HCA Healthcare UK London Digestive Centre

Welbeck Street Diagnostic Centre LLP -The London Digestive Centre is operated by Welbeck Street Diagnostic Centre LLP and is part of HCA Healthcare. The London Digestive Centre is part of the Princess Grace Hospital and is a purpose-built outpatient and diagnostics centre treating upper and lower gastrointestinal diseases, liver and pancreatic disorders, neuro-gastroenterology and ear, nose and throat (ENT) conditions. The service is staffed and designed to offer seamless care pathways from consultation and diagnosis to treatment and long-term condition management. The service specialises in conditions of the stomach, bowel, liver, bile duct and pancreas and offers outpatient consultation and diagnostic services.

The centre is one of 22 outpatient and diagnostics centres that HCA Healthcare operates in the UK and is linked to a nearby hospital within the provider’s network.

The hospital has an advanced imaging suite, 17 consulting rooms, two treatment suites and facilities for x-ray, fibroscan, magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound. There is one ear, nose and throat (ENT) room. A wide range of medical and surgical specialists provide care from the centre, including: hepato-pancreato-biliary (HPB) surgeons, hepatologists, colorectal surgeons, upper gastrointestinal (GI) services and gastroenterology services. GPs provide care from the centre and have a different registration with CQC. This means they are not included in this inspection report.

We inspected outpatients and diagnostic imaging services.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 18 March 2019, along with two further announced visits to the clinic on 26 March 2019 and 27 March 2019.

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 hospital was outpatients. Where our findings on diagnostic imaging – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the outpatients service level.

We found good practice in relation to outpatient care:

• 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 and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them 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, supported them to make decisions about their care, and had access to good information.
• 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 local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• 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 and the community to plan and manage services and all staff were committed to improving services continually.

We found areas of outstanding practice:

• The head of therapy worked with human resources to develop advanced leadership strategies that helped to contribute to a positive, inclusive working culture. This resulted in innovative, motivational opportunities for long-term staff development and sustainability.
• The safeguarding team had prepared a new strategy for staff to identify and respond to domestic violence and abuse. This was an innovative, evidence-based approach that aimed to reduce the risk of staff giving advice that could be harmful and instead take immediate action so that specialist services could provide assistance.
• Specialist dieticians provided highly individualised care and nutrition plans that took into account patients’ country of residence, cultural and religious needs. Where patients lived outside of the UK, dieticians meticulously researched the local equivalent of UK brands of products to recommend these to patients.
• The international business development manager led a programme of cultural competency for staff, which was specific to whether staff were in a clinical or non-clinical role.
• Senior staff demonstrably and persistently encouraged and empowered staff to develop professionally by facilitating opportunities and providing the resources needed for growth.
• Staff demonstrated a proactive and responsive approach to meeting patient’s needs during times of disruption.
• A radiographer had been nominated for two awards led by the provider reflecting their volunteer work outside of their usual role and a humanitarian award.

We found areas of practice that require improvement:

• Although mandatory training was comprehensive and contributed to safe practice, it was not always tailored to specific clinical departments.
• Dedicated medical secretaries ensured diagnostic reports were sent to referring clinicians in a timely manner. However, there was not a centralised system that provided assurance results were received.

Following this inspection, we told the provider that it should make two improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report. 

Nigel Acheson

Deputy Chief Inspector of Hospitals