HCA Healthcare UK The Princess Grace Hospital

Updated 23 August 2021

The Princess Grace Hospital is operated by HCA International. It opened in 1977. It is a private hospital in London with 127 beds. Facilities include eight operating theatres, a nine-bedded critical care unit, and an urgent care centre, as well as outpatient and diagnostic facilities. The hospital primarily serves patients with healthcare insurance or self-funding patients. During the COVID-19 pandemic, the hospital signed a contract with the NHS to provide system-wide support, including forming part of the London Cancer Support Network.

The hospital provides surgery, medical care, urgent care, outpatients and diagnostic imaging. The hospital is registered to provide the following regulated activities:

• Diagnostic and screening procedures
• Family planning
• Management of supply of blood and blood derived products
• Services in slimming clinics
• Surgical procedures
• Treatment of disease, disorder or injury

The hospital has been inspected three times previously, with the most recent inspection taking place in February 2018. There were no outstanding enforcement actions from this inspection.

On this occasion, we inspected Surgery using our comprehensive inspection methodology. The hospital provides day case surgery and inpatient care for private or international patients. The service offered a range of different surgical specialities, including orthopaedic, urology, colorectal, gynaecology, breast and ear, nose and throat (ENT). There were eight operating theatres on two floors with a recovery area on each floor. The inpatient wards for surgical patients were located on the second, fourth and fifth floor. The wards provided 24 hour, seven days a week care.

Activity (June 2020 to May 2021):

• There were 3662 inpatient and 4525 day case surgical patients treated at the hospital; of these 15.5% were NHS-funded and 84.5% other funded. The hospital worked with local NHS trusts as part of the national arrangement with independent healthcare providers during the COVID-19 pandemic.

Updated 23 August 2021

Our rating of this overall location improved to good. Our rating of surgery stayed the same. It was rated good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives and supported them to make decisions about their care. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of patients, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

• We observed staff sharing disposable warming jackets used in theatres, which presented a cross-infection risk for patients as they were for single use only. The hospital stressed this was not usual practice, and had not resulted in any cross-contamination related infections or surgical site infections. Two days after our inspection, the hospital sent a governance newsflash bulletin out to all staff reminding them of the correct use of theatre overalls.
• Not all staff were able to articulate what had been learned from incidents they described, or what they would do if a similar incident occurred in future.
• Not all clinical staff were aware of what the term duty of candour (DoC) meant.
• Patient temperatures were not consistently documented intra-operatively every 30 minutes in line with NICE guideline CG65: Hypothermia prevention and management in adults having surgery. Following inspection, we were provided with evidence that the temperature was monitored via finger probe but had not been documented correctly. Two days after our inspection, the hospital sent a governance newsflash bulletin out to all staff reminding them of the importance of documenting temperatures throughout the patient journey.
• There was insufficient evidence to show that patients were being encouraged to drink fluids up to two hours before their operation to prevent issues such as dehydration, headaches and nausea. Two days after our inspection, the hospital sent a governance newsflash bulletin out to all staff reminding them to do so, and appropriate actions were identified to ensure this would improve.
• Not all staff were able to describe what they would do if they suspected a patient lacked capacity to make a decision.

Updated 30 May 2018

The urgent care centre provides urgent care for adult patients without appointment and is open daily.

We rated this service as good because it was safe, effective, caring, responsive and well-led.

Updated 23 March 2017

The infrastructure for medical services had been progressively developed to enable the delivery of safe and effective for patients. This included the identification of risks at a service and individual patient level, and taking steps to limit the number of patients on the ward when challenges in achieving appropriate staffing levels occurred. There was access to specialist services when patients deteriorated. Sufficient staff, with the appropriate level of knowledge and skills for their job role, were available and they had access to appraisal and support.

Staff were kind and compassionate and patients felt involved in their care and treatment. Psychological support was available for patients to help them cope emotionally with their diagnosis and treatment.

Patients had timely access to care and treatment and investigative and diagnostic services were available seven days a week when required.

There was good access to interpreting and translation services for patients for whom English was not their first language.

There was effective leadership at all levels of medical care services and staff felt supported, valued and engaged. Medical care services had been progressively developed and steps taken to ensure the safety and quality of services when challenges occurred. The consultant team for oncology brought significant expertise and were actively engaged in research and development.

The requirements of vulnerable patient groups were not always fully recognised and met. For example, the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards were inconsistently applied and the needs of people living with dementia were not fully explored and addressed.

Audits to assess the outcomes of care and treatment and benchmark them with other services needed further development.

Care records did not always meet professional standards for documentation and some lacked the detail necessary to provide personalised and effective care for patients.

End of Life Care (EoLC) services required further development and documentation of discussions with patients and decision making in relation to palliative care required improvement.

Updated 23 March 2017

Staffing in the unit was compliant with Intensive Care Society (ICS) guidance, with appropriate numbers of suitably qualified and registered staff. Nurse to patient and doctor to patient ratios were consistently in line with this guidance.

An experienced team of consultants and nurses delivered care and treatment based on a range of best practice guidance. Suitably qualified nursing staff cared for patients. Medical staff were supported by consultants.

There was good access to seven-day services and the unit had input from a multidisciplinary team

The unit had fewer readmissions within 48 hours of discharges, compared to other similar units.

The critical care unit provided a caring, kind, and compassionate service, which involved patients and their relatives in their care. All the feedback from patients and their relatives we spoke with was positive.

Observations of care showed staff maintained patients’ privacy and dignity and patients and their families were involved in their care.

ICNARC (Intensive Care National Audit and Research Centre) data for April 2015 to March 2016 showed that the unit performed better than similar units in many quality indicators.

The complaints process was effective, with appropriate investigations and there was culture of learning from complaints across the board.

There were good governance structures within the hospital and linked with critical care unit.

We saw good local leadership within the unit and staff reflected this in their conversations with us. Staff said the culture on the unit was supportive and any member of staff could approach the leadership team with any issues or new ideas.

The management team had oversight of the risks within the services and mitigating plans were in place.

Although learning from incidents was shared with all staff via learning grids, not all staff were able to give us an example of any changes in the unit due to an incident. This indicated that learning from incidents could be improved among  staff members.  

The storage area where unit waste was collected before disposal was not kept locked and did not comply with the Department of Health 2011 Safe Management of Waste guidelines.

There were no regular joint MDTs within the unit. The unit had put a plan in place to introduce this initiative.

The dietitian told us that they only visit when CCU staff referred patients. Although this was in line with the hospital policy but there were plans to start daily visits to the unit in line with the HCA (provider) standards.

There was poor compliance with DNACPR policy, but action plan was in place to improve compliance.

The unit did not meet all the standards of Intensive Care Society related to screening patients for delirium. Staff were developing a policy to meet this standard.

The relatives we spoke with were not aware of how to make a complaint but they said that they don’t need any information leaflet regarding this as they were happy with the care received and staff were always there to resolve any concerns.

There was no quiet or prayer room facilities for relatives.

Updated 30 May 2018

Outpatients and diagnostic imaging services includes all areas where patients undergo diagnostic testing, receive diagnostic test results, are given advice or provided care and treatment without being admitted as an inpatient.

We rated this service as good because it was safe, effective, caring, responsive and well-led.

Updated 23 August 2021

Surgery was the largest core service provided at this location. Our rating of surgery stayed the same. We rated surgery as good.