Nova Healthcare

Updated 20 December 2016

Nova Healthcare is a day unit, which provides a range of oncology treatments including Stereotactic Radiosurgery (SRS) delivered using the Leskell Gamma Knife used to treat brain metastases, benign tumours and some functional disorders. The unit also offers chemotherapy, radiotherapy, brachytherapy, and robot assisted prostatectomy. Patients are able to access other services provided by the local NHS trust under clearly defined service level agreements. This includes overnight stays where required. Nova Healthcare has close relationships with a home care health provider so that where appropriate some chemotherapy treatment may be delivered at home.

Nova Healthcare is part of Aspen Healthcare which became shareholders in 2015. As a specialist unit it is commissioned by NHS England. Patients are considered for treatment from the Leeds area and nationally. The activity data across the whole organisation is approximately private insurance 53%, NHS 40% AND Norther Ireland 7%. At the time of inspection, the service had three registered managers, one of whom had been in post (although not as registered Manager until 2011) since the inception of the service. Two of the registered managers had applied to be de-registered

This service has a registered manager who has been in post since the inception of the service in 2009, prior to Aspen management.

Updated 20 December 2016

• Nova Healthcare is a care facility providing a range of oncology, haematology (SRS). SRS can be used to treat benign cerebral tumours, secondary metastases and certain functional disorders. In this unit, this is undertaken using a specialist Gamma Knife. There are facilities to perform low and high dose brachytherapy and robot assisted prostatectomy. There are no overnight facilities with most procedures completed as day patients. Those patients requiring overnight care stayed on a ward at the local NHS trust under a service level agreement. A patient hotel is available for patients travelling from a distance for treatment. SRS service is commissioned by NHS England as a specialist service and is managed by the Aspen Healthcare Group who became shareholders in 2015.
• The catchment area provides services to both clients in the Leeds area and across the United Kingdom. There are arrangements in place to treat patients from Northern Ireland.
• The inspection took place 17, 18 and 25 August 2016. This was a planned, comprehensive inspection using our new methodology as part of our commitment to inspect and rate all independent hospitals by 31 March 2017.
• Overall, we rated this service as good. This was a very well led service with a clear vision that was known to all staff and patients. The culture of the organisation was open and collaborative with strong internal and external relationships. All the feedback we received from patients and staff were extremely positive. The response to individual needs and preferences was exceptional in that it provided care that met individuals’ needs and preferences. Radiography services were provided by the local NHS provider clear via service level agreements

Are services safe at this service

• Well embedded systems and processes were in place that promoted patient safety and harm free care. There was good evidence of learning from incidents and an embedded culture of incident reporting.
• Staffing levels allowed staff to deliver a high standard of personalised care.
• Consultant medical advice was readily available with consultant- led treatment plans that mirrored protocols in the Leeds Teaching Hospitals NHS Trust.
• Staff had received relevant training in both adult and child safeguarding training.
• We saw examples of effective multidisciplinary team (MDT) working in the best interests of patients to provide a holistic service where patient choice was facilitated.

However :

• We did not feel that the provider was assured that all local NHS trust staff (radiographers) and doctors working under practising privileges were up to date with mandatory training.

Are services effective at this service

• Policies and procedures were up to date and evidence based.
• The staff working in outpatients and diagnostic imaging departments had received appropriate training. All had received annual appraisals and there was evidence of strong multidisciplinary working across teams and local networks.
• Nursing, imaging and medical staff understood their roles and responsibilities regarding consent and the Mental Capacity Act
• Radiography staff undertook regular audits regarding quality assurance to check practice against national standards.
• Access to information (electronic records, intranet and diagnostic reports) was very good and facilitated holistic oversight of all the care and treatment a patient was receiving, even if this was at a number of treatment centres and providers.

Are services caring at this service

• Patients were respected and valued as individuals.
• Staff provided a very caring and compassionate service. Relationships between people who used the service and staff were caring and supportive.
• We saw that feedback was consistently positive.
• Staff were highly motivated and consistently went the ‘extra mile’ to support patients.
• Emotional support for patients and staff was embedded in the culture of the organisation.

 Are services responsive at this service

• The service was responsive to the changing needs of the patients it served.
• Nova Healthcare delivered personalised care based on a comprehensive assessment of individual needs and preferences.
• The service was able to provide 24 hour care if required via service level agreements.
• There were minimal complaints. The manager responded to negative comments and suggestions with clear evidence of learning where necessary.
• The service embraced the Aspen dementia strategy, and had a member of nursing staff as the local dementia champion.

Are services well led at this service

• The management, staff and patients were aware of and felt a sense of ownership of service vision.
• The governance processes were well developed and integrated seamlessly into the Aspen organisation and the local NHS trust. There was very good oversight of quality of the provision by the medical advisory committee (MAC) and the governance committee.
• There was strong leadership of the service with an open and collaborative approach to the management of the service. Staff we spoke with felt passionate about the service they provided and felt a strong sense of belonging to the unit.
• Employment processes at a local and wider organisational level ensured that staff met the requirements of fit and proper person’s requirements.
• Staff understood the business culture of the organisation.
• We saw evidence of strong engagement with the developments in the use of the Gamma Knife. This included involvement in leading academic ventures with improved patient outcomes.
• Our key findings were as follows:
• We found examples of individualised care for patients.
• There was strong leadership and governance arrangements that ensured a safe and compassionate experience for patients.
• There was an open culture and learning environment within the service where staff felt they could report concerns without fear of recriminations.
• We saw several areas of outstanding practice including:
• Seamless working with NHS professionals at the local NHS trust for the best outcomes for patients.
• Feedback from patients was overwhelmingly positive describing their care in terms of ‘fantastic’ and ‘first class’
• However, there were also areas of where the provider needs to make improvements.
• The provider should:
• Ensure that radiography staff and doctors with practising privileges who access mandatory training through the local NHS trust have figures included in Nova Healthcare training information.
• Ensure that actions from the Nova Healthcare biennial safeguarding self-assessment are undertaken and documented.
• Implement the actions identified following the PLACE audit May 2016.

   Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 20 December 2016

Nova Healthcare demonstrated safe working practice, equipment was well maintained and we observed a safe and clean environment. We saw that record keeping was of a consistently high standard. Nova Healthcare prioritised staff training and had robust processes in place to review consultants’ practising privileges. The service delivered highly compassionate care that was demonstrated to be effective.

The service was very responsive to individual patient needs and staff went out of their way to ensure these were met. This was reflected in patient feedback which was consistently positive.

We found that Nova Healthcare leadership team led the service well and managed all aspects of care and governance. There were clearly defined service level agreements and we observed a truly seamless service with the local NHS trust.

Staff told us that Nova Healthcare was a good and supportive place to work. They said that they would felt comfortable reporting concerns without fear of recrimination.

However, although mandatory training information was available for doctors with practising privileges within individual personal records, this was not collated by the service to provide overall assurance and compliance figures. Actions from the biennial safeguarding self-assessment needed to be undertaken and documented.