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Welbeck Street Diagnostic Centre LLP - The London Digestive Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 8 November 2019

Welbeck Street Diagnostic Centre LLP -The London Digestive Centre is operated by Welbeck Street Diagnostic Centre LLP and is part of HCA Healthcare. The London Digestive Centre is part of the Princess Grace Hospital and is a purpose-built outpatient and diagnostics centre treating upper and lower gastrointestinal diseases, liver and pancreatic disorders, neuro-gastroenterology and ear, nose and throat (ENT) conditions. The service is staffed and designed to offer seamless care pathways from consultation and diagnosis to treatment and long-term condition management. The service specialises in conditions of the stomach, bowel, liver, bile duct and pancreas and offers outpatient consultation and diagnostic services.

The centre is one of 22 outpatient and diagnostics centres that HCA Healthcare operates in the UK and is linked to a nearby hospital within the provider’s network.

The hospital has an advanced imaging suite, 17 consulting rooms, two treatment suites and facilities for x-ray, fibroscan, magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound. There is one ear, nose and throat (ENT) room. A wide range of medical and surgical specialists provide care from the centre, including: hepato-pancreato-biliary (HPB) surgeons, hepatologists, colorectal surgeons, upper gastrointestinal (GI) services and gastroenterology services. GPs provide care from the centre and have a different registration with CQC. This means they are not included in this inspection report.

We inspected outpatients and diagnostic imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 18 March 2019, along with two further announced visits to the clinic on 26 March 2019 and 27 March 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.

The main service provided by this hospital was outpatients. Where our findings on diagnostic imaging – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the outpatients service level.

We found good practice in relation to outpatient care:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

We found areas of outstanding practice:

  • The head of therapy worked with human resources to develop advanced leadership strategies that helped to contribute to a positive, inclusive working culture. This resulted in innovative, motivational opportunities for long-term staff development and sustainability.
  • The safeguarding team had prepared a new strategy for staff to identify and respond to domestic violence and abuse. This was an innovative, evidence-based approach that aimed to reduce the risk of staff giving advice that could be harmful and instead take immediate action so that specialist services could provide assistance.
  • Specialist dieticians provided highly individualised care and nutrition plans that took into account patients’ country of residence, cultural and religious needs. Where patients lived outside of the UK, dieticians meticulously researched the local equivalent of UK brands of products to recommend these to patients.
  • The international business development manager led a programme of cultural competency for staff, which was specific to whether staff were in a clinical or non-clinical role.
  • Senior staff demonstrably and persistently encouraged and empowered staff to develop professionally by facilitating opportunities and providing the resources needed for growth.
  • Staff demonstrated a proactive and responsive approach to meeting patient’s needs during times of disruption.
  • A radiographer had been nominated for two awards led by the provider reflecting their volunteer work outside of their usual role and a humanitarian award.

We found areas of practice that require improvement:

  • Although mandatory training was comprehensive and contributed to safe practice, it was not always tailored to specific clinical departments.
  • Dedicated medical secretaries ensured diagnostic reports were sent to referring clinicians in a timely manner. However, there was not a centralised system that provided assurance results were received.

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

Nigel Acheson

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 8 November 2019

We rated safe as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised

    and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

Effective

Not sufficient evidence to rate

Updated 8 November 2019

We do not currently rate effective for outpatients or diagnostic imaging.

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.

  • Staff gave patients enough food and drink to meet their needs and improve their health. The service made adjustments for patients’ religious, cultural and other needs.

  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.

  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

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

  • Staff gave patients practical support and advice to lead healthier lives.

  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients' liberty.

Caring

Outstanding

Updated 8 November 2019

We rated caring as Outstanding because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

  • Feedback from people who used the service and those close to them was continually positive about the way staff treated people. Patients and their relatives said the services continually exceeded their expectations.
  • There was a strong visible, person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
  • Staff recognised and respected the totality of people’s needs. They took into account people’s personal, cultural, social and religious needs.
  • People who used services were active partners in their care. Staff were fully committed to working in partnership with people and making this a reality for each person. Staff empowered people who used the services to have a voice and to realise their potential. They showed determination and creativity to overcome obstancles to delivering care.
  • Staff placed valued on people’s emotional and social needs and embedded them in care and treatment.

Responsive

Outstanding

Updated 8 November 2019

We rated responsive as Outstanding because:

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.

  • Staff placed people’s individual needs and preferences at the centre of planning and delivery, which led to tailored and flexible services. These provided choice and continuity of care.

  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

  • The involvement of other organisations were integral to how services were planned and ensured they met people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, including for those with multiple and complex needs.

  • Staff had a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met those needs and promoted equality.

  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were significantly better than national standards.

  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

Well-led

Good

Updated 8 November 2019

We rated well-led as Good because:

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

Checks on specific services

Diagnostic imaging

Outstanding

Updated 8 November 2019

We rated this service as outstanding because it was safe, effective, caring, responsive and well-led.

Outpatients

Outstanding

Updated 8 November 2019

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

We rated this service as outstanding because it was safe, effective, caring, responsive and well-led.