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The Christie Private Care part of HCA Healthcare UK Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 20 June 2018

HCA Healthcare UK operates six private hospitals across the country, including The Christie Private Care (the clinic) and a number of diagnostic centres. HCA Healthcare UK entered into a joint venture with a partner NHS trust in 2009 which led to the formation of the clinic. The clinic specialises in the diagnosis, management and treatment of all cancers including haematological. The clinic is based within the partner NHS trust. The first floor contains a dedicated outpatient suite and day care unit; the second floor contains and oncology ward; and the third floor contains an oncology ward and the haematology transplant unit. There are a total of 34 inpatient beds (single rooms). The clinic provides care and treatment for patients with oncological and haematological disease pre and post-surgical intervention, chemotherapy, radiotherapy, transplant, immunotherapy and care in the last days of life. It also provides outpatient and diagnostic imaging. Surgical intervention is provided by the partner NHS trust, as is critical care.

We inspected all aspects of the clinics service provision using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 and 14 March 2018 along with an unannounced visit to the clinic on 26 March 2018.

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.

The main service provided by the clinic was medical care. Where our findings on medical care – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the medical care core service.

We rated the clinic outstanding overall; both medical care, and outpatients and diagnostics, were rated as outstanding.

We rated this service as outstanding overall because:

  • We saw excellent leadership from managers, and all staff were passionate about providing high quality care for their patients.

  • There were comprehensive systems to keep people safe, including excellent processes to protect victims of domestic abuse. It also used innovative practices, such as a safeguarding app, to provide support to staff.

  • The clinic had ongoing, consistent progress towards safety goals, reflected in a zero-harm culture.

  • The service not only met relevant standards in medicines’ management, but looked to continually improve processes. Actions plans were always implemented promptly (for example, following an internal governance report in 2017) and these were demonstrated to have had a measurable effect on patient safety.

  • We witnessed numerous example of exceptional care being provided for patients, for example, by the clinical nurse specialist team.

  • Staff were proud to work for the organisation and spoke highly of the culture; there were high levels of staff satisfaction.The open and honest culture within the service was exceptional. Staff felt valued.

  • Patients, relatives and carers were continually positive about the way staff treated them. People thought that staff went the extra mile, and the care exceeded peoples’ expectations. The clinic had 100% satisfaction scores across all areas in medical care.

  • There was strong multidisciplinary working. Staff teams and services were committed to working collaboratively to deliver more joined-up care for people using the services. All staffing divisions (including non-clinical) attended team huddles which helped contribute to continuity of care. Staff felt supported by their colleagues.

  • The clinic provided a tailored service to each patient, including practical, spiritual and emotional support which were seen as being as important as their physical needs. The radiotherapy team met with patients, and carers, to show them the department and ensure any individual needs were met. Throughout the clinic, patients requiring it were given food packages when being discharged. Complementary therapies were also provided for patients.

  • The clinic’s exceptional and distinctive service valued people’s emotional needs. There was exceptional psychological support provided for patients, including a support group (a well-being space) for patients that was free and seen as part of their ongoing care.

  • Patients could access services and appointments at a time that suited them. Appointment waiting times were consistently low, and the clinic could quickly adapt to the needs of individual patients to provide care in a way that suited them.

  • The leadership, governance and culture was used to drive and improve high-quality patient‑centred care. The clinic could provide excellent examples of how learning had driven improvements in service, for example, the well-being space.

  • There was a proactive approach to anticipating and managing risk to the people who used the services. The clinic had high staffing levels and patients did not wait long to be seen by doctors or nurses. All relevant staff had up to date training.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)

Inspection areas

Safe

Outstanding

Updated 20 June 2018

We rated safe as outstanding because:

  • There was a genuinely open culture in which all safety concerns raised by staff and people who used the service were highly valued as being integral to learning and development. Staff knew how to report incidents and these were shared at weekly meetings. There were clear examples of how incidents had led to learning and improvements in care.

  • All areas we inspected were maintained to a high standard.

  • We found exceptional practice in the management of medicines, including the storage of controlled drugs. Staff compliance with the medicines’ management policy was routinely monitored. The electronic system for prescribing helped to speed up prescription requests and avoided the risk of mislaid or illegible prescriptions, or delays in treatment

  • There were comprehensive systems to keep people safe which took account of best practice. Staff had completed their mandatory training, appraisals were up to date, and competencies reviewed regularly. The clinic had effective infection control procedures in place and staff complied with these.

  • The clinic had a proactive approach to anticipating and managing risk. It ensured that all services had sufficient nursing and medical staff to ensure patient safety, and nursing staff had access to a resident medical officer, 24 hours a day over seven days.

  • Staff could easily track patient care and treatment. Records were completed appropriately and stored securely.

  • The clinic had access to the partner NHS provider’s hotline service – a 24 hour telephone helpline available to patients and carers for advice about management of side effects and complications.

Effective

Good

Updated 20 June 2018

We rated effective as good because:

  • There was a holistic approach to assessing, planning and delivering care, including assessing pain relief needs, and this was in line with evidence-based guidance. The service regularly updated policies and procedures in line with new guidance. It also safely used innovative and pioneering approaches to care, including chemosaturation for liver cancer.

  • We found continuing development of staff’s skills, competence and knowledge; the clinic recognised this as being integral to ensuring high quality care. Staff proactively supported and encouraged acquiring new and transferable skills and share best practice.

  • There was a comprehensive training programme for newly qualified nurses, and appropriate clinical supervision and appraisals systems.

  • Staff, teams and services were committed to working collaboratively and found innovative and efficient ways to deliver more joined up care to patients who used the service.

  • Practices around consent and records were monitored and reviewed consistently to improve how patients were involved in making decisions about their care and treatment.

Caring

Outstanding

Updated 20 June 2018

We rated caring as outstanding because:

  • We observed patients were truly respected and valued as individuals. Staff recognised and respected the needs of their patients. They took patient’s personal, cultural social and religious needs into account and found innovative ways to meet them.

  • Staff empowered patients who used the service by listening to their opinions and thoughts about their treatment plan. Staff took into consideration, the patient’s individual preferences wen delivering care.

  • Feedback from patients who used the service was continually positive about the way staff treatment them. Patients thought that staff went the extra mile to support them and their expectations. Patient surveys demonstrated that 100% of patients recommended the service.

  • Patients and those close to them were actively involved in their care and treatment. Care was tailored to meet their needs following discussions with clinicians.

  • The clinic provided free psychological support, including a well-being space, for patients and their relatives to help come to terms with the development of their illness, including end of life.

  • All staff treated patients with dignity, respect and kindness, and there were numerous examples of staffing having gone the extra mile.

Responsive

Outstanding

Updated 20 June 2018

We rated responsive as outstanding because:

  • Services were tailored to meet the needs of individual people and delivered in a way to ensure flexibility, choice and continuity of care.

  • The clinic used a proactive approach to understand the needs and preferences of different groups of patients. Following comments from patients, the clinic established a range of services to meet the needs of patients. These included clinics in erectile dysfunction, continence and a sexual wellbeing clinic for patients who had had treatment for gynaecological cancers. There was a multi-faith room available for those patients that required it.

  • The clinic strived for excellence within the HCA group. It used cancer waiting times targets (although not necessary for an independent organisation) to benchmark itself against national targets.

  • The service had systems in place that helped to meet the needs of patients with dementia and learning disabilities, and those who did not speak English. Patients could access services and appointments in a way and at a time that suited them. For example, the echocardiogram service regularly saw patients within a few days, and could do so at a patient bedside if this suited them. Patients were attended to immediately on arrival and then accompanied to the ward where they met the nurses who would care for them.

  • People who use the services are involved in regular reviews, and the clinic could demonstrate where improvements had been made as a consequence of these. The clinic investigated complaints comprehensively used learning to develop its service.

  • There were innovative approaches to providing patient-centred care. Dietitians worked collaboratively with specialist nutrition nurses and a local trust in the setting up a prompt discharge of patients on home parenteral nutrition. This prevented patients being exposed to unnecessary distress as a result of patient transfers and lengthy inpatient stays.

  • The clinic provided an echocardiogram service (ECHO) for its own patients but mainly for NHS patients who attended the specialist NHS trust. The service could see patients in two to three days and saved them attending for ECHO in their own trusts which sometimes had waiting lists of several months. 

Well-led

Outstanding

Updated 20 June 2018

We rated well-led as outstanding because:

  • There was compassionate and effective leadership with high levels of experience at all levels, with a desire to deliver excellent and sustainable care, and the desired culture.

  • The visions and values of the clinic were well embedded across the service and staff were focused on achieving these.

  • Staff were proud to work for the organisation and there was a high level of staff satisfaction.

  • There was a demonstrated commitment to best practice performance and risk management systems and processes. The organisation ensured that staff at all levels had the skills and knowledge to use those systems. Actions to address risks and improve services were monitored through audit processes and reported to leadership and governance committees. Risks and learning were effectively disseminated to frontline staff.

  • There were consistently high levels of constructive engagement with staff and patients who used the service. Challenge from patients and staff was used to hold the clinic to account. There were clear examples of how staff and patients had driven improvements in services.

  • There was safe innovation and examples of the clinic seeking out new ways of providing high quality, sustainable care.

Checks on specific services

Medical care (including older people’s care)

Outstanding

Updated 20 June 2018

We rated this service as outstanding.

Medical care was the main activity of the hospital. Where our findings on medical care also apply to other services, we do not repeat the information but cross-refer to the medical care section.

We found that medical care was outstanding for the key questions of safe, caring, responsive, and well-led. We rated effective as good.

The clinic had comprehensive systems to keep people safe. There was an ongoing progress towards safety goals, and a zero-harm culture. Staff managed medicines effectively, including controlled drugs, and the clinic routinely monitored compliance. Records were well maintained and it was easy to track patients’ care and treatment. Staffing levels were high and staff had the right skills to care for patients.

The clinic provided care in accordance with evidence-based guidance. It proactively pursued opportunities to participate in benchmarking and peer review; it was performing at a high level. The clinic also participated in approved accreditation schemes. There was excellent multi-disciplinary working to ensure patients received the best care, with a holistic approach to discharge planning from the earliest possible stage. New staff had a comprehensive induction, and the clinic proactively supported and encouraged staff to acquire new skills.

Staff provided kind and compassionate care. People were continually positive about the way staff treated them and considered they went the extra mile to exceed peoples’ expectation. Wards had a level of serenity; staff attended to patients, making them feel they were their only priority. . The clinic recognised people’s individual needs which was reflected in the care provided, including access to specialist support and counselling.

People’s individual needs were central to how the clinic planned care. There were innovative approaches to providing holistic patient-centred care, including a wellbeing room to meet patients’ psychological needs. The clinic had a proactive approach to understanding the needs of different patient groups with systems in place to meet the needs of patients with protected characteristics. It took account of patients’ religious beliefs and communication abilities. The clinic benchmarked its performance against national cancer waiting time targets and used the results to improve services. Complaint investigations were comprehensive and the clinic could d demonstrate where improvements to services had been made.

There was compassionate, inspiring and effective leadership at all levels, with a deeply embedded system of leadership development and succession planning.  Staff were proud to work for the organisation and spoke highly of the culture. The clinic worked well with other organisations to improve care outcomes, and the clinic looked to consistently improve. Staff were empowered to develop new ways of working and innovation was celebrated.  The clinic encouraged staff to take part in staff and patient engagement meetings in order that the clinic could act on feedback.

Outpatients and diagnostic imaging

Outstanding

Updated 20 June 2018

We rated this service as outstanding. We found outpatients and diagnostic imaging was good for the key questions of safe, and outstanding for the key questions of caring, responsive and well-led. We did not rate effective as we do not currently collate sufficient evidence.

There were comprehensive systems to keep services were safe. Staff were compliant with mandatory training, including safeguarding. The clinic had a sustained track record of safety. The areas we inspected were visibly clean and tidy with effective infection control measures in place. The service encouraged innovation to improve safety, and proactively managed risk.

The clinic used a holistic approach to assessing patient’s care and treatment and ensured that patients were central to how care was delivered, and staff supported patients to live healthier lives via health promotion. The clinic ensured the continuing development of staff’s skills, competence and knowledge with comprehensive training and supervision. Staff worked collaboratively to deliver joined-up care for patients, and had access to a specialist cancer trust.

Patient feedback about the care they received was continually positive. Staff demonstrated a strong patient-centred culture, and respected patients’ dignity and privacy. Staff recognised the emotional and psychological needs of patients, and ensured relatives and carers were active partners in patient care.

The clinic ensured that care was centred on the individual patient and tailored to meet their needs. Patients told us they felt involved with treatment decisions, and care was provided in a consistently timely fashion and in a way that suited them. There were a range of specialist services to support patients including dietetics and physiotherapy, and a number of nurse led clinics. The service ensured that complaints were investigated comprehensively and shared learning with other services (including the partner NHS trust) where appropriate.

The leadership were approachable, effective and had high levels of experience.  Staff were positive about working for the clinic and there were high levels of staff satisfaction. The leadership encouraged staff to develop both personally and professionally. Via monthly team meetings, the service ensured that staff had the wider organisational knowledge to do their jobs.  There was strong team-working and staff engagement throughout the organisation that aimed to improve the quality of care and patient expectations. There were high levels of patient engagement that allowed the development of innovative services, especially in the provision of psychological support to patients.