HCA Healthcare UK The Portland Hospital

Updated 26 May 2022

The Portland Hospital for Women and Children is operated by HCA International Ltd. The hospital service opened in 1983 and has been part of HCA healthcare for the past 15 years. The hospital has 82 in-patient beds, including nine bedded paediatric intensive care unit (PICU), five bedded labour ward and four theatres. It is situated in central London, on Great Portland Street, in the West End, with easy access to public transport and main driving routes. Services are provided from four buildings: 205-209 Great Portland Street, 212 Great Portland Street, 234 Great Portland Street and 215 Great Portland Street. There is also a small paediatric outpatient service located within The Shard. The Portland Hospital for Women and Children provides surgery, maternity care, services for children and young people, termination of pregnancy services and outpatients and diagnostic imaging.

The hospital provides service to both UK and international patients with medical insurance, those who are sponsored by their respective embassies, those who self-fund and a very limited number of patients referred through NHS contracts.

The hospital is registered to provide the following

regulated activities:

· Diagnostic and screening procedures

· Family planning

· Maternity and midwifery services

· Termination of pregnancies (over 16 years old)

· Surgical procedures

· Treatment of disease, disorder, or injury

The hospital has been inspected five times previously, with the most recent inspection taking place in November 2016. The 2016 inspection was a comprehensive inspection of surgery, maternity care, services for children and young people, termination of pregnancy services and outpatients and diagnostic imaging. There were no outstanding enforcement actions from previous inspections, but a number of areas were identified for improvement, even though a regulation had not been breached.

On this occasion, we inspected maternity care and services for children and young people, using our focused inspection methodology as whistleblowing concerns were raised with us. The hospital's current registered manager has been in post since 2019.

Updated 26 May 2022

Our rating of this location stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

However:

• We found that domestic abuse question checks on admission were not documented well.
• Equipment checks for high dependency room on the labour ward were not done regularly.
• On the day of inspection, some medicines including emergency medicines were stored incorrectly and did not match the daily stock list or were kept in an unlocked fridge. The service rectified this immediately on the same day.
• There was variable knowledge of incidents that occurred across the service, with not all staff able to articulate any learning from these.
• At the time of inspection, compliance was lower than expected for some nursing staff competencies in the paediatric intensive care unit (PICU), particularly intravenous infusion training (76%) and drugs by direct injection (83%). Senior staff told us this was due to higher levels of sickness absence due to COVID-19. The hospital ensured fully competent staff were on shift at all times. Figures provided for May 2022 showed that compliance levels for these two competencies had improved to 100% and 97%, respectively.
• At the time of inspection, the inspection team identified concerns about the staffing levels of the on-site security team. Senior staff assured us that they mitigated security risks through a range of measures and that additional support could be offered by the front of house and portering team, but they would review security staffing levels and ensure these were appropriate.
• Staff we spoke to whilst on inspection told us equipment shortages and delays in fixing or collecting broken equipment occurred. This meant there was some clutter in areas of the hospital.
• A mix of paper-based and electronic notes were used across the hospital. Locum RMOs and agency nursing staff could not access the electronic notes, which could cause some fragmentation in regard to record keeping. Some staff on inspection told us issues with the Wi-Fi sometimes meant there were issues with accessing the electronic system at times.
• At the time of inspection, only the imaging department and some ward areas were adapted to meet the needs of children. However, the anaesthetic and recovery areas in the imaging department were not child friendly, along with the day case ward and theatre environment. Senior staff told us this was due to the planned refurbishment of the hospital and these areas would be redesigned with children in mind, but this was not the case at the time of our inspection. In addition, there were not many facilities available for older children, especially in the day case ward, where older TVs did not allow them to use streaming services.
• Although end of life care was rare in children and young people treated at the hospital, there was no formal policy or procedure in place regarding provision for children at the end of life at the time of our inspection. Senior staff told us they were planning to introduce a paediatric mortality framework later in the year.
• Not all staff were aware of diversity and inclusion initiatives taking place across the service.
• Results from the previous staff survey had shown a decline on most measures. Staff told us feedback from these surveys had led to some improvements in staff facilities, although many of the areas were not large enough to accommodate all staff taking breaks.

Updated 26 May 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for children and young people and keep them safe. Staff understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well.
• Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives and supported them to make decisions about their care. Key services were available seven days a week.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service took account of children and young people’s individual needs and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children and young people to plan and manage services and all staff were committed to improving services continually.

However:

• At the time of inspection, compliance was lower than expected for some nursing staff competencies in the paediatric intensive care unit (PICU), particularly intravenous infusion training (76%) and drugs by direct injection (83%). Senior staff told us this was due to higher levels of sickness absence due to COVID-19. The hospital ensured fully competent staff were on shift at all times. Figures provided for May 2022 showed that compliance levels for these two competencies had improved to 100% and 97%, respectively.
• At the time of inspection, the inspection team identified concerns about the staffing levels of the on-site security team. Senior staff assured us that they mitigated security risks through a range of measures and that additional support could be offered by the front of house and portering team, but they would review security staffing levels and ensure these were appropriate.
• Staff we spoke to whilst on inspection told us equipment shortages and delays in fixing or collecting broken equipment occurred. This meant there was some clutter in areas of the hospital.
• A mix of paper-based and electronic notes were used across the hospital. Locum RMOs and agency nursing staff could not access the electronic notes, which could cause some fragmentation in regard to record keeping. Some staff on inspection told us issues with the Wi-Fi sometimes meant there were issues with accessing the electronic system at times.
• There was variable knowledge of incidents that occurred across the service, with not all staff able to articulate what incidents had occurred or any learning from these.
• At the time of inspection, only the imaging department and some ward areas were adapted to meet the needs of children. However, the anaesthetic and recovery areas in the imaging department were not child friendly, along with the day case ward and theatre environment. Senior staff told us the planned refurbishment for these areas would include a more child friendly design, but this was not the case at the time of our inspection. In addition, there were not many facilities available for older children, especially in the day case ward, where older TVs did not allow them to use streaming services.
• Although end of life care was rare in children and young people treated at the hospital, there was no formal policy or procedure in place regarding provision for children at the end of life at the time of our inspection. Senior staff told us they were planning to introduce a paediatric mortality framework later in the year.
• Not all staff were aware of diversity and inclusion initiatives taking place across the service.
• Results from the previous staff survey had shown a decline on most measures. Staff told us feedback from these surveys had led to some improvements in staff facilities, although many of the areas were not large enough to accommodate all staff taking breaks.

Updated 26 May 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for women and keep them safe. Staff had training in key skills, understood how to protect women from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to women, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well.
• Staff provided good care and treatment, gave women enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of women, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated women with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to women, families and carers.
• The service planned care to meet the needs of women, took account of women’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of women receiving care. Staff were clear about their roles and accountabilities. The service engaged well with women and the community to plan and manage services and all staff were committed to improving services continually.

However:

• We found that domestic abuse question checks on admission were not documented well.
• Equipment checks for high dependency room on the labour ward were not done regularly.
• On the day of inspection, some medicines including emergency medicines were stored incorrectly and did not match the daily stock list or were kept in an unlocked fridge. The service rectified this immediately on the same day.
• There was variable knowledge of incidents that occurred across the service, with not all staff able to articulate any learning from these.

Updated 19 June 2017

We rated this service as outstanding because:

• Staff were encouraged to develop within their roles and seek out opportunities for progression. We were provided of numerous examples of support staff being provided support, training and funding to progress to a clinical role.

• There was an active culture of innovation and improvement. We were provided examples of staff members and also whole department efforts that changed working practice across the hospital and other organisations.  

• There was cohesive multidisciplinary team (MDT) working. There was evidence of collaborative working and positive relationships with other departments within the hospital.

• Outpatient and diagnostic services were delivered by caring, committed and compassionate staff. We observed staff interaction with patients and found them to be polite, friendly and helpful. Patient satisfaction results were consistently positive in all areas of the outpatients and imaging departments, with 99% of patients in the most recent survey saying they would recommend the hospital to friends and family based on the care and support they received.

• On inspection we observed numerous examples of the service proactively responding to patient needs and wishes.  

• Complaints were handled in a professional and timely manner within the hospital timeframe.

• We observed that there were minimal waiting times for outpatient clinics and diagnostic imaging. Patients we spoke with confirmed this.

• All departments we visited had clear vision and strategy for future goals and expansion projects. Staff we spoke with were aware of this.

• We saw evidence of positive public and staff engagement. Staff felt highly supported by their managers. All departments we visited demonstrated patient experience was key factor for their service.

However:

• We found that changes in working practices arising from incident learning were not embedded into written policies or procedures in a timely manner.

• Mandatory training rates for staff in the outpatient department did not meet the hospital target of 90% compliance.

Updated 19 June 2017

We rated this service as good because:

• Staff we spoke with felt confident and encouraged to report incidents and we saw evidence of learning from incidents. There was a clear complaints procedure in place and we saw evidence of learning from complaints and incidents. Effective governance structures supported quality improvement through this learning.

• Staff followed infection prevention control(IPC) guidance. We observed staff wash their hands between seeing patients and use personal protective equipment (PPE) effectively. The environment and equipment were clean and ready for use.

• The rate of surgical site infection was below that of other similar hospitals that we hold this type of data for. Compliance with the Safer Steps to Surgery, including the World Health Organisation (WHO) checklist, was closely monitored. Monthly audits showed 100% compliance since April 2016. Unplanned readmission and transfer rates were also lower than other comparable services.

• Patient care was delivered in line with current standards of best practice and guidelines. Regular audits took place that monitored the quality of care and drove improvement across the service.

• There was appropriate medical cover for the surgical wards, 24 hours a day, seven days a week. There was access to relevant consultants where required. Appropriate escalation occurred in the case of deteriorating patients.

• We observed staff treating patients with dignity, kindness and respect. Patient feedback surveys were positive about the care that they received. Post-operative pain was effectively managed, with high patient satisfaction in this area. We saw staff responding promptly to call bells.

• Flexible services were provided to accommodate patients’ individual needs and patients were able to access services in a way and time that suited them. The hospital had a dedicated international patient centre staffed by liaison officers, who assisted and met the needs of the large demographic of international patients.

• The senior leadership team was visible and approachable. Staff felt supported, listened to and valued. They were encouraged to voice concerns or new ideas and to attend additional training suitable to their post.

However:

• Electronic patient records were often incomplete. The lack of an integrated records system meant that regularly used agency staff did not have access to electronic patient records.

• Lack of storage space in theatres was identified as an issue. This meant that equipment was not ideally stored, in corridors and in large cupboards in corridors.

• Compliance rates of pre-assessment before surgery were low, ranging between 50% and 78% in the two months prior to out inspection. To improve this, the hospital recruited a dedicated pre-assessment nurse, scheduled to start in January 2017.

• The last staff survey showed a decline in staff satisfaction and staff commitment. The rate of ward and theatre staff turnover was above the average of other similar hospitals (July 2015 to June 2016).

• There was a resident on-call theatre team available out-of-hours for primarily obstetric patients. The same team covered gynaecology emergencies. The absence of a second theatre team on-call was on the hospital’s risk register and most surgical patients were day cases with low pre-operative risk profiles.

Updated 19 June 2017

We do not currently have a legal duty to rate this service but we highlight good practice and issues that service providers need to improve and take regulatory action as necessary. We found that the TOP service was providing safe, effective, caring, responsive and well-led care to women. This was because:

• Medicines were managed and stored appropriately. Pain relief and antibiotic medications were given to women post-procedure to manage their symptoms.

• Documentation was concise and clear. We saw evidence that legislation relating to the termination of pregnancy (TOP) was followed in all the cases we examined.

• Staff we spoke with were knowledgeable about safeguarding and knew how to recognise if a woman was at risk or had been exposed to abuse, and how to escalate concerns. They were up-to-date with appropriate levels of training.

• Hospital policies were current and appropriately referenced relevant national guidance. The TOPS policy had recently been reviewed and updated.

• Consultants gave women verbal and written information on what to expect during and following a TOP procedure. Nurses on the ward also provided information about what women may experience. Women were able to contact the ward 24/7 after discharge for support or advice. Counselling was available to all women before, during and after they had received treatment, as required. This was from an external provider.

• Nurses shared responsibility for completing audits to monitor compliance and improvement. Records of all TOP procedures were maintained on a spreadsheet to monitor that all Department of Health (DH) Required Standard Operating Procedures (RSOPs) were met.

• Consent and capacity were considered by nurses when a women was admitted for a TOP procedure. All staff demonstrated a working knowledge of the Mental Capacity Act (MCA) and its implications.

• All women referred to the service received timely treatment, often beginning the same day they had their initial appointment.

• Women were given enough information to make an informed choice about the sensitive disposal of pregnancy remains and time to consider this. Appropriate storage arrangements were in place.

However:

• Not all women having surgical terminations had a pre-operative assessment. The hospital had recruited a nurse into a post to perform these, but this was not yet in place.

• The hospital could not be assured that consultants were all returning the HSA4 forms to the Department of Health within 14 days because consultants did not always copy the form to the ward.