Updated 24 May 2017
The London Gamma Knife Centre at Barts is an independent health service provided by HCA International Limited. It provides stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) for adults with certain brain tumors, using a stereotactic frame and cobalt source machine.
The service provides advance radiotherapy services to both NHS and private patients. It is located within Saint Bartholomew's Hospital, which is part of Barts Health NHS Trust. Patients are referred from around southern and central England in to the NHS trust and then onwards to The London Gamma Knife Centre at Barts.
The London Gamma Knife Centre at Barts (LGK) treats patients on a day case basis with provision made for overnight stays in the NHS trust or another HCA facility, which is sometimes required post treatment. It is provided from a basement location in the NHS hospital it works in partnership with and comprises of a treatment room, where the Gamma Knife machine is located, three resting bays for patients, a reception and staff areas. Between July 2015 and June 2016 the service reported 197 cases treated.
As a small service, it is incorporated into the governance and oversight structure of The Harley Street Clinic which also provides radiosurgical services. This is a larger acute hospital also run by HCA International and located nearby.
We carried out an announced inspection of the service on 6 December 2016 and returned, unannounced, on 14 December 2016. We visited all parts of the premises including the treatment room, patient resting bays, reception and staff areas.
To help us come to our ratings we spoke with eight patients (and relatives) by telephone, chosen at random, who had recently completed both Gamma Knife treatment and follow up. We spoke with ten members of staff from a range of specialties and areas of responsibility, including clinical and non-clinical staff. This included consultants, clinical research fellow, chief executive, patient pathway coordinator and non clinical services manager, lead radiotherapist, radiographer, governance lead, chief physicist and chef.
We reviewed over 70 documents relating to the running of the service that were requested prior to and during our inspection. In addition to this we reviewed information while on site, including treatment logs, training records and sets of patient records including assessments and treatment plans.
Our key findings were as follows:
Are services safe?
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There was a very low rate of incidents and systems were in place to report, review, investigate and learn from incidents.
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The service was clean and hygienic and the Gamma Knife treatment room was secure. Equipment had been appropriately serviced and inspected and was safe.
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The service was adequately staffed.
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Patient risk was appropriately assessed and responded to and resuscitation equipment was in place and suitably checked.
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Patients were rested in one of three curtained bays which were adequately equipped.
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There was good joint working with the NHS hospital to ensure appropriate assessment took place.
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Although the service looked out for vulnerability and treated people’s welfare as a priority, there was a lack of understanding about safeguarding procedures and processes.
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Training was recorded as falling below the low expected compliance level of 81%.
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Patients were able to choose to walk, accompanied, back to the service once the stereotactic head frame had been fitted, which had not been formally risk assessed.
Are services effective?
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Effective was inspected but has not been rated. This was because the capturing of patient outcomes was difficult to achieve due to the nature and referral patterns for the service.
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Quality assurance, professional accreditation and benchmarking had taken place.
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Patient treatment eligibility was in line with criteria defined by the NHS commissioning board’s clinical commissioning policies.
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There were clearly defined professional roles, with competent staff to fulfil these roles.
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There were good arrangements in place for multidisciplinary working and joint working with the referring NHS hospital.
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There were suitable arrangements in place for gaining patient consent, with opportunities for patients to ask questions about their treatment.
Are services caring?
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Patients told us that undergoing Gamma Knife treatment could be an anxious time and that staff took in to account that people may be nervous and helped them manage this through their supportive approach. Patients told us this made a significant difference to their overall experience of the service.
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Staff took the time to explain treatment to patients. Patients felt involved in their own treatment and decisions regarding their treatment. Family members and friends who accompanied patients also felt included.
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The service was caring and compassionate in its approach.
Are services responsive?
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There was an increase in demand for the service and The London Gamma Knife Centre at Barts (LGK) had taken appropriate steps to respond to this as well as introduce measures that enabled the best use of treatment time.
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Patients with malignant tumours received timely treatment. The service aimed to treat patients within 14 days. Referral to treatment averaged at around 9 days.
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Patients and referring services received prompt treatment summaries.
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Treatment was planned and delivered in ways that met people’s needs and the service listened to patients’ preferences and accommodated these.
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Assessments identified people’s individual needs, which were being met.
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There were systems in place to effectively respond to concerns and complaints.
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Although the service triaged patients appropriately there was delayed access to treatment for benign patients.
Are services well led?
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There was operational, clinical and non clinical leadership and clear lines of accountability within the service. There was a visible leadership presence and regular rounding by the executive.
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The London Gamma Knife Centre at Barts (LGK) was a small service that had been incorporated into the governance and oversight structures of a nearby acute hospital that also provided radiosurgical services, and belonged to the same provider company, HCA International. We were satisfied that the LGK voice, and issues pertinent to the service benefitted from this arrangement.
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There was also a meeting structure that was exclusive to LGK, with accountability and assurance that fed in to the larger structure.
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There was a clear vision, strategy and improvement plan. Innovation incorporated working with demand and delivering a quality service.
The provider should therefore ensure that:
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Staff have a working knowledge of when it might be appropriate to escalate potential safeguarding issues.
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Training levels were below the already low ‘green’ rating of 81%. The provider should assure itself that training attendance is at an acceptable level and issues from recording training in the new system are resolved.
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Patients are formally risk assessed to be able to choose to walk, accompanied, back to the service once the stereotactic head frame had been fitted.