Mount Vernon Cancer Centre

Updated 18 December 2019

Mount Vernon Cancer Centre (MVCC) is situated in Northwood, Middlesex on a large site owned by Hillingdon NHS Trust and is 33 miles from East and North Hertfordshire Trust’s main hospital site, the Lister. The centre provides a specialist non-surgical cancer service, including tertiary radiotherapy and chemotherapy services.

There are 22 medical inpatient beds located on one ward, which cares for patients who require inpatient treatment because they are unwell during or following their radiotherapy or chemotherapy treatment. Since August 2018, the medical ward also provides end of life care following the closure of the on-site hospice, Michael Sobell House. The hospice contained an inpatient ward and a day centre. Inpatient services were transferred to Wards 10 and 11 at MVCC. Day centre services remained at the hospice. However, Michael Sobell House was due to be managed by a new provider in July 2019. Therefore, ENHT will no longer manage the hospice (inpatient or day centre services). End of life care will continue to be provided on the medical wards.  

A supportive care unit opened in January 2018, and provides cancer treatments and adjuncts, such as blood transfusions on a day care basis. There is also an outpatient department and a radiotherapy centre.  

At the time of our inspection, the trust was in collaboration with external stakeholders to determine the future of MVCC. It had been acknowledged that the complex estates agreement and proximity to the other locations in East and North Herts NHS Trust presented challenges which could be managed better by a more specialist acute NHS provider.

Updated 18 December 2019

Our rating of services stayed the same. We rated it them as requires improvement because:

• We rated safe, responsive and well-led as requires improvement. Caring and effective were rated as good.
• We rated two of the services we inspected as requires improvement and one as good.
• The trust did not make sure the design, maintenance and use of facilities, premises and equipment kept people safe. However, this was challenging due to the complex nature of leasing the premises from another NHS Trust.
• Staff were passionate and committed to delivering quality care; however, the on-going uncertainty surrounding the future of MVCC had an impact on staff morale.

Updated 18 December 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• Mandatory training was not up to date. The premises and equipment did not always keep people safe. Observations were not always completed on time. Patients’ were not always treated for sepsis within an hour. Patients’ were not reviewed by a consultant upon admission. There was not enough medical or nursing staff to keep people safe. Prescribing processes were not always followed. Not all incidents were reported.
• The service did not plan and provide care in a way that met the needs of local people. People could not always access the service when they needed it and receive the right care promptly.
• Not all staff were provided with regular opportunities to meet, discuss and learn from the performance of the service. The service did not always identify potential patient safety risks and issues and identify actions to reduce their impact. Continuous learning and improvement processes were not fully embedded.

However,

• Staff treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers.
• The service provided care and treatment based on national guidance. Staff gave patients enough food and drink. Staff assessed and monitored patients regularly to see if they were in pain. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Staff supported patients to make informed decisions about their care and treatment.

Updated 5 April 2016

Overall the service offered within chemotherapy required improvement, although the service was outstanding for caring.

Although the hospital gathered patient information such as hospital acquired infections and reviewed these through its clinical governance processes, there was no oversight of urgent transfers.

There was a process in place to obtain rapid treatment for patients who were suspected of having neutropenic sepsis via an acute oncology service. Only 30% of patients who were suspected of having neutropenic sepsis received antibiotics within two hours of admission. However, not all these patients were seen at MVCC, but at neighbouring trusts. There was an effective procedure in place to minimise chemotherapy being given via the incorrect route

Staff understood their responsibilities to raise concerns, record and report safety incidents, and near misses, and to report them internally and externally, although learning from incidents and complaints was limited.

All areas appeared clean, the units were bright. However, the building at Mount Vernon was old and required updating and refurbishment.

There were almost always long queues in the outpatients department at Mount Vernon for patients to be checked in for their treatment, although patients who were nervous, for example, if they were needle phobic, were seen and reassured as soon as possible. There were always long waits for treatment, whether the patient chose to have a one stop option, or blood tests on one day and treatment the next. Patients who required daily treatment, but did not need an in-patient bed, were able to stay in the hospital’s on-site hostel.

Patients often needed to go outside the main building to access other services. Often their individual needs were not always met with regards to keeping warm and dry.

Patients who required specialised treatment by a plastic surgeon for extravasation, needed to be transferred off site. The service to insert PICC lines, operated three days per week. This meant patients sometimes had their first treatment via a cannula, without the PICC line in situ.

Infection rates were low. There had been no reported incidents of MRSA or C Diff. in the two years prior to our inspection. Clinical waste was disposed of safely. This included chemotherapy waste. There were arrangements in place for managing medicines, including chemotherapy and radioactive substances to keep people safe.

Generally the hospital was adequately staffed. Mandatory training rates for all staff were at 87% against a hospital target of 90%.

The hospital took part in local, the trust’s and national audit programmes. Audits, undertaken of patients’ records each month were audited against compliance with assessment tools and care bundles.

The hospital was meeting the 31 day target for treating patients who required chemotherapy and radiotherapy for most tumour types.

All the consultants specialised in treating one or two tumour sites only. We found that there was a strong culture of multidisciplinary working between nurses, specialist nurses, doctors, allied health professionals and social workers.

None of the staff we spoke with had received training about the Mental Capacity Act 2005 (MCA).

Patients were given appropriate and timely support and information to cope emotionally with their care, treatment or condition. Patients and relatives were well supported and were given as much or as little information as they wanted. Staff often went out of their way to ensure patient care went beyond their remit as healthcare professionals.

There were links to access special care for patients with a learning disability. Staff had not had any training to care for patients living with dementia.

The ratio of compliments far exceeded the complaints. However, we found that not all complaints, particularly verbal complaints were recorded.

Although each division within the hospital had local objectives, there was no principal cancer strategy, nor was there a director with sole responsibility for cancer. There was no strategic oversight of the chemotherapy service. All staff were aware of the trust’s vision. There was a plan in place to be autonomous from Hillingdon NHS Trust. All the medical staff had an afternoon of management time written into their contracts.

All the staff we spoke with were proud to work for the Cancer Centre and would want their friends and family to be treated there should the need arise.

Updated 17 July 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service was not well led. Although efforts were made to improve leadership and management of the service, the trust had not overcome the challenges of providing a service at a significant distance from the main acute hospital and which served a wider population than that of the rest of the trust.
• The trust did not have a clear vision and strategy for what it wanted to achieve in relation to end of life services at the Mount Vernon Cancer Centre (MVCC). There had been little progress since our inspection in October 2015. It did not have workable plans for the development of services at MVCC, developed with the involvement of stakeholders, patients and staff. There was no information about the model of care and the configuration of services at the MVCC.
• The arrangements for clinical governance did not always operate effectively. The reporting structure was unclear and although there was some discussion of incidents, risks, complaints and patient feedback at the end of life care clinical governance group, information was sometimes missing and there was no clear escalation of issues.
• The trust did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Risks to the service were not always identified or progressed and there was a lack of robust challenge of performance issues.
• The service did not have robust evidence to demonstrate that nurse staffing levels were set appropriately to meet the changing needs of their patients throughout the 24 hour period. Staffing levels at night increased risks to people using the service and had not been addressed over a significant period of time.
• Facilities and premises were not appropriate for the services being delivered. The premises used by the service were not well maintained. Although some improvements to the environment in MSH had occurred since the inspection in 2015, we found significant concerns remained. The service did not control infection well.
• The environment within the inpatient unit was not well adapted to the needs of people using it.
• Training in end of life care was not mandatory in the trust and levels of completion of training in end of life care were low.
• People could not always access the service when they needed it. Limits to the number of admissions and the triage systems meant that patients who required urgent admission were not always able to access the service.

However,

• Staff took steps to safeguard vulnerable adults and responded appropriately to signs of abuse. They engaged appropriately in local safeguarding procedures.
• Staff cared for patients with compassion. Staff provided emotional support to patients to minimise their distress. A range of emotional support was available to patients and their families.
• Staff involved patients and those close to them in decisions about their care and treatment. Patients and their families were aware of the plans for their care and were involved in decision making at every step.
• Staff from different disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• The service managed patient’s pain and other symptoms well. The effectiveness of pain relieving medicines was monitored, reviewed and adjusted accordingly.
• The service prescribed, gave, recorded and stored medicines well
• The service provided care and treatment based on national guidance and evidence of its effectiveness. They assessed staff compliance with guidance and identified areas for improvement.

Updated 18 December 2019

• The service did not always plan care to meet the needs of local people, People could not always access the service when they needed it and sometimes had long waits to see staff at appointments.
• Leaders did not always have the confidence of some staff and information systems did not enable staff to access the information they needed to manage patients and services well. Staff did not always feel respected, supported and valued. The service did not always engage well with staff and the community to plan and manage services.
• Managers did not always monitor the effectiveness of the service. Outpatient services were not available seven days a week.

However,

• 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 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.
• Staff took account of patients’ individual needs and made it easy for people to give feedback.
• Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities and all staff were committed to improving services continually.
• Staff provided good care and treatment, ensured patients were able to eat and drink sufficiently, and gave them pain relief when they needed it. Staff were competent and 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.

Updated 18 December 2019

Our rating of this service stayed the same. We rated it as 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 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. 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 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.