The London Heart Centre Ltd

The London Heart Centre Ltd is operated by The London Heart Centre Ltd. The centre opened in 1978 and has been managed by The London Heart Centre Ltd since 2007. The service offers diagnostic tests for adults aged over 18 years.

Patients are offered electrocardiogram (ECG), stress echocardiography (stress echo), 24-hour blood pressure monitoring, Holter monitor, 14-day heart monitoring, exercise test, transthoracic echocardiogram and contrast echocardiogram services.

The service had two diagnostic imaging rooms in the basement and a consultation room on the ground floor.

We last carried out an announced focused comprehensive inspection of the service in November 2018. The service was rated inadequate for safe and well-led and good for caring and responsive. The service was judged to be inadequate overall and placed under special measures.

We re-inspected this service using our focused comprehensive inspection methodology. Our inspection was announced (staff knew we were coming) to ensure that everyone we needed to talk to was available. We spoke with two patients and five members of staff, including consultants, a cardiac physiologist, senior managers and a receptionist. We observed two episodes of care and treatment and reviewed six care records. We reviewed a range of equipment including emergency equipment and diagnostic devices. We also reviewed the service performance data.

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

Our rating of this service improved. We rated it as Good because.

• Our rating of the service had improved. We rated it as good because the service had taken note of concerns raised about the service at the previous inspection and made improvements in the areas of mandatory training, effective leadership, policies, audits, appraisals, oversight on the risk register, risk assessments, recruitment process leadership, engagement and governance. However, further improvement was identified in the management of incidents, duty of candour, governance process and engagement with the public and stakeholders.

• 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 majority of staff received up-to-date mandatory training. The overall compliance for all staff was 87% which was better than the providers own target (80%).

• 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.

• 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.

• The service used systems and processes to safely prescribe, record and store medicines.

• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.

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

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

• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

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

• People could access the service when they needed it. Waiting times from referral to the diagnostic tests were in line with good practice.

• Leaders had the integrity, skills and abilities to run the service. They were visible and approachable in the service for patients and staff.

• 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 promoted equality and diversity in daily work, and provided opportunities for career development.

• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.

• Leaders and staff actively and openly engaged with patients and staff to plan and manage the service.

• At the last inspection, there was lack of oversight on quality and effectiveness of the services, clinical policies, audits, managing of information and staff recruitment process. During this inspection, we found improvement and the service had addressed the issues and now had processes in place to continually improve the quality of service provided to patients.

However:

• Although staff knew what incidents to report and how to report them, the managers did not investigate incidents thoroughly. Some staff we spoke to did not understand the legal duty of candour.

• Although the service provided mandatory training in key skills to all staff, there was no robust system in place to ensure everyone had completed it. The service did not have a ratified mandatory training policy in place for staff.

• Although there was improvement in the governance process and the current governance structure had recently been initiated, the governance structures were not yet sufficiently embedded to give assurance that it would provide a robust framework of governance.

• Although the service now had up to date policies in line with national guidance, some policies were not yet in place in the service such as did not attend (DNA) appointment and turnaround time of diagnostic tests.

• The service did not have access to an interpreter for patients whose first language was not English.

• Although the service had improved on managing complaints and had complaints leaflets accessible in the waiting room, there were no posters prompting patients on how to make a complaint or raise concerns.

Nigel Acheson

Deputy Chief inspector of Hospitals (London and the South East)