The LOC @ Chelsea is located in Chelsea, is easily accessible by public transport, and provides outpatient cancer treatment and oncology outpatient consulting. LOC @ Chelsea is operated by Leaders in Oncology Care. The service has 15 treatment bays, with two side rooms. Facilities include four consulting rooms, on site oncology pharmacy and aseptic suite, phlebotomy rooms, laboratory and a Positron emission tomography-computer tomography (PET CT) scanner.
The service aims to provide a ‘one-stop' service for its patients including consultation, diagnostic tests, treatment and supportive therapies in one location.
More than 75 cancer specialist consultants practice from the LOC sites. The service holds specialist clinics on different days of the week including clinics for lung cancer, breast cancer, melanoma and the service provided psychological support clinics each Tuesday. The service had a supportive services team (complementary therapists, hair / image specialists, dieticians, etc.) available.
The service provides medical care and diagnostic imaging. We inspected medical care and diagnostic imaging.
We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 11 June 2019. We gave 24 hours’ notice of the inspection because evidence gathering in an unannounced inspection would be affected by the fact that the service has other sites within the provider and not all staff would have been on site.
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.
Services we rate
This was the first time we rated this service. We rated it as Outstanding overall.
- 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. 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 medical and nursing and radiology staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
- Staff kept detailed records of patients’ care and treatment. Records were clear, up to date 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 incidents and reported them appropriately. 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.
- The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. Managers used this to improve the service.
- The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
- Staff gave patients enough food and drink to meet their needs and improve their health.
- 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.
- Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
- Key services were available six days a week to support timely patient 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.
- Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
- Staff provided emotional support to patients and families to minimise their distress.
- Staff supported and involved patients and families to understand their condition and make decisions about their care and treatment.
- The service planned and provided services in a way that met the needs of the patients it provided services to.
- The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.
- 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 within service targets.
- 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.
- Leaders 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. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy.
- Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service 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.
- 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.
- 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.
- Not all staff were not confident in accessing policies via the intranet. Some staff could not show us where to find key documents.
- Patients could not tell the difference between different staff members by grade as uniforms were ambiguous and not explained.
We found areas of outstanding practice in medicine:
- Staff worked especially hard to make the patient experience as pleasant as possible. Clinical Nurse Specialists recognised and responded to the holistic needs of their patients. Staff went above and beyond for their patients.
- Despite the outpatient nature of the service, the service provided a plethora of complementary therapies, from reflexology to massage to assist patients with symptom management.
- The on-site phlebotomists, pharmacy and aseptic suite meant that the service offered a one-stop shop and patients rarely had to wait.
- Data provided showed that 100% of PET CT and CT scans were reported within 24 hours (July to December 2018).
Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.
Deputy Chief Inspector of Hospitals for London and the South