152 Harley Street is operated by 152 Harley Street Limited. Facilities include three operating theatres, a two-bedded level two care unit, a laser treatment room, X-ray, outpatient and diagnostic facilities. There were no inpatient beds.

The service provides surgical, outpatients and diagnostic services for private patients. We inspected areas within surgery and services for children and young people, where concerns hasd been raised to us.

We carried out an unannounced visit on 26 April 2018. During the visit, we focused on areas of concern identified through information sent to us. We reviewed care records of people who had used the service. We reviewed the service’s records such as procedures and audits. We spoke with staff, including administration staff, nurses and a number of consultants.

Throughout the inspection, we took account of what people told us.

For the majority of the issues raised to us, we did not find any evidence to support the concerns. However, we did find that two consent forms out of the 14 that we had reviewed were not signed by the consultant. Patients were changing from outside clothes in the minor procedures operating theatre, which was not in line with infection prevention and control guidance and the storage of procedure log books within theatres was not in line with information governance best practice guidance.

Amanda Stanford

Deputy Chief Inspector of Hospitals London

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. All people were assessed by a practitioner who determined whether it was safe for them to undergo the proposed procedure.

We looked at satisfaction survey results for the period of January 2014 for two respondents. Overall the respondents expressed high levels of satisfaction about the service. Both rated their consultant and overall impression of the service as ''excellent.''

There were systems in place to reduce the risk and spread of infection. The treatment and theatre areas we visited in the service appeared clean and well maintained on the day of the inspection.

The hospital had a medicines policy outlining its practice and procedures for medicine management including controlled drugs (CD).

People were protected from unsafe or unsuitable equipment. Equipment checks on critical equipment such as resuscitation equipment were reviewed in the operating theatre and treatment rooms. Checks were carried out on a daily basis and we saw records to evidence this.

The staff rota identified that staffing was planned in advance depending on the planned admissions / consultations at the service.

We spoke with people who used the service and looked at five patient satisfaction surveys. The majority of people were satisfied with the care and treatment received. They felt that the procedures had been explained well and found the written information provided comprehensive. Consent had been obtained by the most appropriate person on the day of the procedure and the possible risks had been outlined.

Care was planned in a way to ensure a people's safety. People were assessed by the practitioner to determine whether the treatment requested would be suitable. People were provided with post-operative advice and information. There were procedures in place to deal with medical emergencies.

The clinic was clean and well maintained. There were systems in place to reduce the risk of infection, including a policy on infection control and cleaning checklists.

There was a complaints policy and procedure in place and people were given information on how to make a complaint. People we spoke with and the comments from the patient satisfaction surveys were complimentary about staff.

People we spoke to were happy with their care and treatment at this location. They had been given sufficient information about the service and about their treatment. People reported that they had been treated well by staff and could raise a concern if they had one.

152 Harley Street is operated by 152 Harley Street Limited. Facilities included three operating theatres, a laser treatment room, a two-bed level two care recovery area, and X-ray, outpatient and diagnostic facilities. There are no inpatient beds.

The hospital provides surgical, outpatient and some diagnostic services for private patients. We inspected surgery, incorporating children and young persons, outpatients and diagnostic services.

We inspected this service using our comprehensive inspection methodology on 8 and 9 March 2017.

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 do not rate

We regulate cosmetic surgery services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas where the hospital performed well:

• There were systems in place to report and investigate safety incidents and learn from them.
• A regular paediatric agency nurse was used when children’s procedures took place.
• Services were planned to meet the needs and choices of patients, and the arrangements for treatment were prompt.
• Complaints were appropriately acknowledged, investigated and responded to in a timely way.

However, we found the following areas where the service provider needs to improve:

• The new policy and protocols for nurses working in a dual role should be monitored effectiveness and updated for new operations.
• Continue to monitor and seek to improve the transportation outside of the hospital of contaminated surgical instruments by staff.
• Continue to update the risk register with the dates risks are identified, their management and date resolved.
• Consider introducing regular infection, prevention and control (IPC) hand hygiene audits.
• Review and resolve the trip hazard identified in the fourth floor operating theatre.
• Monitor and review fire/ emergency evacuation procedures, especially those for less mobile patients.
• Complete a Disclosure and Barring Service (DBS) check for all staff prior to them commencing employment.
• Clear guidance should be given to reception staff about those patients fasted before a surgical procedure and who should therefore not be offered any food or drinks.
• Consider whether formal recovery training is required to fulfil the full range of nursing duties undertaken by the nursing team.
• Update safeguarding policies to reflect triggers relating to slavery, female genital mutilation (FGM), forced marriage and PREVENT.
• Arrange for staff who had not done so, to complete the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training package.
• Introduce methods to effectively measure patient reported outcomes.
• Make copies of the hospital’s complaints leaflet readily available to patients.

Professor Edward Baker

Chief Inspector of Hospitals