DVDs and other supportive materials for patients with cancer.
  • There had been no formal complaints regarding CyberKnife from June 2015 to July 2016. The staff told us they received very few complaints and could often resolve them quickly and address the concerns immediately.

However:

  • Patient experience survey response rates were variable and were on average 17% for the 12 months prior to our inspection. Only 16 of 92 patients provided with the survey had returned it. We were told action was being taken to try to improve this.
  • It was unclear how the results of the patient experience survey were used. We were not provided with any examples of where patient feedback had been used to improve services.

Well-led

Outstanding

Updated 27 April 2017

We rated well-led as outstanding because:

  • The leadership, management and governance of the service assured the delivery of high quality person-centre care. There were clear governance arrangements in place that reflected best practice. Care was evidence based and action plans were constantly reviewed.
  • We found that staff were actively engaged in activities to monitor and improve quality and outcomes and that opportunities to participate in benchmarking, peer review, accreditation and research were proactively pursued.
  • We saw many examples of innovative practice and staff could tell us about the research being undertaken by the centre and how outcomes were being embedded within clinical practice to benefit patients.
  • We found excellent multidisciplinary team working. Staff, teams and services worked collaboratively to find innovative and efficient ways to deliver more joined-up care to patients. The service was well supported by an active medical advisory committee.
  • The service had a clear vision for The CyberKnife Centre which was integrated into, and supported by, the wider hospital vision and strategy. Staff we spoke with could tell us about the future plans for the centre and said they felt engaged in the planning process.
  • Staff were very positive about the leadership team. They felt their concerns could be raised and would be listened to. Staff spoke with pride about the service and reported the culture of the service made them feel valued and respected.
  • The service actively engaged with patient forums to give updates and information about the service.
Checks on specific services

Medical care (including older people’s care)

Outstanding

Updated 27 April 2017

We rated medical services at The CyberKnife Centre as outstanding overall. The service was rated as outstanding in the effective and well-led domains. We rated safe, caring and responsive domains as good.