HCA Healthcare UK The Harley Street Clinic

Updated 20 April 2023

The Harley Street Clinic is an independent hospital owned and provided by HCA International Ltd. The location is based in London in the Harley Street area. It consists of a main hospital building located at 35 Weymouth Street and uses areas at six other addresses in the immediate vicinity all controlled by HCA International Ltd. All these areas are covered under a single CQC registered location.

The Harley Street Clinic provides services for adults and children in the following specific service user bands;

• Caring for adults over 65 years
• Caring for adults under 65 years
• Caring for Children 0-18 years (outpatients and diagnostics only)

The Harley Street Clinic provides services with the following facilities;

• 85 registered beds which includes the day case oncology unit
• 12 level three adult Intensive Care Beds
• Four operating theatres
• Three cardiac catheter laboratories
• Consulting rooms
• Physiotherapy services
• Pharmaceutical services
• Radiology services
• Cardiac physiology services

The Harley Street Clinic is registered for the following regulated activities;

• Treatment disease disorder & injury
• Surgical procedures
• Diagnostic & screening procedures
• Family Planning services

We previously inspected this location in August 2016 where we issued one requirement notice. The provider has since taken corrective action to rectify the issue. The location has also been inspected in May 2015, November 2013, November 2012 and July 2011.

We inspected this hospital as part of our risk-based inspection methodology. This service had not been inspected since 2016 and had undergone some changes in its service provision. We inspected surgery as this was the main service the hospital provided and this service had undergone changes in its structure and provision. We inspected medical care as this was a significant service the hospital provided and this service had undergone changes in its structure and provision. We inspected outpatients as a requirement of our inspection methodology as the way we assessed this service had changes since the previous inspection. We inspected diagnostic imaging as a requirement of our inspection methodology as the way we assessed this service had changes since the previous inspection. We inspected services for children and young people because there was a requirement notice issued in the previous inspection. We did not inspect the critical care service as there were no risks associated with the service.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service.

Updated 20 April 2023

Our rating of this location ​stayed the same​. We rated it as ​outstanding​ because:

• Staff treated patients with exceptional compassion and kindness, respected their privacy and dignity, and took account of their individual needs. People thought that staff went the extra mile and care and support exceeded their expectations. Staff empowered people who used the service to realise their potential. They provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs and made sure this was reflected in how care was delivered. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment. Consideration of people’s needs was consistently embedded in everything staff did. Patients told us they valued their relationships with staff.
• There was an embedded system of leadership development and succession planning. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy had supporting plans and objectives which were innovative and achievable. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in its daily work, and opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders operated effective governance processes, throughout the service and with partner organisations. Leaders and teams demonstrated commitment to best practice performance and risk management systems and processes. They identified and escalated relevant risks and issues and identified actions to reduce their impact effectively and in a timely manner. Leaders and staff actively and openly engaged with patients, staff, equality groups and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research. Staff were actively participating in research and improvement projects.
• 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 provided a high level of care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. There was a strong, visible, patient centred culture. 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 to support timely patient care.
• The service planned care to meet the needs of local people, and took account of patients’ individual needs, and made it easy for people to give feedback. Patient individual needs and preferences were central to the delivery of tailored services. People accessed the service when they needed it and did not have to wait long for treatment.

Updated 20 April 2023

Our rating for medical care stayed the same. We rated it as outstanding 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 provided a high level of care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. There was a strong, visible, patient centred culture. 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 to support timely patient care.
• Staff treated patients with exceptional compassion and kindness, respected their privacy and dignity, and took account of their individual needs. People thought that staff went the extra mile and care and support exceeded their expectations. Staff empowered people who used the service to realise their potential. They provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs and made sure this was reflected in how care was delivered. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment. Consideration of people’s needs was consistently embedded in everything staff did. Patients told us they valued their relationships with staff.
• The service planned care to meet the needs of local people, and took account of patients’ individual needs, and made it easy for people to give feedback. Patient individual needs and preferences were central to the delivery of tailored services. People accessed the service when they needed it and did not have to wait long for treatment.
• There was an embedded system of leadership development and succession planning. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy had supporting plans and objectives which were innovative and achievable. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders operated effective governance processes, throughout the service and with partner organisations. Leaders and teams demonstrated commitment to best practice performance and risk management systems and processes. They identified and escalated relevant risks and issues and identified actions to reduce their impact effectively and in a timely manner. Leaders and staff actively and openly engaged with patients, staff, equality groups and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research. Staff were actively participating in research and improvement projects.

Updated 20 April 2023

Our rating for this service stayed the same. We rated this service as good because:

• The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service managed infection risks well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave children and young people 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 children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available five days a week.
• Staff treated children and young people 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 children and young people, families and carers.
• The service planned care to meet the needs of local people, took account of children and young people’s 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 children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

Updated 4 January 2017

There was a clear system of incident reporting in place and staff were aware of their responsibilities to report incidents.

Clinical areas throughout the hospital were visibly clean and patient risks were identified and acted upon swiftly.

Staffing in the unit was compliant with Intensive Care Society (ICS) guidance with a suitable number of qualified and registered staff.

Care was provided in accordance with national guidance including NICE guidelines.

The unit contributed to the Intensive Care National Audit & Research Centre (ICNARC) for critical care patients. The rates of early deaths on the unit was below the national average for similar units.

The unit participated in local and national audits to demonstrate patient outcomes.

Nurses received regular supervision and 100% of nurses had undergone an appraisal in the last year.

We observed good working relationships between all grades of staff and all professional disciplines. MDT meetings were well attended.

We reviewed comment slips and ‘thank you’ cards and spoke with patients who found the staff to be very caring and respectful.

The complaint handling process was clear and speedy.

There were arrangements in place for governance, risk management and quality measurement associated with intensive care patients.

There was a comprehensive audit programme and senior staff maintained the risk register.

We observed strong leadership and lines of accountability in the unit were coherent.

Updated 20 April 2023

This is the first time we rated this service. 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.
• 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 the communities it served, took account of patients’ individual needs, and made it easy for people to give feedback. People accessed the service when they needed it and did not have to wait too long for a diagnostic procedure.
• 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.

Updated 20 April 2023

This is the first time we rated this service. 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.
• 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 the communities it served, took account of patients’ individual needs, and made it easy for people to give feedback. People accessed the service when they needed it and did not have to wait too long for an appointment.
• 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.

However,

• Patient records were not always stored securely.
• Not all single use consumables were in date.
• Not all call bells in the toilets were accessible in the event of a patient needing to call for assistance.

Updated 20 April 2023

Our rating of this service improved. We rated it as outstanding 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 managed infection risks 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 provided good care and treatment. They gave patients enough to eat and drink and gave them pain relief when needed. Managers monitored the effectiveness of the service and made sure staff were skilled and experienced. 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. Patients had access to good information and key services were available seven days a week.
• Staff treated patients with exceptional compassion and kindness, respected their privacy and dignity, and took account of their individual needs. People thought that staff went the extra mile and care and support exceeded their expectations. Staff empowered people who used the service to realise their potential. They provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs and made sure this was reflected in how care was delivered. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment. Consideration of people’s needs was consistently embedded in everything staff did. Patients told us they valued their relationships with staff
• The service planned care to meet the needs of local people 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.
• There was an embedded system of leadership development and succession planning. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy had supporting plans and objectives which were innovative and achievable. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear. Leaders operated effective governance processes, throughout the service and with partner organisations. Leaders and teams demonstrated commitment to best practice performance and risk management systems and processes. They identified and escalated relevant risks and issues and identified actions to reduce their impact effectively and in a timely manner. Leaders and staff actively and openly engaged with patients, staff, equality groups and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research. Staff were actively participating in research and improvement projects.

However:

• There was no signage to the multi-faith room and the room itself was small and not accessible to wheelchair users.
• We found some consumable items which were out of date and one with packaging that was not intact.