The London Welbeck Hospital is operated by Welbeck Health Care Limited. It is normally open from Monday to Friday 7am until 8pm but has arrangements to accommodate overnight patients. The hospital has 14 beds. Facilities include two operating theatres, a ward, a minor operations theatre and two consulting rooms for pre and post-operative checks.

The hospital provides cosmetic surgery procedures including abdominoplasty, breast augmentation and reduction and rhinoplasty.

We carried out an announced inspection on 23 November 2016. The hospital was previously inspected in October 2014 and we found the hospital had taken some action to address the concerns we found during that inspection.

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.

We do not currently have a legal duty to rate cosmetic surgery services or the regulated activities they provide but we highlight good practice and issues that service providers need to improve.

We found the following areas of good practice:

• We saw good infection prevention and control (IPC) practices with housekeeping and clinic staff ensuring all areas of the hospital were clean and tidy. Staffs personal IPC practices were carried out to the highest standard.

• Staff were overwhelmingly positive about the local and senior leadership teams and felt they were listened to when they had concerns or suggestions for change.

• There was a service level agreement with both a local NHS and local independent hospital for those patients requiring level 2 and 3 critical care. This allowed patients a choice of NHS or private care if they became unwell.

However, we also found the following issues that the hospital needs to improve:

• We found that only scrub nurses and some healthcare assistants had signed competency booklets. No other staff had signed competencies and senior staff could not be assured that all staff had the correct skills to carry out procedures.

• Staff in theatres were drawing up anaesthetic drugs in advance of anaesthetists being present in theatre. Although there were hospital prescriptions for these drugs they were not in line with best practice.

• Patient observation charts that we reviewed were not always completed fully and could put patients at risk of not being escalated for review by the relevant clinicians.

• An audit in June 2016 had highlighted poor compliance in documenting post-operative consultant visits but we could not view an action plan for this.

• Compliance with mandatory training including basic life support was variable across staff groups.

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

Deputy Chief Inspector of Hospitals

Professor Edward Baker

We spoke with one person who used the service and looked at patient testimonials on the provider’s website. People were satisfied with the care and treatment received.

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

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment because the provider worked in co-operation with others.

There were appropriate recruitment and selection processes in place. Appropriate checks were undertaken before staff began work. Staff and patient medical records were accurate and fit for purpose. Records were kept securely for the appropriate period of time and then destroyed securely.

We were unable to speak to people on the day of the inspection as none were booked in for a procedure. However we reviewed recent survey feedback from people that had used the hospital and they had rated it highly. All respondents rated the care they had received as “excellent” and all said they had been given enough information following their operation.

Before people received any care of treatment they were asked for their consent. The proposed treatment would be discussed with the person along with any potential risks involved. People were required to sign a consent form.

People were cared for in a clean, hygienic environment. On the day of the inspection we observed the service to be clean and well maintained and survey feedback from people described their rooms as clean.

The hospital had the appropriate arrangements in place for staff to follow if they suspected a person was at risk of abuse and how they could prevent this from happening.

People were cared for by staff that were supported to deliver care and treatment safely. Staff received appropriate professional development in the form of appraisals and training. One person commented in a recent survey ‘’very friendly and helpful staff.’’

People knew how to make complaints and we saw that previous complaints were investigated and resolved, where possible, to a person’s satisfaction. We saw that learning took place from this process.

People said that staff respected their privacy and dignity. They felt that they were given sufficient information about the procedures and were provided with detailed information about their treatment and care prior to any procedure being carried out on them. People found the hospital to be clean and well maintained.

The London Welbeck Hospital is a 14 bedded private hospital. The hospital employs the majority of staff on a bank, zero hours contract basis and has 14 substantive staff’. It provides a range of cosmetic surgery procedures such as abdominoplasty, breast augmentation and rhinoplasty and outpatient services. These are two which two of the eight core services that are always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection. The other six core services that are not provided by this hospital are critical care, medical care, children and young people services, urgent and emergency care, maternity and family planning, and end of life care.

The London Welbeck Hospital is based in Marylebone, London. The hospital has three operating theatres, 14 en-suite bedrooms and a very small outpatient department with two consultation rooms. The hospital provides surgery to both male and female patients aged 18 to 65 years, however, at the surgeon's discretion surgery may be offered to patients over the age of 65 years.

The hospital was selected for inspection as an sample of a small specialist private hospital trust in our wave 1 pilot of independent healthcare. The team of five included CQC inspectors, an anaesthetist, nurse and a senior manager from another private hospital. The inspection took place on 22 October 2014 with an unannounced visit on the 31 October 2014.

 Our key findings were as follows: 

Safe:

• There was a paper based incident reporting system that staff were aware of and all incidents were investigated and findings feedback to staff to ensure learning.
• Medicines were stored securely to ensure that unauthorised personal did not have access to them. However, we found one out of date oxygen cylinder,
• The principles of the ‘Five steps to safer surgery’ checklist were embedded into practice and surgical safety checklist  paperwork was completed..
• There was no current and up to date theatre instrument and equipment list to identify when individual items were purchased.

  Effective:

• The outcomes for patients who had undergone elective surgery were not monitored by the hospital.
• Procedures and treatments were not reviewed against national clinical guidelines, and while patients received information about their procedures, there was no evidence this was referenced to best practice.
• Staff were encouraged and supported with their continual professional development and there was a range of opportunities for staff to develop their skills, including completing degree and master’s level studies.

  Caring:

• Staff were caring and treated patients and their relatives with dignity and respect.

• Patients commented positively about their care and treatment. The majority of responses to the provider's patient satisfaction survey were positive .

  Responsive:  

• Patient admissions were arranged in a timely manner with minimal delays for patients.
• Complaints were responded to within the timescales identified in the hospital’s policy.

Well-led:

• The provider did not have a documented vision and clinical strategy to support innovation and growth of the service that had been shared with all staff.
• There was identified leadership in both theatre and on the wards and staff feedback positively about the support they received. There was no designated medical director, medical leadership was provided by the chair of the MAC and the responsible officer.
• There were some governance arrangements in place and evidence of actions taking place following MAC and governance meetings.

We saw outstanding practice including:

The quality of hospital's response to patient complaints was noted to be of a high standard. This included responses prepared that artfully made a direct connection between the issue raised and the action taken.

Importantly, the hospital must:

• The hospital must ensure there are arrangements in place for the care of level 1 patients and ensure all staff are aware of these arrangements.
• The hospital must consider the risks of anaesthetic assistants drawing up anaesthetic drugs before the theatre list commenced taking into account NRLS 'Signal Injectable medicines in theatres' 

 In addition the hospital should:

• The hospital should explore how it utilises the longer term patient feedback collected by the individual surgeons to demonstrate the experience and outcomes for patients using the service.
• In line with best practice should review the consent forms used to ensure patients are provided with a copy of their consent document.
• The level of safeguarding children and adults training and the attended by staff should be reviewed to ensure it is appropriate for the individual staff member's role.
• Patient information should be reviewed to ensure it reflects current best practice
• The hospital should draw up an up to date theatre instrument and equipment list to identify when individual items were purchased and when they are due to be replaced.
• The competencies required for the role of scrub nurse and HCA working in theatres should be identified and the individuals undertaking these roles skills.

Professor Sir Mike Richards

Chief Inspector of Hospitals