HCA Healthcare UK The Christie Private Care

HCA Healthcare UK operates six private hospitals across the country, including The Christie Private Care (the clinic) and a number of diagnostic centres. HCA Healthcare UK entered into a joint venture with a partner NHS trust in 2009 which led to the formation of the clinic. The clinic specialises in the diagnosis, management and treatment of all cancers including haematological. The clinic is based within the partner NHS trust. The first floor contains a dedicated outpatient suite and day care unit; the second floor contains and oncology ward; and the third floor contains an oncology ward and the haematology transplant unit. There are a total of 34 inpatient beds (single rooms). The clinic provides care and treatment for patients with oncological and haematological disease pre and post-surgical intervention, chemotherapy, radiotherapy, transplant, immunotherapy and care in the last days of life. It also provides outpatient and diagnostic imaging. Surgical intervention is provided by the partner NHS trust, as is critical care.

We inspected all aspects of the clinics service provision using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 and 14 March 2018 along with an unannounced visit to the clinic on 26 March 2018.

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 the clinic was medical care. Where our findings on medical care – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the medical care core service.

We rated the clinic outstanding overall; both medical care, and outpatients and diagnostics, were rated as outstanding.

We rated this service as outstanding overall because:

• We saw excellent leadership from managers, and all staff were passionate about providing high quality care for their patients.

• There were comprehensive systems to keep people safe, including excellent processes to protect victims of domestic abuse. It also used innovative practices, such as a safeguarding app, to provide support to staff.

• The clinic had ongoing, consistent progress towards safety goals, reflected in a zero-harm culture.

• The service not only met relevant standards in medicines’ management, but looked to continually improve processes. Actions plans were always implemented promptly (for example, following an internal governance report in 2017) and these were demonstrated to have had a measurable effect on patient safety.

• We witnessed numerous example of exceptional care being provided for patients, for example, by the clinical nurse specialist team.

• Staff were proud to work for the organisation and spoke highly of the culture; there were high levels of staff satisfaction.The open and honest culture within the service was exceptional. Staff felt valued.

• Patients, relatives and carers were continually positive about the way staff treated them. People thought that staff went the extra mile, and the care exceeded peoples’ expectations. The clinic had 100% satisfaction scores across all areas in medical care.

• There was strong multidisciplinary working. Staff teams and services were committed to working collaboratively to deliver more joined-up care for people using the services. All staffing divisions (including non-clinical) attended team huddles which helped contribute to continuity of care. Staff felt supported by their colleagues.

• The clinic provided a tailored service to each patient, including practical, spiritual and emotional support which were seen as being as important as their physical needs. The radiotherapy team met with patients, and carers, to show them the department and ensure any individual needs were met. Throughout the clinic, patients requiring it were given food packages when being discharged. Complementary therapies were also provided for patients.

• The clinic’s exceptional and distinctive service valued people’s emotional needs. There was exceptional psychological support provided for patients, including a support group (a well-being space) for patients that was free and seen as part of their ongoing care.

• Patients could access services and appointments at a time that suited them. Appointment waiting times were consistently low, and the clinic could quickly adapt to the needs of individual patients to provide care in a way that suited them.

• The leadership, governance and culture was used to drive and improve high-quality patient‑centred care. The clinic could provide excellent examples of how learning had driven improvements in service, for example, the well-being space.

• There was a proactive approach to anticipating and managing risk to the people who used the services. The clinic had high staffing levels and patients did not wait long to be seen by doctors or nurses. All relevant staff had up to date training.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)