The London Welbeck Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. We assessed one quality statement on delivering evidence-based care and treatment. Staff did not always follow hospital policies and best practice appropriately, as swab and instrument counts within theatres were not completed in line with hospital policy and best practice. Staff did not always ensure that WHO surgical safety checklists were completed in accordance with best practice. However, staff assessed patients’ mental and physical health needs in line with best practice. This ensured their care and treatment met their individual needs, and personal circumstances were considered.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff did not always follow hospital policies and best practice. For example, swab and instrument counts within theatres were not completed in line with hospital policy and best practice. The lack of an effective approach to these safety checks placed patients at risk of harm, as swabs or instruments may be retained. Staff did not always ensure that WHO surgical safety checklists were completed in accordance with best practice. The lack of an effective approach to these safety checks placed patients at risk of harm, as not all staff were engaged or interacted with the safety checks for surgical procedures. However, patients told us that they received appropriate advice and support from staff, both before and after surgery. Staff met patients’ nutrition and hydration needs and gave patients information about healthy lifestyles. We observed in clinical records that this was in line with best practice guidance.

We observed that the WHO surgical safety checklist was not consistently being used and completed. Staff acknowledged they did not routinely complete the WHO check list. We observed that staff recorded elements of the WHO checklist had been completed, when they had not been. This meant patient records were not accurate and placed patients at risk of harm. There was no policy in place for the application of the WHO Surgical Safety Checklist, as this had not been approved by the provider at the time of our assessment. The lack of this policy meant staff were unclear regarding the service’s approach to using the WHO Surgical Safety Checklist, and there was a risk this was not completed by staff for each service user, in line with best practice. Following our site visit, the provider told us that they had developed an action plan to assess WHO checklist compliance. This included monthly observational audits conducted by theatre clinical leads and the hospital manager. As this action plan was developed post our visit, we were unable to assess if it had been implemented and the effectiveness of the plan. Since our site visit, the provider also told us that the WHO Surgical Safety Checklist policy had been approved by the hospital’s medical advisory committee (MAC). As this policy was approved following our visit, we were unable to assess if this had been implemented, if it was being used consistently and if compliance was being monitored. However, the hospital followed best practice guidance regarding post-operative care and provided patients with a contact number for the hospital. The hospital followed the Royal College of Surgeons best practice guidance, in relation to assessing patients’ psychiatric history and venous thromboembolism (VTE) prophylaxis.

At the time of our site visit, the hospital did not have a WHO surgical safety checklist policy. The lack of this policy meant staff were unclear regarding the service’s approach to using the WHO Surgical Safety Checklist and there was a risk this was not always completed, in line with best practice placing patients at risk of harm. During our site visit, we saw that staff had access to policies and procedures. We saw evidence that hospital policies that were all in date, for example advising staff about the process to enable patients to give valid and informed consent to treatment, and appropriately referenced national guidance and best practice, such as that recommended by the National Institute for Health and Care Excellence (NICE). The provider ensured that staff were up to date with evidence-based good practice and required standards by communicating this to staff via email. We saw evidence the hospital collected data for patients undergoing breast and cosmetic surgery to the Breast and Cosmetic Implant Registry. This enabled the product to be traced in the event of a product recall or other safety concern relating to a specific type of implant.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.