The Care Quality Commission
  • Hospital
  • Independent hospital

Archived: Queen Anne Street Medical Centre Limited

Overall: Good read more about inspection ratings

18-22 Queen Anne Street, London, W1G 8HU (020) 7034 3301

Provided and run by:
Queen Anne Street Medical Centre Limited

Important: The provider of this service changed. See new profile
Important: The provider of this service changed. See new profile

All Inspections

30th July and 13th August 2019

During a routine inspection

Queen Anne Street Medical Centre Limited (QASMC Ltd) is a private independent acute care hospital, operating under the same provider name. The service was established in 2005 and is located in central London, easily accessible via public transport.

The service primarily serves the communities of London and accepts patient referrals from outside of this area, including from overseas.

QASMC Ltd provides specialist medical care offering a range of surgical surgery, outpatient consultations and diagnostics. In addition, there are separately registered services related to clinical trials, which do not come under the regulatory duties of the Care Quality Commission.

The services provided a range of cosmetic surgery such as: transgender feminisation procedures, invasive spinals surgery, treatment for join problems including joint injections and arthroscopy. The service also provided ophthalmic diagnostics, lung function testing and colposcopy procedures.

There are on-site consultation facilities and access to some diagnostics, including exercise electrocardiographs, pulmonary functions test, ultrasound and biopsies.

The service was registered in January 2011 with the Care Quality Commission for the following regulated activities:

  • Diagnostic and screening procedures.

  • Surgical Procedures.

  • Treatment of disease, disorder or injury.

The service has a registered manager who is also the nominated individual. There is a designated controlled drug accountable officer (CD AO).

The most recent inspection was carried out in February 2017. Whilst there were no breaches in the regulations during this inspection, we made a number of recommendations to address identified shortcomings.

Prior to this, a comprehensive inspection was undertaken on 16th May 2013, where the service was found to be meeting the required standards at the time.

23 February 2017

During a routine inspection

Queen Anne Street Medical Centre Limited is operated by Dr Brian Leaker. The service has one inpatient and four day care beds. Facilities include one operating theatre and recovery area, outpatient and diagnostic facilities.

The service provides a range of surgery to adults only. This is predominantly cosmetic in nature, although there are some general eye surgery and endoscopic procedures undertaken. They also provide private consultations and outpatient diagnostics, which include pulmonary function tests, colposcopy and cardiac function test. We inspected surgery and the outpatient department using our comprehensive inspection methodology, and included our outpatient findings within the surgical report. We carried out an announced inspection on 23 February 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this location is surgery.

Services we rate

We rated this hospital as requires improvement overall.

  • Professional practice guidance was not always adhered to in the operating theatre. The clinic was not following The National Institute for Health and Care Excellence (NICE) guidelines CG65 Hypothermia, Prevention, and management. This was highlighted to the medical director and since the inspection; we have seen evidence of the appropriate course of action the service has taken with regard to hypothermia management.

  • Within the operating theatre equipment used for managing a patient with a difficult airway was not logically stocked or fit for purpose. Some items of equipment were stored separately, which would reduce the response time, and checking of this equipment was not being routinely undertaken. Wall mounted patient use equipment storage boxes and trolleys were not sufficiently clean.

  • The new safeguarding policy for children and adults did not refer to female genital mutilation (FGM).

  • The arrangements for collecting reliable information on patient outcomes were limited. Further, the effectiveness of services provided was not subject to detailed audit against national guidance.

  • The risk register did not have detailed information about the level of risk and mitigations. There were no risks related to outpatients on the risk register. Further, the governance arrangements were not sufficiently robust for managing risks.

However we found the following areas of good practice:

  • Staff we spoke with understood how to report an incident. Feedback would be given through theatre team meeting and on a one to one basis.

  • Staff had access to infection prevention and control policies and had received necessary training. There had been no reported incidents of hospital acquired infections for the period October 2015 to September 2016.

  • We found there were sufficient number of appropriately skilled staff to care for patients that were receiving care and treatment.

  • Staff in theatres followed the World Health Organisation’s safety checklist and these were completed appropriately.

  • There was a designated safeguarding lead and there were appropriate numbers of staff trained in safeguarding. Staff we spoke with were able to give examples of what would constitute a safeguarding referral to be made.

  • Patient care was consultant-led and there was 24-hour cover provided by a resident medical officer who was based on site.

  • There were systems to check the competencies of consultants who had applied to work under practising privileges at the service. This process involved the application being reviewed and agreed by the medical advisory committee.

  • Systems had been implemented to ensure staff received an annual appraisal.

  • Consent was sought prior to treatment and surgical procedures.

  • Staff were caring, compassionate, and treated patients with dignity and respect. Their privacy and dignity was maintained, and staff ensured patients were involved in how their care was delivered.

  • Services were delivered in a way that met the needs of patients who attended the service. The service had clear admissions criteria, which meant they were able to exclude patients they were not able to provide care and treatment for.

  • Managers were aware of the need to develop their service and to ensure the sustainability by responding to new markets.

Professor Edward Baker

Deputy Chief Inspector of Hospitals London

1 and 7 September 2016

During a routine inspection

We undertook an unannounced focused inspection at the Queen Anne Street Medical Centre in response to concerns raised regarding the surgical services and the governance arrangements. The concerns related to cross infection issues, medicine management and the lack of leadership in the surgery department.

We inspected on the 1 September 2016, and undertook a further unannounced inspection on 7 September 2016.

During our inspection, we reviewed surgical services, which included the operating theatre and recovery area. We spoke with surgery staff and members of the senior staff, including those responsible for monitoring the quality of service provision and overall governance.

This report covers the areas we inspected with regards to the specific concerns raised. As this was an unannounced focused inspection we have not considered all of the key lines of enquiry. The service will be undergoing a full comprehensive inspection in February 2017.

Our key findings were as follows:

  • Staff, including the safeguarding lead were not trained to the recommended level in safeguarding vulnerable adults and children. Safeguarding vulnerable individuals was not included as part of mandatory safety training.
  • The safeguarding policy was outdated and did not refer to the most recent guidelines. Information with respect to female genital mutilation, child sexual exploitation, and child slavery was not included.
  • There were no full pre-assessment records kept at the centre. Staff were unaware of the pre-assessment checks taken prior to patient’s treatment. As such, we were unable to see evidence of risk assessments having been undertaken,
  • No in-depth audits of surgical site infections, hand hygiene, or World Health Organisation (WHO) safer surgery checklists were completed.
  • Leadership of the theatre department lacked direction. Staff told us they did not feel confident to raise issues or report incidents to the manager.
  • The service did not have a duty of candour policy, and although some staff knew it meant being open and honest, they were unaware of the finer details of the regulation.

However:

  • The centre had provided an action plan for safeguarding and pre-assessment checks, after we raised concerns.
  • The plans included safeguarding training for all staff, which was expected to start in September 2016. This would include a safeguarding lead trained to level three.
  • The company assured us they would be asking patients to complete a comprehensive pre-assessment check prior to treatment and details be kept in the patient records.
  • Medicine management was kept in good order by the pharmacy department and staff had received good training.
  • Staff had received a good level of resuscitation training from the centre.
  • Equipment had been regularly serviced and stickers were placed on equipment to show they had been checked.
  • The governance team held regular meetings to keep up-to-date on risks, Key Performance Indicators (KPI), and incidents.
  • Incidents were discussed at the Medical Advisory Council (MAC) meetings.
  • Learning from incidents was shared to each department manager and they cascaded information to staff.
  • Staff were trained to the appropriate level of competence to fulfil their duties within their role.
  • The senior team managed revalidation and training well, with meetings to discuss practising privileges of each consultant surgeon.
  • The centre used an early warning score (EWS) system, to determine if patients needed further medical assistance. Escalation process involved transferring patients to another independent hospital or calling emergency services for life threatening cases.
  • Staff wore the appropriate personal protective equipment when treating patients.
  • The centre had a service level agreement with an NHS hospital for the decontamination of all instruments.
  • Patient records were stored safely in lockable cupboards and were in line with the Data Protection Act.
  • Patients were able to participate in a 30-day follow up questionnaire. The centre used this questionnaire as a tool to measure infection rates.
  • We were told the provider engaged with the Private Healthcare Information Network (PHIN) so that data could be submitted in accordance with legal requirements regulated by the Competition Markets Authority (CMA).
  • We were told the service was not yet collecting data for Patient Reported Outcome Measures (Q-PROMS) for relevant cosmetic procedures performed at the location.
  • A Total Quality Management (TQM) patient satisfaction survey was managed internally. The TQM for theatres from January 2016 to August 2016 showed patient satisfaction was consistently above 95%.

During our inspection, we did not observe any areas of outstanding practice.

However, there were areas of practice where the service needed to make improvements.

Importantly the service should:

  • Make sure staff are trained to the appropriate safeguarding level and establish a safeguarding system within the centre, which includes mandatory training and an appropriately trained safeguarding lead.
  • Update their safeguarding policy to reflect intercollegiate guidelines.
  • Devise a system whereby comprehensive patient pre-assessment information can be accessed in patient records.
  • The WHO surgical safety checklist needs to be led in a more robust and efficient manner, so it is clear and not disjointed.
  • Improve leadership and communication within the theatre department team, so staff are fully engaged and feel confident to report issues and raise concerns.
  • Theatre team meetings should be documented with clear agenda and actions.
  • Involve and expect all staff regardless of their job role,to report clinical incidents.
  • Consider how the theatre staffs knowledge and understanding of the duty of candour can be improved.
  • Make sure staff keep the theatre fire exit clear at all times. It should not be blocked with large equipment.
  • Consider clearly identifying storage areas within theatre, and where staff need access to the hand washing facilities, this access is not obstructed.
  • Monitor staff compliance with regard to single use items of equipment.

Professor Sir Mike Richards

Chief Inspector of Hospitals

16 May 2013

During a routine inspection

Before people underwent treatment their consultant would explain their procedure to them, including the risks and benefits. They were asked to sign forms to indicate this had taken place and that they consented to the proposed course of treatment. People we spoke with confirmed this had happened and all the patient records we looked at included completed consent forms.

Appropriate checks took place before, during and after treatment to ensure that people were safe and well. People we spoke with confirmed that details about their medical history had been taken prior to treatment taking place. They said they would rate the service "very well" and that it was "fantastic". In recent patient feedback all respondents said that they had received sufficient post-operative information. Staff had received training in what to do in a medical emergency and the centre had appropriate medical emergency equipment and drugs available.

On the day of the inspection the centre was clean and tidy. In recent patient feedback the majority of people rated the cleanliness of the centre as "excellent". There was an appropriate infection control policy and procedure in place which was adhered to.

Suitable employment checks were undertaken before staff began work. The service had a complaints policy and procedure but at the time of the inspection no significant complaints had been made regarding the centre.

19 April 2012

During a routine inspection

We have not been able to speak with people using the service because on the day of our inspection there were no patients able or willing to speak to us who were receiving treatment. We gathered evidence of people's experiences of the service by reviewing the results of recent patient feedback questionnaires. In the questionnaires people who had used the service were asked about the information they were given about their treatment, how they were cared for by staff and the quality of treatment they received. Across the majority of questions people who had used the service rated it as 'excellent' or 'very good'.