The London Heart Centre Ltd is operated by The London Heart Centre Ltd. The centre opened in 1978 and has been managed by The London Heart Centre Ltd since 2007. The service offers diagnostic tests for adults and young people.

Patients are offered electrocardiogram (ECG) and stress echocardiography (stress echo) services. The service had two diagnostic imaging rooms in the basement and a consultation room on the ground floor.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 06 November 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.

Services we rate

We rated it as inadequate overall.

• The service did not have an effective leadership structure including staff with the right skills and abilities to provide high-quality sustainable care.
• The service did not have an effective system to improve service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.
• Policies and procedures were not reviewed regularly and updated where required.
• There were no clear lines of accountability and responsibility for completing the action plans from the governance audit, and Legionella and fire risk assessments.
• There was no identifiable escalation policy for urgent findings or deteriorating patients.
• The service did not comply with its recruitment policy to ensure all checks were completed prior to employment.
• The service did not have a risk management strategy, setting out a system for continuous risk management.
• The service did not actively engage with patients, staff, the public and local organisations to plan and manage appropriate services.
• The service did not show commitment to improving services by learning from when things went well or wrong, promoting training and innovation.
• The service did not provide adequate mandatory training in key skills to all staff. The service did not have a mandatory training policy or document that set out what skills were required to perform individual tasks.
• Staff did not have adequate training on how to recognise and report abuse. Not all staff members understood how to protect patients from abuse, the relevant organisations to report to and their contact details.
• The service was not registered to receive safety alerts
• No health and safety risk assessment of the premises had been undertaken.

However, we also found the following areas of good practice:

• The service controlled infection risk well. Staff kept equipment and the premises clean and adhered to infection control and prevention methods.
• The service had suitable premises and equipment and maintained them well.
• The service provided care and treatment based on national guidance. Managers checked to make sure staff followed guidance.
• Staff of different grades worked together as a team to benefit patients. Doctors and other healthcare professionals supported each other to provide good care.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• The centre had a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with four requirement notices that affected London Heart Centre Limited. Details are at the end of the report.

‘I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.’

Nigel Acheson

Deputy Chief inspector of Hospitals (London and the South East)

There was no opportunity to speak with people coming for tests on the day of the visit. However, we saw evidence that people were asked about their experiences of the service.

Prior to undergoing tests, the cardiologist sought information about a person's medical history, medications and allergies and gave people full explanations about the tests. The cardiologists had systems in place to monitor the quality of test results and benchmarked them to assess their accuracy.

On the day of the inspection the centre was clean and tidy. Personal protective equipment was available and staff cleaned clinical areas in between people's appointments.

Staff were suitably qualified and received appropriate training to enable them to provide the care that people needed.

Complaints and incidents were recorded and investigated and there was evidence that learning took place from these and changes were made to the service as appropriate.