We carried out a review of the data available to us about King Edward VII's Hospital on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about King Edward VII's Hospital, you can give feedback on this service.
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 and learned lessons from them.
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 planned care to meet the needs of local people, 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 and the community to plan and manage services and all staff were committed to improving services continually.
However:
Staff had a variable understanding of following safe procedures for children accompanying a patient who is attending the outpatient department.
The service did not have relevant information promoting healthy lifestyles and support inpatient areas. There were no information leaflets or material available within the clinics, nor there was any information within the outpatient department displayed directing patients where to access information related to a healthy lifestyle.
This was a focused follow up inspection to investigate whether concerns from our previous inspection on 9 April 2019 had been resolved. We did not rate this service at this inspection. The previous overall rating of good remains.
At this inspection we found:
King Edward VII’s Hospital is operated by King Edward VII’s Hospital Sister Agnes. The hospital has 50 beds. Facilities include three operating theatres, a four-bed level three critical care unit, and X-ray, outpatient and diagnostic facilities.
The hospital provides surgery, medical care, critical care, outpatient services and diagnostic imaging. We inspected all core services.
We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection between 11 and 13 December 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.
The main service provided by this hospital was Surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service level report.
Services we rate
Our rating of this hospital improved. We rated it as Good overall.
We found mainly good practice in all the key questions for all the five services we inspected.
The hospital had made significant improvements in the services of surgery and outpatients; both of these services had previously been rated as requires improvement.
We found the following areas of good practice across all services:
However, we also found the following issues that the service provider needs to improve in surgery, critical care, outpatients and diagnostic imaging:
Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements. We also issued the provider with a requirement notice. Details are at the end of the report.
King Edward VII's Hospital is an independent hospital located in central London, initially opened as a hospital for officers in the armed forces, it is now a hospital open for the whole public. The hospital registered as a charity in 1962 and has focussed most of it charitable efforts in providing subsidised private healthcare for veterans, serving personnel and their families.
The hospital employed 233 consultants under practising privileges and 67 qualified nursing staff. It has 55 beds including four level three critical care beds in their own department. The remaining beds were split over three wards with one ward being for day cases and the rest being mixed with surgery or medical patients. The hospital had two laminar flow theatres and one 4K integrated theatre for scope work. Other facilities included a therapies department with hydrotherapy pool, a radiology department with CT, MRI, ultrasound, general x-ray, fluoroscopy and mobile imaging and a breast care unit with separate consulting rooms, mammography and ultrasound. The hospital had a total of 11 consulting rooms in all areas for outpatient appointments.
The hospital provides surgery, medical care, critical care and outpatients and diagnostic imaging. We inspected all of those core services. We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on the 31st January 2017 to the 2nd February 2017.
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.
The main service provided by this hospital was surgery . Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the core service.
Services we rate
We rated this hospital as requires improvement overall. Below is a summary of reasons broken down by core service.
We found that within recovery unit the medicines cabinet was regularly kept unlocked, the risk of ‘poor medicines management, theft, fraud or harm especially in relation to management of controlled drugs’ was on the departmental risk register.
The difficult airways trolley in theatres was shared with the critical care unit (CCU) and we were informed that if the CCU required it, it would be taken down in the lift. When not in use, dust covers were placed on equipment.
We had concerns that senior leaders did not have an adequate management strategy on incident investigations. We observed that there were 671 incidents not marked as complete with some awaiting investigation and some awaiting completion by senior staff.
There was a lack of oversight of consultant’s practising privileges, with 68 consultants not having the expected full standard of documentation in their files at the time of inspection.
Four out of 11 records we reviewed contained an incorrectly completed VTE risk assessment.
However:
The environment was clean and fit for purpose and we observed staff complying with infection control and prevention guidelines.
Staff were supported by managers, mentors and practice development nurses to deliver effective care and treatment, through meaningful and timely supervision and appraisal.
Patients told us they felt supported and informed about their treatment. Patients and families we spoke with said staff explained their care and treatment to them and visited them regularly.
There was a dementia champion that had arranged talks from dementia charities for the staff. A dementia integrated care pathway had also been created.
Leadership was visible and supportive at all levels in the surgical services and staff told us they felt valued by the senior leadership team. They were able to contribute their views and felt new ideas were welcomed and listened to.
Most staff were aware of their responsibilities with regards to duty of candour, although some senior members of staff were not entirely clear that there had to be both a verbal and written apology.
Advice regarding VTE prophylaxis as recommended by NICE was not always followed. However, the hospital had identified this in an audit in December 2016 and had taken some actions to address this issue by the time of inspection.
Consultants did not always adhere to the “bare below the elbows” requirement for the prevention and control of infection. The hospital explained that a number of consultants visited patients to review them and would remove any inappropriate items prior to an actual examination taking place.
Safeguarding training was provided by an external organisation and senior leaders said the company could not confirm in writing that training was to level 2 or 3.
Entries in some patients' care records did not comply with professional standards for record keeping in that there were issues with legibility and the identification of staff entering information into the care record.
Although numbers requiring end of life care were small, effective ceilings of care were not always established and patients were not always referred for palliative care early enough in the care pathway. Staff expressed the need for further training and supervision around how to support and care for dying patients. The hospital had identified this as an area for further staff training in a needs analysis for the next financial year .
The requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were not always well understood and applied. DNACPR forms were not always filled out in enough detail.
Discussions with patients and families were not evident in all of the notes that we examined, with often little detail of any difficult conversations.
An audit of three records of patients living with dementia in December 2016 found that one did not have a full and proper assessment or application of care pathway, and two patients were not given any information or advice at assessment or admission. We found that the care plan was not fully explained or filled out in the two records of patients living with dementia that we looked at. There were no patient passports or ‘this is me’ care plans evident.
There was no link nurse for patients with learning disabilities. There was no specific training or policy on caring for these patients.
There was no clear, separate strategy in place to develop and improve end of life care services within the hospital.
The service did not participate in any national audits related to medical care or end of life care as the numbers of patients who would be eligible to be included was very small.
The risk register was general with no specific risks for each ward environment or type of patient specified, and no clear mitigation in some cases.
Medicines were managed and stored appropriately. Staff told us the pharmacy services were easily available and pharmacists visited the wards daily.
Nursing staff demonstrated an awareness of safeguarding procedures and how to recognise if someone was at risk or had been exposed to abuse. They knew how to escalate concerns.
There were sufficient nursing and medical staff to ensure patient safety was maintained at all times.
Hospital policies were current and referenced according to national guidelines and recommendations.
Nursing and medical staff completed a variety of local audits to monitor compliance and improvement.
Pain was assessed and well managed on the wards, with appropriate actions taken in response to pain triggers.
In the Patient-Led Assessments of the Care Environment (PLACE) assessment in 2016, the hospital scored 97.3% overall for food and hydration, against a national average of 88.2%.
Staff received annual appraisals on their performance, which identified further training needs and set achievable goals. Staff were satisfied with the quality of the appraisal process. The hospital was supporting nurses with the revalidation process.
Patients were cared for in a caring and compassionate manner by staff throughout their stay.
Patients were able to access care and treatment in a timely way. There were clear admission processes and no problems with flow or discharge throughout the hospital.
The number of complaints in line with national average. When complaints were received they were used to identify learning and improve patient experience.
Most nursing and medical staff thought that their line managers were supportive and approachable. They felt able to raise concerns.
Feedback was sought from staff and the public to develop and improve the service.
Staff were encouraged to report incidents and knew the process to follow if an incident occurred.
Staff understood their roles and responsibilities with regards to safeguarding and could tell us how they would escalate any concerns.
The environment was fit for purpose and we observed staff complying with infection control and prevention guidelines.
Medications and controlled drugs were stored safely and appropriately.
Mandatory training compliance was generally good.
Policies and procedures were readily available to staff and referenced best practice guidance.
There was appropriate assessment of pain relief and nutrition for patients.
There were minimal non-clinical transfers out of the CCU and only a few patients were discharged out of hours.
ICNARC data demonstrated that patient outcomes including mortality and readmission rates, were as expected.
There was appropriate seven day services provided by the ITU fellows and physiotherapists, as well as seven day access to investigations and scans.
Staff treated patients with respect and we saw staff interacting in a friendly and professional way with patients.
The unit provided compassionate care and patients were treated with dignity and respect.
Friends and family test results were good with 99% of people saying they would recommend the service to others.
The service provided a flexible number of level two and level three beds, which could be flexed according to patient need.
There were no elective operations cancelled due to unavailability of CCU beds between January 2015 and January 2016.
Whilst a number of services were not directly available within the hospital, such as psychology, the hospital could make referrals on an individual need basis.
We saw good leadership within the unit and this was reflected in the conversations we had with staff. There was a positive culture across the service and staff spoke positively about the leadership team.
There was evidence of staff and public engagement and changes being made as a result of feedback.
However;
The vision was to increase the number of patients seen in critical care, however there was no formal strategy in place to say how this would be achieved.
We had concerns, senior leaders did not have oversight on incident investigations. We saw no evidence that action plans had been developed and shared with staff.
The risk register did not match the risks we found and identified within the service. The risk identified by the senior leaders as their biggest concern was not on the service’s risk register.
There was a general lack of audit and quality improvement work looking at adherence to national guidance and best practice.
There was no dementia training and the dementia pathway had not been developed at the time of the inspection. Staff had a limited knowledge of how to treat dementia patients.
Complaints were investigated at a more senior level within the hospital and critical care staff had no oversight of these.
The provision of occupational therapists, dieticians and speech and language therapists was not sufficient to meet recommended standards.
We had concerns that critical care nurses were not getting sufficient access to critical care patients to keep their skills up to date.
Whilst staff demonstrated a good knowledge and understanding of the Mental Capacity Act we found no capacity assessments in any of the patient records that we reviewed.
There was a lack of audit activity within the service.
We were not assured learning from incidents was disseminated amongst staff.
The isolation room did not fulfil all requirements for an isolation facility.
We were not assured there was appropriate consultant cover due to consultants working across two different hospitals at the same time.
The outpatient department did not maintain accurate, complete and contemporaneous patient records.
Equipment list in diagnostic imaging was incomplete.
Referral forms in diagnostic imaging were not accurate.
Access to information was limited because the hospital did not keep any medical records of outpatients.
There were no signatory lists that staff had read local rules and IRMER guidance.
We did not see any special arrangements for patients with learning disabilities or living with dementia.
However,
Staff were encouraged to report incidents and knew the process to follow if an incident occurred.
Staff understood their roles and responsibilities with regards to safeguarding and could tell us how they would escalate any concerns.
The environment was fit for purpose and we observed staff complying with infection control and prevention guidelines.
Diagnostic imaging services were delivered in line with current evidence-based standards and legislation.
Privacy and dignity of patients was consistently maintained and patient feedback results showed high satisfaction rates.
Services were organised to provide same day diagnostics to patients whenever possible.
The service actively sought patient feedback.
Following this inspection we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices; the details are at the end of this report
We looked at satisfaction survey results for the period of October ' December 2013 to which 325 people responded. Overall the respondents expressed high levels of satisfaction about the care they had received.
Care and treatment was planned and delivered in a way that was intended to ensure potential risks to people's health were considered and people's needs were assessed. We observed that care records for people using the service were securely stored across the hospital and could be located promptly.
There were systems in place to reduce the risk and spread of infection. Overall the ward and theatre areas we visited in the service appeared clean and well maintained on the day of the inspection.
Medical equipment committee meetings were held quarterly. Issues with equipment were identified within this forum along with actions to follow up on.
The provider had effective recruitment and selection processes in place. We saw vacancies were currently being advertised on the website.
Over 96% of people who responded in the hospital's recent survey rated their overall care as ``excellent' or ``very good'.
There was a consent policy and procedure in place and the hospital were found to be following their own guidance in obtaining consent from people. People we spoke with confirmed they were asked for their permission before care and treatment was carried out.
Staffing levels were planned and adjusted to accommodate the specific needs of people using the hospital.
Staff we spoke with knew what procedures to follow if they suspected abuse and people we spoke with told us they felt safe at the hospital. The hospital only treated adults.
It was evident that people knew how to make a complaint. People we spoke with knew how to raise complaints.
Patients described staff as treating them as individuals, with personalised care. We were told by the patients that information about their treatment and care was regularly supplied to them by staff and that they were kept informed regarding their progress and changes in their treatment plans.
Patients told us that staff responded quickly to their call bells and that the hospital environment was comfortable and clean.