Healthcare in London: First Edition by Senate Publishing Limited

HEALTHCARE IN LONDON Medical excellence in the UK’s capital city

Published by Senate Publishing www.senatepublishing.co.uk +44 (0) 20 7723 9825 info@senatepublishing.co.uk

Chairman Lord David Evans Chief executive Caroline Minshell Managing editor Barry Davies Art editor J-P Stanway

Print management TU ink, London www.tuink.co.uk

Printed by Ganboa Centro Gráfico, Spain

Cover image credits: Brian A Jackson / iStock, HCA Healthcare UK

HEALTHCARE IN LONDON Medical excellence in the UK’s capital city

INTRODUCTION

LONDON: A WORLD LEADER IN HEALTHCARE PROVISION AND RESEARCH | Sir Robert Naylor

VISITING LONDON FOR HEALTHCARE

A PROUD HISTORY OF MEDICAL INNOVATION

LONDON: CENTRE OF MEDICAL EXCELLENCE

YOUR MEDICAL CARE IN LONDON

ONCOLOGY: FOCUSING TREATMENT ON THE INDIVIDUAL | Professor Justin Stebbing

UROLOGICAL INNOVATIONS | Mr Jonathan W A Ramsay

COLORECTAL SURGERY: CUTTING-EDGE CARE | Mr John T Jenkins

MATERNITY AND IVF

EXPORTING EXPERTISE

PARTNERS IN HEALTHCARE | Dr Ajay Rajan Gupta

YOUR STAY IN LONDON

PLANNING YOUR TRIP

EXPLORING THE CITY

THE HEIGHT OF HOSPITALITY

PARADISE FOR SHOPPERS

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Sir Robert Naylor INTRODUCTION

LONDON: A WORLD LEADER IN HEALTHCARE PROVISION AND RESEARCH It was a great privilege to be invited to write this introductory article to Healthcare in London in recognition of our fantastic hospitals and wonderfully dedicated staff. London is acknowledged by many as being one of the world’s vibrant cultural centres, as well as having some of the greatest hospitals aligned to some of the leading universities in the world. The assertion that “the NHS is the closest thing the English people have to a religion” goes some way towards explaining how much we value what we have created and

the outcry when anyone suggests any alternative to our comprehensive system free at the point of access. The concept of “free” healthcare has been drummed into us from infancy, so much so that many of us now take it for granted. I’m proud to be biased. My life has been dedicated to the National Health Service and for much of the last two decades I have had the privilege of leading one of the world’s top academic health science centres – University College London Hospitals. We existed in a world of

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collaboration with a diverse collection of world-class private hospitals, sharing outstanding clinical and support staff. The Organisation for Economic Co-operation and Development (OECD) and the influential Commonwealth Fund have judged the NHS as being the best, safest and most affordable healthcare system in the world. It is the second time in a row that the study, which is undertaken every three years, has rated us top, just ahead of Australia and the Netherlands.

This extraordinary affection for the NHS, and its top international ranking, is even more remarkable because the UK spends only 9.9% of GDP on healthcare, in comparison to the US, which spends a whopping 16.6% – over 5% more than France, the next highest – without getting better outcomes overall. Topquality healthcare and financial prudence go hand in hand, a relationship always at the forefront of political debate.

The UK's renowned National Health Service (NHS) collaborates with a wide range of world-leading private hospitals (PHOTO: STURTI / ISTOCK)

Jeremy Hunt, the UK’s Health Secretary, lauded our achievements, saying, “These

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Harley Street is the epicentre of private practice, housing a selection of internationally renowned hospitals

outstanding results are a testament to the dedication of NHS staff who, despite pressure on the front line are delivering safer, more compassionate care than ever. The NHS has again showed why it is the single thing that makes us most proud to be British.” London’s unique place within the UK and internationally was fully demonstrated at the 2012 London Olympic Games, with the NHS being given a starring role in the opening ceremony. With an increasingly diverse and comparatively young population, the needs of London’s citizens are different and, in many ways, more demanding than for others. It is this balance of heritage, diversity and thirst for innovation that makes London arguably the most innovative city in the world. The highest benchmark for academic standards is the QS World University Rankings, which in 2016-17 rated four English universities in the top 10 – Imperial College London and University College London included. This outstanding achievement, for a country that houses fewer than 1% of

the world’s population, is even more remarkable. Biomedicine teaching and research has become such a dominant subject in university curricula that the symbiotic relationship with healthcare and hospitals is a major influence on reputation. It is here that London’s three outstanding Academic Medical Centres excel, bringing firstin-man research discoveries, through translation, direct to the patient bedside, now and for future generations. Nowhere is this more evident than in the recently opened $1 billion Crick Institute. It is a new type of biomedical research institute, a collaboration between government, leading London research universities and prominent charities. It will soon become one of the world's leading medical research institutes, at the heart of which will be a commitment to the highest-quality science. Uncompromising commitment to excellence, emphasis on multidisciplinary research, focus on emerging talent and novel ways of partnership working will set new standards in world-class research. It will bring in the brightest and best young talent and then export them back to continue their research across the UK.

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In terms of education and training, competition for places in London’s medical schools is intense, not only for trainee doctors, but for the full range of health professionals. Those training in London will go on to pursue careers not only throughout the UK, but across the world, benefiting from the thorough and internationally recognised grounding for which our medical schools and higher education institutions are highly recognised. London has long been one of the international centres for health tourism. Harley Street is the epicentre of private practice, housing a selection of internationally renowned hospitals. Many other equally excellent private hospitals exist in London and are explored elsewhere in this publication. The outstanding medical staff in these hospitals are largely drawn from the major teaching hospitals located nearby. But history is being overtaken by events. The development of new market entrants is bound to represent a challenge for existing private hospitals, such as the outstanding Wellington Hospital, a flagship for HCA’s historical dominance on the London scene. The world-class Cleveland Clinic, for decades the top cardiac centre in the world, is currently developing a major new hospital in central London – a potential shock wave for existing centres. Equally, the Emirates based VPS Healthcare is opening a new

150-bed cancer hospital in west London, whilst Spire Healthcare and others have similar ambitions. All of this will consolidate and strengthen London’s leading international position. There is no doubt that this increased competition, in an already crowded marketplace, will sharpen the emphasis on both clinical quality and standards of hospitality. This can only be of benefit of overseas patients and strengthen yet again the attractiveness of London as the safest and most comfortable place to be treated.

In discussing the future landscape, a spokesman from LaingBuisson, a leading healthcare consultancy, said that, “The biggest driver seems to be access to leading clinicians from London teaching hospitals. Clinically, there’s a trend towards super-specialisation of clinicians and this combination of world-leading clinicians combined with significant private hospital investment is a big draw for patients, both UK and overseas.” This trend of sophistication is best demonstrated in the ambitious privatesector development of the most complex technology, including proton-beam therapy, in London’s private hospitals, matching the very best public provision in major academic centres' hospitals. 2 The recently opened $1 billion Crick Institute

Sir Robert Naylor is the former Chief Executive, University College London Hospitals NHS Foundation Trust

for biomedical research (PHOTO: ANGELO HORNAK | 3 London's teaching hospitals train future medics from all over the world (PHOTO: STURTI / ISTOCK) | 4 HCA Healthcare UK's Wellington Hospital (PHOTO: HCA HEALTHCARE UK)

/ ALAMY)

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Committed to the care and improvement of human life HCA Healthcare UK is a leading private healthcare group with more than 30 award-winning clinics and hospitals located across the country. It is an internationally renowned company, proud to provide truly exceptional healthcare to patients from the UK and all over the world. A committed team of specialists combine unrivalled expertise and genuine compassion to support you every step of the way. HCA UK covers complex and urgent care, primary care, outpatient and day-case treatment for individuals of all ages, as well as giving access to the best consultants, sameday appointments and rapid admissions. More than 3,000 leading consultants run their private practices from an HCA UK hospital or specialist treatment centre, supported by multidisciplinary clinical and nursing teams. Their generous nurse-to-patient ratios are among the reasons why 81% of patients rate their experience with HCA UK as ‘excellent’. The result is a team who will listen and who you can depend on for around-the-clock care.

HCA UK want to provide the highest possible standards of care. To do this, it puts clinical governance at its core – the work that goes on in the background to ensure that the checks, balances and structures are in place to ensure patients receive the best care at every facility in our network.

In pursuit of our mission, we believe the following statements are essential and timeless:

• We recognise and affirm the unique and intrinsic value of each individual

• We treat all those we serve with compassion and kindness

• We act with honesty, integrity and fairness It means making sure that doctors, nurses and therapists are up to date with the latest medical knowledge and expertise, that staff work as a team to give patients exceptional care tailored to their individual needs, that patients’ experiences and outcomes are monitored. Clinical governance is driven by a team of the UK’s leading doctors. These doctors choose to treat their private patients at HCA UK hospitals because they are passionate about giving patients the best possible care, using state-ofthe-art facilities and the latest technology.

in the way we conduct our business and in our personal behaviour • We trust our colleagues as valuable members of our healthcare team and pledge to treat each other with loyalty, respect and dignity

Above all else, HCA UK is committed to the care and improvement of human life. In recognition of this commitment, HCA UK strives to deliver high-quality, cost-effective healthcare in the communities we serve.

Maintaining high levels of quality is extremely important if we are to deliver the best care. HCA UK is proud to be regulated, accredited and awarded by the following:

• CHKS • Joint Advisory Group (JAG) • Laing & Buisson 2015 award • Private Hospital Group of the Year 2016 • International Medical Tourism Journal (IMTJ) • Cancer Network of the Year 2016

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Private hospitals in London HCA UK’s private hospitals in London are the company’s overseas division and you are able to benefit from their world-renowned experience and expertise. Each of the private hospitals in London is a Centre of Excellence, where you will receive the highest standard of care delivered by dedicated medical teams.

HCA UK’s network of facilities and key NHS hospital partnerships in London and Manchester provide a range of services. Let’s start with its seven world-class private hospitals:

The Harley Street Clinic

The Lister Hospital

London Bridge Hospital

As one of London’s premier cancer centres, it offers a fully integrated approach to cancer treatment, from diagnosis to aftercare.

One of the highest-rated hospitals in terms of patient care and hotel services, which aims to give patients the very best experience on their journey to recovery.

Internationally recognised for cardiac services, cancer, renal medicine, neurology, orthopaedics and other areas of acute medicine.

The Portland Hospital

The Princess Grace Hospital

The Wellington Hospital

The only acute private hospital of its kind in London. Maternal choice is core to its obstetric and midwifery care.

One of the UK’s best-known acute hospitals, specialising in leading-edge cancer care, brain and spinal medicine, gastroenterology and prostate treatment.

The UK’s largest private hospital, offering the latest diagnostic and imaging units and care services in cardiology, neurology, orthopaedics, urology and gynaecology.

Joint ventures HCA UK has partnered with leading NHS hospitals to offer high-quality treatment within state-of-the-art facilities, supported by the latest technology of large NHS hospitals including:

• Harley Street at University College London (UCH)

• Harley Street at Queen’s, based in Queen’s Hospital, Romford

• The Christie Clinic, a partnership with The Christie NHS Foundation Trust in Manchester

For more information, please visit: www.hcahealthcare.co.uk

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From the introduction of penicillin to groundbreaking cancer treatments and research, the UK has a long-standing and welldeserved reputation for medical discoveries VISITING LONDON FOR HEALTHCARE

A PROUD HISTORY OF MEDICAL INNOVATION The United Kingdom has long had an enviable tradition for scientific discovery and expertise, not least in the field of medicine. The country’s hospitals and clinics are home to many of the world’s leading specialists in the full range of medical specialisms, with the highest concentration to be found in London. Historically, UK doctors and scientists have been at the forefront of developing new medical techniques, procedures and treatments – many of which are still in use today, or which form the basis for more recent innovations and those arriving in the near future. Among the most significant British medical breakthroughs was Sir Alexander Fleming’s discovery of penicillin in 1928, which revolutionised the treatment of infections. While studying influenza, Fleming – a doctor who carried out research under Sir Almroth Wright, a pioneer in vaccine therapy – noticed that mould had developed in a Petri dish being used to grow the staphylococci germ. A bacteria-

free circle had formed around the mould – later identified as a rare strain of Penicillium notatum – and Fleming correctly deduced that the mould had released a substance that repressed the growth. After further experimentation, Fleming named the active substance ‘penicillin’. Prior to the introduction of penicillin, mere cuts and scratches could lead to death by blood poisoning, as well as other infections that would be considered minor today. The account given by Fleming credits the discovery as serendipitous, and at the time he would have been unaware of the massive impact that penicillin would have on modern medicine. The Second World War meant large-scale production of the antibiotic was unlikely in Britain, where the chemical industry was fully occupied with the war effort. As a result, after the discovery of penicillin and the initial recognition of its potential in London, the United States played a larger role in developing production of the drug. The introduction

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of penicillin as a life-saving substance in the 1940s marked the dawn of an era of antibiotics that continues to this day. Beyond antibiotics, other areas of research have led to great leaps forward in disease treatment. In the past 40 years, research into cancer has doubled patient survival rates. The charity Cancer Research UK is pioneering this research with the aim of bringing forward the day when all

cancers are cured. It was almost a century ago, in 1923, that Cancer Research UK awarded its first grants for radium to treat cervical cancer. Today, radiotherapy is one of the cornerstones of cancer treatment, and is received by 40% of survivors. In 2013, Cancer Research UK researcher Professor Tim Maughan described radiotherapy – which uses high-energy x-rays that target human DNA – as experiencing a “quiet revolution”,

Sir Alexander Fleming's discovery of penicillin marked a new era of antibiotics (PHOTO: WORLD HISTORY ARCHIVE / ALAMY)

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very accurately to where the cancer is – we want to eradicate the cancer and not normal tissue,” says Professor Maughan. “Precision is key and something we have completely transformed by successfully harnessing developments in advanced physics, computer science and engineering. Radiotherapy is curative, cutting-edge and costeffective. The more we invest in fine-tuning it, the more patients we will be able to save in the future.”

with treatments constantly being finetuned to enhance their effectiveness. One early challenge with radiotherapy was the effect that the treatment had on healthy cells surrounding those that were cancerous. Healthy cells in the spinal cord, salivary glands or brain, for example, could suffer long-term damage from radiotherapy. However, breakthroughs such as intensitymodulated radiotherapy enable doctors to closely target a tumour. Also making advances is proton beam therapy – treatment in which the beam stops at the tumour without travelling any further into the body. “We make radiotherapy safe by targeting the X-ray

As technology and medicine continue to evolve, it is evident that the two are becoming increasingly intertwined. One area receiving attention is personalised medicine, exploring the use of tailored treatments. The idea is that patients receive targeted treatment specifically designed for them and the stage of their disease, as well as their individual symptoms and genetics. It is one of the world’s fastest-growing areas of research. Health-tracking technology is leading the way as we enter the realm of smart pills. The tiny sensor fits inside an antibiotic capsule. Once you’ve taken your pill, it feeds information back to your physician. It not only lets your doctor know that you’ve taken the medication, it also tracks other relevant data such as your heart rate.

1902

1923

1935

Sir Almroth Wright develops a system of anti-typhoid fever inoculation

Cancer Research UK awards its first grants for radium to treat cervical cancer

Cancer Research UK discovers a link between the sun and cancer and issues its first warning on sun exposure

1900

1910

1920

1930

1940

1928

1949

Scotland’s Alexander Fleming discovers penicillin, the world’s first antibiotic

First artificial intraocular lens transplant surgery for cataract patients at St Thomas’ Hospital in London, by Sir Harold Ridley

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2-3 Patients visiting London can expect to be examined and treated using some of the latest medical technology (PHOTOS: HCA HEALTHCARE UK) | 4 Many modern drug treatments have been developed in the UK (PHOTO: JOVANMANDIC / ISTOCK)

1953

1963

Frances Crick discovers the molecular structure of DNA with American James Watson

The first human cancer virus is discovered. Today, up to a fifth of all cancers globally are linked to viruses and bacteria

1954 Sir Richard Doll publishes the findings of a study that provides the first proof of a link between smoking and lung cancer 1950

1960

1960s James W Black develops propranolol – the first of a class of beta blockers, used to manage abnormal heart rhythms

1950s Sir John Crofton discovers an effective treatment for tuberculosis

1956 Scientists conduct early studies into the effectiveness of cervical cancer screening, which today saves around 5,000 lives annually in the UK alone

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5 Patients receiving treatment in London hospitals and clinics can look forward to a personal level of service (PHOTO: THE LONDON CLINIC) | 6 Advances in genetics are assisting in the treatment of many diseases, including cancers (PHOTO:MOODBOARD / ALAMY) 5

1970 Professor John Hobbs carries out the world’s first successful stem cell transplant

1970s Sir Peter Mansfield contributes to the development of magnetic resonance imaging, for which he later receives the Nobel Prize

1990 The international Human Genome Project is launched

1972 The drug cisplatin is developed by a team involving UK scientists. Today, more than 95% of men with testicular cancer survive thanks to their research

1970

1980

1990

1971

1981

CT scanning, developed by Sir Godfrey Hounsfield, is introduced into medical practice in Wimbledon, London

Sir Martin Evans discovers how to culture embryonic stem cells

1978 The world’s first test-tube baby is born by caesarian section at Oldham General Hospital

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One major benefit of these sensors is that doctors will have greater insight into the reasons why a patient may report that their medicine is ineffective. Rather than simply increasing the dosage, a doctor will be able to tell whether the medication is being taken correctly and rectify the situation based on data. Although this may sound futuristic, such technology is already being introduced.

Cancer Research UK believes that personalised treatment could eradicate the disease

Cancer Research UK is also focusing on personalised medicine. Increasingly, tumours are being classified according to their genetic make-up, rather than where they develop, and the charity believes that personalised treatment could eradicate the disease. In line with this goal, Cancer Research UK joined the International Cancer Genome Consortium (ICGC), one of the most ambitious biomedical research efforts ever undertaken.

targeted drugs that can be matched to faults in an individual patient’s cancer. The UK branch of Cancer Research is leading the ICGC oesophageal cancer project and jointly leading the prostate cancer project with the Ontario Institute of Cancer Research and Prostate Cancer Canada.

The project will map the genetic faults in 50 of the most important cancer types and information from 25,000 cancer samples will be made freely available to cancer researchers around the world. It aims to identify all genetic faults in a large number of individual cancers. The next step will be to determine which faults are driving the growth of the cancer, and ultimately discover

Thanks to decades of research and dedication, more people are surviving potentially fatal illnesses and diseases. London is bearing witness to the confluence of some of the world’s best researchers, and we are now in the golden age of medical discovery – the tipping point at which scientists agree medical innovations and major breakthroughs will be more prevalent than ever before.

2006

2017

Dolly the sheep is the first mammal cloned from an adult somatic cell by a team at the University of Edinburgh

2004 A vaccine against Human Papillomavirus (HPV) is developed that will help prevent cervical cancer

Researchers at London’s Institute of Cancer Research and the Royal Marsden NHS foundation trust develop a blood test that could transform treatment for prostate cancer

2015 Great Ormond Street hospital cures a baby with terminal cancer using a pioneering genetic therapy

2010 It is found that flexiscope screening could help prevent a third of bowel cancer cases

2000

2010

2009

2012

2017

A major international study helps track down the five gene variations that can increase the risk of glioma, a type of brain tumour

A British man has his kidney cancer removed with a ‘robotichand’ technique

Manchester gets the NHS’s first high-energy proton beam cancer therapy machine

England’s chief medical officer calls for routine genomic testing to bring forward the era of precision medicine

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OUR VISION IS TO BE THE MOST TRUSTED HOSPITAL

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The London Clinic is the United Kingdom’s largest independent hospital. Established in 1932 in the Harley Street area at the heart of London’s historic medical community, we have been providing the highest standard of individualised care ever since Our hospital has 220 beds for inpatients, with 10 operating theatres and six surgical wards. For our most critically ill patients or those with complex medical or surgical needs, a 13-bed intensive care unit (ICU) ensures we can provide the right care with the latest in technology and psychologically influenced design. The London Clinic welcomes all international patients looking to be treated at our central London hospital. To make your stay and treatment as comfortable as possible, we have an on-site International Office that provides a dedicated service for all of our international patients, their families and companions. While travelling abroad for medical treatment can be a big decision, our dedicated international team will look after you during your time with us, and you can be sure that we will provide the best possible care and attention to help you feel at home as quickly as possible.

Our International team look after your appointment bookings with our leading consultants and organise your admission to The London Clinic. If your treatment at The London Clinic is covered through an insurance company or sponsor, the International team will liaise with them to assist with your appointments and admission. If you are paying for your own treatment, the International team will be able to assist with guide prices through our self-pay team.

We have interpreters available to patients seven days a week. All of our interpreters speak Arabic and some additional languages, including German, French, Farsi and Turkish. We have also put in place alternative options when interpreters are not available, so that translation services are always provided.

We do not charge for the provision of our in-house interpreters and translation service. Our team visits you regularly during your stay with The London Clinic to assist you with your ongoing requirements.

We also offer a chaperone service to all patients receiving treatment at The London Clinic for any consultations or examinations, giving you peace of mind.

Our international chef ensures our patients and their visitors can enjoy dishes that are consistent with their culture, and is more than happy to visit patients and understand their needs and preferences to produce dishes for their specific requirements. During Ramadan, our catering team can provide freshly prepared food to be consumed during the night.

The London Clinic’s team of International patient relations coordinators and interpreters are available to assist patients with interpretation and translation of all appointments, procedures and visits to the hospital.

The London Clinic, 20 Devonshire Place, London W1G 6BW

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The London Clinic’s values are Pioneering, Inspiring and Caring, and we are dedicated to providing world-class care to our patients. Leading international consultants work at The London Clinic and we invest in innovative new technologies that enable them to offer innovative procedures and treatment techniques. A small selection of these are explained below:

PIONEERING TREATMENT FOR LIVER CANCER

CYBERKNIFE PRECISION RADIOTHERAPY FOR CANCER

The London Clinic is one of the few hospitals in the UK to offer patients Selective Internal Radiation Therapy (SIRT). This is a new treatment technique to accurately target primary liver cancer or cancer that has spread to the liver from other parts of the body, such as the bowel.

The London Clinic is proud to offer CyberKnife precision radiotherapy as an alternative to surgery for complex or inoperable cancer cases.

Millions of tiny radioactive beads (microspheres) are injected into the arteries that supply the cancers and they selectively treat the cancers in the liver. The microspheres block the tumour vessels and they emit radiotherapy directly to the cancers from inside the body. SIRT can also be given in combination with chemotherapy. Patients may benefit from SIRT therapy if their liver cancers cannot be removed by surgery. SIRT can be used to treat secondary tumours in the liver that started in the bowel or spread to the liver from other organs, such as the breast or stomach. It can also treat primary liver cancer.

CyberKnife therapy delivers highly-focused beams of radiation from a robotic arm that can be directed from virtually any direction – this is known as stereotactic ablative body radiotherapy. The machine has tracking software that detects any movement of the tumour or patient and automatically repositions the radiotherapy beam in order to minimise damage to healthy tissue. Because of its pinpoint accuracy, CyberKnife allows larger doses of radiotherapy to be delivered, meaning that the patient requires fewer hospital visits.

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STATE-OF-THE-ART CARE FOR CRITICALLY ILL PATIENTS

HAEMATOLOGY SERVICES

The London Clinic’s new Intensive Care Unit (ICU) is a state-of-the-art facility designed to provide the very best environment to nurse patients who are critically ill, and to be as comfortable as possible for patients, their families and companions. Our ICU is supported 24 hours a day by a dedicated team of specialist ICU consultants and nurses. The facility incorporates sophisticated medical technology to provide our consultants and nurses with everything they need to look after our patients, including:

The London Clinic is one of the few hospitals in the UK to offer bone marrow and peripheral blood stem cell collection. Established in 1985, our stem cell transplant unit has become one of the largest stem cell collection centres in Europe.

13 spacious individual patient rooms with windows providing natural light

Our team of nationally and internationally renowned haematologists have specialist experience and expertise in all aspects of haematology, including stem cell transplant, leukaemia, myeloma, coagulation and thrombotic disorders. We can provide all the most effective modalities of treatment, including the latest developments in chemotherapy and stem cell transplant procedures.

A sophisticated airflow system throughout and four isolation rooms to protect patients with compromised immune systems or those who are vulnerable to infection

Smart-glass technology that can switch from transparent to opaque with the press of a button – giving privacy to our patients, their family and companions

Sophisticated lighting that can be dimmed, along with offering a choice of different colours to suit each individual patient Televisions in every room with wireless connectivity, including a patient entertainment system that can provide a stimulating environment, so patients can enjoy pictures or videos of their favourite pastimes or from their friends and family.

If you would like to contact the International team to discuss your medical needs, please contact us: T: +44 (0) 20 3219 3266 | F: +44 (0) 20 3219 3516 internationaloffice@thelondonclinic.co.uk www.thelondonclinic.co.uk

The London Clinic, 20 Devonshire Place, London W1G 6BW

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History, experience and expertise are key reasons why London ranks among the world's best destinations for medical care VISITING LONDON FOR HEALTHCARE

LONDON: CENTRE OF MEDICAL EXCELLENCE As increasing numbers of people have embarked on medical tourism in recent years, it isn't surprising that attention has turned to London as a destination for treatment. The city’s reputation for medical excellence dates back centuries and it is renowned for playing host to many of the world’s top consultant and surgeons, as well as training the health professionals of tomorrow. Many visitors to London for private healthcare are drawn by the famous Harley Street Medical Area – the world’s largest concentration of medical expertise in a single location. Starting from a small collection of six doctors in 1840, their number grew to over 1,000 just a century later and expanded ever more quickly in subsequent years. Covering 92 acres of prime real estate in the heart of the city, the area surrounding the iconic Harley Street now plays host to more than 5,000 practitioners, clinics and hospitals;

these include The London Clinic, The Harley Street Clinic, The Portland Hospital for Women and Children and The Princess Grace Hospital. The abundance of private hospitals and clinics isn’t confined solely to the Harley Street area, with The London Bridge Hospital, The Lister Hospital and The Wellington Hospital, all part of HCA UK’s collection of central London hospitals. Towards the outskirts of the city, patients can choose to receive treatment in the suburbs in hospitals close to Wimbledon Common and Hampstead Heath, for example. Treatment is also offered to private patients at London hospitals that form part of the UK’s National Health Service (NHS) – among them the world-famous Guy’s and St Thomas’ Hospitals and the Royal Free London. Private patients are accommodated in dedicated rooms, receiving high-quality care from consultants who work at the hospital. One

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advantage for patients choosing their care in an NHS private wing is their access to facilities such as intensive care units, which may not be available in a private hospital. London’s reputation for medical excellence is in no small part due to its worldrenowned NHS teaching hospitals, which educate and train around 40,000 health professionals every year. Students at these 14 prestigious hospitals, some of which were founded in the 19th century, benefit from being able to develop their skills on a wide variety of cases presented by London’s diverse population.

Focus on oncology Much of this launch edition of Healthcare in London is dedicated to the cancer treatment options on offer to international patients in the capital’s private hospitals and clinics. Leading consultants in this wide-ranging field of medicine discuss the background to their innovative and inspiring work. They also describe the latest technologies, therapies and drug

treatments, which these specialists have been involved in developing. There is also a focus on paediatric services, underlining the comprehensive service offered to child patients and their families at the Portland Hospital, designed to reduce the trauma of surgery for both the patient and their concerned relatives. This informative article also highlights recent advances in surgical technology and techniques in treating curvatures of the spine in children.

Patients visiting London for healthcare can take advantage of the latest developments in treatment and technology (PHOTO: THE LONDON CLINIC)

The reach of London’s medical excellence also extends beyond the shores of the United Kingdom, with new medical facilities around the world drawing upon the expertise of its teaching hospitals and universities. A prime example of such a partnership is described by Dr Ajay Rajan Gupta (p72), who explains a groundbreaking partnership that is seeing world-class public medical facilities being developed in India with the cooperation of King’s College Hospital.

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Improving the health of communities we serve through world-class medical research, education and patient care

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The Royal Free Hospital has an international reputation for providing the highest standards of care for its patients, through the delivery of world-class expertise and local care. At the Royal Free Private Patients Unit, we generate additional funds for the hospital to support NHS facilities and we design our private investments to directly benefit NHS patients. We are one of the UK’s largest trusts, delivering care to more than 1.6 million patients each year in three main hospitals – Royal Free Hospital, Barnet Hospital and Chase Farm Hospital – in addition to a network of clinics provided at other trusts’ hospitals and community sites. We have been pioneering research and treatments since 1828 and continue to lead improvements in healthcare in the 21st century, from targeted cancer therapies to new surgical procedures. As well as offering an exceptionally wide range of services to patients, we are a campus of University College Medical School and conduct important medical research, much of it of international status. A founding member of the academic health science network UCL Partners, we also train doctors, nurses, midwives and many other clinical and non-clinical professionals. For many years the Royal Free London has had some of the lowest mortality rates in the UK and currently mortality is the second lowest. The RFL is one of the first NHS trusts to require staff to be “bare below the elbows” which has ensured their continuing excellent record in infection control.

Located in the heart of Hampstead Heath, the Private Patients unit located on the 12th floor of the Royal Free combines the convenience, comfort and personalised attention of a Private Hospital with state-of-the-art services, technology and professional excellence expected from a top London teaching hospital. At the Royal Free Private Patients Unit, we offer access to London’s expert consultants across a wide range of specialties, including: Amyloidosis, Breast Surgery, Cardiology, Clinical Oncology, Dermatology, Endocrinology, Gastroenterology, General Surgery, Geriatric Medicine, Gynaecology, Haematology, Haemophilia, Hepatology, HPB Surgery, Immunopathology, Infectious Diseases, Nephrology, Neurology, Nuclear Medicine, Oncology, Ophthalmology, Trauma & Orthopaedics, Plastic & Reconstructive Surgery, Rheumatology, Urology and Vascular Surgery. Our Private Patients have quick and easy access to a professionally trained consultant of their choice and can be seen as either an outpatient, inpatient stay or day-case procedure. We have a dedicated outpatient clinic located on the first floor of the hospital, known as the Lyndhurst Rooms. All diagnostic facilities are available under one roof, from a simple blood test to more complex scans. The combination of in-house diagnostics, a high-quality interpretation of results and the ability to consult across the whole hospital community gives the very best environment for a quality outpatient outcome. Our wards and staff are equipped to deal with some of the most complex cases. We can offer patients a friendly, personalised service based on their requirements, and have a dedicated team of nurses, administrative and hospitality staff to ensure every patient has a pleasant stay.

To find out more or to book an appointment, please contact our enquiries team on 020 7317 7751 or visit our website: www.royalfreeprivatepatients.com

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Professor Justin Stebbing YOUR MEDICAL CARE IN LONDON

ONCOLOGY FOCUSING TREATMENT ON THE INDIVIDUAL London is at the forefront of new and innovative treatments for cancer, including advances in personalised and precision medicine

London is steadily becoming one of the leading healthcare destinations in the world, for patients, for their families, and for the best researchers and doctors there are. The combination of individualised but multi-disciplinary care, led by our universities and medical schools, is already prolonging quality and quantity of life and increasing the cure rate for most diseases, whether they affect men or women, young or old, and are common or rare. Within this, there is an emerging paradigm of precision medicine, in which the use of molecular data at the point of care directly impacts patient treatment and clinical decision-making. This has already had a substantial, direct clinical impact on many aspects of healthcare services, but, up until now, these have been surprisingly infrequent. Oncology and cancer care, for example, is at the front line of personalised medicine, moving beyond the previous

model of giving cancer therapeutics based on trials of largely unselected patients beyond a simple phenotypic marker, to leading the way in utilising the molecular profile of an individual's cancer genome to optimise their disease management. At the centre is the patient, with personalised medicine offering the promise of delivering safe and efficacious cancer treatments that are targeted, biologically rational and avoid over- and under-treatment common with traditional chemotherapy, thus reducing toxicities associated with non-specific modes of action of chemotherapy.

Transforming treatments Advances in precision cancer medicine include well-established molecularly targeted therapies for patients with HER2positive breast cancer, BRAF-mutant metastatic melanoma, those with EGFRmutant or ALK-translocated lung cancer, and those with BCR–ABL-translocation-

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positive chronic myelogenous leukemia – all great examples. Clinical trials in London have led to many advances in treating these tumour types, turning them into long-term diseases that people live with, as opposed to dying from. In London we are introducing large-scale genomic technologies at the point of care, aiming to: i) catalyse discoveries in translational oncology and drive new research that aims to dissect selective responses to targeted, immune-driven therapies and to chemotherapies; ii) identify novel targets for which therapies are now in development, and; iii) establish in real time, without delays, the right therapy for that person. Indeed, propelled by the ability to generate increasingly complex molecular data directly from patient tumour and germ-line (the underlying genetics of a person) samples, the cycle of translating discoveries into

clinical practice is accelerating. Using cell-free DNA, which includes DNA derived from every cell type in a person’s cancer, on a rapid, ongoing basis should allow this to occur. Remarkably, there is an infinite requirement for this, as tumours can change by the second and no two tumour cells are exactly the same. Indeed, the stupidest cancer cell is cleverer than the cleverest oncologist.

Personalised medicine A molecular arms race to keep up would seem the safest strategy, but this has been constrained for too long by cost. There are now many new discoveries in personalised and precision medicine to live a healthier, longer life. However, until recently, even in an exceptionally well-heeled practice, most patients are not willing or able to pay enough for the doctors to devote as much attention to each individual patient, to acquire the necessary equipment, to

A patient receives ultrasound scanning of a thyroid (PHOTO: ALEXRATHS / ISTOCK)

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employ sufficiently well-trained staff and to spend the time and effort on continuing education to make such a practice viable. Going forward, the vision for world-leading healthcare in London is that each patient now would be an individual – a onesize-fits-all approach would be relegated. This isn’t just for cancer, it applies to every specialty from primary care and paediatrics, to intensive care, cardiology, neurology, endocrinology, rheumatology and all of the surgical specialties alongside which true multi-disciplinary care occurs.

Spreading the benefits Clinical trials, both led by doctors and by biotechnology and pharmaceutical companies. are moving to the forefront of care in London, for devices and techniques as well as drugs. In conjunction with NHS England, the 100,000 Genomes Project aims to bring the benefits of personalised medicine to the NHS and make this an everyday reality across diseases. To make sure patients benefit from innovations in genomics, the UK Government has committed to sequencing 100,000 whole human genomes, from 70,000 patients, by the end of this year. Successful delivery of the 100,000 Genome Project will enable us to achieve a number of ambitions, including: i) to be the first country in the world to sequence 100,000 whole human genomes for the treatment of patients with rare/inherited diseases or common cancers; ii) to have high consent rates from patients and public support for genomics; iii) to have established world-leading genomics services within the NHS; iv) to have educated and trained health professionals within the NHS in genomics and its

applications for improved patient care and treatment, raising broad awareness and understanding of the advantages genomic medicine offers to patient care in the NHS; v) to be the home of world-leading genomics companies that will work in partnership with the NHS and its academic research partners, and; vi) to have stimulated the development of diagnostics, devices, medicines and treatments based on a new understanding of the genetic and molecular basis of disease. This is the ultimate in what is called benchto-bedside translational approaches, and in this we are leading the way. Some patients taking part in the 100,000 Genome Project will benefit because a conclusive diagnosis can be reached for a rare/inherited disease, or because a “stratified” cancer treatment can be chosen that is most suitable to their individual cancer. For most, the benefit will be in knowing that they will be helping people with similar diseases in the future through research on the genome and associated clinical data.

The vision for world-leading healthcare in London is that each patient now would be an individual

Their involvement in the project will allow an infrastructure to be developed, which in the future will support genomic services to be applied more widely to patient care in the NHS and across many clinical specialties. This will naturally lead to benefits in the private sector, because the same individuals work in both sectors in London. For example, I personally work at Imperial College, where I have my research laboratory, I work at Imperial College Healthcare NHS Trust where I see NHS patients, and I have a small clinic on Harley Street where I see some private patients and am involved in a number of trials

2 London is one of the leading centres of cancer research (PHOTO: BSIP SA / ALAMY)

3 Private hospitals in London offer world-class facilities for cancer treatment (PHOTO: CURTSEYES / ALAMY)

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Setting the standard for private cancer care The Duchess of Devonshire Wing is a state of the art, purpose built cancer centre, located at the top of Devonshire Place in the heart of London’s premier medical district.

Cancer surgery Chemotherapy Radiotherapy

The facility encompasses all cancer treatment modalities under one roof, enabling our specialists to deliver personalised care in spacious, restful and fully equipped surroundings.

CyberKnife Immunotherapy Radionuclide therapies

We are recognised for the quality of our care and dedication, putting patients first and setting the standards for the end-to-end patient experience in private medical care combined with our holistic support services.

Oncology counselling Complementary therapies

Find out more at

www.thelondonclinic.co.uk The London Clinic Duchess of Devonshire Wing, 22 Devonshire Place, London W1G 6JA, United Kingdom internationaloffice@thelondonclinic.co.uk T: +44 (0) 20 3219 2366

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of new immunotherapy combinations. Many of my colleagues are simply the best in the world at what they do. A recent report – Generation Genome, by the UK Government’s Chief Medical Officer, Professor Dame Sally Davies – discusses how we can offer DNA testing as standard care in so many diseases, such as cancer, and we are already using this to identify and treat different infection strains. In my laboratory, we are studying the way our genetic code is turned on or off or regulated, and the way a cell can turn into a specific type of cell, including stem cells and cancer cells. We hope to use this to benefit our patients. Our scientists at Imperial, the Crick, University College London, King’s are leading the way in new technologies, such as CRISPR. Many human diseases are caused by the mutation of a stretch of DNA, even a change in a single nucleotide. Adapted from a primitive bacterial immune system, CRISPR does its handiwork by first cutting the double-stranded DNA at a target site in a genome and, in doing so, it gives us an ability to greatly alter genetic material as a new therapy for diseases. This has been used in London to understand early embryonic development and use stem cells more reliably to treat disease. 4 MRI scanning is among the diagnostic tools available to cancer specialists (PHOTO: SHAPECHARGE / ISTOCK)

While the main aim is to improve the lives of patients, there are potentially many economic benefits for the nation

and, ultimately, the world in which we live. Some may be unexpected, built on new, as yet undiscovered technologies that will emerge, and we need to be patient. But such benefits may include improved diagnostic tests, better tailored treatments and development of new treatments and medicines. The role of diet, exercise, complementary medicine utilising techniques from hyperthermia to metronomic chemotherapy, acupuncture to antioxidants would be at the forefront of care here, not relegated to an afterthought. It would place the patient’s psychologic state of wellbeing at the centre of their outcomes – in many ways this is as important as the surgery or medicines – one without the other is sub-optimal. Finally, we aim to prospectively collect data here, own those data, and link phenotype such as behaviour and history, to the genetics of the cancer or any disease, and the individual as a whole. In doing so, we aim to transform the lives of our patients and their families together, to disrupt the course of disease, and offer the very best healthcare in the world.

Professor Justin Stebbing is Professor of Cancer Medicine and Oncology, Consultant Oncologist, Imperial College London and Imperial College London Healthcare NHS Trust

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‫وضع معاي�ي الرعاية الخاصة للسرطان‬ ‫يعد جناح دوقة ديفونشاير األكرث تطورا‬ ‫بني خصيصا كمركز للرسطان ويقع عند‬ ‫بداية شارع ديفونشاير بليس بقلب الحي‬ ‫الطبي املتميز يف منطقة مارليبون بلندن‪.‬‬ ‫جراحة الرسطان‬ ‫العالج الكياموي‬ ‫العالج االشعاعي‬

‫يضم املركز كل وسائل معالجة الرسطان‬ ‫تحت سقف واحد مام يتيح لإلختصاصيني‬ ‫توفري رعاية شخصية متكاملة يف محيط‬ ‫فسيح‪ ،‬مريح ومجهز بكل املعدات‪.‬‬ ‫الجراحة باالشعاع )‪(Cyberknife‬‬ ‫العالج املناعي‬ ‫عالج النويدات املشعة )‪(Radionuclide‬‬

‫نتميز يف لندن كلينيك بجودة الرعاية واضعني‬ ‫بذلك معايري الرعاية الكاملة واملتكاملة‬ ‫ملرىض الرسطان مبراكز العالج الخاصة‬ ‫والتي تتضمن خدمات الدعم الشاملة‪.‬‬ ‫استشارات املشورة للرسطان‬ ‫عالجات تكميلية )مكملة(‬

‫مزيد من املعلومات تجدها هنا‪:‬‬

‫‪www.thelondonclinic.co.uk‬‬ ‫‪The London Clinic Duchess of Devonshire Wing, 22 Devonshire Place, London W1G 6JA, United Kingdom‬‬ ‫‪internationaloffice@thelondonclinic.co.uk T: +44 (0) 20 3219 2366‬‬

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SPONSORED FEATURE

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Dr Hendrik-Tobias Arkenau INTERVIEW

CUTTING-EDGE CANCER RESEARCH Dr Hendrik-Tobias Arkenau, founding Executive Medical Director of Sarah Cannon Research Institute UK, discusses the latest developments in treating cancers

Please tell us about yourself and your practice I am Medical Oncologist and Executive Medical Director for the Sarah Cannon Research Institute, which is the cancer research arm of HCA UK here in London. In this role I focus on clinical research of new drugs, and new trials for patients with advanced cancers. I am also a Gastrointestinal (GI) Oncologist, innovating the treatment for conditions such as bowel cancers and stomach cancers with new drug treatments. In addition, I am part of the cancer service line structure and leadership team at HCA UK, to integrate the latest technologies and treatments into our service within our six central London hospitals and in Manchester.

What facilities do you have at the Sarah Cannon Research Institute? The team at Sarah Cannon Research Institute uses the latest techniques to target cancer treatments more effectively (PHOTO: HCA HEALTHCARE UK)

The institute is the only independentsector, phase-one, early drug-development unit in the UK. We are focusing on development of new anti-cancer drugs,

which often make their way from testing on mice and monkeys into patients for the first time, and are often based on biology, cancer genetics or immune signatures. We try to target treatments to ensure patients get the most effective treatment with as few side effects as possible, so we take a very personalised approach to our patients. The unit has 40 team members, ranging from medical doctors and the nursing team to data-entry staff. The unit is integrated into the wider cancer network to offer patients within HCA UK access to the latest medications, and it is also integrated into our global Sarah Cannon network, the largest USbased drug development network, and it is strategically very important that this unit is located in London so that patients in the UK can access new drugs not yet available within the National Health Service or even in the private sector.

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Immunotherapies have shown to be effective in cancers that were previously untreatable Your specialism has seen some significant advances over past few years. Which would you consider the most exciting and most promising? I am most excited about the evolution of immunotherapies, which have shown to be effective in cancers that were previously untreatable, such as melanoma and lung cancer, among others. At this point the majority of progress has been made with what we call ‘checkpoint inhibitors’ – drugs that target specific interactions between T cells and cancer cells – and these really are the first steps in showing that some cancers considered incurable are now becoming what we would call ‘chronic disease’, so patients can live for many years with these new drugs. Beyond this, there is a variety of new treatments that I summarise under the umbrella of ‘Cellular Therapies’ – for example, genetically modified immunecells can fight cancer very effectively. This is what the media often refers to as C/ART cell therapy. At HCA UK and Sarah Cannon, we are in the process of offering this. We are already running studies of TIL therapies – effectively, extracted highly effective T cells that are re-infused into patients – and we are seeing very exciting results. These are very complex treatments that cannot be performed in an outpatient unit, so these patients are treated in our private inpatient facilities at the UCLH (University College London Hospitals). Another exciting development is combining these immunotherapies with targeted drugs. Often cancers not only have signatures that respond to immunotherapies, but also genetic changes that are of relevance in driving cancer. Combining these immunotherapies with a very targeted approach towards these genetic mutations and alterations will help to control tumour growth

better. We are running several trials at Sarah Cannon that are very promising. For example, we are running and coordinating the largest bladder cancer study of combining a checkpoint inhibitor with targeted small molecules. Personally, I think this a smart and highly personalised approach. The most important advances in which HCA UK has made significant investment is in the understanding of cancer genetics. HCA UK has built a molecular pathology lab, the only one of its kind in the country, where we screen our patients on a broad gene panel to understand cancer biology. The aim is to better integrate molecular pathology with day to-day oncology care. Importantly, at HCA UK we have established a genomic review board, which is like a multidisciplinary team meeting of specialists, oncologists and clinical geneticists. With this approach, we are leading something unique in Europe. The aim is to understand what genetic alterations mean and, in the context of disease status, to put these in context for patients and to aid oncologists in making the right decisions. Unfortunately, cancer is often detected too late. What is important to HCA UK is putting early detection systems in place and to offer patients early screening – for example, for prostate cancer, breast cancer and colon cancer. That is exciting because cancers behave differently in these early stages, and with new technologies we can detect cancers early to avoid them becoming metastatic and advanced.

What does the future hold? With increasing understanding of complex biology including interactions between environment and host there are great opportunities to prevent cancer at an early stage. We will see an increase in cancer vaccine programmes focusing on individual immune and genetic factors, which will be the ultimate personalised medical approach.

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SPONSORED FEATURE

HCA UK aims to detect cancers early to give patients the best possible outcomes (PHOTO: HCA HEALTHCARE UK)

Sarah Cannon Research Institute Sarah Cannon, the global cancer institute of Hospital Corporation of America (HCA), offers integrated cancer services with convenient access to cuttingedge therapies for those facing cancer in communities across the United States and United Kingdom. By bringing together a network of renowned cancer experts, we are collaborating and sharing best practices that address every aspect of the cancer journey, from screening and diagnosis through treatment and survivorship. Our research arm, Sarah Cannon Research Institute, was formed more than 20 years ago to ensure patients could access cutting-edge therapies closer to home. In partnering with leading pharmaceutical/biotech companies and investigators, we offer more than 500 clinical trials annually.

Our Mission People who live with cancer – those who work to prevent it, fight it, and survive it – are at the heart of every decision we make. Bringing the most innovative medical minds together with the most passionate caregivers in their communities, we are transforming care and personalizing treatment. Through clinical excellence and cutting-edge research, Sarah Cannon is redefining cancer care around the world.

Ethics and Compliance As the newly formed cancer service line of HCA, Sarah Cannon has a comprehensive Ethics and Compliance programme that includes:

— Articulating standards of compliance and ethical conduct — Creating awareness of these standards

Collectively, our comprehensive patient-centric services ensure that we are fulfilling our mission to advance science and transform care.

among everyone in the company

— Providing a means to report exceptions (ie possible misconduct)

— Monitoring and auditing performance in areas of compliance risk

— Establishing organisational supports for this entire effort

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Mr Jonathan W A Ramsay MS FRCS FRCS(Urol) YOUR MEDICAL CARE IN LONDON

UROLOGICAL INNOVATIONS Developments in medical technology and the expertise of internationally renowned specialists have positioned London at the forefront in treatment of urological conditions

London is a unique destination for all patients with urological conditions. Clinical and academic urology is well represented in London. All the university-based urology departments have flourished over the past 10 years, and larger groups of clinicians have fostered rapid subspecialisation, against a background of strong academic portfolios. Such an environment encourages innovation, and in urology this has often been led by technology. Early adoption of research evidence has led to early uptake of multi-parametric MRI scanning in the diagnosis of prostate cancer. More widespread use of any technique in UK National Health Service (NHS) practice clearly benefits the experience of the same clinicians working in private practice. The old adage that volume drives quality is even more important when applied to new diagnostic and therapeutic techniques. Another example of the early introduction of a novel technology via NHS practice is represented by the Urolift system for

treating benign prostatic hyperplasia (BPH). This technique, pioneered and tested in the UK, has just achieved US Food and Drug Adminstration (FDA) approval. Even in more unusual conditions, cooperation between the public and private sectors can create larger evidence-based practice with outcome measurement. The NHS in England has recently approved micro-testicular sperm extraction in cases of male infertility, due to non-obstructive azoospermia. So, this interface between public and private practice is of often hidden benefit to our private patients. Most of the Central London universitybased NHS providers have substantial facilities for private practice. The private premises at Imperial Private Healthcare offer a comprehensive range of urological treatments, backed by an integrated nephrology and renal transplant service (including renal dialysis) and a large and progressive oncology department.

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At the Royal Marsden Hospital in Fulham, which adjoins the Royal Brompton, urological cancer treatments, combining complex open and robotic surgical interventions, aligned with strengths in medical and clinical oncology, have developed rapidly, particularly in the fields of both testicular and renal tumours. At Guy’s and St Thomas’, a rapid expansion in the workforce of consultant urologists (numbering 19 in 2017) has allowed further sub-specialisation, and the development of multi-disciplinary working across the sometimes difficult interface of paediatric and adolescent urology. Paediatric cases can be transitioned into specialist adult urological care, and one of the most challenging areas of urological practice, cystinuria, has an international focus at Guy’s, with 200 cases in long-term follow-up. The theme of multi-disciplinary working has been extended to benign urological conditions in all of the London centres. At St George’s Hospital and University College London (UCLH), the management of patients with urinary tract calculi has correctly achieved more importance, so that endo-urologists, specialised uro-radiologists, nephrologists and microbiologists can combine to plan procedures to achieve better outcomes. These are important innovations, and have naturally been extended into private practice, so that the private patient arriving in London, referred to one consultant urologist, will have the benefit of a multidisciplinary approach to their condition. London-based urologists have significant private practices and were some of the first specialists in London to adopt a ‘chambers’ model, in which a group of urologists, who together offer a full range of specialist practice, combine to provide elective and emergency care, often hosted by one of the providers of inpatient and outpatient private care. HCA Healthcare UK hosts one typical group of urologists in Central London (The London Urology Associates), and other ‘independent’ providers, such as The London Clinic, also offer a broad general urological practice, with an on-call system consisting of London-based consultant urologists.

If the generality of provision of private urological services is both broad and available, what about the ‘super specialists’? London is rich in internationally renowned urological specialists, with leaders in prostate cancer diagnostics and treatment, stone disease, and andrology. Many of these specialists are prominent in the European Association of Urology (EUA), which enriches the opportunities for collaborative research and innovation. London urologists are also well represented in the United States, where they have made significant contributions to the activities of the American Urological Association. As with many UK-based practices, the urologists can draw from, and contribute to, both the European and North American ‘best practice’ guidelines in urology. London has a thriving community of consultant urologists, who commit to the four ‘As’ of private practice – we are available, approachable, able and aspirational.

1 Patients visiting London for urological treatments experience a high standard of personal care | 2 Recent innovations, developed in the UK, have been extended into private practice in London and are available to international patients (PHOTOS: HCA HEALTHCARE UK)

Mr Jonathan W A Ramsay is a consultant urologist/andrologist at Imperial College Healthcare NHS Trust

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SPONSORED FEATURE

Professor Christopher Eden INTERVIEW

ADVANCES IN CANCER SURGERY Leading Consultant Urologist Professor Christopher Eden describes the latest techniques in prostate cancer surgery

Robotic surgery enables prostate cancer operations to be carried out with evergreater precision, improving patient outcomes in terms of continence and potency (PHOTO: HCA HEALTHCARE UK)

Please tell us about yourself and your practice I've been a Consultant Urologist for the past 20 years. My particular contribution to urology has been as one of the worldwide pioneers of laparoscopic (keyhole) urology. This involves carrying out relatively major operations on patients without making a large wound. It has been a passion of mine for decades and I have a number of UK firsts under my belt in terms of procedures performed. Two years ago, I moved from laparoscopic to robotic surgery, so instead of the surgeon and his assistant holding the instruments and the camera this is done by a computercontrolled machine. Most of my practice is now related to prostate cancer, both in the outpatient clinic – where men with an elevated PSA or urinary symptoms can be treated – and in the operating theatre.

Where do you work and what facilities do you have? My main presence is at the London Bridge

Hospital, but I have also worked at The Princess Grace Hospital – both central London hospitals that are extremely well equipped. The particular facilities that I use at both hospitals are the surgical robots: the da Vinci Xi at London Bridge Hospital and the da Vinci Si at The Princess Grace Hospital. Both have MRI scanning, CT scanning, nuclear medicine and the latest diagnostics. The London Bridge Hospital also has an intensive care unit and frozen section analysis; in other words, it has the capability to enable the pathologist to examine tissue during the operation in order to maximise functional results without cost to the cancer control.

Your specialism has seen many advances over the past few years. What would you consider the most significant? The main advance over the past 20 years has been in the sphere of minimalaccess surgery – laparoscopic surgery and, more recently, robotic surgery. This has really changed patient outcomes, in

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SPONSORED FEATURE

particular for prostate cancer, in terms of continence and potency. Robotic surgery allows patients a completely different set of outcomes, much of which is due to the 3D vision and precisely controlled instrumentation. The latest advances in prostate cancer surgery relate to a new approach called Retzius-sparing, which approaches the prostate gland from underneath the bladder rather than from above it, as is the case with conventional prostate surgery. The technique was initially developed in Milan, Italy, seven years ago and I was the first in the UK to use it in 2016. It almost completely guarantees that patients won’t experience any incontinence after prostate cancer surgery.

2-3 Robotic surgery has brought about a departure from operating techniques that have existed for at least a century (PHOTO: HCA HEALTHCARE UK)

Although surgery is the most effective intervention for prostate cancer, in the past patients have understandably investigated alternatives – such as radiotherapy, high-intensity focused

ultrasound, cryotherapy and focal therapy – because they have been concerned about the negative consequences of surgery, namely incontinence and impotence. Retzius-sparing prostatectomy addresses both of these concerns by leaving intact the anchor points for the continence mechanism at the front of the prostate and also by preserving arteries that are important for erections. The operation is technically difficult to perform as it is done in a very confined space and this is where the robot is particularly useful by giving the surgeon a 30-degree up view that cannot be replicated by open surgery, together with motion-scaled and precise movements of the surgical instruments.

What outcomes can a prostate cancer patient expect after surgery? Out of approximately 3,000 keyhole prostate cancer surgeries, I've done

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SPONSORED FEATURE

195 operations using the Retzius-sparing technique, which has completely transformed the continence outcomes. We have published the results of our first 40 cases, which showed that 97.5% of patients were socially continent (zero to one pad per day) and that 90% were totally continent at four weeks after surgery. This is three times better than the results seen in the past with conventional surgery done by the most experienced surgeons. In terms of potency, one would expect that preserving more arteries going towards the penis will result in better potency than previously seen, but we need longer follow-up of patients to investigate this. So, it's a really exciting departure from an operation that has basically been done the same way ever since it was conceived more than 100 years ago, and the reason for that is the robot.

nights, have a catheter for nine days and be back to doing 90% of their normal activities within three weeks.

What future developments do you expect in your specialism? I think the next major advance will be the ability to fuse in real time the MRI scan image of the prostate, together with the location of the cancer, with the view that the surgeon has. This will allow even more accurate surgery and even better cancer and functional outcomes. There are a number of technical hurdles that need to be resolved first, but I believe that they will all be overcome within the next decade.

Typically, a patient having this surgery would be in hospital for one or two

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Mr John T Jenkins YOUR MEDICAL CARE IN LONDON

COLORECTAL SURGERY CUTTING-EDGE CARE London is at the forefront of treating colorectal diseases, with unique expertise across a wide range of treatments

London offers safe, reliable yet innovative and cutting-edge care for those with colorectal diseases. London offers the highest-quality interventions for patients requiring treatment for both benign and malignant colorectal and intestinal diseases, and remains at the forefront internationally for patient-centred care. Treatments that are offered cover the entire breadth of diseases, supported by specialist surgery, oncology, gastroenterology, radiology, anaesthesia and endoscopy. Patients travel nationally and internationally for these specialist treatments, owing to the unique expertise that London offers and the historic impact upon the treatment and understanding of colorectal disease that the city has had. London is home to world-renowned centres of excellence for colorectal and intestinal disease, such as St Mark’s Hospital and Academic Institute.

St Mark’s Hospital was founded in 1835 and remains the oldest and only specialist hospital in the UK, and possibly worldwide, that is exclusively dedicated to treating colorectal and intestinal diseases. It has defined not only the management of the breadth of colorectal diseases, but also the identification, understanding and verification of how such diseases arise. It has a powerful brand and has become synonymous with both colorectal disease and colorectal surgery over the past nearly two centuries, yet still retains its place at the forefront of colorectal surgery. It is a truly multi-disciplinary and multi-speciality hospital that has a tertiary and quaternary referral practice treating all colorectalrelated pathologies. The hospital offers treatment to both National Health Service (NHS) patients and private healthcare patients, both nationally and internationally.

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Colorectal diseases are also treated to the highest quality in many other sites across London, within the NHS and in a multitude of private healthcare facilities. Some facilities are entirely independent, such as the London Clinic, which offers tertiary referral-level colorectal surgery, King Edward VII Hospital or others affiliated with healthcare providers such as BMI or HCA UK, mostly resident in the Harley Street area. Standards of care are universally applied for both NHS and private hospitals to assure patients that they will receive the highest possible standard of care in whatever facility they are treated.

Services offered in London

the complications from surgery carried out elsewhere, nationally or internationally. Surgeons from the London hospitals have been and are in the vanguard of clinicians and researchers leading the world in colorectal care and colorectal surgery. These surgeons not only lead technical surgical developments, such as in minimally invasive surgery, but also the scientific understanding in areas such as cancer, proctology and inflammatory bowel disease, to minimise the trauma and impact of treatment upon patients to maintain and enhance quality of life where possible. Care is delivered with the integrated multidisciplinary team structures inherent in modern UK surgical practice.

Colorectal surgeons in specialist London hospitals will offer treatments for benign and malignant conditions that may be relatively minor or extremely complex, requiring extensive major surgery, or for

London has centres of excellence that treat the multitude of colorectal and intestinal disorders in high volume and with high quality. Few cities worldwide can

Laparoscopy surgery in progress (PHOTO: BARRY DIOMEDE / ALAMY)

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make similar claims to this concentrated and long-standing expertise. Below are some examples of treatments and processes in which London excels: Colorectal cancer surgery and treatment High-volume colorectal centres in London were early adopters and leaders in the development, training and propagation of laparoscopic colorectal resection for primary bowel cancer. Some centres will offer laparoscopic resection to over 95% of primary cancer resections. Though the true role of robotics in colorectal surgery remains unclear, some London centres will now also offer this option. The benefits of laparoscopy for inflammatory bowel disease management are now established and, as above, London colorectal surgeons have pioneered these options with acceleration of patient recovery and improved patient experience. St Mark’s Hospital offers the highest volume of ileo-anal pouch surgery in the UK.

Intestinal failure surgery and management London has one of the recognised quaternary referral Intestinal Failure Units in the UK at St Mark’s Hospital, with other smaller units in London providing treatments for intestinal fistula and short bowel syndrome. With this is a huge experience in complex abdominal wall reconstruction with collaborative input with specialist plastic surgeons. Revisonal ileo-anal pouch surgery and ileo-anal pouch excision This is a niche area of IBD surgery and is offered in only very few centres in the UK. London, by merit of the volume of primary ileoanal pouch surgery performed in the city offers reversional surgery with a similarly, albeit relative, high volume. Complex proctology As a result of the historic influences and experience in London in proctology, there is an exceptionally high standard of assessment and treatment for patients with complex proctological issues, including those specific to women either after childbirth or trauma or surgery. Our proctologists will offer high-volume minor proctology with a positive patient experience. Faecal incontinence treatment and surgery Those involved in managing patients with complex pelvic floor problems in London offer a sensitive and patientcentred approach to these difficult problems, often resorting to surgery where the multitude of other options have failed to yield a positive outcome. Complex reconstructive options are also offered for those after pelvic trauma and for the after effects of previous surgery that has produced unexpected or unusual complications, eg after haemorrhoid or other anal surgery. Prolapse surgery is offered laparoscopically as a standard, with some units offering a robotic option. Intestinal endometriosis surgery Patients with Stage IV Endometriosis with rectovaginal involvement will often require a collaborative approach to their management, and several Nationally Accredited Centres for managing intestinal endometriosis are resident in London Advanced therapeutic endoscopy with new techniques London has several outstanding and world-leading centres of excellence in advanced therapeutic endoscopy, and in relation

to colorectal surgery and colonoscopy. Using the latest adjuncts to enhance image quality and with novel therapeutic options, patients that might otherwise have required major surgery are now suitable for much less invasive and more patient-friendly options. Hybrid procedures involving laparoscopy and endoscopy are now flourishing in London and offer new options for those that might have previously required major surgery alone. Polyposis syndromes and prophylactic surgery, family cancer genetics and counselling Much of the understanding of the genetics of colorectal cancer comes from our historic and detailed recording of patients with polypsis syndromes, and these patients and the long-term follow-up information have provided insight into the relevance of specific genes in the modern era. The Polypsis Registry in St Mark’s has prospectively recorded the lives of patients with these rare syndromes since the 1920s and has unlocked the knowledge of how certain cancers develop and might be inherited. The Family Cancer Clinic continues such work with Lynch syndrome and other inherited syndromes. Rare pelvic and retrorectal tumours, small bowel tumours and polyps The experience in managing difficult pelvic tumour means that these rarities imply the same skill set as possessed by those surgeons treating advanced and recurrent pelvic cancer. The collaborative approach to laparoscopy and endoscopy means that, increasingly, patients with small bowel disease are being offered less invasive and less morbid options for their treatment, with a more rapid recovery. Exenteration surgery for advanced and recurrent colorectal cancer London has hospitals that offer options for surgical treatment for advanced and recurrent colorectal cancer. Combined, the London centres offer possibly the highest volume worldwide in this area and offer additional interventions, such as intra-operative radiotherapy (IORT) and heated intraperitoneal chemotherapy (HIPEC). These services are supported by Medical and Clinical Oncologists across London and offer options for patients where other centres may not have the necessary experience or support for their patients. Patients

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will travel internationally to ensure their options for salvage are optimised as much as is possible. Specialist gastrointestinal radiology The decision-making process in colorectal surgery is greatly enhanced by the quality of radiology and the interaction with the radiologist as part of the multidisciplinary team. Ensuring that all radiology is with a specialist radiologist and that a team-based approach is followed ensures that the highest standards of care exist. A radiologist that knows the patient well will treat the patient well. Specialist nursing staff, affiliated specialist oncology and radiotherapy services The backbone of clinical care is integrated, educated and enthusiastic nursing care, and in specialist facilities we have developed a multitude of specialist nurses and nurse consultants who provide a meaningful link and support to patients undergoing the multitude of treatments for colorectal diseases. Specialist gastro-intestinal pathology Specialist GI pathology, much like radiology, requires close team integration.

Enhanced recovery/fast-track surgery Enhanced recovery, or fast-track, was rolled out nationally as a standard of care across the UK and is embedded in all aspects of major colorectal surgery. It has been proven to reduce complications and hospital stays and produces a more satisfied and functionally able patient.

2 Surgeons using the da Vinci Xi surgical system carry out a colorectal surgery at the Royal Marsden in London (PHOTO: JONATHAN BRADY / PA ARCHIVE / PA IMAGES)

Training and education for surgeons and specialist nurses Embedded in the UK and London medical culture is the importance of training well and training individuals how to train well, as we believe that this will ensure surgery and other treatments are delivered consistently and with affirmation that effectiveness is maintained. Multidisciplinary team working At the core of working in the NHS and in the private London hospitals is the ethos of close team-working to improve patients outcomes and experience. Research in this area has been led by the UK.

Mr John T Jenkins is a consultant colorectal surgeon at St Mark's Hospital in London and is honorary senior lecturer at Imperial College London

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INTRODUCTION Advanced Oncotherapy is set to deliver disruptive proton therapy technology in the treatment of cancer.

and treatment, with the aim of delivering treatment as safely and efficiently as possible.

Its innovative LIGHT Proton Therapy Solution* has been designed to offer clinically superior treatments for cancer patients, as well as operational advantages for hospitals and clinics.

Medical professionals are beginning to view cancer as a chronic, manageable disease; the focus for oncology providers is to deliver new, targeted treatments with reduced side effects and limited impact on the quality of life for patients.

CANCER

Each year, millions of people worldwide undergo treatment for cancer based on focused beams of high-energy X-rays – external beam radiotherapy. Radiotherapy is one of the three main modalities for treating cancer, the other two being surgery and chemotherapy. Radiation is effective in cancer treatment because it can kill cancerous cells by breaking their DNA strands, but it can also affect healthy tissue. For this reason, the radiation must be directed very carefully.

RADIOTHERAPY

Cancer, the second leading cause of death globally, according to the World Health Organization, is the name given to a very large group of diseases that share one common characteristic – the excessive or unregulated growth of cells. The growth of healthy, normal cells is strictly controlled biologically, but in cancer these controls fail and cells start to grow and behave abnormally, forming lumps or masses of tissue called tumours. There are more than 100 different types of cancer, and each is classified by the type of cell that is initially affected. Oncology, the treatment of cancer, is developing rapidly, with far greater emphasis now on precision cancer medicine

Significant effort has, therefore, been directed to the development of new radiation therapies, which improve targeting and limit unwanted side effects. This is best exemplified through the successful development of proton therapy.

Indirect Route radiation

water free radical

DAMAGE

radiation Direct Route

Radiation can damage DNA through two mechanisms: direct hits and through free radical formation

* The LIGHT Proton Therapy System is still subject to conformity assessment by AVO's Notified Body as well as clearance by the USA-FDA. Treatment of first patients at 141/143 Harley Street, with clinical operations to be run by Circle Health in a joint venture with Advanced Oncotherapy, is due in 2020. www.circlehealth.co.uk

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Dose (%)

Bragg Peak

100 X-rays (Photons)

Focussing the proton radiation effect to the tumour location 60

40 Protons 20

Tumour 10

Depth (cm)

Energy deposition as a function of depth

PROTON THERAPY X-ray based radiotherapy ionises cells along the entire trajectory of the X-ray beams, including healthy cells, leading to potentially serious side effects. This problem is exacerbated when cancer is located near a vital organ. A proton delivers a radiation dose profile with most of the dose delivered at its stopping point (the Bragg peak), sparing the patient’s healthy cells. The most significant difference between proton and X-ray or gamma-ray treatments is, therefore, that the proton field has no exit dose. Proton therapy, a form of particle therapy, would be the preferred approach in most patients with localised tumours. Proton therapy can treat tumours in a more precise manner and can provide radiation dose deposition that better matches the actual three-dimensional shape of tumours, such that surrounding tissues typically receive two to three times less radiation. Side effects can then be reduced to a minimum.

X-rays

Protons

Significant radiation dose in healthy tissue in the upper example (Intensity Modulated Radio-Therapy), compared to proton treatment in the lower example. In both treatments of endometrial cancer, the patient receiving IMRT will experience notable discomfort during treatment, due to the dose to the bowel

As growing tissues are more sensitive to radiation, proton therapy has also become an ideal tool for childhood cancers. However, in spite of clinical benefits, the high cost of proton therapy has hindered its uptake. Many hospitals, and by implication the patients and those paying for treatment, do not have the budget required to invest in high-cost treatment options. There are approximately 13,400 radiotherapy systems in use, equating to roughly 1.9 systems per million people. By contrast, there are approximately 60 proton therapy systems globally or 0.2 systems per million people.

Far less irradiation with protons to healthy tissue in front of tumour (red ellipse) and almost none behind it, where the critical spinal cord is located

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Advanced Oncotherapy’s technology is expected to be sufficiently disruptive to the radiotherapy market to substantially alter this picture and make proton therapy far more accessible.

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ADVANCED ONCOTHERAPY

LIGHT

Current proton therapy systems, based on cyclotrons or synchrotrons, have cost and clinical limitations that are inherent to the nature of their proton accelerating systems. A.D.A.M. S.A., based in Geneva, was founded to develop a linac-based solution, which will overcome these limitations. Advanced Oncotherapy acquired in A.D.A.M. S.A. in 2013. Since then, there is also a partnership with CERN, the European Organisation for Nuclear Research, on development of accelerator parts and operating test sites.

Advanced Oncotherapy’s LIGHT (LINAC Image Guided Hadron Technology) system is designed to provide next-generation solutions to patients and hospitals alike. It stands apart from all existing proton therapy systems in that, at its heart, is a linear proton accelerator. This fact that has profound implications for the way it operates.

LIGHT accelerator, beam transfer line and treatment room

The LIGHT system has been designed to offer: FOR PATIENTS

FOR OPERATORS

>> Non-invasive treatment – a painless process;

>> A complete, turn-key solution – fully integrated and optimised system;

>> More accurate tumour targeting – small beam spot size with highly rapid beam modulation, maximising accuracy of tumour targeting while facilitating adaptive treatment;

>> Potential for hypofractionation – better targeting can reduce required number of treatment sessions;

>> Reduced side effects – lower radiation dose in healthy tissue, fewer side effects and improved quality of life during and after treatment;

>> Enhanced efficiency – linear accelerator with very high proton transmission efficiency, independent of beam intensity;

>> Operational excellence – linear and modular design enables greater ease of manufacturing, building refurbishment/construction, transportation, installation, maintenance and, ultimately, decommissioning (ie positive cost implications for patients and hospitals).

>> Safer treatment – accuracy is even more important when tumours are located near critical organs or structures (eg brain or heart) and in paediatric cases.

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LONDON  HARLEY STREET London has a rich history of ground breaking research into cancer treatment. Selecting just one example, The Institute of Cancer Research has been at the forefront of discoveries linking smoking with cancer, chemotherapeutic drugs,

immunotherapy, the role of genes in hereditary factors and the significance of DNA damage as the fundamental cause of cancer.

141/143 Harley St, showing consulting and administrative offices, the LIGHT proton accelerator, beam transfer lines and a treatment room

Advanced Oncotherapy’s first site for the innovative LIGHT system is the world-renowned Harley Street Medical Area. Harley Street provides an ideal location:

> Providing access to advanced treatments and services; > Operating like one large virtual hospital, with referrals across clinics and hospitals;

> It is a centre of medical excellence; > Is situated in central London, with all its amenities, > It has medical practitioners with expertise across the

attractions and infrastructure.

full range of disciplines; www.harleystreetmedicalarea.com

CONTACT For further information on Advanced Oncotherapy and its innovative LIGHT system, please get in touch. WEBSITE: TELEPHONE: EMAIL: POST:

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www.avoplc.com +44 (0)20 3617 8728 info@avoplc.com Advanced Oncotherapy plc, Third Floor, 4 Tenterden Street, London W1S 1TE

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Your path to recovery starts here The Wellington Hospital’s Acute Neurological Rehabilitation Unit is the UK’s largest private unit specially designed for neurological rehabilitation patients. HCA Healthcare UK treats patients with complex neurological injuries and conditions affecting the brain and nervous system, bringing together experts from a range of specialisms to work together as a Multidisciplinary Team (MDT) around the patient’s rehabilitation needs. From the moment a patient arrives at our specialist unit, we’re by their side. HCA UK supports patients throughout their care, including assessment, treatment and comprehensive aftercare plans.

We treat patients right from the onset of their condition back to full health. Alongside the expertise of our specialist medical and nursing care, we can also offer patients immediate access to our intensive care units – giving them complete peace of mind that their every need will be taken care of. We care for patients with a range of neurological conditions:

• Stroke • Traumatic brain injury • Spinal cord injury • Encephalitis • Multiple sclerosis • Parkinson’s disease • Guillain-Barre syndrome

The Wellington Hospital North Circus Road St John’s Wood London NW8 6PD Inpatient neurological rehabilitation + 44 (0) 207 483 5348, + 44 (0) 207 483 5363 Outpatient neurological rehabilitation + 44 (0) 207 483 5184

rehabilitation.wellington@hcahealthcare.co.uk

www.thewellingtonhospital.com

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YOUR MEDICAL CARE IN LONDON

MATERNITY AND IVF London is home to topquality facilities for maternity care, in terms of both treatment and comfort. The city also has a world-class reputation for assisting those requiring medical help to start a family

Private maternity services are becoming an increasingly popular choice for expectant parents, particularly in cases where there are complications during pregnancy (PHOTO: HCA HEALTHCARE UK)

Increasing numbers of parents are opting for private maternity services in London, due to the capital’s reputation in the field and their desire for a highly personalised service. This can also provide an additional degree of reassurance in cases where there are complications during pregnancy. London’s private maternity hospitals and units also provide a level of comfort that is on a par with some of the city’s high-quality hotels, with en suite rooms and extensive dining options. Among the most prestigious is The Portland Hospital for Women and Children, the UK’s only private hospital with an onsite neonatal intensive care unit, which offers both consultant and midwife-led care. All its rooms can accommodate a partner to stay, and room service is available around the clock to provide a variety of high-quality meals. International visitors are well catered for, with a range of services including arranging

interpreters for non-English-speakers, who can act as liaison between patients and staff. The hospital also offers a Middle East food menu and provides Arabiclanguage television and newspapers. Among the best known of London’s maternity hospitals outside the UK is The Lindo Wing at St Mary’s Hospital, which has often featured in global news bulletins as the setting for a succession of births to the British royal family. Founded in 1937, The Lindo Wing witnessed the birth of the children of Princess Anne (the Princess Royal), the Duchess of Gloucester, Princess Michael of Kent, and Diana, Princess of Wales. More recently, the Duke and Duchess of Cambridge welcomed their children, Prince George and Princess Charlotte, to the world at the same location, in 2013 and 2015 respectively. At the Westminster Maternity Suite, part of St Thomas’ Hospital on the south bank of the River Thames, the

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high standard of maternity services is complemented by recently refurbished facilities and an impressive view of the Houses of Parliament and Big Ben.

than 40 years, with the first ‘test tube’ baby, Louise Brown, being born at Oldham General Hospital, Greater Manchester, in July 1978. Today, one in 50 children in the UK is born as a result of IVF treatment.

Fertility treatments

2 The UK has been at the forefront of IVF treatments for more than four decades | 3 Newborns and their parents can enjoy their first moments together in high-quality surroundings (PHOTO: HCA HEALTHCARE UK) | 4 London hospitals and clinics also provide a range of antenatal tests on an outpatient basis (PHOTO: HCA HEALTHCARE) (PHOTO: ISTOCK / NEVODKA)

For couples experiencing difficulty in conceiving, London clinics are a popular port of call, particularly for those who have yet to find a solution through previous treatments elsewhere. UK scientists and doctors have been at the forefront of in vitro fertilisation (IVF) research and treatment for more

IVF treatment involves an egg being taken from the ovaries of a woman and fertilised by sperm in the laboratory. Once this embryo begins to grow, after two to six days, it will be placed back inside the womb to develop and grow. IVF treatment can be carried out with a couple’s own sperm and eggs, or with those provided by donors.

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The Lindo Wing at St Mary’s Hospital has been the setting for a succession of royal births

There are several stages to IVF treatment, which begins with suppressing the woman’s natural menstrual cycle with medication. Further medication is then used to encourage greater production than usual of eggs from the ovaries.

London has numerous options for couples seeking IVF treatment. Among the capital’s leading IVF clinics is The Lister Fertility Clinic in Chelsea. As the UK's largest private IVF unit, it proudly boasts of more than 17,000 babies being born as a result of its fertility treatments since 1988.

The patient is then monitored for a period of around two weeks, with ultrasound scans to check the development of the eggs and blood tests to help determine the best time to collect them and the drug doses required. The eggs are then collected via a needle inserted into the ovaries, via the vagina.

Elsewhere, the Centre for Reproductive and Genetic Health (CRGH), on Great Portland Street, claims the highest rate of live births of any IVF or ICSI treatments per embryo in London. Established in 1990, it also has one of the UK’s largest donor egg banks.

After collection, the eggs are mixed with sperm to fertilise them over a period of two to five days. Typically, up to 75% of the eggs will be fertilised (becoming embryos) and are then transferred into the womb. A pregnancy test two weeks later will determine whether the treatment has been successful.

The London Fertility Centre in Harley Street advertises its services as a treatment destination for international visitors, highlighting that all its doctors speak Arabic and that its staff are conversant in 20 other languages. The clinic also offers consultations via Skype or phone to reduce the need for a lengthy stay.

5 The Duke and Duchess of Cambridge present their newborn daughter, Charlotte, on the steps of the Lindo Wing at London's St Mary's Hospital (PHOTO: DOMINIC LIPINSKI / PA ARCHIVE / PA IMAGES)

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Improving the health of communities we serve through world-class medical research, education and patient care

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Hadley Wood Hospital is a new private outpatient and day-case facility conveniently situated in a discreet, tranquil location near Barnet High Street, close to a wealth of shops, restaurants and other local amenities. We offer the warmest welcome, the highest quality and choice of private healthcare, and excellent standards of nursing and clinical expertise across a wide range of specialties for both self-paying and insured patients. The hospital has been opened by the Royal Free London Private Patients Unit and combines the convenience, comfort and personalised attention of a private hospital with state-of-the-art technology and the professional excellence you would expect from a top London teaching hospital. The Royal Free London NHS Foundation Trust is one of the UK’s largest trusts, delivering care to more than 1.6 million patients each year. A hospital with a reputation for medical excellence, the Royal Free Hospital has been delivering world-class healthcare since 1828, with the Private Patients Unit in existence for over 25 years.

At Hadley Wood Hospital, we offer access to London’s expert consultants across a wide range of specialties including: Radiology, Orthopaedics, Urology, Endoscopy, Gastroenterology, General & Colorectal Surgery and Cosmetic Surgery. With diagnostics, imaging and surgery housed under one roof, we ensure that our patients experience the smoothest journey from diagnosis to treatment. Boasting eight consulting rooms, a minor treatment room, a dentistry room, an endoscopy suite, a radiology suite and two day-case theatres, we provide the very best environment to ensure our patients experience the world-class care that is synonymous with the Royal Free London. Whether you are a day-case patient or outpatient, at Hadley Wood Hospital you will be cared for by a team of nursing staff dedicated to ensuring you receive the best possible treatment and the quickest possible recovery.

To find out more or to book an appointment, please contact our enquiries team on 020 7317 7751 or visit our website: www.royalfreehadleywood.com

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When it comes to your health, you deserve the best Established in 1998, Aspen Healthcare is the proud operator of nine award-winning private healthcare facilities across the UK, including four acute hospitals, two specialist cancer centres and three day-surgery hospitals. We are renowned for the highest standards of patient care, our commitment to excellence and our outstanding patient safety record.

Exceptional consultant doctors

World-class private healthcare

Looking after you as we would our own families

At Aspen Healthcare, we work with over 1,000 carefully selected specialist Consultant doctors, all of whom are registered with the General Medical Council (GMC) and are leading experts, both locally and internationally, in their medical specialty.

Our highly respected hospitals and clinics provide a wide range of treatments and services in our world-class facilities.

Aspen Healthcare’s mission is to provide first-class independent healthcare in a safe, comfortable and welcoming environment; one in which we would be happy to treat our own families.

We pride ourselves on working with only the best Consultant doctors, all of whom must pass a rigorous application process and be approved by our Medical Advisory Committee before they are granted practicing privileges to work with us. They are supported by our team of expert healthcare professionals and will lead your care while you are with us.

We offer most medical specialties, ranging from cardiology to cosmetic and reconstructive surgery; ear, nose and throat (ENT); gastroenterology; general medicine and surgery; gynaecology; haematology; oncology; orthopaedics; paediatrics; pain management; urology – and much more.

This means when you come to an Aspen Healthcare facility you will be welcomed by our friendly and expert team and can be confident you are in very safe hands.

So, whether you need a consultation, diagnostic imaging or surgical services, we can care for you from diagnosis through to treatment and aftercare.

aspen-healthcare.co.uk

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Why choose Aspen Healthcare? When it comes to your health, you deserve the best.

Quality assured All nine Aspen Healthcare facilities have been inspected by the independent regulators of health and social care in the UK (Care Quality Commission and Health Improvement Scotland) and found to be ‘outstanding’,‘very good’ or ‘good’ at delivering safe, effective, caring, well-led and responsive healthcare. Unlike many of our competitors, we can proudly say that 100% of our healthcare facilities have been approved by the national healthcare regulators. With Aspen Healthcare, you can be assured you are dealing with an innovative healthcare provider committed to setting new standards in patient care. We were the first healthcare provider in the UK to have all our facilities accredited by the Association for Perioperative Practice for surgical practice and the first in the UK to have WorldHost® accreditation for outstanding customer service.

With Aspen Healthcare, you can be assured you are dealing with an innovative healthcare provider committed to setting new standards in patient care.

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I We are committed to offering firstclass independent healthcare in a safe, comfortable and welcoming environment; one in which we would be happy to treat our own families I We work with only the best consultant doctors, who must pass our rigorous selection criteria before they can work with us I We provide the highest levels of clinical expertise and nursing care I Our safety and cleanliness records are outstanding. We have 0% MRSA bloodstream infection ratings in all our facilities I We are continually investing in our facilities, specialist medical equipment and technology, ensuring that Aspen Healthcare hospitals and clinics are fully equipped to provide world-class healthcare I 99% of our inpatients rate the overall quality of their care as ‘excellent’, ‘very good’ or ‘good’

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Welcoming International P At Aspen Healthcare, we know that finding the right medical treatment abroad can be a challenge. That’s why our International Patient Team do all they can to ensure that choosing Aspen Healthcare is a simple and stress-free process.

Dedicated support from our international patient centre team Our multi-lingual International Patient Team speaks English, Arabic and other languages to offer a friendly and personalised service for our international patients. Working closely with patients and visitors from all over the world they are here to support you before, during and after treatment and through any follow-up care. They will guide you through all the aspects of your care and help you to navigate your way from initial referral through to appointment and admission.

As an international patient you can expect: I A team of dedicated international liaison officers who co-ordinate bookings for international customer including private patients and embassies I Interpreting services I Advice and support with accommodation bookings I Transport and travel assistance I Help with booking taxis to and from hotels and into Central London for patients, family and friends I Other assistance and support as necessary

Supporting you all the way I Your first consultation as an outpatient will be arranged at a time most convenient to you I Your personalised treatment will be tailored around you, with your choice of consultant, location and timing I Your treatment will performed in one of our modern, state-of-the-art hospitals, by our outstanding team of world-class clinicians I Each hospital has the latest generation imaging, diagnostic and medical equipment and technology

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I You will be allocated your own comfortable, private ensuite bedroom with all the comforts and conveniences you’d expect to find in your own home while you recover I Each inpatient bedroom has an ensuite bathroom and shower, satellite television, a direct dial telephone, free wifi and internet access and comfortable seating for your visitors I You will be able to access international TV channels including European, Arabic and Asian and have a selection of international newspapers delivered to your room

I You will enjoy delicious food prepared by our award-winning on-site chefs who come from five-star hotels I You will have tailored menu options that respond to any cultural and religious requirements and if there is a special dish you require we can prepare it for you I Flexible visiting times means friends and family can visit you at almost any time

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l Patients Discreet and professional service protecting your privacy All our hospitals and healthcare centres are fully compliant with the Data Protection Act 1998. All personal information is held in the strictest confidence and no information will be shared without your knowledge and consent. The Access to Health Records Act 1990 gives patients the right of access to medical information about themselves in manually held records made after 1 November 1991. Our hospitals and healthcare centres regularly host VIP guests, including local dignitaries and celebrities. Our highly skilled and professional team is experienced in protecting your privacy and ensuring your treatment is delivered with the utmost discretion.

Easy-to-reach locations All our world-class healthcare facilities are located in convenient locations close to London airports (Heathrow, Gatwick, Stansted, Luton and City) and major regional airports (Edinburgh, Glasgow, Manchester, Leeds, Birmingham, East Midlands and Liverpool).

We know that finding the right medical treatment abroad can be a challenge. That’s why our International Patient Team do all they can to ensure that choosing Aspen Healthcare is a simple and stress-free process.

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With you all the way

Parkside Private Hospital

Parkside Private Hospital supports people through the entire patient journey, from initial consultation and diagnosis, through to surgery or treatment and then follow-up care and rehabilitation, if needed.

Parkside Private Hospital is an award-winning independent private hospital located in Wimbledon, London. Providing medical services for 30 years, we pride ourselves on our high standards of clinical care and expertise, friendly atmosphere and continuing investment in facilities, technology and training.

Specialties include:

Parkside Private Hospital offers services to patients who require both elective and emergency surgical, medical and oncological treatments. We provide everything you would expect from an award-winning private hospital, offering consultations and treatments with our outstanding team with little or no waiting times.

I Gender Clinic

I Breast Surgery I Cancer & Oncology I Cosmetic Surgery I Dermatology I Diagnostic Imaging I Ear, Nose, Throat (ENT) I Gastroenterology I General Medicine I Gynaecology I Oral and Maxillofacial

Exceptional care

Accreditations

I Orthopaedics

At Parkside Private Hospital we work with more than 200 of London’s most experienced Consultants who hold senior posts within major NHS Teaching Hospitals. Many of these Consultants have both national and international practices and are leaders in their chosen fields. They are supported by a strong team of highly experienced and qualified nurses and allied healthcare professionals to ensure our patients always receive the highest possible standards of care.

I BUPA accredited Breast Cancer Unit

I Paediatrics

I BUPA accredited MRI Unit

I Plastic & Cosmetic Surgery

We have been inspected by the Care Quality Commission (CQC), the national healthcare regulator and rated as a ‘Good’ hospital. According to independent market research company Howard Warwick, 98% of patients would recommend Parkside Private Hospital to their family and friends and 99% of patients feel they have received quality care.

I BUPA accredited Haemato-oncology Unit I BUPA accredited Stem Cell Transplant Centre.

I Urology I Weight-loss Surgery

I WorldHost® Customer Care Training I AfPP Accreditation I UKAS Accredited Pathology Laboratory

Close to Central London Parkside Private Hospital is located in Wimbledon and is easily accessible from Central London and the Home Counties.

“...with my warmest thanks to all the staff for the wonderful treatment, in particular the nurses and physios during my knee replacement.” Mrs A.C, London SW14

To make an appointment, contact The International Patient Centre Team Telephone: +44 (0) 208 971 8013 Email: info@aspenlondonhospitals.co.uk parkside-hospital.co.uk

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Highgate Private Hospital

Located in the heart of North London, just steps from Hampstead Heath, Highgate Private Hospital is easily accessible from Central London and the Home Counties. We provide outstanding healthcare, working with more than 200 of London’s most experienced and celebrated Consultants, doctors and allied healthcare specialists. Quality assured

Accreditations

Highgate Private Hospital is committed to delivering the highest quality of patient care at all times. We have been inspected by the Care Quality Commission (CQC), the national healthcare regulator and rated as a ‘Good’ hospital, with our leadership recognised as outstanding.

I WorldHost® Customer Care Business Status

According to independent market research company Howard Warwick, 99% of patients would recommend Highgate Private Hospital to family and friends.

I Association of Perioperative Practice (AfPP) accredited for surgical care I LaingBuisson 2016 Healthcare Awards Finalist – Nursing Practice

Close to Central London Highgate Private Hospital is situated in North London and is very accessible to Central London.

“I have just come home from the best hospital experience with Highgate Hospital.... From the moment I arrived I was put at ease.” Ms R.B, February 2017

Committed to patient-centred care We recognise that coming into hospital can be a daunting experience but we are committed to making sure your time at Highgate Private Hospital is as easy, relaxed and comfortable as possible. We’re proud of our high standards of nursing care, friendly atmosphere and investment in medical technology, staff, training and facilities. Following the recent completion of our £17 million redevelopment and expansion programme, we offer a wide range of outpatient services and medical specialties to our patients including:

I Cosmetic Surgery

I Imaging & Diagnostics

I Ear, Nose & Throat (ENT)

I Orthopaedics & Spinal Surgery

I Gastroenterology I General Surgery I Gynaecology I Health Screening

I Pain Management I Physiotherapy I Urology

To make an appointment, contact The International Patient Centre Team Telephone: +44 (0) 208 971 8013 Email: info@aspenlondonhospitals.co.uk highgatehospital.co.uk

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Delivering high-quality holistic Cancer care

Cancer Centre London Established in 2003, Cancer Centre London is an awardwinning specialist oncology centre offering exceptional patient-centred cancer care and treatments. A recognised centre of excellence for cancer treatment, Cancer Centre London is registered to treat adult patients (18 years and older) who have cancer. Treatments include chemotherapy, radiotherapy, photodynamic therapy treatment and surgery.

At Cancer Centre London, we understand the difficulties patients and their families face when dealing with cancer. Our dedicated staff work together to provide a friendly and supportive cancer service, tailored to our each of our patients’ individual needs. We look after both the physical and emotional needs of our patients, before, during and after treatment by offering a wide range of holistic support services to patients and their loved ones. Support services include: I Cancer information centre I Counselling I Complementary therapies I Diagnostic imaging I Dietician

We treat a range of cancers, including: I Blood cancers

I Head and neck cancers

I Pain-management services

I Bone cancer

I Lung cancer

I Palliative care

I Breast cancer

I Neuroendocrine Tumours

I Pathology

I Cancer of unknown primary

I Skin cancers

I Physiotherapy

I Gastro-Intestinal cancers

I Urological cancers

I On-site pharmacy

I Gynaecological cancers

I Support groups

To make an appointment, contact The International Patient Centre Team Telephone: +44 (0) 208 971 8013 Email: info@aspenlondonhospitals.co.uk cancercentrelondon.co.uk

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Outstanding cancer care from an outstanding team At Cancer Centre London, our highly experienced Consultant doctors are internationally renowned and pioneering leaders in their medical specialty. They are specifically chosen for their expertise in delivering the highest quality cancer care and clinical outcomes. Our Consultant doctors are supported by our experienced and expert oncology nursing teams, radiographers, physicists, pharmacists, resident medical officers, healthcare assistants, outpatients team and hotel services team to deliver the highest quality care to our patients at all times. We combine this outstanding expertise with the latest medical and surgical techniques and advanced treatment programmes, and ensure our patients have access to the latest and most effective drugs, to deliver the most effective cancer care.

Quality assured Cancer Centre London has been inspected by the Care Quality Commission (CQC), the national healthcare regulator and rated as a ‘Good’ hospital and extremely responsive to its patients and their families.

Accreditations & awards I Caspe Healthcare Knowledge Systems (CHKS) accreditation (Cancer Standards) and ISO 9001:2008 certification I BUPA accredited Breast Cancer Unit I BUPA accredited Haemato-oncology Unit I Winner ‘Innovation in Technology’ Award 2015 LaingBuisson Healthcare Awards I Finalist ‘Healthcare Outcomes’ Award 2016 at the LaingBuisson Healthcare Awards I Macmillan Quality Cancer Environment (MQEM)Award I WorldHost® Customer Care Training certified

Close to Central London Cancer Centre London is located in Wimbledon and is easily accessible from Central London and the Home Counties.

“...many thanks for looking after me so brilliantly for six months. Your care, attention and professionalism were outstanding.” Mr C.W, London SW18

According to independent market research company Howard Warwick, 98% of patients said they received ‘excellent’, ‘very good’ or ‘good’ care.

To make an appointment, contact The International Patient Centre Team Telephone: +44 (0) 208 971 8013 Email: info@aspenlondonhospitals.co.uk cancercentrelondon.co.uk

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SPONSORED FEATURE

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SPONSORED FEATURE

Mr Colin Nnadi INTERVIEW

DEVELOPMENTS IN SPINAL SURGERY Leading Consultant Spine Surgeon Mr Colin Nnadi explains how recent developments in treating early onset scoliosis are easing the stress for children with the condition

Please tell us about yourself and your practice I am a Consultant Spine Surgeon with a specialist interest in paediatric spinal deformity. My private practice is at The Portland Hospital for Women and Children and my National Health Service practice is at the Oxford University Hospital. I've been in practice for over 10 years and one of my main interests is the treatment of early onset scoliosis (a condition which involves a curvature of the spine), in particular the magnetic growing rods that have revolutionised the treatment of children with the condition.

What is it like to work at the Portland Hospital and what facilities do you have?

New procedures and technologies are able to reduce the number of operations required for children with early onset scoliosis (PHOTO: HCA HEALTHCARE UK)

One of the great things about working at The Portland Hospital is the multidisciplinary nature and team approach of the service. I am part of a group of experts who regularly deal with children who have complex spinal conditions,

in addition to other serious medical problems. From my paediatric colleagues on the wards to the nursing staff in theatres, we have a very capable team supported with a state-of-the-art theatre facility that we use to treat these children. We also have specialist physiotherapy and children’s rehab teams supported by child psychologists and play specialists. A lot of these children are very ill and coming into hospital can be daunting. I think we are extremely lucky to have the holistic service that we offer at The Portland Hospital. It is the largest private purposebuilt children’s hospital in the UK that specifically deals with children’s problems, not just in spinal surgery but across the whole range of medical specialties. Throughout treatment there are interactions with the various members of the team before surgery, after surgery and all the way through to discharge. That is the sort of environment that I enjoy being part of, and one which I am sure families

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SPONSORED FEATURE

It’s about trying to make the hospital a home away from home

should expect to be the norm. What we are trying to provide is the ‘one-stop shop’ where children and their parents see different members of the team in as short a time period as possible, and where members of the team are in constant communication around the child’s care. By so doing, treatment is individualised to optimise time in hospital and make it a thoroughly enjoyable experience. There are parent facilities for overnight stays and we also encourage the children and families to engage with each other whilst on the wards. There are playroom facilities and common rooms where families can socialise and exchange experiences. It’s about trying to make the hospital a home away from home, so that both the child and their parents feel relaxed. As The Portland Hospital is in central London, families will often go sightseeing or shopping when the children have recovered from surgery and are well enough to go outside, which in itself is a psychological boost.

Your specialism has seen many advances over the last few years. What would you consider the most significant? Historically, the mainstay of treatment of scoliosis for children who failed conservative therapy, such as bracing, was surgery. Children with severe curves would have what we call a definitive spinal fusion. The difficulty with that was, if you fuse the spine at a very early age, then the child ends up with a short trunk and may run into problems with their respiratory function and breathing later in life.

Treatment then evolved into using growing rod systems. The principle was that you would insert these rods into the backs of these children to try and control the spinal curve, while at the same time lengthening the spine on a regular basis to keep up with growth. However, the big drawback was, to do this successfully, these children required repeated surgery; in some cases, if the rods were inserted very early, such as at the age of six, such children would have undergone between 10 and 20 operations by the time they were ready to have definitive surgery at the age of 12. As you can imagine, that is terrifying for any child and a huge burden on the family. In the past five to 10 years, the introduction of magnetic growing rods has meant that the surgical episodes for treatment of scoliosis in very young children have diminished considerably. There is one operation to insert the rod, with subsequent lengthening carried out remotely with a machine that allows the rods to be lengthened in clinic without the need for surgery. In this way, we can keep up with the growth of the child, lengthen the rods and control the curve without having to perform repetitive surgeries. All round, it's generally better for those children and their families and it is such an advancement on the treatment that had gone on beforehand. A lot of the pioneering work around the magnetic growing rods took place in the UK and I'm proud to have been a part of that process.

2 The Portland Hospital has a dedicated physiotherapy team to aid children with their rehabilitation after surgery | 3 Play facilities help children interact with each other and ease the stress of their treatment (PHOTOS: HCA HEALTHCARE UK)

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SPONSORED FEATURE

What future developments do you expect in your specialism? I think the future will see the proliferation of non-invasive growing rod technology. The next stage is to develop intelligent growing rod systems that ‘talk’ to each other so that, as well as determining the expected growth of the child, we can improve the accuracy of the lengthening process and better control the spinal deformities. There are also other growing rod systems, which we offer at HCA UK. There is the Schilla growing rod system, which again is a modification of the non-invasive growing rod technology; essentially, it's a telescopic growing rod system that requires one operation to insert the rods, and then the system grows with the child over a number of years.

method called the Schroth method, which combines physical therapy with breathing exercises. This technique takes into account the effect that the spinal curvature may have on the respiratory system, whereas conventional physiotherapy focuses on the trunk muscles’ core stability. This method is starting to gain traction in the United States and I think it will do so here in the UK.

4 The team at The Portland Hospital provide a complete and integrated service throughout a child's treatment and recovery (PHOTO: HCA HEALTHCARE UK)

Also, there are new bracing techniques that we offer at The Portland, which not only help to control the curve, but also provide the ability for in-brace correction. In effect, they are active braces that facilitate correction as well and will have an important role to play in the treatment of scoliosis.

From a non-operative point of view, physiotherapy has previously been used as a way of trying to control the spinal curvature, but there is an alternative

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Our paediatric team helps kids say …KAPOW!!! again.

Our paediatric consultants at The Harley Street Clinic and The Portland Hospital are amongst the very best. So, whether they’re toddlers or teenagers, in for a routine operation or a complex procedure, your child will be in safe hands.

Search: HCA Paediatric

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HCA Healthcare UK shares innovative paediatric healthcare solutions in Dubai

Senior doctors from HCA Healthcare UK participated in the third Latifa Hospital International Paediatric and Neonatal Conference, held in Dubai on 23-25 March 2017, to support healthcare industry stakeholders in the United Arab Emirates (UAE). Having already established their Middle Eastern headquarters in Dubai Healthcare City, HCA UK's senior consultants presented their innovative solutions at the conference, which hosted 11 sessions and eight workshops, focusing on various sub-specialties in paediatrics and neonatology. HCA Healthcare UK also had a stand at the event to share further information with visitors. “Our conference aims to unite clinicians, international and regional experts who will showcase latest developments and studies in paediatrics, paediatric surgery and neonatology fields,” explained Dr Mahmoud Saleh El-Halik, Head of Paediatric and Neonatology, Latifa Women & Children’s Hospital.

Senior consultants from HCA Healthcare UK – Dr Josu De La Fuente, Dr Robert Yates, Dr Sanj Bassi, Dr Simon A Clarke and Dr Stergios Zacharoulis – shared their knowledge and experience on paediatrics, paediatric surgery and neonatology. They highlighted issues in paediatric oncology, paediatric cardiology, paediatric neurosurgery, paediatric minimally invasive surgery, and blood and bone marrow transplant, among other challenges. “We are delighted to bring our experience and thought process to this conference and add value to the government authorities and other industry stakeholders in the UAE and the region,” said Andrew Coombs, Group Commercial Director, HCA Healthcare UK. “We are here at the conference to also understand the paediatric challenges faced by countries in the GCC and we would like to support and provide them with the right solutions at the right time.”

Aida Yousefl, CEO of The Harley Street Clinic and Portland Hospital, added: “The majority of childhood deaths result from preventable and reversible causes. The delay in recognition, late presentation and illness severity make the first 24 hours of hospitalisation the most vulnerable period. In addition to preventative care and nutritional support, the development of effective paediatric emergency and critical care services in GCC countries can substantially reduce mortality in children under five years. “Due to our close proximity, we aligned to support the cases in the UAE and are committed to bringing our most innovative solutions to the healthcare sector in the region, sharing knowledge to better paediatric patient outcomes all over the world. We would like to thank Latifa Hospitals for putting such an important conference together.”

“We are pleased to welcome experts from HCA Healthcare UK and other healthcare entities from across the globe. As medical practitioners involved in paediatrics, we all have a big responsibility for taking care of children. They are the future of any economy. It is our responsibility to protect them from a variety of risks, including, but not limited to, interruptions during pregnancy, genetic anomalies, perinatal injuries, congenital defects, malnutrition and environmental diseases.”

For more information, please visit: www.hcahealthcare.co.uk

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A chance to live a fuller life; to see every day in glorious high definition A world-renowned and thriving medical community. Prestigious establishments offering leading healthcare treatment. World-class surgeons and excellent outcomes. These are some of the reasons that people all over the world, and across the UK, choose to travel to London for their personal healthcare treatment. They want the best. And especially those seeking treatment for their eyes. The most precious of our senses, we cannot imagine life without vision, so when we are faced with a deterioration in our eyesight, perhaps due to the natural ageing process or due to an eye disease, only the best is good enough. Optegra Eye Hospital London is a unique hospital, found in the Harley Street medical

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district, as it focuses purely on eye health. As part of an international eye hospital group, it not only invests in the latest, safest and most efficient technologies, it also provides access to over 90 leading eye surgeons, and can treat the A to Z of eye health under one roof. Whether you are interested in vision correction, from laser eye surgery to lens replacement, or treatment for a condition such as cataract, glaucoma or age-related macular degeneration, Optegra has all the experts to hand. Every Optegra consultant is NHS-trained and a Fellow of the Royal College of Ophthalmologists (RCO). They are renowned in their field and completely committed to providing patients with first-class eye treatment; they have carried out thousands of surgeries.

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FLAGSHIP HOSPITAL Optegra’s Queen Anne Street hospital opened in 2016 and is truly considered a five-star environment as visitors step into the latest high-tech, fully equipped hospital in the Harley Street district. Patients say that its light, welcoming and contemporary setting relaxes them, with the feel of a luxury hotel rather than a hospital. Quality is apparent throughout the operating theatres, consultation rooms, waiting areas and patient pods, where patients are provided with their own dedicated spaces for the duration of their stay, both pre and post-operation.

WORLD-CLASS TECHNOLOGIES World-class eye care requires world-class technology. That’s why at Optegra you will find some of the most advanced equipment available. Optegra Eye Sciences works with the leading manufacturers and suppliers of ophthalmic equipment and instruments. It constantly monitors and assesses the quality and performance of the equipment to ensure that the very highest standards are maintained. One of the latest treatments available at Optegra Eye Hospital London includes third-generation laser eye surgery. SMILE is a bladeless, flapless, minimally invasive alternative to laser surgery. Considered the ‘keyhole surgery’ of laser, the technology means that the popular, 30-year-old laser eye techniques can, for the first time, be performed without creating a ‘flap’ on the surface of the eye. SMILE stands for SMall Incision Lenticule Extraction. It allows laser eye surgery with the smallest of holes – just 2mm wide – which naturally heals, leaving the surface of the eye stronger, and less at risk of future damage.

Treatments available at Optegra:

♦♦ vision correction to restore long and short sight ie laser eye surgery and lens replacement

♦♦ cataract and cataract refractive surgery ♦♦ cosmetic eyelid surgery to change how you look and also how much you can see:

♦♦ eyelid surgery (blepharoplasty)

♦♦ treatment of all medical eye conditions including: ♦♦ age-related macular degeneration (AMD) ♦♦ diabetic-related eye conditions ♦♦ floaters ♦♦ glaucoma ♦♦ keratinous ♦♦ retinal detachment ♦♦ stem-cell transplants

Another very popular treatment at Optegra is ClarivuTM lens replacement, which is a sophisticated development of cataract surgery, the world’s most frequently performed surgical procedure. Clarivu lens replacement surgery is a procedure where the natural lens of the eye is permanently replaced with an artificial intraocular lens (IOL). This proven procedure has been performed thousands of times and typically takes just 20 minutes per eye, and can lead to a life without glasses or contact lenses.

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RED FLAGS Many ignore the advice to have regular eye tests, believing there is no need, as their vision is fine. Yet one in 10 who have their eyes tested find out that their vision is not as strong as it can be, or indeed that they have an eye condition that needs treatment. Many conditions, such as glaucoma, do not have symptoms in their earliest stages, and yet treatment is more effective the sooner it begins.

Opticians and optometrists recommend the simple eye test as the one most important step to protecting your vision – even if you think your sight has not changed. There are also, however, certain ‘red flags’, changes in vision that should be considered warning signs of a potential problem. These include:

♦

Sudden loss of vision

♦

Blind spot or curtain across vision

♦

Double vision

♦

Flashes and floaters – dark shapes passing across vision

♦

Distorted vision

These ‘red flags’ could be signs of serious problems, so it is vital to be checked quickly by your local optician or optometrist.

HOW CAN OPTEGRA HELP YOU?

“Everyone makes you feel welcome and it was a lot easier than I thought it was going to be. The procedure was perfect really and now I think ‘What was I worried about?’. Before you know it, it is all done and you have perfect vision!” – Judd Trump, world number-three snooker champion, had laser eye surgery at Optegra Optegra Eye Hospital London can be found at 25-27 Queen Anne Street, London W1G 9HT. Whether you are considering medical, cosmetic or vision-correction treatment, book your personal one-to-one consultation for an initial examination of your eyes and to find out how our ophthalmic experts can support you. You will meet your personal surgeon from the outset and hear their recommendations for your individual case.

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Optegra also regularly hosts open evenings, offering a chance for you to tour the hospital and experience its tranquility and professionalism at first hand; ask your questions and meet the surgeons.

For more information, please visit optegra.com or phone 0808 159 9580

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£5

CORRE

ON SUR

OFF

LENS REPLACEMENT SURGERY

OFF VIS

£500

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Bringing the best in healthcare from around the world to address local needs is the raison d'être of Dr Ajay Rajan Gupta’s Indo UK Institute of Health (IUIH) – an outstanding example of how London's medical expertise is being employed internationally EXPORTING EXPERTISE

PARTNERS IN HEALTHCARE In a joint statement on 12 November 2015, the Prime Ministers of India and the UK announced a historic Health Collaboration Agreement for setting up Indo UK Institutes of Health (IUIH) in 11 Indian states to bring world-class, affordable, accountable healthcare to the masses. This project, the largest of its kind between two governments – UK and India – involves an investment of over £1 billion into Indian healthcare.

It is supported by the Indian Government's Ministry of Health and Family Welfare, and Invest India, the national investment facilitation agency for India – an initiative of the Department of Industrial Policy and Promotion (DIPP), Ministry of Commerce and Industry. A bilateral India and UK task force involving government representatives is helping to drive the initiative forward. “We are accountable to both the Indian and UK governments, who are continuously monitoring the progress we are making,” informs Dr Ajay Rajan Gupta, Group MD and CEO, IUIH.

“If we desire to do something for India, the time is now, for we have a progressive Prime Minister at the helm. It is his dynamism and vision that drove me to think of this venture,” he adds. The foundation stone for the first IUIH Medicity was laid by the Honourable Chief Minister of Maharashtra, Mr Devendra Fadnavis, in Nagpur on 13 August 2017. Almost immediately after this, the Honourable Chief Minister of Andhra Pradesh, Mr Nara Chandra Babu Naidu, laid the foundation stone for IUIH’s second Medicity in the new state capital Amaravati on 16 August 2017. In fact, IUIH has tied up with Larsen & Toubro and commenced the construction of its Nagpur Medicity on 15 December 2017, within four months of the foundation stone being laid. “The first phase of the Nagpur Medicity shall be operational by 2019,” says Dr Gupta. Besides Maharashtra and Andhra Pradesh, IUIH will be building more Medicities in Telangana, Punjab, Gujarat, Rajasthan,

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Karnataka, Uttar Pradesh, West Bengal, Madhya Pradesh and Haryana. Each IUIH Medicity shall have seven distinct yet connected zones. The Healthcare Delivery Zone will house a 1,000-bed NHS (UK National Health Service)-branded hospital with Trauma Centre, day surgery centre, NHS e-Health centre etc. The Education and Training Zone will comprise a medical college, nursing college, PG academy and a training facility for allied health professionals. The Clinical Support Services Zone shall have centres for diagnostic imaging, pharmacy, pathology laboratories, medical supplies, blood bank etc. Meanwhile, the Medical and Technology Zone will accommodate medical device/equipment manufacturers, pharmaceutical production and healthcare technology companies including IT service providers. The Research and Development Zone will incubate healthcare start-ups and have centres for big data analytics, as well as medical supplies development. Cutting-edge medical research shall be conducted here, forming the IUIH Medicities Centres of Excellence in different domains such as genomics, stem cells, translational research etc. The Commercial Zone will have a hospital hotel to facilitate patients and those accompanying them, including a nursery, wellness centre and retail area. “The objective is to make every IUIH Medicity a medical tourism hub and attract patient traffic from across the globe. NHSstandard healthcare at lower price points is our winning formula to tap the medical tourism business potential. This shall not just contribute to the exchequer, but lead to overall development of the region, too, in line with the government’s Smart Cities initiative. The Administration Zone, besides the office area, will have house transport facilities and a helipad for air ambulance. According to Dr Gupta, “The NHS has been ranked the number-one health system by the Commonwealth Fund, a US think tank, in comparison with health systems of 11 countries – including US, Canada, Australia, France and Germany – when it comes to safety, affordability and efficiency. What gives us immense satisfaction and pride is the fact that the masses in India shall have ready access to what’s globally best and at prices they can afford. Besides this, the fact institutions of

global repute and legacy, such as King’s College Hospital London, are setting up operations in India is in no way is a small feat. The first two IUIH Medicities in Nagpur and Amaravati are being developed in association with King’s College Hospital.” IUIH has tied up with leading implant companies – including Stryker, Medtronics, Zimmer Biomet and Johnson & Johnson – and leading medical equipment companies, such as Toshiba, GE Healthcare, Philips and Canon. Many of these will start their manufacturing operations in IUIH Medicities in accordance with Prime Minister Modi’s ‘Make in India’ programme, further bringing down healthcare costs for patients in India. Elaborating further, Dr Gupta says, “We have cemented tie-ups with global leaders such as IBI for design of the Medicities, Cushman & Wakefield as project managers, PwC as fund advisors, KPMG as tax advisors and auditors, and EY as programme assurance partners. We are also relying heavily on technology and have a tie-up with IBM for big data analytics. Our e-Health and m-Health platforms will facilitate the exchange of patients’ medical records electronically using telemedicine, tele-radiology and tele-pathology for diagnostics etc. Our partnership with Google and other technology service providers will enable delivery of these advanced services. It’s all about covering the last mile and taking healthcare services to the patient’s doorstep.”

1 Narendra Modi, Prime Minister of India, announced the Health Collaboration Agreement with his UK counterpart in 2015 | 2-3 Ceremonies for the laying of foundation stones in Nagpur and Amaravati (PHOTOS: IUIH)

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Packages that combine medical care with travel and convalescence arrangements are growing in popularity and cementing London’s status as a leading destination for medical tourism YOUR STAY IN LONDON

PLANNING YOUR TRIP World-renowned for its exceptional healthcare, London is proving to be hugely attractive for those seeking specialist health services. The city has long stood out in the medical sector in terms of quality and professionalism – a fact that is encouraging a steady flow of international patients. But it is not just for hospital stays that these patients are coming to London. The city is witnessing a boom in its medical tourism sector as patients arrive from around the globe not only to make the most of London’s unrivalled private medical services, but also to enjoy the sights, sounds and tastes of one of the most famous cities in the world. This upward trend did not go unnoticed, and since 2016 the Harley Street Medical Area – renowned since the 19th century as a hub for private specialists in medicine and surgery – has been spending many millions of pounds improving existing buildings and

erecting new ones, as well as carrying out comprehensive refurbishments. The aim is to attract both new clinics and new medical tourists to the location.

International prestige According to research by Paola Putzolu, winner of the 2016 Tourism Management Institute Postgraduate Prize, “medical tourism in the city is able to attract an exclusive market with peculiar characteristics. London is the only medical hub in the world that has the highest concentration of medical professionals in a radius of few miles. This characteristic contributes to its uniqueness and attracts not only the most renowned medical professionals in the world, but also an upper-class market seeking highly specialised and technological medical care. It is essential to reinforce the London brand as a medical tourism hub.” In part due to increased international competition in the private medical sector, London is working to improve its offering

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with a range of extensive and diverse packages to suit every patient. New tour companies are providing comprehensive packages that include a broad range of services. These ‘medical concierge’ companies assist international patients in navigating the UK health system and make travel to and around the city as smooth and manageable as possible. Such companies include London Medical Concierge, which personalise its services to each patient’s needs, from researching and contacting leading experts and consultants to providing the latest information on clinical trials. The services are inclusive and available to everyone, from those seeking a second opinion on an oncology diagnosis to acne sufferers seeking an appointment to explore their options. London Medical Concierge was created by CEO and founder Kirsty Ettrick, who spent countless hours searching for experts, treatments and options when

her husband was diagnosed with a complex and aggressive cancer. “I began to realise that guiding people to the right medical expert and treatments was something I was passionate about doing,” she wrote in an article for the Huffington Post. “I set about building a network of experts who were highly regarded in their clinical fields as a ‘backbone’ of a new venture.”

Medical concierge services in London are expanding, taking in the esteemed hospitals, practitioners and clinics of the Harley Street Medical Area (PHOTO: THE LONDON CLINIC)

Ettrick says that medical concierge services are often wrongly perceived as a product for the rich and elite, but “when a member of your family or a close friend receives a devastating diagnosis, you need answers, quickly and at an accessible cost, which is something we are now able to provide”. Today, there is a range of concierge services to choose from. Harley Street Cancer Concierge, for example, aims to make finding the right cancer care simpler, more efficient and less distressing. Many cosmetic surgery practices also now offer VIP concierge services, arranging travel and

hotel stays in London, as well as meetings with your surgeon before a procedure and post-surgery visits to your hotel room to monitor the healing process.

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As one of the world's most vibrant and historic cities, London has no shortage of things to do and sights to see for visitors and their families YOUR STAY IN LONDON

EXPLORING THE CITY The metropolis of London has evolved over centuries. Originally a small walled city, it has emerged as an expansive urban hub. Today, London is the biggest city in Western Europe, a melting pot of cultures that blend together to make London a thriving international centre. Covering a vast area and with influences from all around the world, the city offers plenty to explore and experience, from some of the world's most recognisable landmarks to lesser-known areas that reveal different aspects to this diverse destination.

Lush green parks are a distinctive feature of London, which has more parkland than any other capital. These sanctuaries within the city include the eight Royal Parks, which between them cover more than 5,000 acres.

Another of the Royal Parks, Kensington Gardens, is situated behind Kensington Palace, a residence of the royal family since the 17th century. Its State Rooms are open to the public and the palace also hosts a range of exhibitions. St James’s Park is London’s oldest park and the site of the Blue Bridge, from which you can enjoy spectacular views across the lake to Buckingham Palace – home of Her Majesty Queen Elizabeth II.

Regent’s Park, just north of Harley Street, boasts the capital’s largest grassed area for sports and is home to the worldrenowned ZSL London Zoo. In Hyde Park,

Those seeking the two largest of the Royal Parks need to venture to the outskirts of the city. Richmond Park – the largest urban parkland in Europe – and Bushy

The Royal Parks

The Millennium Bridge leads across the Thames to St Paul's Cathedral, one of London's most famous and recognisable sights (PHOTO: JOHN KELLERMAN / ISTOCK)

visitors can take in famous landmarks including the Serpentine lake, Speakers’ Corner and the Diana, Princess of Wales Memorial Fountain. From mid November, the south-east corner of the park is transformed into Winter Wonderland, home to the UK’s largest open-air ice rink, seasonal shows, festive markets and more than 100 rides and attractions.

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Those with an appreciation for architecture will be captivated by Covent Garden, home to a bustling piazza and an elegant Market Building.

Park, close to Hampton Court Palace, are both havens for wildlife, including deer.

London is a fascinating city that is easy to explore on foot

This entire area comprises London's famed West End, a concentration of the city's major tourist attractions, shops and amusement venues. The West End is best known as London's 'Theatreland' district, with 40 venues staging globally acclaimed productions. Cavernous theatres and more intimate venues sit alongside historical landmarks, restaurants and galleries. From Piccadilly Circus, visitors can take a five-minute walk to the Royal Academy of Arts, an artist-led institution hosting prominent exhibitions.

Though sprawling, London is a fascinating city that is easy to explore on foot. From Harley Street, take a 15-minute stroll to Mayfair, setting for some of the country’s finest shops and restaurants, including London's largest concentration of five-star hotels. From here, visitors can make the short journey towards Oxford Street – a shoppers' paradise – and beyond to Soho.

South of Soho is Trafalgar Square, home to Nelson's Column – a monument commemorating Admiral Horatio Nelson, who died in the 1805 Battle of Trafalgar – its iconic stone lion statues and the Fourth Plinth, which features a rolling programme of temporary artworks. Art lovers will also enjoy the National Gallery, which houses one of the world's greatest collections of paintings.

Having shaken off a seedy past, Soho today is London’s playground – a square mile bounded by Oxford Street to the north, Regent Street to the west, Piccadilly Circus to the south and Shaftesbury Avenue, Covent Garden and Leicester Square to the south-east. It is home to an eclectic mix of eateries, boutiques and nightlife options, including music venues catering to all tastes.

Many of London’s arts and historical attractions are free to visit, including the National Gallery; Tate Modern, Britain’s national gallery of international modern art; Tate Britain, home to a collection of British art from 1500 onwards; the British Museum in Bloomsbury, which is dedicated to human history, art and culture; the Museum of London, where you can learn about the city’s history; and the National

2 London's Royal Academy of Arts hosts world-class exhibitions (PHOTO: STEPHEN CHUNG / ALAMY) | 3 The annual tennis championships at Wimbledon attract sports fans from all over the world (PHOTO: SALLY ANDERSON SPORT / ALAMY) | 4 Guardsmen march past Buckingham Palace, which opens its doors to the public in the summer (PHOTO: PETER PHIPP / TRAVELSHOTS.COM / ALAMY)

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Portrait Gallery, housing a collection of portraits of historical figures and famous people. To the west, in Kensington, visitors to the Science Museum and the Natural History Museum can experience interactive exhibitions and unique collections. London's most-visited landmarks include Westminster Abbey – one of the world's great churches – Big Ben, the Houses of Parliament and the London Eye. As the River Thames snakes east, it reaches the Southbank Centre – Europe’s largest centre for the arts. On the opposite bank is Somerset House, which stages outdoor concerts and film screenings in its impressive courtyard in the summer, and an ever-popular ice rink during the winter months. Beyond the Millennium Bridge on the south bank of the river is Shakespeare’s Globe, a reconstruction of a 17thcentury theatre where audiences of up to 1,400 spectators can see the Bard's plays re-enacted in an open-air setting.

Where old meets new The historic City of London – known as the Square Mile – is the heartland of London’s trading and financial services industries, featuring a unique blend of old and new that sees centuries-old buildings standing in the shadows of

gleaming modern skyscrapers. Standing serenely amid the City's daily bustle is St Paul’s Cathedral, the seat of the Bishop of London and a Grade-I listed building. The cathedral dates from the 17th century and is one of London's most famous and recognisable sights. Within the City, visitors can take in The View from the Shard – a panorama offering 360-degree views up to 40 miles – and the Gherkin, an iconic structure at the heart of London’s financial district. Venturing east will lead to the Tower of London, which houses the Crown Jewels, and the iconic Tower Bridge.

Head further along the Thames for the O2 arena and exhibitions, leafy Greenwich Park, the National Maritime Museum and the Royal Observatory – location of the prime meridian. Although London is a year-round tourist destination, many choose to align their visit with the city's cultural and sporting events. The All England Lawn Tennis Championships take place at Wimbledon in early July, attracting fans from all over the world. Another popular summer attraction is the Proms – an eight-week programme of mostly classical music concerts and events held in the Royal Albert Hall, Cadogan Hall and the Royal Parks.

5 One of the world's most famous structures, Tower Bridge looks even more spectacular at night, flanked by the city's skyscrapers, including its tallest – the Shard (left) (PHOTO: ULTRAFORMA / ISTOCK) | 6 The Natural History Museum houses 80 million specimens, including some collected by Charles Darwin (PHOTO: EYE35 / ALAMY)

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London’s has a reputation for providing some of the finest hospitality anywhere in the world, offering a wealth of top-class options for those staying and dining in the city YOUR STAY IN LONDON

THE HEIGHT OF HOSPITALITY Visiting London for treatment doesn't have to mean missing out of the finer things in life. While in the city, patients and their families can indulge in the luxurious surroundings of some of the world's most famous hotels, as well as taking the opportunity to sample the best in fine dining at the capital's leading restaurants.

High-quality hotels Central London has a wide selection of top-class hotels to choose from, most of which are within close reach of leading hospitals and clinics, including those in the Harley Street area. The Langham London is a five-star hotel that has been hosting guests since 1865, when it was opened by the Prince of Wales (who later became King Edward VII). The opulent building is within a five-minute walk from Harley Street (and Oxford Street shopping district in the other direction). Boasting the title of Europe’s first Grand Hotel, The Langham underwent a refurbishment of most of its luxurious

rooms and suites only two years ago. Its attractions include the Palm Court restaurant, Grand Ballroom and, most recently, The Wigmore – a modern British tavern serving reinterpretations of classic pub cuisine. The Langham also boasts Europe’s first Chuan spa. In English, ‘Chuan’ translates as a serene course of water, which in Chinese culture is considered to be the source of life and balance. The spa offers a luxury haven in the heart of London with a philosophy built on the values of traditional Chinese medicine. South-west of The Langham is Park Lane, which sits along the eastern boundary of Hyde Park and is surrounded by greenery. The street is renowned as being one of the most fashionable places to live in London, and luckily for those just visiting the city, it is also one of the best places to stay. Situated here is the Four Seasons Hotel London at Park Lane – a five-star, chic hotel offering high-style dining and a skilled concierge team and featuring a

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1-3 The luxurious interior of the Langham, which has hosted guests for more than 150 years (PHOTO: LANGHAM HOTEL)

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glass-walled rooftop spa and lounge. Another five-star option is the London Hilton on Park Lane, providing all the sumptuous extras that have come to be associated with the group. Further along the street is 45 Park Lane, a contemporary five-star hotel that is part of the Dorchester Collection. In addition to well-appointed rooms and suites and world-class dining, 45 Park Lane hosts a programme of art exhibitions that opened with an impressive showcase of art by 10 of Britain’s leading artists throughout the hotel. Other five-star hotels in the area include the Sheraton Grand London Park Lane, a celebrated and comfortable Art Deco hotel, and Grosvenor House Hotel, a JW Marriott hotel featuring newly renovated guest suites and unparalleled services. 4-5 Park Lane's premier hotels include The Dorchester and the London Hilton Park Lane (PHOTOS: SHUTTERSTOCK)

Fine dining The quality of London's leading hotels in matched by the standard of its best

restaurants, and Michelin-starred dining experiences are abundant. Alyn Williams at the Westbury offers a seven-course vegetarian tasting menu alongside meatier options, while Amaya in Belgravia serves up pan-Indian tapas. Tamarind of Mayfair was one of the first Indian restaurants in the world to win a Michelin star, and today the eatery upholds its reputation for serving world-class Indian cuisine. The dining room is accessed down a dimly lit staircase, at the bottom of which diners will find an intimate space that lends itself well to the rich flavours of diverse and vibrant contemporary Indian cuisine. Two-Michelin-starred restaurants include Dinner by Heston Blumenthal, serving up futuristic fare; Greenhouse in Mayfair with its modern French cuisine; Le Gavroche, which, according to London’s Time Out, offers “unapologetically old-school fine dining” complemented by an impressive wine list; and Umu, which impresses with its polished decor and service.

AFTERNOON TEA, ANYONE? London is the ideal place to partake in the very British tradition of afternoon tea, which was popularised in the 1840s by the Duchess of Bedford. Served at around 4pm each day, the modern ritual of afternoon tea involves sitting down for a luxurious light meal of sandwiches, scones and cake, served with a pot of tea. Today, many of London’s most esteemed dining establishments invite guests to indulge in afternoon tea amid suitably elegant settings. On Piccadilly, the Ritz offers 18 different types of loose-leaf tea to accompany finely cut sandwiches, fresh scones, pastries and teacakes. Claridge’s in Mayfair has its very own tea connoisseur, who carefully selects teas from around the world to complement the food. Serving afternoon tea since 1865, the Palm Court at the Langham offers guests a bespoke version of the afternoon tea tradition, while at Fortnum and Mason, afternoon tea is taken in the Diamond Jubilee Tea Salon – an oasis of tranquility in the Piccadilly store. CATH HARRIES / ALAMY

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London is also home to a smattering of restaurants proudly boasting three Michelin stars. Alain Ducasse at the Dorchester is frequented by London’s elite, who enjoy exquisite French fare in a traditional setting, with the central table Lumière offering private dining behind a fibreoptic curtain. Meanwhile, the Gordon Ramsey restaurant in Chelsea serves up an inventive menu in an elegant setting.

to enjoy cuisine from all corners of the world, and for those wishing to stay close to Harley Street there is plenty on offer. Portland Restaurant takes its culinary inspiration from the freshest ingredients and decides on its menu daily, based on the finest fresh produce that is delivered by their trusted suppliers each day. Just a three-minute walk from Harley Street, diners can expect great food and excellent service.

Global cuisine Beyond the award winners, there is a vast array of delectable dining experiences to be found on the city's streets. Being an international city, London’s food scene is globally competitive, with diners able

Also a three-minute walk away is Picture Marylebone, a restaurant specialising in modern European food. Diners can expect a wide selection of dishes that change weekly and a fairly priced menu.

6 London has no shortage of fine dining, with culinary creations from Michelinstarred chefs including Michel Roux Jr at Le Gavroche (PHOTOS: JIM DYSON / GETTY IMAGES)

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London is an essential shopping destination, offering visitors a unique retail experience with its wealth of world-famous stores and iconic brands YOUR STAY IN LONDON

PARADISE FOR SHOPPERS London is a haven for those who love to shop and the city is famous for its illustrious emporiums – the big-name department stores to which visitors from around the world flock. One such store is Harrods. With more than a million square feet of retail space, the luxury department store is recognisable for its signature green bags and extravagant offerings. Yet this is no exclusive club; the store’s motto is ‘Omnia Omnibus Ubique’, which is Latin for ‘all things for all people, everywhere’ – a notion reflected in the visitor numbers it attracts. Every year, more than 15 million people pass through the doors of the Knightsbridge store.

agents. Its famous pet department closed in 2014 after nearly 100 years, during which time – and before the 1976 Endangered Species Act came into force – it sold exotic animals such as tigers, camels and alligators! Today, Harrods stretches over seven floors and stocks goods from the ordinary to the exquisite. Visitors can sample food produced by internationally acclaimed chefs in its restaurants and cafes, and the store frequently stages exhibitions and shows. Known for its grandeur, the store's palatial exterior and the baroquestyle dome are instantly recognisable.

Oxford Street

The brightly lit exterior of Harrods in fashionable Knightbridge is one of the best-known sights in London after dark (PHOTO: CHRIS DORNEY / ISTOCK)

Harrods had humble beginnings. Established in 1849 by Charles Henry Harrod, the store was comprised of a single room selling tea and groceries. Steady expansion saw Harrods evolve into a thriving department store, and in the following years it became a public company with its own bank and estate

From Knightsbridge, visitors can make the short journey north to Oxford Street, home to Selfridges department store. Like Harrods, Selfridges boasts a regal exterior, identifiable by its towering stone columns and intricate, ornate clock. Yet inside, the store nods to modernity, with glossy surfaces and more accessible

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2 Inside Selfridges' flagship store on Oxford Street – one its four UK outlets (PHOTO: NEWSCAST ONLINE LIMITED / ALAMY)

3 Hamleys toy shop on Regents Street is a must for families with children (PHOTO: INCAMERASTOCK / ALAMY)

4 Designer brands abound in the boutiques of New Bond Street (PHOTO: CHRIS BATSON / ALAMY)

product lines for younger customers. Selfridges boasts the largest women’s and men’s shoe departments in the world, and across all product ranges it aims to suit a variety of tastes and budgets.

brands and exclusive designer products. Fashion items, fine jewellery, art and antiques are all available, and, since its founding in 1700, the street has become synonymous with the rich and famous.

As with Harrods, Selfridges is all about the experience. From DJs spinning tracks to live cookery demonstrations and fashion shows, the store is a hive of activity. Famed for creating some of the most imaginative window displays in London, customers visiting during seasonal periods will be wowed by the creativity on display.

Designer brands including Bulgari, Burberry, Chanel, Louis Vuitton, Mulberry and Ralph Lauren all call Bond Street home, and such prestigious labels come together to offer a unique blend of style, history, elegance and opulence. The area is a playground for celebrities, socialites and the wealthy, and shopping is not the only activity on offer – it also houses some of the world’s leading and best-known hotels and restaurants, including Claridge’s and The Ritz, where

Not far from Oxford Street is Bond Street, a thoroughfare in historic Mayfair revered for its elegant stores, luxury

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5 Liberty on Great Marlborough Street specialises in luxury goods, from fashions to fragrances (PHOTO: STEVE VIDLER / ALAMY)

visitors can enjoy a traditional English afternoon tea in luxurious surroundings. Other big-name emporiums in London include Hamleys, the world’s oldest and largest toy shop. The Regent Street store is set over seven floors and sells more than 50,000 toys. Iconic stores Harvey Nichols, Fortnum & Mason and Liberty can all be found nearby on the tourist trail.

Tax-free shopping As well as being lured by London’s exemplary stores and products, visitors from abroad might also be tempted by possible eligibility for a valueadded tax (VAT) refund. VAT is a 20% sales tax levied on most goods and services, excluding basic food items, books and children’s clothing. By law, restaurants must include VAT in their prices. However, some overseas visitors are exempt from paying VAT.

The VAT refund scheme is called the Retail Export Scheme or Tax-Free Shopping. To qualify for a VAT refund, you must have spent fewer than 365 days living in the UK out of the two years prior to making the purchase, and you must be leaving the European Union for at least 12 months within three months of making the purchase. Not all retailers participate in the scheme, and stores have varying minimumpurchase conditions. In participating shops, and if your purchase qualifies, you can request a VAT 407 form in store. You must present this with the goods and receipts to customs when you depart the UK. VAT-free goods must be declared, and therefore cannot be shipped home. Customs will certify the form, and the form should then be returned to the shop for a refund. An administration or handling fee will usually be deducted, and the refund takes around eight to 10 weeks to be processed.

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Breaking down the barriers to employment At Kennedy Scott, we have spent the past 28 years understanding and supporting people for whom getting up and going to work every day is just a distant memory or a long-held dream, working with government and employers to bring people with health and disability challenges into the workplace.

Teresa Scott OBE, CEO of multi-award winning employability services consultancy Kennedy Scott, explains how her company helps government and business to remove obstacles preventing people with disabilities and health issues from finding work

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Our work has included helping the UK Government design new integrated programmes for people with disabilities, illness or mental health challenges, working collaboratively with local healthcare services to prevent this vast source of talented people from being lost to the UK workforce. On a local level we have supported thousands of people. Every day, in their delivery of the UK Government’s highly successful Work Programme and National SES Programme, our caseworkers meet people who have complex barriers to employment. Contrary to their image in some sections of the media as ‘scroungers’, these unemployed people want to work, but are struggling to overcome issues such as low self-esteem, anxiety or depression, brought on by a physical illness, accident or conflict injuries, responsibilities as a carer or having dependents compounding the problem. With the right specialist help and small adjustments within the workplace, these people are no longer condemned to an endless cycle of benefits, poverty or unemployment. Employers are thus able to choose from a wider pool of committed and talented individuals who, for instance, happen to be in a wheelchair, suffer from learning difficulties or encounter mental health challenges.

Using a bespoke and customised assessment process called KSIS, hailed as revolutionary by the UK Government, Kennedy Scott’s highly trained national team of caseworkers, employer account managers and facilitators quickly identify the real issues affecting an individual’s rehabilitation. Subsequently, they work together to simultaneously address all of their barriers, creating a unique ‘circle of support’ around the individual that increases their resilience to future setbacks, sustaining them into work and beyond.

EXPANDING THE TALENT POOL

Employers, particularly those in the UK, are searching an ever-diminishing pool of talent to meet their organisations’ demand for growth, but this need not be the case any longer. Around the world, more disabled people than ever are successfully

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SPONSORED FEATURE

overcoming their individual challenges to secure and thrive in worthwhile jobs or return to a previous career. Employers worried about perceived difficulties in the future may initially be reluctant to take on staff they consider could be a liability in the future. However, in my experience, such fears invariably prove unfounded. Many years ago I employed, at director level, someone who told me at her interview that she had multiple sclerosis. I respected her honesty, which meant we could pace her workload and offer flexible working so that any medical appointments were taken in non-working time. As a worker she always gave 100%, worked long hours and became a great manager who developed other younger members of staff. She was quite simply a committed, reliable, professional, passionate director, who took no more days of sick leave than any other member of staff. Employers are missing a huge opportunity in not recruiting people with disabilities or health challenges. With assistance and support from specialists, they can very quickly adapt their businesses or working environment to embrace a wider pool of talent.

ADVICE AND GUIDANCE

Employers benefit from the advice and guidance that our account managers can provide on the minor adjustments that might be necessary to accommodate a new member of staff. In many cases, we can advise on the application for Access to Work, which provides further

support for the individual, should they require specialist equipment or support with travel arrangements during their first few weeks of employment. Kennedy Scott also acts as a post-treatment support network for those recovering from illnesses such as cancer. We offer a consultancy service to help people or overseas governments put an individual’s well-being at the centre of their treatment and rehabilitation, which can increase their chances of a successful outcome. Tailored, customised, multidisciplinary, wraparound support provides cancer patients, well enough to return to work, with a much-needed phased return to the workplace. It gives employers a helping hand with advice and guidance on the local support network available to both employer and customer. With the right help and advice, employing a person with a disability, anxiety or depression can be carefully navigated to benefit all involved and enrich the workplace.

Kennedy Scott – Head Office Enterprise House Beeson's Yard Bury Lane Rickmansworth WD3 1DS Tel: 01923 712 817 Fax: 01923 712 849 Email: info@kennedyscott.co.uk

www.kennedyscott.co.uk

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London has a world-class reputation for medical excellence. Increasingly, overseas patients have been discovering the benefits of visiting the UK’s capital city for treatment at internationally renowned private hospitals and clinics. Healthcare in London highlights the expertise, specialist treatments and procedures, technology and facilities that are available to today’s medical tourists. Contributions from leading consultants and medical experts provide an essential guide for potential patients considering medical care outside their own country. As well as focusing on London’s private healthcare facilities, Healthcare in London also highlights the many attractions that visitors can enjoy during their stay in the capital – from must-see tourist destinations to the best hotels, restaurants and shopping experiences.

www.senatepublishing.co.uk +44 (0) 20 7723 9825 info@senatepublishing.co.uk