Royal Brompton & Harefield Hospitals Specialist Care - Wimpole Street

Updated 24 March 2020

Royal Brompton & Harefield Hospitals Specialist Care- Wimpole Street is operated by Royal Brompton and Harefield NHS Foundation Trust. This location opened in 2016. It is an NHS service in London, although this location mainly treats the trust’s private patients. As a specialist heart and lung trust, Royal Brompton & Harefield NHS Foundation Trust takes referrals from all over the country and does not have a local population in the traditional sense, as such. The service also treats private patients from overseas; with the largest group of overseas patients travelling from the Middle East. The service mainly treats adults, but also treats a small number of children, from birth to 18 years, (approximately 10 children each month) in a dedicated paediatric outpatient clinic. The same number of children also undergo simple diagnostic tests at this location.

This was our first inspection of this location since it registered with CQC in 2016. We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 21 and 22 January 2020. The inspection was unannounced (the provider did not know we were coming).

Updated 24 March 2020

Royal Brompton & Harefield Hospitals Specialist Care- Wimpole Street is operated by Royal Brompton and Harefield NHS Foundation Trust. The service has no overnight beds. Facilities include outpatient and diagnostic facilities. The provider, Royal Brompton and Harefield NHS Foundation Trust, is a specialist heart and lung trust.

The service provides outpatients consultations with the trust’s cardiologists and respiratory specialists, and diagnostic imaging. Diagnostic imaging facilities include magnetic resonance imaging (MRI), computerised tomography (CT) scanning, X-ray and positron emission tomography–computed tomography (PET-CT) scanning. A CT scan uses a number of x-rays from around the body to create a three-dimensional picture of tissue and organs. The service is one of a limited number of UK centres offering cardiac PET imaging with rubidium. This type of scan uses a mild, radioactive dye called rubidium to highlight the areas of the body where cells are more active than normal to detect disease. Together, a PET-CT scan can detect whether there's a blood supply shortage or blockage. We inspected both the outpatients and diagnostic imaging core services.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 21 and 22 January 2020. The inspection was unannounced (the provider did not know we were coming).

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 diagnostic imaging. 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 diagnostic imaging service level.

Services we rate

This was the first time we had inspected this location since it registered with CQC in 2016. We rated it as Good overall.

We found good practice in relation to outpatients and diagnostic imaging:

• 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. They received training on how to recognise and report abuse.
• 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 equipment competently. Staff managed clinical waste well.
• Staff completed and updated risk assessments for patients and removed or minimised risks.
• 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.
• 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 managed patient safety incidents well. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
• 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.
• 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. Staff provided emotional support to patients to minimise their distress. They supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• 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.
• 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 had the 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.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. 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.

We found outstanding practice in relation to diagnostic imaging:

• The service used novel PET-CT imaging techniques to attain detailed images of the heart and respiratory system. The radioactive substances required for the scan were generated on-site and required significant expertise to set-up and run. The specialist cardiac PET-CT imaging conducted at the site was mainly used by NHS patients from the trust which was a tertiary centre with a national patient cohort. The modality was cost intensive and therefore not readily available throughout the UK.

However:

• The provider’s practising privileges policy (relevant to three consultants who held practising privileges at this location) did not include information on how practising privileges were reviewed, focusing instead on the granting of these privileges.
• Response rates to patient surveys were low.

Following this inspection, we told the provider that it should make some 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 (London and the South)

Updated 24 March 2020

Diagnostic imaging was the main activity at this location. Where our findings on diagnostic imaging also apply to the outpatients’ core service, we do not repeat the information but cross-refer to the diagnostic imaging section.

We rated this service as good because it was safe, caring, responsive and well-led. We inspected, but did not have enough evidence to rate, the effective domain.

Updated 24 March 2020

Outpatients consultations represented a smaller proportion of activity at this location. The main service was diagnostic imaging. Where arrangements were the same, we have reported findings in the diagnostic imaging section.

We rated this service as good because it was safe, caring, responsive and well-led. We inspected, but did not have enough evidence to rate, the effective domain.