We served a warning notice on Welbeck Healthcare Limited on 13 November 2024 for failing to meet the regulations related to assessing the risk of, and preventing, detecting and controlling the spread of infections, including those that are health care associated at The London Welbeck Hospital. Welbeck Healthcare Limited failed to assess the risks to the health and safety of service users of receiving the care or treatment at The London Welbeck Hospital. Welbeck Healthcare Limited failed to effectively manage the proper and safe management of medicines at The London Welbeck Hospital.
We served a warning notice on Welbeck Healthcare Limited on 13 November 2024 for failing to meet the regulations related to establishing and operating effective systems to assess, monitor, and improve the quality and safety of the service provided to service users at The London Welbeck Hospital. This included a failure to mitigate the risks relating to the health, safety and welfare of service users and improve outcomes for service users at The London Welbeck Hospital.
We rated it as good because:
However:
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
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:
Effective:
Caring:
Responsive:
Well-led:
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:
In addition the hospital should:
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.
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.