The Care Quality Commission (CQC) has told The London Clinic, a charitable hospital in London, to make improvements to its surgical services, following a recent inspection.
The London Clinic, on Devonshire Road (London W1), is one of the UK’s largest private hospitals. It is registered to provide a range of surgical procedures, as well as diagnostics and screening, treatment of disease or injury, and management of the supply of blood and blood derived products.
CQC carried out an unannounced inspection of the surgical services in June, after receiving information of concern about the safety and quality of the service. The concerns arose after several never events* took place in the department. The service reported four never events in total between January and September 2020. These involved surgical items which were left in the body after surgery, and in one case wrong tooth extraction.
Following the inspection, the rating for surgical services went down from good to requires improvement. The surgical service has been rated inadequate for being well-led, requires improvement for being safe, effective and responsive and good for being caring. The provider has now been served with a warning notice requiring it to improve governance of the surgical service.
The overall rating for the hospital is good and it is rated good for being safe, effective, caring and responsive, but requires improvement for being well-led.
Nicola Wise, CQC’s head of hospital inspection for London, said:
“We inspected The London Clinic because we were concerned about the number of serious incidents and never events that had taken place when performing surgery on patients. The provider told us that the COVID-19 pandemic had put additional pressures on the department because, in addition to the usual private work, they were also working with the NHS which meant that their theatre activity had significantly increased, resulting in higher volumes of more complex work and working with teams that were new to the organisation.
“Although we understand the pressures that healthcare providers have faced, and continue to face, as a result of the pandemic, never events are precisely that - they should never occur. If they do, it is important that they are thoroughly investigated to ensure that they do not happen again. In this case, each incident was fully investigated, and learning was shared with all staff.
“However, while leaders told us that they were committed to continuous learning, improvement and innovation, we did not see clear evidence of this during our inspection.
“We found that there was an inconsistent approach to dealing with incidents, and we were not assured that all staff were able to recognise what should be logged as an incident. For example, we found that there were 11 incidents in which pregnancy tests had not been carried out prior to surgery, which had been logged as ‘negligible – no harm’. If a patient who was pregnant had been operated on, both they, and their unborn child, would have been at risk of harm. By not recording these incidents as being potentially harmful, opportunities to learn lessons have been missed.
“We were also concerned to hear that some staff reported a dictatorial approach to leadership and felt they were unheard when it came to raising concerns about senior management. We heard from staff that that there was lots of fluctuation in the leadership team and that leaders of departments and teams would sometimes leave their post suddenly, without any handover period, making it challenging for staff to continue in their absence.
“We have told the provider that it must make a number of improvements to the service and we will continue to monitor it closely to ensure that these take place.”
Inspectors found the following:
- Leaders did not always have the skills and abilities to run the service. The service did not always operate effective governance processes. Staff at all levels were unclear about their roles and accountabilities.
- Leaders and teams used systems to manage performance. However, risks were not always identified and escalated appropriately.
- The service had an inconsistent approach to managing patient safety incidents and learning was not always used to improve patient care.
- Although nurse staffing levels matched the planned numbers during the inspection, the use of bank or agency staff was high. In addition, the service had a high sickness rate and staff turnover rate.
- Most of the policies that inspectors reviewed were out of date and there were ineffective systems to review policies.
- The service did not have strong systems for monitoring the outcome of care and treatment. Some of the local audit results, including controlled drug compliance audits, care bundle audit and consents audits were consistently below the provider’s target for the period reviewed.
- The service did not investigate complaints fully and lessons learned were not always shared with staff.
- The service collected data and analysed it. However, staff could not always find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
However:
- Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
- Staff had training in key skills and understood how to protect patients from abuse.
- The service controlled infection risks well. Staff assessed risks to patients, acted on them and kept good care records.
- 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. Key services were available seven days a week.
- 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 also provided emotional support to patients, families and carers.
- The service planned care to meet the needs of local people and took account of patients’ individual needs. People could access the service when they needed it and did not have to wait too long for treatment.
- 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.
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