The inspection focused on cancer services provided by The Princess Grace Hospital. During this inspection we visited the Breast Unit and the in-patient oncology ward. We spoke with three patients and four relatives who were available during our inspection. We also spoke with 14 staff of all disciplines, including support staff, nurses, medical staff, pharmacists and managers. People were positive about the care and treatment they had received and the survey results we saw supported this.

People received safe, effective care that was planned in a way that ensured their safety and welfare. Peoples' needs were assessed and reviewed by a multi-disciplinary team. Information was provided in a format that met people's needs to ensure they understood and were able to make decisions.

There were arrangements in place to deal with medical emergencies. Treatment protocols and procedures reflected national guidelines. Medicines were stored securely and were safely administered by appropriately trained staff.

Staff received appropriate professional development and support. There were systems in place to monitor the quality of service provided.

During this inspection we visited operating theatres, the endoscopy unit and the four floors on which the wards were located, all within the main building. We also visited the urgent care centre and the recently refurbished intensive therapy unit (ITU).

People told us that the staff at the hospital “really listened” to them and described their care and treatment as “fantastic”. They said they received sufficient information about their care and treatment and felt “fully involved and supported to understand what was happening to me”.

The hospital had systems for diagnosis, assessing people’s needs and delivering care and treatment. People we spoke with were very satisfied with their care and treatment.

When we undertook our inspection visit the hospital was undergoing a phased refurbishment. Feedback from patients and staff was that the environment was clean, bright and comfortable.

There were sufficient staff on duty, a nurse told us “we can get very busy, but if we need extra help we only have to ask”. Managers regularly assessed the service demands in each department to ensure that patient welfare was not put at risk because of insufficient staff.

We reviewed the hospital’s process for handling complaints and found that people were given good information about how to complain and their concerns were addressed within the service’s protocols.

The Princess Grace Hospital is operated by HCA International. The hospital has 126 beds. Facilities include eight operating theatres, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, urgent care, outpatients and diagnostic imaging. We inspected surgery, urgent care centre and outpatients and diagnostic imaging.

The CQC had received information raising concerns about the outpatients and diagnostic imaging service during the 12 months before this inspection, which led to the decision to plan this inspection. The concerns were around staffing issues, imaging request procedures and culture. The hospital has been inspected twice previously, and the most recent inspection took place in August 2016.

We inspected Urgent Care, Surgery and Outpatients and Diagnostic Imaging using our focussed inspection methodology. We carried an unannounced visit to the hospital on 6 and 7 February 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 Urgent Care, Surgery and Outpatients and Diagnostic Imaging as ‘good’ overall.

The ratings of the Urgent Care and Surgery core services improved from requires improvement to good since our last inspection.

The rating for Outpatients and Diagnostic Imaging core service was good, which was the same as the last inspection. Concerns raised with the CQC about this service were found to have been dealt with by the provider or could not be substantiated during inspection, except for a few individual staff members expressing worries about the culture in the hospital.

We found good practice in relation to urgent care, surgery and outpatients and diagnostic imaging:

• 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 controlled infection risk well. Staff kept equipment and the premises clean. They used control measures to prevent the spread of infection.

• The service managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance. The service monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn and improve.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• People could access the service when they needed it and there were no waiting lists. Waiting times for consultations, treatments and diagnostic services were minimal.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

• Leaders were committed to improving services and had implemented positive changes since the previous inspection.

• There was a realistic strategy for achieving the priorities and developing good quality and sustainable care. The hospital had effective structures, systems and processes in place to support the delivery of its strategy including a sound governance system.

• Patients had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

We found areas of outstanding practice in outpatient care :

• A patient navigator role was implemented in the breast institute, the role is designed to ensure the patient pathway is fully completed and continued after the patient leaves the department. The navigator calls the patient at home to organise any further care if needed and this has ensured that patients are followed up appropriately and that no patient is missed.

We found areas of practice that require improvement in urgent care:

• The electronic systems did not always work well together in the urgent care centre to allow staff access to all necessary information at all times.

• Patients’ privacy was not always ensured.

We found areas of practice that require improvement in surgery:

• Assessments for risk of venous thromboembolism were not always completed correctly.

• Possible risks of cross contamination in theatres were not always kept at a minimum.

We found areas of practice that require improvement in outpatient care:

• Out of the 24 staff we spoke with the majority of staff spoke positively regarding the working culture, however four members of staff told us they felt there was a culture of bullying.

Amanda Stanford

Deputy Chief Inspector of Hospitals (London)