Practice Plus Group Hospital - Ilford

Updated 4 April 2019

North East London Treatment Centre (NELTC) is located on a large campus in North East London that also contains an acute NHS hospital, a NHS community and mental health trust and a large care home. Patients attended pre-surgery clinics, pre-assessment, surgery and post-operative follow-up appointments in the same building. The service has six surgical theatres, 22 in-patient beds (Kingfisher Ward) and 24 day-case beds in the day surgery unit. The service had eight clinic rooms on-site for outpatient appointments and some ENT outpatient clinics also took place at GP health centres located at Hornchurch and Ilford.

NELTC opened in March 2007. NHS treatment centres are private-sector owned and are contracted to treat NHS patients free at the point of use. In 2014, the treatment centre was acquired by Care UK Clinical Services Ltd, the largest independent provider of NHS services in England. The hospital has had a registered manager in post since January 2019.

NELTC provided inpatient and day case elective surgery with associated outpatient and diagnostic clinics across seven disciplines: Orthopaedics, general surgery, ophthalmology, urology, gynaecology and ears, nose and throat (ENT). The service also offered a Joint Advisory Group (JAG) accredited endoscopy service. It provided services to people living in North East London and Essex. The model of care focuses on treating adults who are generally healthy and who do not have significant co-morbidities. It did not provide treatment to and care to children, nor did it provide treatment for 16 – 18 year old young adults.

The CQC last undertook a comprehensive inspection of the service in September 2016 when it was rated as ‘requires improvement’ overall. We inspected Surgery and Outpatients. Following our last inspection in September 2016 we issued one requirement notice requiring the service to take action to remedy breaches to Regulation 17 (2) (b), in relation to risk management in the surgical service and issued 15 actions the provider should take to improve. During this inspection, the service had dealt with or shown improvement for the previously reported concerns.

Updated 4 April 2019

North East London NHS Treatment Centre is operated by Care UK. The service has six operating theatres, one endoscopy suite, 22 bedded inpatient ward (Kingfisher), two post anaesthetic care units consisting of five recovery bays, day surgery unit with 23 patient bays, onsite pharmacy and outpatients department (eight consulting rooms).

The service provides surgery, outpatients and diagnostic imaging. We inspected surgery and services for outpatients and diagnostic imaging. Although the service did provide some diagnostic services such as ultrasound on site, the bulk of the diagnostic service is outsourced to other external providers and was therefore not included in this inspection.

We inspected this service using our comprehensive inspection methodology, which we carried out on an unannounced inspection on 22 and 23 January 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.

Our rating of this hospital/service improved. We rated it as Good overall.

We found good practice in relation to outpatient care and surgery:

• The service had taken action to ensure that the World Health Organisation’s Five Steps to Safer Surgery checklist was embedded in the theatre routine.
• There was a positive learning culture throughout the service. Staff were encouraged to report incidents and near misses. Learning from incidents was cascaded to staff both within the service and across the provider as a whole. The service reported no never events and had minimal serious incidents.
• All staff had up to date mandatory training.
• Cleanliness and infection control policies and controls were in place, including for the environment.
• Patient records were completed consistently and to a high standard.
• Safeguarding processes and training were in place and staff demonstrated good knowledge of these.
• The service demonstrated effective internal and external multidisciplinary (MDT) working.
• The service benchmarked patient outcomes to ensure the best standards of care. Outcomes were in line with national expectations. We saw procedures had been developed in line with national guidance and staff were aware of how to access them on the shared drive and intranet.
• Staff were competent to carry out the role for which they were employed and were supported to do so. The service developed staff with specialist skills to enable them to provide nurse led clinics. All staff had completed their appraisals and performance development plans.
• Most specialities offered evening and weekend clinics which facilitated patient access to appointments at times which suited their needs. The service offered patients 24 hours seven days a week advice line.
• All staff including consultants demonstrated empathy and compassion with patients in the context of the sensitive nature of many of the procedures carried out and provided emotional support. Staff spoke about patients with care and compassion, demonstrating genuine concern for their wellbeing.
• Patients told us they felt listened to by health professionals, and felt informed and involved in their treatment and plans of care.
• Access and flow through the service was generally highly effective.
• The service reflected and responded to the needs of local people through the provision of information in a range of languages and the use of face-to-face interpreters.
• The service worked collaboratively with the CCG and the local trust next door to reduce waiting times. Services were planned and delivered in a way that met the needs of the local population.
• The service had reduced their ‘do not attend’ rates by implementing a pre-appointment call in addition to text reminders.
• There was a clear vision and strategy for the service of which staff were aware.
• The leadership team recognised areas for improvement since the inspection of September 2016 and had taken proactive steps to address them. The leadership team continued to recognise the need for improvement and was working to deliver this.
• Generally there was a positive culture throughout the service. We found highly dedicated staff who were positive, knowledgeable and passionate about their work.
• Although some members of the senior leadership team were relatively new, senior leaders told us the team felt more stable.
• The centre suspended cinical activity bi-monthly for quality governance and assurance meetings and all staff were invited to attend.
• Staff we spoke with said, they felt they could raise concerns and were confident that they would be dealt with appropriately.
• We saw evidence of public and staff engagement. The centre demonstrated and confirmed that patient experience was the key factor for their service development.

We found areas of practice that require improvement in relation to outpatient care and surgery:

• There were communication issues between the bookings team and the theatre team as well as between the theatre team and the recovery team which had the potential to impact on the delivery of an effective service.
• The risk register was not always directly related to specific risks within the service itself, but reflected generic or specultative risks.
• Due to patients sometime undergoing surgery with a different consultant than the one who had undertaken their consultation, difference of clinical opinion had the potential to impact on whether a patient received the same treatment for which they had initially been booked, or was treated at all.
• The fridge log was not completed regularly and we found several omissions.
• Although the service had an Infection Prevention and Control policy for Carbapenamase producing Enterobacteriaceae (CPE), staff awareness was inconsistent.
• Although the service had made some improvements to friends and family test scores, further improvement was required to increase the response rate.
• Although most staff we spoke with demonstrated awareness of the senior leadership team, some staff were not aware of the senior leaders’ names or roles.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South East)

Updated 4 April 2019

Updated 4 April 2019