The London Clinic

Updated 20 December 2021

Established in 1932, The London Clinic is a charitable hospital governed by the Trustees of The London Clinic Limited. The hospital provides a range of services to the local population of London, as well as overseas patients. The hospital has on average 23,000 inpatient episodes and 110,000 outpatient attendances per year. The hospital is registered to provide diagnostics and screening; treatment of disease, disorder or injury; surgical procedures; management of supply of blood and blood derived products. The original hospital at 20 Devonshire Place has seven main and three additional operating theatres, and six dedicated specialty wards for a range of surgery, including: urology, gynaecology, thoracic surgery, orthopaedics and spinal procedures.

The London Clinic was last inspected in June 2021 and the report was published on 03 September 2021. The location was rated Good overall. Surgery was rated Requires Improvement overall, with Requires Improvement in the Safe domain, Requires Improvement in effective, Good in caring, Requires Improvement in responsive and Inadequate in well-led.

Following the June 2021 inspection, we used our enforcement powers to serve a Warning Notice to the provider under section 29 of the Health and Social Care Act 2008. This was served for failing to comply with Regulation 17: Good Governance.

This report relates to the return visit, conducted on 03 November 2021, to check compliance with the Warning Notice and to check if the provider was now meeting Regulation 17: Good Governance.

Following this inspection, there is no change in rating, as inspectors only looked at compliance with the previously issued Warning Notice and did not conduct a full inspection assessment of the provider’s services.

Although, we found improvements had been made in the majority of areas noted within the warning notice, inspectors had concerns relating to the handling of complaints. We will follow up with the provider to ensure improvements in this area are made in a timely manner.

Updated 17 November 2017

• Electronic patient records were shared by doctors, nurses and other healthcare professionals in an accessible manner, which contributed to the provision of on-going care.
• Staff were knowledgeable about the hospitals safeguarding policies and clear about their responsibilities to report concerns.
• The hospital used a combination of professional guidance produced by the National Institute for Health and Care Excellence (NICE) and the Royal Colleges.
• Nursing staff in oncology and endoscopy informed us they received specific training. Nursing staff had access to a practice development nurse who provided clinical support and development.
• Staff treated patients and visitors with compassion and care. Staff interactions with patients were courteous and professional.
• Patients told us they were happy with the care provided and that they were treated with dignity and respect.
• The hospital undertook its own patient satisfaction survey; the results from the six month period from April 2016 to September 2016 showed that 99% of patients were extremely likely to recommend the service to others.
• The diagnostic imaging department used their own satisfaction survey. The results showed a consistently high level of satisfaction with the service.
• Patients we spoke with felt well informed about their care and comprehensive information regarding care and treatment was provided throughout their stay. staff explained clearly the nature of tests required and the purpose of clinical observations.
• Cancer patients had access to counselling services and could also be referred to local NHS community support teams with links to other community based organisations.
• We saw patients had their needs assessed. Patient records contained a range of risk assessments which were correctly completed and reviewed as required.
• Inpatients had single rooms that provided privacy and comfort with ensuite facilities. There was no restricted visiting times for patients.
• Patient admissions were planned for a mutually convenient date.
• All patients were admitted under the care of a named consultant. The consultants reviewed patients prior to commencement of each treatment and provided a 24 hour on call service as and when required.
• Intentional rounds were undertaken regularly by nursing staff to monitor patients welfare and any change in the patient’s clinical condition.
• We observed call bells were answered quickly. Patients told us staff answered bells straight away.
• Patients whose first language was not English had access to interpreters. Leaflets were available in both English and Arabic.
• Staff told us managers were supportive and approachable, they also felt they had opportunities for personal development and when they raised concerns they were listen to and their concerns addressed.
• Staff were very proud to work for The London Clinic; they were enthusiastic about the care and services they provided for patients. They described the hospital as a good place to work.

However

• The inpatient medical services assessed patients by using the Early Warning Score system (EWS). The audit calendar and records audit did not include an audit of EWS to identify deteriorating patients. This meant compliance with evidence based practice and patient outcomes in this area was not measured.

Updated 17 November 2017

• The new team structure that had been introduced placed issues of safety such as safeguarding and infection prevention and control at the forefront of nursing practice. 
• The new unit had been designed to ensure the safest possible care, including highly effective isolation rooms.
• There were embedded systems and procedures to ensure positive outcomes for patients and to maintain quality of life.
• There was effective multidisciplinary team working across the unit, to ensure the best possible care for patients.
• The unit participated, and scored well in the Intensive Care National Audit and Research Centre (ICNARC) audit.
• Local policies and procedures on the unit were in line with national guidelines.
• We observed positive, caring interactions between staff and patients and their families.
• Patients we spoke with were overwhelmingly positive about the care they received and the attitude of the staff.
• Patients and family members confirmed they had been kept informed of their progress and treatment options.

However

• There was some poor practice with respect to storage of specific medication and accessibility to medicines by non-authorised personnel via key passes provided. Both of these issues were resolved during the course of our inspection.

Updated 17 November 2017

• There was evidence of a good incident reporting culture; incidents were discussed at the End of Life Care Steering Group.
• Anticipatory medicines were routinely prescribed. Pain management and symptom control protocols were well established and were seen to be evidence based, in line with national standards. 
• Records were up to date, well completed and readily available.
• Care was based on ensuring the person remained as comfortable as possible, at all times. Proactive, anticipatory care plans were put in place to ensure that non specialist staff were aware of the best way to manage symptoms.
• Symptom assessment tools had been introduced to help support non-specialist staff to effectively and safely manage the dying patient.
• An end of life care resource folder had been developed and was available and used on all wards.
• Staff knew the palliative care team members and the consultant by name. Staff told us they were visible and responsive when called to see a potential end of life care patient or a patient requiring symptom management.
• Arrangements were made quickly and effectively if a patient wanted to be discharged home to die.
• Care of deceased patients appeared to be good and in line with expected standards.
• Arrangements were in place for the repatriation of foreign nationals when requested via contact with the Embassy concerned and the hospital’s own international team.
• Accommodation was made available to families so they were able to stay at the hospital with their family member during their last days.
• A counsellor was available for both patients and their families.
• Patients and relatives could access the hospital’s Chaplaincy service for the multiple faith groups.
• There was an End of Life Care Steering Group, which reviewed the service.

Updated 17 November 2017

• There were reliable systems, processes and practices in place to protect patients from avoidable harm and abuse.

• Patient areas were visibly clean and tidy and staff complied with infection prevention practices.

• There was evidence of treatment across outpatient’s services that were delivered in line with national guidance and best practice.

• Staff had access to provision of evidence-based advice, information and guidance.

• Staff with specialist skills and knowledge supported their colleagues to provide advice or direct support in planning or implementing care.

• Appropriate referrals were made on to specialised services to ensure that patients’ needs were met.

• Patients had access to medical care 24 hours a day, seven days a week, either in outpatient clinic times or via the resident medical officer.

• There were systems for clinical staff to securely access patient tests and imaging results.

• There was a clear hospital vision and set of values which staff were aware of, and aligned to their work.

• Staff were able to raise concerns, which in turn would be escalated to the clinical governance committee.

• The hospital was supported by an active medical advisory committee, which regularly monitored consultants’ fitness to practice.

• Patients we spoke with felt able to raise any concerns they had with their consultants.

• There were governance arrangements in place and performance, quality and safety were regularly monitored.

• The senior management team demonstrated effective leadership and were supported by a committed and competent management team.

However,

• Structures to monitor the governance and risk management systems were not always effective enough.  For example, the hospital did not have a robust enough system of audit in place. This meant improvements were not always identified or action taken

Updated 20 December 2021