We carried out this inspection on the 12 February 2014. During the CQC’s inspection of University College London Hospital (UCLH) in November 2013, we were given statistical information regarding the incidence of Clostridium Difficile Infection (C Diff) at the hospital site. C Diff is a type of bacterial infection that can affect the digestive system. It most commonly affects people staying in hospital. The information included data specifically relating to the provider’s service and indicated a significantly high incidence of infection, when compared with other clinics and services provided at the UCLH site. The rate had peaked in September 2013.

The Harley Street at UCH service is located on the 15th floor of the main UCLH building in Euston Road. There are two wings, which are known as wards, although they consist of 31 private rooms. The patients’ private rooms have en-suite toilets and shower rooms.

We visited the service with a specialist infection control advisor. We spoke with the provider’s chief operating officer and the service matron. We inspected the premises, including three unoccupied private rooms, the two clinical rooms and the kitchen.

After the inspection, we asked the provider to send us various documents relating to its infection control processes. These included policy documents, cleaning checklists, a remedial action plan, produced in October 2013, in response to the reported statistics that we had seen in November 2013 and up-to-date figures of C Diff incidence. We noted that the rate of C Diff incidence had reduced significantly due to the actions that had been implemented.

However, during our inspection we noted some issues relating to the cleaning of the premises, which we brought to the provider’s attention. These were addressed at the time and it was agreed that some new measures would be introduced to monitor cleanliness aspects of the service.

People felt involved in deciding the type of treatment that they had. They were happy with the service and felt that staff were caring and that they were "in safe hands." People said that they were treated with dignity and respect and that they were able to talk about their treatment. Some people did not speak or understand English and the provider had made provision for a team of interpreters to be available daily. People said that they felt safe and that they were well treated. Staff felt supported by the provider. They told us that their training was updated whenever new procedures were implemented. The provider had systems in place so that patients could comment on the service. The provider reviewed the service and changed the way it operated in response to people’s comments or its own reviews of the service.

The private patients’ centre was located within University College Hospital in London. There were 31 private rooms with en-suite facilities, a phlebotomy suite and a dedicated pharmacy. The unit appeared visibly clean and common areas were uncluttered.

A range of haematology and oncology procedures were provided seven days a week. Service level agreements were in place between the provider and the Trust for a range of services including the use of the intensive care unit, infection control processes, diagnostic imaging, pathology and the emergency response team.

The provider operates an hotel service and people told us that food could be ordered at any time and hot and cold drinks were available on demand. People told us that the food was not of good quality and needed to be reviewed. Senior staff told us that changes were being made and that this had been driven by complaints and suggestions. A new kitchen was part of the refurbishment.

People told us that staff were approachable, professional and always on hand. People could also access a range of support services including counselling, complementary therapies and support groups. We saw information was available to patients, carers and relatives throughout the unit. The information included printed material, books and papers. People we spoke with were happy with the service and felt that they were fully informed at every stage and felt in control of their care.

People we spoke with indicated that they were satisfied with the services provided at the hospital. They felt that they had been fully informed about their treatment and care needs, had been involved with their care and treatment at all stages, and were made aware of their progress.

People told us they were given appropriate information about their care and treatment. They told us that medical and nursing staff went through their care and treatment plan in detail. They were able to make informed decisions and choices before and during their stay in the Hospital.

Harley Street at University College Hospital (HS at UCH) is operated by HCA International Limited. The hospital specialises in adult haematology, haematopoietic stem cell transplant and oncology. There is one inpatient ward on the 15th floor of the host hospital with 31 individual patients' rooms. There is also a dedicated outpatient and day care facility on the 5th floor of the Cancer Centre providing chemotherapy, immunotherapy, supportive care and outpatient services. There is a radiotherapy facility located within the host hospital's radiotherapy department.

The hospital provides medical care and outpatients and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology by carrying out an announced inspection over three days.

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.

We rated this hospital as outstanding overall. We rated both core services, medicine and outpatient and diagnostic imaging services, as outstanding.

We found outstanding practice in relation to medicine:

• There were clearly defined and embedded systems, processes and standard operating procedures to keep people safe.
• Mortality and infection rates were routinely collected, monitored and reviewed. There was a comprehensive local audit plan.
• Senior leaders actively encouraged openness and transparency.
• There was a sufficient number of staff. Staff were well trained and knowledgeable. They assessed, monitored and managed the risks to people who use services.
• Patients’ care and treatment was planned and delivered in line with evidence-based guidance, standards, best practice and legislation.
• Staff were well motivated. They consistently considered peoples’ personal, cultural, social and religious needs and delivered kind and compassionate care. We observed that patients’ privacy and dignity was maintained at all times.
• The service had been independently reviewed and accredited as meeting internationally recognised quality standards.
• Staff worked together within teams and across services to plan and deliver care and treatment to patients. We observed excellent multidisciplinary team working (MDT) between the nursing, medical and support staff on the unit.

• The service had a highly visible, passionately engaged senior leadership team.

We also found an outstanding practice in relation to outpatient care:

• Without exception, patients told us they were treated with kindness, dignity, respect and compassion.

• Treatment was always consultant led and used evidence based best practice.

• There were reliable systems, processes and practices in place to protect patients from avoidable harm and abuse.

• There was a robust system for capturing and learning from incidents and complaints.

• Senior managers were approachable, visible and listened to staff and patients concerns and ideas. Overall there was a strong sense of teamwork.

• Staffing levels and skill mix met the patients’ needs.
• The radiotherapy department were complying with relevant policies, procedures and regulations to protect patients, staff and the public.

Professor Edward Baker

Deputy Chief Inspector of Hospitals