Our Quality Promise. Our quality outcomes are updated regularly throughout the year on our website

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3 Our Quality Promise HCA Hospitals is a leading private healthcare provider, specialising in acute and complex medical care. Through a world-class network of hospitals and clinics in London and Manchester we provide centres of excellence in areas such as cancer, cardiac, neurology, paediatrics and orthopaedics, often working closely with leading experts from NHS teaching centres. Our dedication to providing care at the highest level is reflected in our transparent approach to reporting our quality data and treatment outcomes. We believe that this evidence-based approach is the only true way for us to demonstrate our value to our patients. Our quality outcomes are updated regularly throughout the year on our website

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5 Zero hospital-acquired infections of C. Difficile in HCA hospitals INFECTION

6 Issue 4 April 2012 HCA Hospitals was the first private group to submit infection data to the Health Protection Agency; now all hospitals in the NHS and independent sector must submit their MRSA and C. Difficile rates. We are pleased that last year there were no reported hospital-acquired cases of C. Difficile in our hospitals. Hospital-acquired Clostridium Difficile Our rates of MRSA were nearly 5 x lower than the national average although in previous years we had zero cases. Our aim is to repeat this high standard. This data relates to only hospital-acquired infection (HAI). Visit /InfectionsAZ/HCAI/ for further information. Hospital-acquired MRSA bacteremia INFECTION

7 Zero infections following hysterectomy INFECTION

8 Issue 4 April 2012 The charts are based on data provided to the Health Protection Agency Surgical Site Infection Surveillance Service (SSISS) for key surgical procedures. In HCA hospitals in 2011 there were no hysterectomy infections for inpatient cases. Hysterectomy - surgical site infection rate (inpatient) Minimal infection rates (below the national average) were recorded for: Knee surgery - surgical site infection rate (inpatient) Hip arthroscopy - surgical site infection rate (inpatient) HCA hospitals 2011 National cumulative 2011 zero HCA hospitals HCA hospitals National cumulative National cumulative 2011 Cardiac bypass - surgical site infection rate (inpatient) HCA hospitals 2011 National cumulative 2011 Source: Health Protection Agency Surgical Site Infection Surveillance Service INFECTION

9 First-class cardiac survival rates compared with other UK and European centres CARDIAC SERVICES

10 Issue 4 April 2012 HCA is the largest provider of cardiac surgery in the independent sector in the UK with patient numbers similar to many NHS units. 1 Our three main cardiac units are at The Harley Street Clinic, London Bridge Hospital and The Wellington Hospital and we are still the only private hospital group to provide our cardiac data to the national Central Cardiac Audit Database (CCAD) which monitors the performance of cardiac centres throughout the NHS. HCA has an increasingly complex case mix of high risk patients, yet our very pleasing survival outcomes continue to improve year on year. When benchmarked against national and international survival rates, HCA cardiac surgery units demonstrate first-class, risk-adjusted results. The table on the right shows risk-adjusted cardiac surgery survival rates across all three HCA cardiac surgery units. 1. Analysis of three year, risk-adjusted data commissioned by HCA International Granted by the Clinical Cardiovascular Management Network in association with HCA s Quality, Safety and Performance Improvement HQ Risk-adjusted cardiac surgery rates across all three HCA Cardiac Surgery Units. 100% 96.7% 98.16% 98.62% 80% 60% 40% 20% / / /11 Our hospitals collect cardiac data in the following areas: 1 Adult Cardiac Surgery Adult Cardiac Interventions Congenital Heart Disease Transcatheter Aortic Valve Implantation (TAVI) Cardiac Rhythm Management Our Cardiac Units were granted Centre of Excellence status in 2009 for their services. 2 CARDIAC SERVICES

11 HCA is the largest private provider of critical care beds in the UK and transfers from NHS units are accepted CRITICAL CARE

12 Issue 4 April 2012 Around one in five of our beds is either critical care or high dependency. 3 This reflects the complex level of care provided across the HCA hospital group and all of our hospitals now have the highest level (Level 3) critical care beds to support any complex cases as necessary. Hospital The Harley Street Clinic The Lister Hospital ITU Adult 7 6 ITU Paediatric 13 0 HDU Paediatric 5 0 HDU Adult 5 0 Other supported care 2 Level 1 HCA is still the only private hospital group in the UK to submit its intensive care data for external audit alongside the majority of NHS hospitals. Although ICNARC (Intensive Care National Audit & Research Centre) do not publish these data we use it within our hospitals to benchmark our performance and ensure that we continue to the meet the very high standards that support the consistently high survival rates we have achieved in recent years. London Bridge Hospital The Portland Hospital The Princess Grace Hospital The Wellington Hospital NICU cots 4 SCBU cots 3. Clinical Governance & Quality Annual Report 2012 CRITICAL CARE

13 Live birth rates at The Lister Fertility Clinic are above the national average (in mothers under 40 years) FERTILITY

14 Issue 4 April 2012 The Lister Fertility Clinic is the largest purely private clinic in the UK, undertaking 2,500 IVF cycles per year. The Lister Fertility Clinic achieves above average live birth rates for under 40s. (Right) Live births per embryo transferred in the year ending 2nd quarter 2010 This shows the likelihood of each embryo transferred resulting in a live birth. It takes into account how many embryos were transferred in a cycle. It presents how many women had a live birth out of the total number of embryos transferred across all cycles. The success rates appear lower than for live birth per cycle started because clinics often transfer two embryos per cycle. (Below) Live births per treatment cycle started in the year ending 2nd quarter 2010 women under 35 years 25% 30% 35% 40% 45% 50% Age Under Live births per embryo transferred 241 out of out of out of out of 1047 Predicted chance of a patient having a live birth Predicted chance between: 26.4%-36.7% Most likely around: 31.3% Predicted chance between: 18.7%-27.9% Most likely around: 23.0% Predicted chance between: 13.5%-23.1% Most likely around: 17.8% Predicted chance between: 6.7%-12.2% Most likely around: 9.1% How does clinic compare to the national average? Above national average live birth rate of: 22.2% Above national average live birth rate of: 18.1% Above national average live birth rate of: 12.9% Consistent with national average live birth rate of: 7.2% 45.4% 32.5% Average for The Lister Fertility Clinic National average This shows how many women had a live birth out of all the women who began a treatment cycle. A treatment cycle starts when a woman begins taking fertility drugs to stimulate her egg production Over out of out of 102 Predicted chance between: 2.0%-8.9% Most likely around: 4.2% Predicted chance between: 0.1%-10.3% Most likely around: 1.0% Consistent with national average live birth rate of: 3.4% Consistent with national average live birth rate of: 1.5% Source: FERTILITY

15 Most cancer patients choose to have their surgery 8 days after their referral (average waiting time for the NHS is 62 days) CANCER CARE

16 Issue 4 April 2012 At HCA hospitals our average waiting time for cancer patients from referral to surgery is 21 days, with a median of 8 days. This includes patients who choose to delay their surgery due to personal circumstances and when this surgery is non-urgent. As a result the mode is 8 days from referral to 1st operation. In the NHS the average waiting time is 62 days. CANCER CARE

17 HCA cancer centres exceed European standards for breast cancer in four key areas CANCER CARE

18 Issue 4 April 2012 HCA is committed to ensuring our cancer services are of the highest possible quality and to monitoring the outcomes of the cancer care we provide. Our hospital facilities contribute to the UK cancer registries and national clinical audits, key parts of the National Cancer Data Repository hosted by the National Cancer Intelligence Network. External accreditation of services requires the collection of comprehensive clinical datasets, demonstrating adherence to guidelines such as those issued by the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services. The breast cancer specialists we work with agree our quality standards and HCA is proud to exceed European standards in four key areas: 100% of cases identified through imaging are correctly excised in the first surgical biopsy [standard 95%] 88.6% of patients with pt1 cancers undergo breast conserving surgery [standard 80%] In 96.6% of cases hormone receptor status is available to inform treatment choices [standard: 95%] In 99.6% of cases histopathology grading is available to inform discussions about treatment and survival [standard 95%] Our pre-operative diagnosis rate for breast cancer is 94.5% (NHS standard >90%) European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services. CANCER CARE

19 The only private hospital group with a quality-accredited Bone Marrow Transplantation Unit CANCER CARE

20 Issue 4 April 2012 HCA has the only private Bone Marrow Transplant Unit to achieve the international quality accreditation standard awarded by JACIE (the Joint Accreditation Committee). The unit is located within our specialist cancer centre, Harley Street at University College Hospital. The Joint Accreditation Committee-ISCT (International Society for Cellular Therapy) and EBMT (European Group for Blood and Marrow Transplantation) is a non-profit body established for the purposes of assessment and accreditation in the field of haematopoietic stem cell (HSC) transplantation. Accreditation is the means by which a centre can demonstrate that it is performing to a required level of practice in accordance with agreed standards of excellence. Essentially, it allows a centre to certify that it operates an effective quality management system. A quality management system is a mechanism to ensure that procedures are being carried out in line with agreed standards with full participation by all staff members. For further information please visit related-organizations/jacie JACIE in collaboration with FACT (Foundation for the Accreditation of Cellular Therapy) has established standards for the medical and laboratory processes for the provision of haemopoetic stem cell transplantation (bone marrow transplantation) and conducts inspections to measure compliance. CANCER CARE

21 The first and only private integrated inpatient rehabilitation unit in the UK to achieve the highest international quality accreditation* *CARF (Commission on Accreditation of Rehabilitation Facilities) REHABILITATION

22 Issue 4 April 2012 HCA has the largest private comprehensive integrated unit in the UK at The Wellington Hospital. The Acute Neurological Rehabilitation Unit provides inpatient interdisciplinary rehabilitation programmes to patients aged 18 and over with acquired brain injury, neurological conditions and complex medical disabilities. Accreditation is awarded on the basis of an externally audited survey of more than 1,000 standards. The auditors commended the unit on its competent, passionate team of consultants, nurses, therapists and other personnel who are dedicated to providing high quality services to all persons. In Spring 2011, the unit was awarded a three-year CARF 5 accreditation, the highest accreditation awarded by the Commission on Accreditation of Rehabilitation Facilities REHABILITATION

23 Nearly 3/4 of our severely injured and ill patients discharged from our Rehabilitation Unit achieved their goal of admission REHABILITATION

24 Issue 4 April 2012 At The Wellington Hospital Acute Neurological Rehabilitation Unit we believe it is important to measure the outcome following rehabilitation. We measure outcome in various ways: the Northwick Park Dependency Scale, the Modified Barthel Index and goal achievement and discharge destination. Goal achievement is based on whether the patient has achieved goals set on admission to the unit. These goals are set in conjunction with the rehabilitation team and the patient, together with their family. For a copy of The Acute Neurological Rehabilitation Unit 2011 Outcomes Report, please contact the Director of Rehabilitation at The Wellington Hospital: The Director of Rehabilitation The Wellington Hospital Circus Road St John s Wood London NW8 6PD REHABILITATION

25 Unplanned transfers from HCA to other hospitals are 15 x lower than the national average for elective admissions UNPLANNED TRANSFERS

26 Issue 4 April 2012 Unplanned transfers to another hospital are one of the key standard clinical performance indicators required by the Care Quality Commission. It is rare that a patient needs to be transferred to another hospital outside the HCA group. This is because we specialise in acute and complex medical conditions and our hospitals are fully equipped and staffed to deal with most medical emergencies. % of patient discharges 0% 0.5% 1% 1.5% 2% 0.06% HCA average % National average 2011 Source: Elective NHS HES (Hospital Episode Statistics) More than 3,100 doctors and specialists, many from London s teaching hospitals, treat patients privately at our HCA hospitals. We also have intensive care units at all of our hospitals and one in every five beds is allocated to critical care. UNPLANNED TRANSFERS

27 Unplanned returns to the operating theatre are more than 10 x lower than the national average for planned surgery at an HCA hospital UNPLANNED RETURNS

28 Issue 4 April 2011 Unplanned returns to the operating theatre within the same admission is one of the key standard clinical performance indicators required by the Care Quality Commission. There is a very low rate of unplanned returns to theatre within HCA hospitals, despite the fact that we undertake complex cardiac, cancer, paediatric and high dependency care. This is a reflection of the quality of our surgical teams and facilities such as intensive care units at all hospitals. % rate of unplanned returns to theatre 0% 1% 2% 3% 4% 5% 6% 0.42% 5.07% HCA average 2011 National average 2011 Source: Elective NHS HES (Hospital Episode Statistics) UNPLANNED RETURNS

29 HCA hospitals achieved 100% compliance with all CQC inspected outcomes of care in 2011 CARE QUALITY COMMISSION

30 Issue 4 April 2012 During 2011, several HCA hospitals were independently audited by the Care Quality Commission as part of a requirement to rigorously monitor outcomes of healthcare under the Health and Social Care Act Our hospitals achieved 100% compliance with all inspected standards. These achievements are included in the adjacent table which shows an average of CQC audited outcomes for the NHS and independent sectors as a whole. 6 Auditing is a continuous process, for the most up-to-date analysis please refer to the CQC website - (or the URL below). Independent audit monitoring outcomes of NHS hospitals and independent sector NHS Independent Sector Respecting and involving people Consent to care and treatment Care and welfare of people Meeting nutritional needs Safeguarding people from abuse Cleanliness and infection control Management of medicines Safety and suitability of premises Safety, availability and suitability of equipment Complaints 6. The State of Healthcare and Adult Social Care in England, An Overview of Key Themes in Care 2010/11. (Accessed April 2012) CARE QUALITY COMMISSION

31 Still the only private hospital group in the world to have all our hospitals independently quality accredited at the same time QUALITY ACCREDITATION

32 Issue 4 April 2012 Independent evaluation has shown that accreditation results in consistently higher standards of patient safety and quality. 7 The CHKS Accreditation Unit is a leading provider of healthcare intelligence and quality improvement services. The accreditation is a measure of the overall quality of a hospital and it has been shown that hospitals with CHKS accreditation provide a better quality of service. The accreditation programmes are based on a standards framework that covers healthcare governance, quality of services, risk management and patient experience of services. These standards exceed those required by regulation. 7. Impact of quality strategies on hospital outputs. Suñol R, Vallejo P, Thompson A, Lombarts MJ, Shaw CD, Klazinga N. Qual Saf Health Care Feb; 18 Suppl 1:i62-8 QUALITY ACCREDITATION

33 As part of our commitment to monitoring patient experience, HCA has also recently adopted Patient Recorded Outcome Measures (PROMs) PATIENT OUTCOMES

34 Issue 4 April 2012 Patient Recorded Outcome Measures (PROMS) 8 have been mandatory within the NHS since They are intended to provide a measure of the patient s health-related quality of life before and after surgery and assess outcomes such as pain, mobility and everyday living. Hip & Knee PROMS - % Health Gain January - June 2011 (n=81) 0% 20% 40% 60% 80% 100% During 2011, HCA elected to adopt PROMS for our patients undergoing orthopaedic procedures in our hospitals so we could benchmark our quality in relation to national averages within the NHS. The first six months data for hip patients showed that 100% of patients would recommend our hospitals for this treatment Patient Reported Outcomes Measures (PROMs). (last accessed April 2012). 9. CHKS Report January PATIENT OUTCOMES

35 95% of our consultants would recommend our hospitals to family and friends CONSULTANT SATISFACTION

36 Issue 4 April 2012 An independent consultant satisfaction survey undertaken in early 2010 asked consultants to rate the quality of HCA hospitals compared with other independent sector hospitals where they work. HCA has close to 3,100 consultants with practising privileges across our hospitals covering 50 different medical specialties. Most of our consultants also hold posts in London s top NHS teaching hospitals. CONSULTANT SATISFACTION

37 98.5% of patients would recommend our hospitals to family and friends (Based on feedback from 13,651 patients) PATIENT SATISFACTION

38 Issue 4 April 2012 Source: Continuous independent survey. We ask our patients to let us know what they think about all of our services from catering to clinical care and from admission to discharge. Our survey is independently managed and analysed. 10 HCA patient satisfaction survey - % good or better than good 0% 20% 40% 60% 80% 100% 99.2% Overall hospital cleanliness In 2011, 13,651 patients completed our survey: 99.1% 98.4% Overall quality of care Nursing care 10. HWA Consulting PATIENT SATISFACTION

39 HCA has been voted one of the world s most ethical companies for three years running AWARDS

40 Issue 4 April 2012 More quality awards and nominations than any other private hospital group 2011 Winners The Laing & Buisson Independent Healthcare Awards: The most comprehensive Outcomes Programme in the Independent Sector Best Medical Practice 2011 Finalists Independent Healthcare Awards: Innovation Best Use of Technology Excellence in Training Nursing Practice Public Private Partnership Excellence in Risk Management HCA named in Ethisphere's 2009, 2010, 2011 World's Most Ethical Companies Health Investor Awards Private Hospital Group of the Year, Finalist 2010 Winners Nursing Times and Health Service Journals Awards Top Employers for Managers in the Independent Sector The Nursing Midwifery Council Top Healthcare Employer for Nurses and Midwives in the Independent Sector 2010 Finalists Independent Healthcare Awards: Nursing Practice Risk Management Medical Practice Innovation Hotel Services The Queen s Awards for Enterprise International Trade 2009 AWARDS

41 That s why we are the hospitals of choice for London, used by over 400,000 people each year HOSPITALS OF CHOICE

42 To make an appointment with one of our 3,100 consultants please call us on +44 (0) or visit HCA CONNECT

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44 HCA CENTRAL LONDON LOCATIONS Information correct as at April Latest data available at HCA International Ltd.