Archived: Schoen Clinic London

Schoen Clinic London is operated by Schoen Clinic London Ltd. The hospital has 39 beds, although only 16 of these were in regular use at the time of our inspection, as the service opened on 15 August 2018. An additional six beds on another 14-bedded ward (which was not officially open at the time of inspection) were sometimes in use for day case surgery. Facilities include eight day-case places, three laminar flow operating theatres, five post anaesthetic care unit beds, two treatment rooms, ten consulting rooms, and a physiotherapy department with three individual treatment rooms, and one group room. Diagnostic imaging was provided by another provider via a service level agreement, although this was collocated in the same building.

There is also one satellite consulting room for initial consultations only, sublet from another provider. No diagnostic tests or interventions were carried out at this satellite site.

The hospital primarily serves patients requiring elective specialist orthopaedic surgery, on a private basis. No NHS patients are treated at the hospital. The hospital had recently started to accept some patients aged 16 or 17 years, but told us that these patients were carefully assessed on an individual basis. The hospital/service provides surgery and outpatient services. We inspected both of these core services.

We inspected this service using our comprehensive inspection methodology. We gave 48 hours notice of the inspection because evidence gathering in an unannounced inspection would be impacted by the fact that the service undertakes procedures at variable times, as it is a relatively new service. We carried out the inspection on 12 April 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.

Services we rate

This was the first time we rated this hospital. We rated it as Good overall because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
• The service had enough medical and nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up to date and easily available to all staff providing care.
• The service used systems and processes to safely prescribe, administer, record and store medicines, on the whole.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service used safety monitoring results well. Staff collected safety information and shared it. Managers used this to improve the service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health. The service made adjustments for patients’ religious, cultural and other needs.
• Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. Data so far was limited as the service had only opened in August 2018.
• The service made sure staff were competent for their roles.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff provided emotional support to patients to minimise their distress.
• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided services in a way that met the needs of the patients it provided services to.
• The service was inclusive and took account of patients’ individual needs and preferences.
• People could access the service when they needed it and received the right care promptly.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
• The service had a vision for what it wanted to achieve and workable plans to turn it into action.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.
• For the most part, the service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.
• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The service engaged with patients and staff to plan and manage appropriate services.
• The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

However:

• Not all staff had received all of their mandatory training at the time of inspection. There was an ongoing mandatory training improvement action plan in place to address this.
• We found some issues with infection prevention control (IPC) in the theatre department and inpatient ward on the day of inspection.
• There continued to be higher levels of bacteria than normal in the water system.
• There were some minor issues found with resuscitation and difficult airway equipment on the day of inspection.
• Not all staff in recovery were aware of the steps to take in the event of recognised sepsis.
• Not all fluids or medication were stored satisfactorily in theatres on the day of inspection.
• As the service had only opened in August 2018, evidence of effectiveness was limited in terms of patient outcomes, audit activity and continuing professional development opportunities for staff.
• Patient survey response rates were sometimes low.
• At the time of inspection, there was no formal guidance or policy in place relating to the opening of extra beds for day case surgeries.
• There was no formal mechanism to measure staff satisfaction or experience at the time of inspection.
• The service had high staff turnover rates and had not explored the reasons for this.

We found areas of outstanding practice in surgery:

• Consultant intensivists covered the day-to-day care of patients on the ward and PACU. This differs from most other private providers, where this care is usually managed by middle-grade doctors. The consultant intensivists providing 24-hour support each had substantial years of experience in caring for deteriorating patients across a broad range of specialities, with enhanced skills in early diagnosis and management of complications and comorbidities. This meant a higher level of support for patients post-operatively.
• The service had purchased virtual reality (VR) headsets for patients undergoing procedures under local anaesthetic or spinal anaesthetics. They were designed to relax and reduce stress and anxiety for the patient, without the need for extra sedation or general anaesthetics. The headsets contained a range of movies, documentaries and environments appropriate to the age and preferences of the patient.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals