Archived: Harley Street at Queens

Updated 13 July 2017

Harley Street at Queen's (HSQ) is a partnership between HCA Healthcare UK and Barking, Havering and Redbridge University Hospitals NHS Trust (the host trust). The service opened in 2010 and is based at Queen's Hospital, Romford. The service benefits from a variety of service level agreements with the host trust for core services; including access to pharmacy services, imaging, surgery theatres, clinical nurse specialists, and critical care.

The service consisted of 14 inpatient beds (for medical and surgery patients), 6  chemotherapy treatment chairs, 2 consulting rooms in the outpatient department, a dedicated pharmacy service, a dedicated complimentary therapy room, and a radiotherapy suite. The service provided Medical Care, Surgery, and Outpatients appointments. S ervices are primarily delivered to people living in North East London; however the service will accept referrals from outside the area. The model of care focuses on treating adults who are generally healthy and who do not have significant co-morbidities. It did not provide treatment to and care to children, nor did it provide treatment for 16 – 18 year old young adults.

Medical services include oncology, older people’s care, and some medical specialities such as gastroenterology . They include services that involve assessment, diagnosis and treatment of adults by means of medical interventions. Surgery pre-assessments and post-operative care was delivered within the service, with surgery delivered in the Queen's Hospitals theatres. Outpatients appointments was comprised of pre-assessment appointments for medical and surgical care, and follow-up appointments after discharge from the ward.

Updated 13 July 2017

Harley Street at Queen's (HSQ) is a partnership between HCA Healthcare UK and Barking, Havering and Redbridge University Hospitals NHS Trust (the host trust). The service opened in 2010 and is based at Queen's Hospital, Romford. The service benefits from a variety of service level agreements with the host trust for core services; including access to pharmacy services, imaging, surgery theatres, clinical nurse specialists, and critical care.

The service consisted of 14 inpatient beds (for medical and surgery patients), 6 chemotherapy treatment chairs, 2 consulting rooms in the outpatient department, a dedicated pharmacy service, a dedicated complimentary therapy room, and a radiotherapy suite. The service provided Medical Care, Surgery, and Outpatients appointments. Services are primarily delivered to people living in North East London; however the service will accept referrals from outside the area. It did not provide treatment to and care to children, nor did it provide treatment for 16 – 18 year old young adults.

We carried out a comprehensive announced inspection of Harley Street at Queens on 7 and 8 December 2016 as part of our second wave of independent healthcare inspections.

We inspected the following two core services:

• Medicine
• Surgery

We did not inspect aspects of the service delivered by the host trust through service level agreements.

Our key findings were as follows:

Are services safe?

• There were robust systems in place for reporting, investigating, and sharing learning from incidents. 
• The service had established systems in place for infection prevention and control, and the environment was clean and well maintained. 
• There were systems in place to ensure the safe supply and administration of medicines. The service had effective security measures in places for managing medicines, and there was checking procedures that ensured the accuracy of prescriptions.
• We reviewed sets of patient notes and found records to be comprehensively completed, legible, and clear. The service regularly audited patient records to evaluate the quality of completed notes.
• There were local standard operating procedures in place to keep vulnerable children and adults safe from harm and abuse.
• The service was staffed appropriately to meet the needs of patients, and could arrange for regular bank staff to fill shifts when needed.
• We saw evidence in patient records that where risks had been identified in risk assessments the service put plans in place to minimise the impact on patient care.

Are services effective?

• Staff provided care and treatment in line with national best practice guidance of recognised organisations, including the National Institute for Health and Care Excellence (NICE). 
• The service used a local audit plan to monitor and measure clinical standards and outcomes. 
• The ward had achieved UK Oncology Network accreditation through evidence of care and treatment benchmarked against national best practice guidance.
• An acute pain team including pain consultants was available on-call at all times to the service, and patients we spoke with stated any discomfort they had was well managed.
• The service had a dedicated chef who worked with the dietitian to design individualised menus for patients. We saw assessments of patients nutritional needs completed in case notes.
• The service audited patient outcomes and used a trend analysis as part of the internal governance process to review performance.
• All staff received an annual appraisal from a senior member of their team.
• Nurses and healthcare assistants were cross-trained to care for both surgery and medical patients and undertook a range of specialist training in addition to the standard mandatory package. 
• Staff documented consent to care and treatment at the pre-assessment and pre-operative stages and we saw this was documented and signed. Staff also undertook Mental Capacity Act training as part of their safeguarding training.

Are services caring?

• Patients we spoke with stated they were happy with the treatment they received at the service. Patients told us they felt treated with dignity and respect, and felt that staff were supportive and friendly.
• Feedback collected by the service from patients following treatment was positive.
• Staff had involved patients in deciding their own treatment plans. Patients we spoke with said they felt involved in the treatment process and planning. 
• Staff demonstrated dedication to empowering patients, their families and carers. 
• A counsellor was available on the ward on a weekly basis and provided support to patients, relatives and staff. 
• A multi-faith chaplaincy service was available 24-hours, seven days a week.

Are services responsive?

• The service had a number of service level agreements with the host trust that improved their access to specialist healthcare staff and equipment. This included access to the trust tissue viability team, safeguarding, critical care staff, infection prevention and control, dementia nurses and learning disabilities leads.
• An admissions policy was in place that meant patients were only accepted if the service was confident their needs could be met. 
• Staff maintained an awareness of the diverse needs of patients and used this understanding to provide a range of printed information from national specialist organisations. 
• The service had a follow-up policy and would call each patient 72 hours after discharge to find out how they were feeling and answer any questions they might have.
• The service demonstrated learning from complaints and provided examples where changes to practice were implemented as a result of patient feedback.
• Information was available in other languages than English, and the service had access to interpreters if needed for patients. 

Are services well-led?

• There was evidence the clinical governance structure was fit for purpose and resulted in positive change. The service had oversight of their main risks and were addressing them accordingly.
• The service had a strategy in place for the future and this included expansion of delivery of care as well as further collaborative working with the host trust. Staff stated they were well informed as to the future goals of the service and felt they could contribute ideas.
• Staff we spoke with stated that the culture at the service was very positive and they enjoyed working there.
• Staff we spoke with stated that management were accessible and supportive. 
• The matron and ward manager led a monthly meeting that included all staff to discuss governance and audit issues, incidents and complaints.
• Resident Medical Officers were actively involved in research, including in research fellowships and the provider encouraged their professional development where possible.
• The service had invested in the professional development of their staff, and looked to develop their team by offering opportunities for internal promotion.
• The staff at the service worked collaboratively with the host trust, and stated they had a good relationship with the host hospital's staff.

However:

• The Medical Advisory Committee did not have current representation in their attendees for general medical specialities. 
• Feedback collected from patients was not separated into the different types of treatment modalities.

The provider should:

• The provider should ensure there is representation on the Medical Advisory Committee for other general medical specialities.
• The provider should consider ways to ensure that patients are effectively informed of the counselling and other therapies services that are available.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 13 July 2017

There were systems in place for reporting, investigating, and sharing learning from incidents.

The service had arrangements in place for infection prevention and control, and the service environment was clean, spacious and well maintained.

The service was staffed appropriately to meet the needs of patients, and could arrange for regular nursing bank staff to fill shifts when needed.

Staff provided care and treatment in line with national best practice guidance of recognised organisations, including the National Institute for Health and Care Excellence (NICE).

We saw good examples of multidisciplinary working across medical services.

Patients we spoke with stated they were happy with the treatment they received at the service. Feedback collected by the service from patients following treatment was also positive.

The service had a number of service level agreements with the host trust that improved patient access to specialist healthcare staff and equipment. This included access to the trust tissue viability team, safeguarding, critical care staff, infection prevention and control, dementia nurses and learning disabilities leads.

There was evidence the clinical governance structure was fit for purpose and resulted in positive change. The service had oversight of their main risks to the service and were addressing them accordingly.

Staff we spoke with stated that the culture at the service was very positive and that management were accessible and supportive.

The staff at the service worked collaboratively with the host trust, and stated they had a good relationship with the host hospital's staff.

However:

The Medical Advisory Committee did not have current representation in their attendees for general medical specialities.

Feedback collected from patients was not separated into the different types of treatment modalities.

Updated 13 July 2017

We looked at the service's arrangements for reporting, investigating, and sharing learning from incidents and found robust systems to be in place.

The service had the appropriate mix of nursing and medical staff to meet the needs of patients, and could arrange for nursing bank staff to fill shifts when needed.

We saw evidence in patient records that where risks had been identified in risk assessments the service put plans in place to minimise the impact on patient care.

Staff provided care and treatment according in line with national best practice guidance of recognised organisations, including the National Institute for Health and Care Excellence (NICE).

The service used a local audit plan to monitor and measure clinical standards and outcomes. The service audited patient outcomes and used a trend analysis as part of the internal governance process to review performance.

There was a positive relationship between different healthcare disciplines in the service, which contributed to delivering more comprehensive care.

Patients told us they felt treated with dignity and respect. and felt that staff were supportive and friendly. Feedback collected by the service from patients was also positive.

The service had a number of service level agreements with the host trust that improved their access to specialist healthcare staff and equipment. This included access to the trust tissue viability team, safeguarding, critical care staff, infection prevention and control, dementia nurses and learning disabilities leads.

The service had a strategy in place for the future and this included expansion of delivery of care as well as further collaborative working with the host trust. 

Staff we spoke with stated that they enjoyed working at the service and morale was good. Staff also stated that management were supportive and accessible.