Healthcare in London: Second Edition by Senate Publishing Limited

HEALTHCARE IN LONDON HEALTHCARE IN LONDON: SECOND EDITION – 2019

SECOND EDITION – 2019

HEALTHCARE IN LONDON SECOND EDITION – 2019

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 Printed by Masar Printing and Publishing | Cover image credits: Justin Kase/Alamy, Hero Images Inc./Alamy © 2019. The entire contents of this publication are protected by copyright. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher. The views and opinions expressed by independent authors and contributors in this publication are provided in the writers’ personal capacities and are their sole responsibility. Their publication does not imply that they represent the views or opinions of Senate Publishing and must neither be regarded as constituting advice on any matter whatsoever, nor be interpreted as such. The reproduction of advertisements in this publication does not in any way imply endorsement by Senate Publishing of products or services referred to therein.

HEALTHCARE IN LONDON: SECOND EDITION – 2019

CONTENTS INTRODUCTION

LONDON WELCOMES THE WORLD Lord David Evans of Watford

CHOOSING LONDON FOR HEALTHCARE

AN ABUNDANCE OF TREATMENT OPTIONS

LEADING THE WAY IN MEDICINE Dr Nick Plowman, Clinical Oncologist

HERITAGE BUILDINGS, 21ST CENTURY HEALTHCARE The Howard de Walden Estate

BUPA CROMWELL HOSPITAL

ONCOLOGY

WORLD-LEADING CANCER TREATMENT The Royal Marsden Private Care

IMMUNOTHERAPY TO TREAT CANCER | HCA Healthcare UK

DEALING WITH BREAST DISEASES Mr Ragheed AM Al Mufti, Consultant Breast Surgeon, King Edward VII’s Hospital

COST-EFFECTIVE PROTON THERAPY | Advanced Oncotherapy plc

POSITIVE STEPS IN PROTON THERAPY Nicolas Serandour, CEO Advanced Oncotherapy plc

NHS PRIVATE PATIENT UNITS

DRAWING ON THE EXPERTISE OF THE NATIONAL HEALTH SERVICE | Sir Robert Naylor

CLINICAL EXCELLENCE IN THE HEART OF LONDON Guy's and St Thomas' Private Healthcare

ROYAL FREE LONDON PRIVATE PATIENTS

PUTTING RESEARCH INTO PRACTICE | Imperial Private Healthcare

PIONEERING HEART AND LUNG CARE Royal Brompton & Harefield Hospitals Specialist Care

ROYAL FREE LONDON PRIVATE PATIENTS: HADLEY WOOD

EXCELLENCE AND INNOVATION

ADVANCES IN PROSTHETICS | Mr Norbert Kang and Mr Alex Woollard, Consultant Plastic Surgeons, Royal Free Hospital

WORLD-LEADING CARDIAC CARE | HCA Healthcare UK

A FULFILLING CAREER IN MEDICINE | Julius Patrick, Senior Clinical Physiologist, Bupa Cromwell Hospital

INNOVATIONS IN TREATMENT FOR MULTIPLE SCLEROSIS HCA Healthcare UK

DEALING WITH LIVER DISEASE | Mr Charles Imber, Consultant Surgeon, Royal Free Hospital

SWIFT SOLUTIONS FOR BETTER VISION | Mr Alex J Shortt, Consultant Ophthalmic Surgeon, Optegra Eye Hospital London

IMAGING REIMAGINED | Michael Bradfield, CEO Fairford Medical

YOUR STAY IN LONDON

MEDICAL CONCIERGE SERVICES

100

LONDON'S ATTRACTIONS

108

HOTELS AND HOSPITALITY

112

A PERFECT LOCATION FOR RETAIL THERAPY

PHOTOS:

1 JANINE WIEDEL PHOTOLIBRARY/ALAMY 2 CURTSEYES/ALAMY 3 TAMAS GABOR/SHUTTERSTOCK

INTRODUCTION

Lord David Evans of Watford

LONDON WELCOMES THE WORLD It is my great pleasure to welcome you to the second edition of Healthcare in London, which casts a spotlight on the world-class range of private healthcare options available to visitors to the UK’s capital. Following the success of our previous publication, we are pleased to feature an even wider selection of London-based hospitals and clinics, each highlighting the top-quality treatments and facilities they provide, as well as reinforcing the reputation of the UK as a world-leading centre for medical excellence and innovation.

The combination of London's medical facilities and expertise, plus its many attractions and entertainments, makes the UK capital an ideal choice for international medical tourists (PHOTO: JAMIE PADDOCK/ALAMY)

Such a reputation is both long-standing and well-earned, in London and across the country as a whole. The history of new medical techniques, procedures and treatments that emanated from the UK is marked by breakthroughs that continue to underpin today’s medicine. Such

milestones include Alexander Fleming’s discovery of penicillin, numerous new techniques in the diagnosis and treatments of cancers, and the birth of the first ‘test tube’ baby in 1978 – just a few of the advances that have changed lives not only in the UK, but also the world over. This culture of innovation continues today, evidence of which can be found in the contributions to this publication from companies developing technology that will make advanced treatments available to more people in more places. Examples include Advanced Oncotherapy (AVO), which aims to bring proton therapy cancer treatments to more locations with their LIGHT system, significantly reducing the size and, importantly, cost of such specialised equipment. We also hear from Fairford Medical on its innovative approach to mobile diagnostic imaging.

INTRODUCTION

the state-of-the-art Cromwell Hospital and the aforementioned AVO, which will welcome its first patients in 2020.

A national institution For more than 70 years, the bedrock of the UK’s medical prowess and innovation has been its renowned National Health Service (NHS). Since its foundation in 1948, the NHS has fostered skill and expertise that is revered the world over. Today, private patients from home and abroad can also benefit from the unrivalled knowledge of the world-class consultants, surgeons and staff of the NHS, with several of London’s best-known hospitals offering Private Patient Units (PPUs) to welcome international visitors. These facilities offer separate rooms and facilities for fee-paying patients, the revenue from which subsidises the core purpose of the NHS – to provide healthcare for the UK population, free at the point of delivery. In this edition of Healthcare in London, we are pleased to devote a section of the publication to highlighting the facilities and treatment options provided by a selection of these PPUs, including Guy’s and St Thomas’ Hospitals, Imperial Private Healthcare, the Royal Free London, the Royal Brompton and the Royal Marsden.

The UK’s position at the forefront of private healthcare provision is in no small part due to the plethora of hospitals, clinics and specialists that occupy the Harley Street Medical Area – the world’s largest concentration of specialist healthcare providers. We are privileged to include the Howard de Walden Estate, owners of the globally famous street and its environs, as one of the key supporters of Healthcare in London.

Choosing London as the location for private medical treatment is a decision that is not only based on the excellent standards of healthcare that are available. Outpatients requiring a course of treatment and the families of inpatients will also want to consider the city’s many top-quality accommodation options, and its wealth of attractions and entertainments. In the final section we highlight the best that the city has to offer, as well as profiling medical concierge services that can help patients and their companions make their stay as pleasurable as possible.

Situated in the heart of London, Harley Street and its surroundings have hosted a collaborative community of medical professionals for two centuries, providing some of the best and most advanced treatments found anywhere. Several of the area’s prominent hospitals, clinics and consultants share valuable information on their services within the pages of this publication – these include HCA Healthcare, King Edward VII’s Hospital, Optegra Eye Healthcare,

A unique combination of medical experience and expertise, top-class facilities and treatments, and unrivalled accommodation and attractions makes London an outstanding choice for private patients. I hope this second edition of Healthcare in London will again prove valuable in assisting medical practitioners in selecting the best healthcare options for their patients, who will receive the warmest of welcomes in one of the world’s most famous capital cities.

2 Dedicated medical staff are at the heart of London's superb reputation for medical excellence (PHOTO: CURTSEYES/ALAMY)

FREE

CONSULTATION AND THOROUGH EYE EXAMINATION*

CHOOSING LONDON FOR HEALTHCARE

A wealth of expertise and high-quality private facilities are the key reasons why so many patients choose London for their medical treatment

AN ABUNDANCE OF TREATMENT OPTIONS London is justifiably renowned for providing some of the best private treatment anywhere in the world. The capital possesses numerous prestigious hospitals and clinics, with many globally lauded consultants and surgeons on their staff. Overall, the UK has a well-established private healthcare sector, for both urgent and non-urgent treatments, with around one in four operations performed privately.

1 London boasts the highest concentration of medical professionals anywhere in the world, many of whom work in the Harley Street area (PHOTO: EMILE HAYDON/ALAMY)

Internationally, London is unique in that it has the highest concentration of medical specialists within a radius of only a few miles – many of whom are located in the hospitals and clinics of the esteemed Harley Street Medical Area. Such a wealth of top-class facilities brings to the city not only some of the best medical professionals, but also attracts an increasing number of

patients from overseas. Many hail from the Middle East, seeking the best in healthcare combined with the luxurious surroundings of London’s hotels and the city’s myriad entertainments. The choices of hospitals in London also includes several that are part of the UK’s National Health Service (NHS). Although the NHS is taxpayer-funded, its ability to provide services is also supplemented by revenue derived from the private sector. Over recent years, these facilities and their highly regarded specialists have become increasingly accessible to private patients from home and abroad via Private Patient Units. This publication includes profiles of the facilities, services and medical specialisms provided by a selection of these hospitals (see page 44), many of which are renowned as teaching hospitals

CHOOSING LONDON FOR HEALTHCARE

The range of healthcare services on offer in London is broad and diverse

producing specialists that become leaders in their field. These hospitals are also are the forefront of research that has positive effects for patients around the world. Among the medical fields in which the UK is among the world leaders in research and treatment is in oncology. Several of the capital’s leading providers of state-ofthe-art cancer facilities and treatments outline their services and facilities in the pages of this publication (see page 24). These include the Royal Marsden – the first hospital in the world dedicated to the study and treatment of cancer, HCA Healthcare and Edward VII’s Hospital. 2 The UK has a well-established private healthcare sector that can offer top-quality facilities (PHOTO: CURTSEYES/ALAMY)

Several of the many other treatment areas are covered within these pages, from cardiology and transplantation

to ophthalmology and haematology – further emphasising London’s position as one of the most attractive cities to visit for specialist healthcare, to access the best in facilities and some of the world’s finest practitioners. The range of healthcare services on offer in London is broad and diverse – the choice being so wide that it is sometimes difficult for patients to decide on which hospital, clinic or specialist to select for their treatment. For assistance in selecting between treatment options, medical concierge services can be of great assistance (see page 96), offering guidance in selecting the most suitable location for treatment and also making sure that the time spent in London by patients and their families is as comfortable as possible.

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CHOOSING LONDON FOR HEALTHCARE

Dr Nick Plowman Clinical Oncologist

LEADING THE WAY IN MEDICINE British medical schools and universities train many doctors who later either remain within the UK system or migrate abroad. Many take part in scientific research and/or assist in clinical trials – so important to the many advances in medicine that have occurred over the last decade or two. In my own specialty of cancer/oncology, I have trained many of the country’s leading oncologists and at least four of our graduates are Professors in Oncology in other countries from USA to Australia. My own research programmes at St Bartholomew’s Hospital in London have defined two new syndromes of extreme radiosensitivity and our clinical research has led to changes in the best standard of care for aspects of advanced breast cancer and prostate cancer across the world. Some of our focal brain treatment work at Bart’s has also been ground-breaking. Many of my colleagues can boast similar advances in medicine and surgery due to their own research programmes.

Not surprisingly therefore that there has been a constant stream of international patients to London seeking premier treatment for often difficult and complex conditions – often having failed straightforward therapies abroad. UK medicine has had an excellent reputation for ethically sound, evidence based and advanced medical practice. Nowhere is this reputation more closely guarded than in Harley Street – that central London street where 1,500 of the country’s leading doctors have an office and close to which are multiple hospitals, laboratories and imaging centres offering fast turnaround tests, so necessary for accurate and speedy diagnoses. In my own practice, it is unusual for us not to be able to come to a diagnosis and treatment recommendation for a cancer patient in less than a week of arrival in London. Due to the proximity of so many experts, it is once again unusual not to have any expert involvement

needed from other specialists – perhaps an operation – within another week – if this is in the patient’s interest. I am aware that similar short timescales are practiced by my colleagues in other specialties. Returning to oncology, which I know best, once diagnosed and staged, a cancer patient will start a programme that may include surgery, chemotherapy, radiotherapy and, nowadays in oncology, those potentially exciting new cancer treatments, such as genomically targeted therapies (attacking the downstream products of mutated oncogenes) or immunotherapy (facilitating the body’s immune system to attack cancers, which are all potentially antigenic and, hence, vulnerable to immune attack) by virtue of their multiple mutations. We are fortunate to be able to resource new drugs early – even if the patient needs to be part of a trial – and this access to new drugs is a bonus for complex, previously heavily treated cancer patients who come

to London in expectation of new therapies. To quote one recent example, I have an international patient who has done well for several years on a genomically targeted drug, but now has a life-threatening relapse. By analysis of cancer cell-free DNA circulating in the blood (from a 20ml blood sample taken from a vein) and by nextgeneration genomic sequencing, we found that the cancer was escaping down a new genetic pathway: P13K. We have sourced a new drug that blocks this pathway for this patient and expect a further remission. Take the surgical and medical skills available in London, the easy access to these and diagnostic and therapeutic advances, together with frontier new developments – no wonder that the international demand for UK medicine continues. London can boast world-leading surgical and medical skills, with numerous hospitals, laboratories and imaging centres ensuring fast diagnosis and treatment for visiting patients (PHOTO: JANINE WIEDEL PHOTOLIBRARY/ALAMY)

CHOOSING LONDON FOR HEALTHCARE

HERITAGE BUILDINGS, ST 21 CENTURY HEALTHCARE Summon up in your mind a picture of a world-class medical area, and it probably doesn’t look quite like this. You probably imagine a sprawling modern campus, all glass and aluminium, imposing but characterless, set in an anonymous out-of-town location. It’s unlikely that your mental picture would consist of a grid of historic townhouses, including genuine masterpieces of Georgian architecture, situated in the middle of an international city and surrounded by the bustle of daily life.

1 The history of Harley Street as a centre of medical excellence dates back to the 19th century (PHOTO: THE HOWARD DE WALDEN ESTATE)

But while the Harley Street Medical Area (HSMA) may not be the archetype of a world-class medical enclave, that’s precisely what it is. By any measure,

the healthcare services on offer here compete with, and often surpass, those of any purpose-built clinical centre anywhere on the planet. Harley Street’s history as a centre of medical excellence dates back as far as the 19th century, but in recent years, the modernity of the area’s tenants has become as central to its appeal as the rich heritage of its buildings. Behind those period facades stand 21stcentury facilities, functioning right at the cutting edge of modern medicine. Over the past decade, the HSMA’s longestablished healthcare providers – The London Clinic (including its London Clinic

CHOOSING LONDON FOR HEALTHCARE

2-4 The Harley Street Medical Area is the home to hospitals and clinics that cover almost every medical specialism, offering world-class levels of expertise (PHOTOS: THE HOWARD DE WALDEN ESTATE)

Cancer Centre, which houses some of the world’s most advanced radiology equipment), HCA (including The Portland Hospital, The Princess Grace Hospital and The Harley Street Clinic), King Edward VII’s Hospital, Moorfields Eye Hospital – have been joined by some exceptional new peers: Royal Brompton & Harefield Hospitals’ private diagnostics and outpatients centre; the flagship hospital of eye specialists Optegra; Isokinetic’s Fifa-accredited rehabilitation centre; the multi-specialist London Claremont Clinic; an addiction and mental health outpatient treatment centre run by the Priory Group; the first overseas outpost of Germany’s highly regarded Schoen Clinic. There are more on their way: The Royal Marsden arrives soon, while Advanced Oncotherapy’s linear proton beam therapy unit – a world first – is under construction on Harley Street. The USA’s two highestperforming academic medical centres, the Cleveland Clinic and the Mayo Clinic (the latter in a joint venture with the University of Oxford), are anticipated to join them soon. As well as these hospitals and clinics, the HSMA is home to hundreds of small

practices and independent clinicians, covering just about every conceivable medical specialism, as well as dentistry, psychiatry and a whole host of other sectors. Inevitably, given the size of the medical community, other related services have been drawn to the HSMA. Physiotherapists, nutritionists, fitness trainers and pharmacists, for example, are all close at hand when their expertise is required. Perhaps the most unusual aspect of the HSMA is that this isn’t an isolated enclave, filled with nothing but doctors. Surrounding the medical buildings, and even sharing the same streets with them, are restaurants and cafes, shops and cultural institutions. There are numerous hotels, quiet parks and attractive streets. For patients undergoing treatment, or for the family and friends supporting them, the HSMA provides an environment that is both comfortable and laden with welcome distractions. The area’s Marylebone location also provides an unrivalled level of accessibility. Sitting right in the heart of a truly global city, it is connected not just with the rest

5-7 The Harley Street Medical Area provides many welcome distractions for visiting patients and their families – from upmarket hotels, restaurants and shops to quiet parks and stylish cafes (PHOTOS: THE HOWARD DE WALDEN ESTATE)

of the UK, but with the entire world. It is a short journey from several airports including, in Gatwick and Heathrow, two of the best-served in Europe. It is closely tied in to London’s public transport network and is just a short hop from numerous mainline stations, including the Eurostar terminals at St Pancras station.

disparate group of hospitals, clinics and practitioners is now a tight-knit collective. These institutions are working together to make this an ever more accessible and attractive destination for anyone seeking expert medical care. Dedicated medical concierge Lexihealth has been brought to the area to help patients navigate the wide diversity of available options.

In recent years, the HSMA’s landlord, The Howard de Walden Estate, has been working with the area’s healthcare providers to offer an increasingly joinedup service. What was previously a

The Harley Street Medical Area is clearly a world-class medical destination, even if – on the surface, at least – its appearance is nothing like that of a typical one.

www.hdwe.co.uk

Bupa Cromwell Hospital Exceptional healthcare – one phone call away At Bupa Cromwell Hospital, we recognise the need to provide a smooth and effective service to our international patients. That is why we have a dedicated International Patient Centre, providing ease of access and continued support throughout the entire patient journey. From the moment a patient first makes contact with us to when they leave the hospital and return home – our team of specialist advisors remains one phone call away.

An international reputation We have established a global reputation for innovation, clinical excellence and service quality, and are a hospital of choice for international royalty and dignitaries – welcoming patients from over 160 countries worldwide. Our dedicated International Patient Centre helps patients to plan their stay and organise their treatment. Our International Patient Centre assists with: • Appointments and admissions • Visa assistance • Dietary and cultural requirements • Free interpreters for any language, and access to multi-lingual consultants across a broad range of specialties, and multi-national nursing teams • Payment • Second opinion

A comprehensive healthcare solution Bupa Cromwell Hospital covers a range of healthcare needs, from outpatient services to treating conditions requiring multi-disciplinary care. Over 70 specialties are delivered by more than 500 consultants, with many from London’s top teaching hospitals. A multi-disciplinary team approach ensures the best possible care, with patient cases discussed by a range of specialists within each clinical area. Our highly experienced nurses, clinical and support staff offer first-class knowledge, complemented by dedication and compassion. We are recognised as a centre of excellence for oncology, cardiology, paediatrics, orthopaedics, lung, complex surgery and medicine. Our state-of-the-art diagnostic equipment and operating theatres are equipped with the latest technology, and we have an adult intensive care unit for patients who require specialised monitoring and treatment. Our on-site General Practitioners (GPs) offer primary care services – including family medicine, health screening and 'well woman' services – as well as referrals to specialist consultants. Appointments with our GPs can usually be made on the same day.

What our patients say Our dedication to caring for our patients is supported by our patient satisfaction scores. Nearly 98% of our patients who visited our hospital in December 2018 said our overall quality of care was good, very good or excellent. Just over 97% from the same period said they were likely or extremely likely to recommend us, and the same number said the overall impression of our accommodation was good, very good or excellent.

Some of our key services Dialysis Away from Home (holiday dialysis) At Bupa Cromwell Hospital, we want to assist patients in making their dialysis experience convenient, comfortable and stress-free. Whether patients are in London for business or pleasure, we can help make their visit seamless and relaxed. Our team of exceptional doctors and nurses all work together to provide safe, efficient and effective haemodialysis treatments.

We are innovators and investors Being innovative in our field ensured we were the first private hospital in the UK to open a Gamma Knife Centre, and the first to establish a dedicated Radiotherapy Department. We constantly invest in the latest diagnostic equipment and treatment developments, from ambient MRI machines, to robot-assisted joint replacement surgery. We have recently invested £30m in patient rooms, clinical areas and our elegant receptions to ensure we can guarantee exceptional clinical care in first-class surroundings. “Our exclusive suites are the largest and most luxurious in the UK,” says Hospital Director Philip Luce. “We are creating and maintaining a world-class customer experience, which is key to our ambition to serve our patients in the best way possible.”

About the dialysis unit: • Our dialysis unit offers nine dialysis stations, using the latest Gambro haemodialysis machines – the Artis Physio system and the AK 98 dialysis machines • Reclining chairs for maximum comfort. Beds are available, subject to availability and patient need • Complimentary fresh sandwiches and beverages Liver Health Clinic Our Liver Health Clinic offers a full assessment of a patient’s liver health and does not require a referral from a GP. All tests are carried out in the first appointment. Patients are seen by a Liver Specialist and Dietitian in their second appointment and, 24 hours later, a Specialist Nurse follow-up appointment is arranged to answer any further questions. Finally, a full Liver Health report is available within seven days of the first appointment.

Paediatrics Our newly refurbished Children and Young People’s Department – Skyline – offers expert care in a calm and safe environment. The department is supported by leading consultants from London’s top teaching hospitals and a resident consultant paediatric intensivist, on-site 24 hours a day, seven days a week. There is a children's only entrance to the hospital and we cover a wide range of specialties for children aged from zero to 18 years of age. Our multidisciplinary team includes a play specialist, paediatric physiotherapists, occupational therapists, dietitians, speech and language therapists, as well as highly skilled and trained paediatric nurses.

Luxury accommodation We offer the ultimate healthcare environment to match our exceptional quality of care. The Royal and Presidential Suites are the UK’s most luxurious hospital suites, featuring separate dining, lounge and bedroom areas. There is private nursing and a team of VIP coordinators to make sure everything runs smoothly. Both suites have been furnished to the highest standards and offer outstanding service quality, and can also be combined to create an entire private wing. Our Ambassador and Executive suites also provide high-quality accommodation, and patients in all four suites have access to a host of services to provide the most comfortable hospital stay possible.

Going above and beyond Our desire to go the extra mile isn't restricted to consultations and medical treatments. Alongside our end-to-end healthcare solutions, we offer a host of hotel and concierge services to make your stay as comfortable and stress-free as possible. So if you need a suit to be dry-cleaned or a driver to pick up relatives from the airport, it can all be organised directly through the hospital. Our hotel and concierge services include: • Additional security – for VIP guests • Hairdresser and beauty treatments • Drinks and cakes for special occasions • Transport – including taxis and limousine pick-up • Hotel/apartment accommodation – for friends and family • Complimentary international newspapers

For more information about the hospital and its services, please contact our International Patient Centre on +44 (0) 20 7460 5586 or email ipc@cromwellhospital.com

ONCOLOGY

WORLD-LEADING CANCER TREATMENT International patients are increasingly choosing to travel to London to access world-leading healthcare. In oncology, The Royal Marsden is a pioneering treatment and research centre that ranks among the best hospitals in the world.

the patients I met today, it would be hard not to feel positive about the work being done here, and the real difference it makes. A difference which I know extends beyond the four walls of the hospital to cancer patients across the UK and internationally.”

About The Royal Marsden

The integrated NHSPrivate Care model

The Royal Marsden, together with its academic partner The Institute of Cancer Research, is Europe’s largest comprehensive cancer centre. It is rated as one of the top three cancer centres globally, and is a world-leader for cancer diagnosis, treatment, care, research and education. Each year The Royal Marsden sees and treats over 55,000 cancer patients from 62 nationalities and has over 800 clinical trials open at any one time. HRH The Duke of Cambridge has been the president of The Royal Marsden for over 10 years and regularly visits the hospital and its patients. On a recent visit, The Duke remarked: “Seeing the courage and spirit of

The Royal Marsden offers patients both NHS and privately funded cancer care and is the most successful NHS Private Patient Unit (PPU) in the UK, turning over in excess of £100 million in 2017-18. Private patients receive the same levels of exceptional care as The Royal Marsden’s NHS patients, with additional benefits brought through private healthcare, including rapid access, hotel services, single en-suite rooms and direct access to their treating consultant. The income received from private practice at The Royal Marsden enables continued investment into the latest technology, equipment,

new facilities and pioneering research programmes, improving treatment and care for all Royal Marsden patients. The combined model provides The Royal Marsden with economies of scale, offering cost savings and the purchasing power to access higher specification equipment or supplies. Increased patient volumes enable more specialist services, such as rehabilitation and support with the physical and emotional side effects of cancer.

kinase (ALK) inhibitors. Patients with advanced lung cancer were previously only living for one year on average. Now those who are identified as having an ALK abnormality in their tumour can be treated with a variety of ALK inhibitors; simple tablets that are taken daily. Patients with ALK mutations treated in this way are now living in excess of three years on average – a threefold increase in the survival rate over the past 10 years.

Immunotherapy Targeted therapies The Royal Marsden has been at the forefront of research into targeted therapies – drugs that are focused on a specific molecule involved in cancer growth. By integrating the latest advances in genomic medicine and cancer immunology, The Royal Marsden has been able to offer patients improved cancer treatments, tailored to their individual tumour profile. One class of targeted drugs benefiting lung cancer patients is anaplastic lymphoma

Immuno-oncology is an area of research that explores interaction between cancer and the immune system in order to find new treatments, using the body’s own immune system to destroy tumours. The Royal Marsden has been involved in the clinical trials of many of the drugs used in these treatments, working with the major pharmaceutical companies in their development. In addition, it is one of the Centres of Excellence in the Roche imCORE Network, which spans nine countries and brings together 21 of the

1 Trina Herbert, Senior MR Linac Radiographer and Cynthia Eccles, Brachytherapy Superintendent Radiographer, with patient | 2 Professor Vinidh Paleri, Consultant Head and Neck Surgeon with the da Vinci surgical robot in Theatres, Chelsea (PHOTOS: THE ROYAL MARSDEN)

ONCOLOGY

The Royal Marsden has the most comprehensive programme of robotic surgery for cancer care in the UK. It is the only UK centre delivering surgical cancer care with excellent outcomes across multiple disciplines. This includes: oesophagectomy (upper GI), liver resection and Whipple’s (HPB), cystectomy and urinary reconstruction (urology), anterior resection and colectomy (colorectal), and radical hysterectomy image-guided lymph node dissection (gynaecological). Robotic-assisted techniques enable pioneering, life-saving interventions. Benefits include a reduction in surgical trauma, minimising blood loss, and speedier post-operative recovery. One example of this pioneering work is the establishment of a unique transoral robotic surgery programme. 3

3 The Royal Marsden Hospital, Chelsea | 4 Dr Mike Hubank, Head of Clinical Genomics (Research) in the Centre for Molecular Pathology, Sutton (PHOTOS: THE ROYAL MARSDEN)

world’s leading academic, scientific and clinical experts in cancer immunotherapy to collaborate in investigating the most promising new approaches in treatment. For example, pembrolizumab and nivolumab are two monoclonal antibodies used against melanoma, non-smallcell lung cancer, kidney cancer, bladder cancer, head and neck cancers, and Hodgkin lymphoma. Both new drugs have undergone trials at The Royal Marsden.

“Seeing the courage and spirit of the patients I met today, it would be hard not to feel positive about the work being done here” HRH The Duke of Cambridge

Nivolumab, in combination with another immunotherapy drug, ipilimumab, has also been successful in treating melanoma. A trial led by Professor Larkin, Consultant Medical Oncologist at The Royal Marsden, showed that, in 58% of patients, the two drugs combined shrank tumours and stopped the cancer advancing for nearly a year on average. Professor Larkin says: “By giving these drugs together, you are effectively taking two brakes off the immune system rather than one. The immune system is able to recognise tumours it wasn’t previously recognising and destroy them.”

Robotic surgery The Royal Marsden was the first hospital in England to introduce the da Vinci robotic surgical systems, revolutionising the surgical treatment of cancer patients. Now, using two da Vinci Xi systems,

For the removal of a tumour from the base of the tongue, the traditional approach would be a jaw-splitting procedure, associated with long surgery times (up to 12 hours) and long recovery times (up to three weeks in hospital). Using the robotic technology, consultant head and neck surgeon Professor Vinidh Paleri can access the area through the mouth, in a procedure that can take only three hours and has a recovery time of up to 10 days. The Royal Marsden team has the most extensive experience with transoral robotic surgery, with no other centre carrying out these procedures in such numbers.

Radiotherapy The Royal Marsden’s Radiotherapy department is one of the largest in the UK – treating up to 5,000 patients and delivering more than 75,000 treatments each year. The Royal Marsden operates 11 linear accelerators. As a result, the Trust is able to deliver all forms of advanced external-beam radiotherapy including image-guided radiotherapy (IGRT); intensity-modulated radiotherapy (IMRT); stereotactic body radiotherapy (SBRT); and volumetric modulated arc therapy (VMAT). The unit works in close partnership with The Royal Marsden’s academic and research partners to design, deliver and assess the latest techniques and remain at the forefront of international radiotherapy delivery. One example

is CHHiP, a five-year landmark trial of 3,200 men, demonstrating that fewer, larger doses of intensity-modulated radiotherapy work equally well as more, smaller doses for prostate cancer patients. The new regime saves each man 17 hospital visits, significantly reducing treatment costs, reducing the severity of damage to healthy tissue, and allowing more patients to be treated on the same number of linear accelerators. Sarah Helyer, Radiotherapy Services Manager explains: “Developments in radiotherapy imaging allow us to target tumours with sub-millimetre precision. Greater accuracy means that fewer healthy cells are damaged, which, in turn, means higher doses can be given. This makes treatment more effective and reduces side effects.”

MR Linac The latest technology in radiotherapy is the Magnetic Resonance Linear Accelerator (MR Linac) which combines real-time imaging with pinpoint radiotherapy to target tumours more reliably and improve patient outcomes.

The new technology can track tumours that move and change shape – even during treatment – to precisely target the radiation beam at the tumour and minimise damage to healthy tissue. The Royal Marsden is part of an international research consortium leading trials in seven centres worldwide to optimise MR Linac technology and allow oncologists to better target tumours that move in response to natural changes in the body, such as breathing, the bladder filling or bowel changes. The Royal Marsden treated the first patient in the UK and the third in the world on the MR Linac in September 2018, as part of a clinical trial.

Cavendish Square In 2020, The Royal Marsden Private Care will open a diagnostic and treatment centre on Cavendish Square. The new facility, in the heart of London’s medical district, will offer The Royal Marsden’s world-class outpatient, chemotherapy, diagnostics and minor procedures services to UK and international private patients.

Further information For more information about The Royal Marsden or to refer a patient, please: Visit: royalmarsden.nhs.uk/private Email: int@rmh.nhs.uk Call: +44 (0)20 7808 2063

Immunotherapy to treat cancer

In recent years, immunotherapy has been used increasingly in the treatment of cancer – some of the latest therapies available to HCA Healthcare's private patients in London

Surgery, chemotherapy and radiotherapy remained the three pillars of cancer treatment for many years, joined more recently in the last 10 to 20 years by targeted therapies – drugs that target cancer cells by identifying specific molecular changes. Then, in what many call the “fifth pillar” of cancer treatment, immunotherapy has emerged and continues to gain traction as a mainstay of cancer therapy, using drugs to strengthen and stimulate a patient’s own immune system to target tumours. One such immunotherapy approach is called adoptive cell transfer (ACT). As opposed to attaching a drug to a patient’s immune cells, in ACT a patient’s immune cells are collected, engineered, and used to treat their cancer. Whilst many types of ACT in development show great promise, CAR T-cell therapy has advanced the furthest. We talked to Professor Stephen Mackinnon, from HCA Healthcare UK, at University College Hospital in London, about this exciting new treatment:

What is CAR T-cell Therapy? CAR T-cell therapy is the name given to chimeric antigen receptor (CAR) genetically modified T cells. Our T cells play a vital role in our immune system, orchestrating the immune response and killing cells infected by pathogens. On the surface of every cancer cell are specific antigens relating to that type of cancer. In CAR T-cell therapy T-cells are collected from the patient’s blood and genetically modified in a laboratory, these adapted cells are then re-infused into the patient and now have the ability to recognise specific antigens on tumour cells and eradicate them.

Professor Stephen Mackinnon, HCA Healthcare UK, at University College Hospital in London

How is it different to traditional immunotherapy?

What makes this treatment so exciting?

Traditional immunotherapy usually refers to drugs used to stimulate or programme a patient’s immune system to seek and destroy cancer cells, whereas CAR T-cells are created from a patient’s own blood cells and engineered in a lab to be re-infused and recognise cancer cells – there are no drugs involved.

This is not an extension or improvement of an existing treatment; it is a first-of-a-kind therapy that has the potential to revolutionise the approach to cancer treatment. CAR T-cell Therapies are a breakthrough treatment for many patients, offering a highly successful, well-tolerated treatment option where previously there may have been none. Patients receiving this therapy show a rapid and durable regression and remission that we haven’t observed in other recognised treatments.

How is the procedure performed? The patient comes into hospital and undergoes an apheresis procedure to isolate and collect their T-cells. These T-cells are transported to a laboratory where they are engineered to express CARs that recognise cancer cells. These modified T-cells are then grown and expanded within the laboratory and, at the time the patient is scheduled to receive them, these modified T-cells are then reinfused to the patient following a course of conditioning chemotherapy.

Who is a candidate for CAR T-cell therapy? There are many clinical trials being undertaken for patients with Myeloma, Acute Lymphoblastic Leukaemia and Diffuse Large B-Cell Lymphoma. At HCA Healthcare UK, CAR T-cell therapy will initially be available to patients with Acute Lymphoblastic Leukaemia or Diffuse Large B-Cell Lymphoma.

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

What’s next in CAR T-cell Therapies? CAR T-cell therapies seem to have a lot of potential, but further research is needed to make them mainstream and available to patients globally. Many labs around the world are currently testing these therapies, not just for blood cancer, but also for solid tumours such as pancreatic and brain cancers. Given the amount of interest that the field has generated among researchers worldwide, it is likely that the next decade will be transformative in defining the cancer-treatment paradigm.

When will it be available? HCA Healthcare UK at University College Hospital will be the first UK private provider to offer CAR T-cell therapy, working with globally recognised biotech companies in the commercial setting. This therapy will be available to international patients by the end of 2018.

CAR T-cell therapy A revolutionary treatment that uses the patient's own immune system to fight certain types of cancer

How does CAR T-cell therapy work?

1 2 3 4 5 6

Apheresis Patient's white blood cells are isolated, collected and sent to the laboratory.

T-cell activation/ reprogramming T-cells are genetically transduced ex vivo with a lentiviral vector encoding the anti-CD19 CAR.

Modified T-cell expansion Cells undergo ex vivo expansion on magnetic antibody-coated beads.

Lymphodepleting chemotherapy Patient may receive a preparative lymphodepleting regimen before T-cell infusion.

Infused Modified cells, CAR T-cells, are infused through an IV back into the patient's blood.

Cancer cell death CAR T-cells track down and kill the patient's tumour cells.

ONCOLOGY

Mr Ragheed AM Al Mufti Consultant Breast Surgeon King Edward VII’s Hospital

DEALING WITH BREAST DISEASES Breast symptoms are very common, and the majority of patients presenting to the Breast Surgical Clinic have benign conditions. The commonest presenting symptoms in patients attending a breast clinic (in over two-thirds of patients) are a breast lump or a painful lumpiness of the breast.

the United Kingdom – 1 in 8 of the country's women can expect to develop the disease in her lifetime, and 1 in 20 women will die from breast cancer. The rate of diagnosis has more than tripled over the past three decades, but breast cancer mortality has gone down from 69% in 1979 to 21% in 2010.

When a patient presents to the general practitioner with a breast lump, lumpiness or nipple symptoms, the concern is always whether there is any chance this is cancer or not, and whether the general practitioner can manage this at the surgery. National BASO (British Association of Surgical Oncology) guidelines, which are updated regularly, have been issued concerning early referrals to the breast clinic, and prompt, urgent referral is needed in a significant number of cases.

When a patient presents to the general practitioner with a breast lump, assessment of the character of the lump is necessary, to determine whether the lump is discrete or if it is a diffuse nodularity. A discrete lump stands out from the surrounding breast tissue, and is usually felt with measurable borders, but a generalised nodularity is ill-defined lumpiness that changes with the menstrual cycle and is often present in both breasts.

Although benign breast lumps are far more common than malignant ones, breast cancer is one of the most important diseases of women. Breast cancer is the most common cancer in women in

Over 90% of patients seen at the breast clinic with a lump have a benign lump, but a full urgent assessment of any breast lump is important to rule out cancer. It is quite often that a cancerous lump may look or feel similar to a benign lump,

and only triple assessment in a Rapid Access specialised breast clinic would make the diagnosis. Triple assessment would involve surgical clinical, breast imaging (mammography and/or ultrasound) and cytology/histology assessments.

Breast assessment services at King Edward VII's Hospital At King Edward VII's Hospital, patients are seen urgently, within hours or a couple of days of referral, and are then offered the triple assessment at the same day clinic. They are given the diagnosis and treatment plans at the same clinic, in a one-stop clinical set-up. The BASO guidelines indicate that all patients with breast symptoms that require a one-stop clinic assessment should be seen within two weeks, and that treatment for cancer should be scheduled within four weeks. All subsequent specialist scans and tests are carried out urgently within a couple of days, without any delay in the patient’s management.

1 Initial clinical assessment of a patient at the One-Stop Clinic includes a mammogram

2 Patients receive comprehensive information on their diagnosis and any treatment they may require from a specialist consultant 2

The One-Stop Breast Assessment Clinic The One-Stop Breast Assessment Clinic at King Edward VII's Hospital provide a comprehensive way of assessing and investigating any patient with breast symptoms – including patients with breast lumps, nipple discharge or retraction, breast contour changes or any other cause for concern – in a safe, friendly and caring environment.

ONCOLOGY

3 Patients are kept informed every step of the way by a friendly and knowledgeable medical team | 4 King Edward VII's Hospital offers patients the best-quality care in state-of-the-art facilities 3

This clinic carries an initial clinical assessment of the patient by a specialised consultant breast surgeon, who would then request an urgent mammogram (special X-ray of the breast), ultrasound scan (scanning of the breast using special sound waves), MRI (Magnetic Resonant Scan), cytology (taking cells

Conditions that require referral to the Rapid Access Breast clinic All patients with a discrete breast mass/lump. Fine-needle aspiration by general practitioners is not recommended Any multiduct nipple discharge in patients aged over 50 years Any single-duct nipple discharge in women of any age Bloodstained, persistent or troublesome discharge in women of all ages Severe mastalgia that interferes with the patient’s life style or sleep, which has failed to respond to simple measures of wearing a well-fitted supporting bra and common analgesia medications Nipple retraction and distortion, changes in skin contour or any nipple eczema Asymmetrical nodularity that persists after menstruation Request for assessment of a patients with strong or high-risk family history of breast cancer Patients that have tested positive for the Breast Cancer gene mutation (BRCA 1&2) Patients with developmental and congenital breast abnormality and marked asymmetry Patients with macromastia, especially where this causes neck and back pain

from a lump for examination under the microscope using a fine needle aspirate, or a core biopsy (taking a very small piece as a specimen of tissue under a local anaesthetic for a special microscopic histological examination). The benefit of running a One-Stop Breast Assessment Clinic is that all these tests are carried out at the same clinic visit and that the diagnosis is made within a couple of hours at the clinic (or within 48 hours of the patient’s clinic visit). This method is an excellent and an accurate way of assessing more than 95% of breast lumps, and is of great value in reassuring patients with benign breast lump or benign conditions of the breast. It can also establish a diagnosis of a cancerous breast lump in a large proportion of patients very quickly, although such patients may require further tests to confirm the diagnosis of breast cancer. In a minority of patients with breast cancer, the One-Stop Clinic can have an adverse psychological effect if a patient is attending the clinic alone and is then informed of the diagnosis of cancer unexpectedly. Accordingly, all patients attending the one-stop rapid access breast clinic are advised to bring a spouse, a friend or a relative with them. The One-Stop Breast Assessment Clinic has been running smoothly, due to the availability of various expert personnel

ONCOLOGY

The One-Stop Breast Assessment Clinic Patient with a breast lump or symptoms of concern

Referred to the One-Stop Rapid-Access Breast Clinic

The patient is seen by a specialist consultant breast surgeon

Clinical examination

Breast imaging by a specialist radiologist (eg mammogram, ultrasound scan, MRI)

Needle biopsy, if needed

Patient is seen again by the specialist surgeon for discussion of the results and plans for any treatment needed 4

of a specialist “Breast Multi-Disciplinary Team” at one site – comprising the surgeon, radiologist, breast radiographer, cyto-histo-pathologist and breastcare specialist nurse – in a friendly and safe clinical environment. In the private breast clinics at King Edward VII's Hospital, patients are seen in a state-of-the-art private consulting room. There are many top-quality breast-specialist consultant surgeons and cancer specialists available, dealing with a large number of patient referrals with breast symptoms. In addition, specialist consultant radiologists and pathologists are available on site to provide expert services for running a rapid-access diagnostic breast clinic.

The Family Breast Cancer Clinic Patients with a family history of breast cancer fall into three categories – low risk, moderate risk and high risk. Thankfully, more than 90% of patients

with a family history of breast cancer fall into the low-risk category, and only a very small minority of patients with a family history have a high risk of developing breast cancer themselves. It is recommended that any patient who has a very strong or significant family history of breast cancer should be referred to our specialised family breast cancer clinic (which is part of the rapid-access breast clinic), as they will require a special breast screening programme and genetic counselling and genetic screening, in order to identify any inherited or genetic predisposition. High-risk patients will require genetic testing and may require prophylactic bilateral mastectomy and breast reconstructions (ie removing the breasts to prevent future cancers). Such specialised family cancer clinic is available in our specialised cancer centre at King Edward VII's Hospital.

www.kingedwardvii.co.uk

ONCOLOGY

COST-EFFECTIVE PROTON THERAPY Introduction

Radiotherapy

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

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.

Cancer Cancer is the second leading cause of death globally, according to the World Health Organisation. But treatment of cancer, is developing rapidly, with far greater emphasis now on precision cancer medicine and treatment, with the aim of delivering treatment as safely and efficiently as possible. * 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

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.

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. 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.

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.

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.

Proton therapy is an alternative radiotherapy modality that spares healthy tissue. A proton beam has 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.

As growing tissues are more sensitive to radiation, proton therapy has also become an ideal tool for childhood cancers. However, despite 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.

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

1 Radiation can damage DNA through two mechanisms: direct hits and through free radical formation | 2 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

Bragg Peak

Dose (%)

100

X-rays (Photons)

Focussing the proton radiation effect to the tumour location 60

40 Protons 20

Tumour 0

Depth (cm)

Energy deposition as a function of depth

ONCOLOGY

X-rays

Protons

By contrast, there are approximately 60 proton therapy systems globally or 0.2 systems per million people. Advanced Oncotherapy’s disruptive technology is expected to substantially alter this picture and make proton therapy far more accessible.

It stands apart from existing proton therapy systems in that, at its heart, is a linear proton accelerator. This fact has profound implications for the way it operates. The LIGHT system is designed to offer:

For Patients Non-invasive treatment

Advanced Oncotherapy Current proton therapy systems where protons are accelerated in cyclotrons or synchrotrons, have cost and clinical limitations that are inherent to the nature of these accelerating structures. Advanced Oncotherapy's technology will overcome these limitations.

In 2013 the company acquired A.D.A.M. S.A., a Geneva-based start-up that was founded to develop a solution based on a linear accelerator, which provides more flexibility at a significantly lower cost. As an additional advantage, A.D.A.M. S.A. has a partnership with CERN, the European Organisation for Nuclear Research, on development of accelerator parts and operating test sites. In 2018, Advanced Oncotherapy signed a major contract with the Science and Technology Facilities Council to establish a UK assembly and testing centre for the LIGHT system at STFC's Daresbury Laboratory. Through these two partnerships, Advanced Oncotherapy can profit from the knowledge of worldrenowned physicists and engineers in the development of its technology.

3 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 | 4 LIGHT accelerator, beam transfer line and treatment room

LIGHT Advanced Oncotherapy’s LIGHT (LINAC Image Guided Hadron Technology) system is designed to provide next-generation solutions to patients and hospitals alike.

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

For Operators A complete,compact, turn-key solution – fully integrated and optimised system with minimal footprint; 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 decommissioning, reducing cost to patients and hospitals.

5 141/143 Harley St, showing consulting and administrative offices, the LIGHT proton accelerator, beam transfer lines and a treatment room

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.

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

− It is a centre of medical excellence; − It has medical practitioners with expertise across the full range of disciplines;

− Providing access to advanced treatments and services;

− Operating like one large virtual hospital, with referrals across clinics and hospitals; − Is situated in central London, with all its amenities, attractions and infrastructure. www.harleystreetmedicalarea.com

For further information on Advanced Oncotherapy and its innovative LIGHT system, please get in touch. Website: www.avoplc.com Telephone: +44 (0)20 3617 8728 Email: info@avoplc.com Post: Advanced Oncotherapy plc, Third Floor, 4 Tenterden Street, London W1S 1TE

ONCOLOGY

Nicolas Serandour INTERVIEW

POSITIVE STEPS IN PROTON THERAPY Advanced Oncotherapy CEO Nicolas Serandour explains how the company’s LIGHT system for treating tumours will soon benefit patients in London and worldwide

What is proton therapy and how does it differ from other treatments? In the field of cancer there are different modalities to kill tumours, one of which is radiation therapy. This consists of using particles that damage the DNA of cells and, consequently, kill tumours. Radiation today is largely delivered through X-rays, using photons. However, this method can lead to side effects because the photon beam does not discriminate between cells at different depths. Proton therapy is a different type of radiation, the major benefit of which is that most of the radiation is deposited at a particular depth which can be tuned to the tumour site itself, sparing much of the healthy surrounding tissues. Up to now, the problem with providing proton therapy is that, protons require much bigger accelerators. Also,

because current proton therapy accelerators are circular, they are bulkier, requiring very large infrastructure, and have more technical constraints. As a result, such therapy has been very expensive, and this cost has been passed through to patients.

What benefits does LIGHT bring to the patient community? To start with, cancer treatment involves a large ecosystem with the patients at the core, and LIGHT makes proton therapy more accessible to them. When a treatment requires visits every other day, the patient should not have to travel far from home, and that's why it is important to have proton therapy systems installed in the centre of big cities. With the design of LIGHT, which accelerates protons in a straight line, avoiding the large infrastructure of circular acceleration, we can address the concerns of everyone in that

1 A scale model shows how the LIGHT system will operate | 2 A close-up view of the complex machinery behind LIGHT (PHOTOS: ADVANCED ONCOTHERAPY)

ONCOLOGY

It is amazing to think that a state-of-the-art proton facility hides behind a prestigious period building

ecosystem – the radiation oncologists look to have better tools to treat cancer, hospitals want to deliver the best treatments at less cost to more patients, a wider base of patients are offered the treatment and they don’t need to self-fund it.

Last October, AVO announced an important milestone for LIGHT. Can you tell us more about this? The LIGHT system integrates a series of accelerating units that are added sequentially – the more units you have in the machine, the more “powerful” the accelerator, and the wider the range of tumours that can be treated. What we announced is the fact that we manufactured, assembled and tested all the units together to create a proton beam capable of treating superficial tumours. This requires low energy, somewhere between 50 and 70 mega electron volts. This is significant because the challenge in the development of this breakthrough technology has always been the initial acceleration. This means that we can now start the last step of adding the remaining accelerating units. If I were to use a car analogy, I would say that we've been able to make a Formula One car and we're now starting a final step of adding the last cylinder.

Why did AVO choose London for its first installation? We were pleased to partner with the Howard de Walden Estate, which has developed the prominent Harley Street Medical Area. They have been an outstanding partner to work with. The Estate is also covering the £10 million building costs, as a testimonial of their commitment and a huge validation of the work that our team has done to make LIGHT compact and easier to install. A simple comparison can really help to understand how LIGHT is ideally suited for being installed in the heart of London, and, more generally, in dense areas. For example, a proton project in St Petersburg required a five-acre greenfield site, while the Harley Street project will take up a total area of only 15,000 square feet. The fact we can install a machine in

the city is extremely important for patients. The beauty of AVO's equipment is that it can be delivered to sites module by module, which has enormous positive implications for logistics. One magnet delivered to St Petersburg weighed 37 tonnes, while the heaviest magnet at Harley Street is just five tonnes. Statistics like these give an indication of the huge difference that the LIGHT system can make.

How is the construction of the new Harley Street facility progressing? Progress there has been really impressive. I would say it is amazing to think that a state-of-the-art proton facility hides behind a prestigious period building, in the heart of Marylebone in London. The demolition, excavations, piling and the construction of a new basement structure have all been completed within a limited number of hours per day, keeping the neighbourhood in mind, and the on-site team is now focused on completing the roof installation.

What is your focus ahead of opening the clinic to its first patients in 2020? The last steps are being completed before the fit-out can start in the second half of this year. Our plan is based on an assembly site which is located at Daresbury, operated with our partner, the Science and Technology Facilities Council. In the meantime, and prior to first patients, we will receive the relevant certifications and prepare for the installation of the system on site.

What are AVO’s expansion plans beyond London? Our plan goes well beyond London as, obviously, cancer has no borders. We have received approaches from parties located in city centres across Europe, Asia and the United States and are having discussions with various people around the world who would like to install a machine at the lowest possible cost.

3-4 New facilities are taking shape behind the original facade of the Harley Street building (PHOTOS: ADVANCED ONCOTHERAPY) 4

NHS PRIVATE PATIENT UNITS

Sir Robert Naylor

DRAWING ON THE EXPERTISE OF THE NATIONAL HEALTH SERVICE For much of the past two decades, I had the privilege of leading one of the world’s top academic health science centres developed in collaboration with University College London, sharing outstanding clinical and academic staff. Our mantra was to excel in delivering "top quality healthcare, outstanding education and world-class research", embedding this throughout the organisation. This could only be achieved through the dedication and professionalism of all our staff, with a sense of pride in being part of something special. The extraordinary affection for the UK's National Health Service (NHS), and its top international ranking (in 2016-17 the

OECD rated four English universities in the world’s top 10) is remarkable because the UK spends only 9.9% of GDP on healthcare, compared to the US, which spends a whopping 16.6% without getting better outcomes. Topquality healthcare and financial prudence go hand in hand, a relationship always at the forefront of political debate.

Creating value 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 an alternative to our comprehensive system, free at the point of access. The concept

1 University College London Hospital (UCLH) – one of the world’s top academic health science centres (PHOTO: ARCHIMAGE/ALAMY) | 2 Robotic surgery at UCLH (PHOTO: JEFF GILBERT/ ALAMY) | 3 The world-renowned Moorfields Eye Hospital (PHOTO: BRIAN ANTHONY/ALAMY) 2

4 Opened in 2016, biomedical research centre the Francis Crick Institute is a partnership between Cancer Research UK, Imperial College London, King's College London, the Medical Research Council, University College London and the Wellcome Trust (PHOTO: ARCHIMAGE/ALAMY)

of “free” healthcare has been drummed into us from infancy, so much so that many of us now take it for granted. Biomedicine teaching and research has become such a dominant subject in university curricular that the symbiotic relationship with healthcare and hospitals has created London’s three outstanding Academic Medical Centres, bringing first-in-man research discoveries, through translation, direct to the patient bedside. Nowhere is this more evident than in the recently opened $1bn Crick Institute, named after a London based Nobel prize-

winner. It’s a new approach to biomedical research and is fast becoming one of the world's leading medical research institutes. Uncompromising commitment to excellence, emphasis on multidisciplinary research, focus on emerging talent and on novel ways of partnership working are setting new standards in world-class research. Sustaining this excellence is one of the most exciting challenges facing NHS management today. London continues to lead the world in many areas; for example, we were first to centralise the management of new

NHS PRIVATE PATIENT UNITS

stroke patients, where we can now evidence dramatic improvements in patient outcomes – lives have been saved and suffering reduced at no extra cost. We have concentrated the provision of the most complex cardiac, neuroscience and paediatric specialities with remarkable improvements in patient mortality rates. Other international cities are following London’s lead and will reap similar benefits.

drawn from the nearby major teaching hospitals. New market entrants, such as the world-class Cleveland Clinic, for decades the top cardiac centre in the world, will be a potential shock wave for existing centres. This and other developments will consolidate and strengthen London’s leading international position as the safest and most comfortable place to be treated.

5 An air ambulance lands on the roof of the Royal London Hospital (PHOTO: COMMISSION AIR/ | 6 Guy's Hospital is one of London's largest teaching hospitals (PHOTO: GRANT ROONEY PREMIUM/ALAMY) | 7 The skills and expertise within the UK's National Health Service are now available to international visitors via Private Patient Units (PHOTO: CURTSEYES/ALAMY) ALAMY)

Alongside the NHS, the private sector, with its epicentre in Harley Street, houses a selection of internationally renowned hospitals, with medical staff

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

NHS PRIVATE PATIENT UNITS

CLINICAL EXCELLENCE IN THE HEART OF LONDON Guy’s and St Thomas’ NHS Foundation Trust comprises two of the world’s most prestigious and respected teaching hospitals, situated in the heart of London. It boasts a proud history of high-quality care, clinical excellence and innovation that dates back more than 900 years. It undertakes groundbreaking research and engages with key partners to drive forward innovations that benefit patients. The Trust runs Guy’s Hospital in London Bridge, St Thomas’ Hospital in Westminster and Evelina London Children’s Hospital, as well as community services in the south London boroughs of Lambeth and Southwark. As one of the country’s largest hospital trusts, Guy’s and St Thomas’ employs thousands of staff and treats millions of patients every year. It is dedicated

to serving the communities in which it operates as well as providing more highly specialist care to patients from across the UK and beyond. High-quality and personal care is at the heart of the Trust’s work. Guided by its values, Guy’s and St Thomas’ puts patients first. Guy’s and St Thomas’ is also part of King’s Health Partners, an Academic Health Sciences Centre that pioneers health research and provides highquality teaching and education. This partnership ensures Guy’s and St Thomas’ provides private patients with a unique combination of complex care and high-quality medical services with the comfort of a private facility, conveniently located in central London, close to many of the city's iconic landmarks.

The hospital Trust works with internationally renowned consultants and specialist staff, who have access to cutting-edge technology and modern facilities. All profits from Private Patient Services are reinvested to support the delivery of NHS clinical services for the benefit of all patients. Guy’s and St Thomas’ Private Healthcare welcomes patients from around the world and offers clinical specialities for every stage of life, from neonatal care to services for children, young people and adults. Private patients benefit from consultant-led care, which draws on the huge expertise and resources that reside within the organisation. Many patients find having their procedure or treatment in one of the top teaching hospitals, with the extensive, round-the-clock support services that this has, to be hugely reassuring.

As a large teaching hospital, Guy’s and St Thomas’ has the full support of NHS specialist services and access to the Trust’s comprehensive intensive care and emergency facilities, offering the best of private care and clinical services. With expert teams on hand, patients can be assured of added safety and support at every stage of their treatment.

International patients Guy’s and St Thomas’ aims to ensure that the cultural and religious needs of all patients are met with sensitivity and understanding. The service has its own International Patients team, which is dedicated to providing a professional Arabic translation and liaison service to support relationships with embassies and health offices. There is also language support and interpretation services to patients from around the world.

1 The expert teams at Guy's and St Thomas'

ensure the best in care for all patients, with the knowledge that their treatment is taking place at one of the country's top teaching hospitals

NHS PRIVATE PATIENT UNITS

Our centres of excellence Paediatrics at Evelina London Children’s Hospital. Evelina London provides complex private paediatric care and is one of only two specialist children’s hospitals in London. The state-of-the-art facility is an environment in which young patients can feel comfortable and relaxed. Among the hospital’s proudest achievements is being the first children’s hospital in the UK to be rated as ‘Outstanding’ by the Care Quality Commission.

2 High-quality and personal care is at the heart of the Trust’s work | 3 Guy's and St Thomas' welcomes patients of all ages from around the world

The hospital has a long and proud history, celebrating its 150th anniversary in 2019, having moved from its original site in 2005 to occupy the first new children’s hospital building in London for a century. Evelina London is a growing hospital and will open new cardiac and critical care wards, with ambitious plans for further expansion. Evelina London has received three royal visits in the past year, including one from the Duchess of Cambridge to open the new 59-bedroom facility, providing a ‘home away from home’ for families of children staying at the hospital.

Facts and figures (2018)

2.5 million patient contacts 89,000 inpatients 1.28 million outpatients 6,567 babies born 205,000 emergency and urgent care attendances

The vision of the hospital is to improve the lives of children and young people by putting its patients and their families at the heart of everything it does. This means providing consistently outstanding and life-enhancing healthcare; educating and training staff to deliver effective childcentred care and treatment; and undertaking research that changes practice and adds to knowledge of how to improve child health. Evelina London offers a comprehensive range of clinical services, from routine to specialist services for babies and children who require complex multidisciplinary care. Its location on the St Thomas’ Hospital site uniquely positions it to provide the full range of specialist services to support private patients – from conception, antenatal care, childhood through to adult life.

Renal services and transplantation Guy’s and St Thomas’ Renal Service is internationally recognised as one of the largest and most established renal units in the world, with an excellent standard of clinical care. The centre provides a diverse range of clinical services and has

been a leader in kidney care since the 1970s. Specialist renal services include transplantation, with Guy’s and St Thomas’ specialising in complex transplant cases. It has the UK’s largest antibody incompatible transplant programme and the only such programme for children. The Trust’s vascular access operations include radiocephalic and brachiocephalic fistulae, grafts and complex cases where access is difficult. Its programme is supported by an excellent interventional radiology service. There is also a paediatric vascular access service with an outstanding international reputation. The renal service provides a comprehensive haemodialysis service and can accommodate overseas patients. Treatment is delivered in a nurseled dialysis centre. which is located a short walk from Guy’s Hospital.

Specialist respiratory services Guy’s and St Thomas’ Specialist Respiratory Service offers acute and long-term management of patients with severe respiratory failure. The extracorporeal membrane oxygenation (ECMO) service is derived from cardiac bypass technology and allows mediumto-long-term support for patients with devastating heart or lung failure. Many patients with severe lung failure have pneumonia and require approximately 10-14 days of ECMO before their condition improves. There is a group of patients (approximately 1 in 8) who appear to have pneumonia, but actually have progressive lung disease. The team at Guy’s and St Thomas’ has significant expertise in this area, combining novel treatment approaches with rehabilitation on ECMO that has enabled many patients with this condition to survive. In recent years there has been a rise in the recognition of the chronic critically ill. These patients often have long intensive care stays and have severe ICU-acquired weakness as part of their problem. Guy’s and St Thomas’ respiratory Intensive Care Unit (ICU) is capable of providing full multiple organ support to patients with a variety of medical and surgical problems. Care is provided by an experienced multidisciplinary team with expertise in the management of such patients.

NHS PRIVATE PATIENT UNITS

Assisted Conception Unit Guy’s and St Thomas’ Assisted Conception Unit (ACU) offer services of the highest standard: its results exceed the national average for all common assisted conception techniques, including in-vitro fertilisation (IVF) and Intracytoplasmic sperm injection (ICSI). The unit regularly reviews and updates its practice through research and audit. The aim is to improve the experience of patients and enhance success rates. Above all, it offers support both during and after treatment. The ACU team is comprised of doctors specialising in reproductive treatment, specialist fertility nurses and embryologists. The unit also offers counselling, which is confidential and free of charge, and encourages all couples and individuals to see a counsellor for support. Guy’s and St Thomas’ ACU is dedicated to improving treatment outcomes for its patients. Fertility treatment has progressed vastly due to past research,

and the ACU runs an extensive research portfolio that includes both academic and commercial clinical trials.

Cardiovascular services Guy’s and St Thomas’ has one of the largest cardiovascular centres of excellence in the country. The unit has built an international reputation and today welcomes patients from around the world. It is home to multidisciplinary teams of expert consultants, researchers and nurses, all of whom have access to the latest clinical equipment.

“Our private patients service draws on the world-class clinical expertise and facilities that we have at Guy’s and St Thomas’, to offer the highest standard of care for patients from around the world” Dr Adam Fox, Commercial Medical Director, Guy’s and St Thomas’

The unit is at the forefront of pioneering cardiovascular treatment, leading the way in the use of TAVI (transcatheter aortic valve implantation) – a minimally invasive way of treating a heart valve that greatly improves recovery time. Its use of new treatments is built on expertise, with the unit specialising in a range of services, including adult congenital heart disease, arrhythmia, heart failure, inherited cardiac conditions, interventional cardiology, cardiac imaging, structural intervention and valve disease.

www.guysandstthomasprivatehealthcare.co.uk

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

Located in the heart of Hampstead Heath, the Royal Free London Private Patients Unit combines the convenience, comfort and personalised attention of a Private Hospital with the very best state-of-the-art services, technology, and professional excellence you would expect from a top London teaching hospital. We are proud to bring the very best skills and standards of the NHS to the benefit of our private patients and, in doing so, support the continued development of the NHS and the Royal Free London through our success. We accept patients from the UK via GP and selfreferrals and from overseas via government sponsorship or self-referral. Our referrals team will help patients book consultations and treatments with the patient’s consultant of choice and, where needed, will provide the patient with information about the hospital and consultants to aid their decisions. They will guide the patient step by step through all the administrative steps needed, whether the case be a simple consultation or a complex international admission.

Private Patients Unit, we make every effort to ensure that all of our patients’ needs are addressed on every level even before they start their journey.

The private patients unit has strong links with all of the consultants and specialists as well as with every department within the Royal Free London thus ensuring that our private patients enjoy full access to all the specialist services that the hospital has to offer.

Our dedicated enquiries and referrals team are able to provide our international patients with a letter of invitation to support international UK entry visa applications for medical care. We can also make accommodation and local transport arrangements on behalf of our private patients.

We understand that travelling to another country for medical care can be a daunting experience. When our patients travel to the Royal Free London

Alongside organising interpreting services as required, we also maintain a permanent Arabic liaison team to support this patient group.

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

NHS PRIVATE PATIENT UNITS

PUTTING RESEARCH INTO PRACTICE Operating across five hospital sites, Imperial Private Healthcare provides its patients with access to a whole range of services 24 hours a day. These include coronary care, state-of-the-art diagnostics and maternity services, as well as specialist care of complex and long-term diseases, such as cancer.

In partnership with leaders in research Imperial Private Healthcare is part of one of the UK’s leading academic hospital groups – Imperial College Healthcare NHS Trust – with more than 500 expert consultants covering every medical, diagnostic and surgical specialty. With partners Imperial College London, The Royal Marsden NHS Foundation Trust and Royal Brompton & Harefield NHS Foundation Trust, Imperial Private Healthcare has created the Imperial College Academic Health Science Centre. This is one of 11 academic health science centres in the UK working to

ensure the rapid translation of research for better patient care and excellence in education. Bringing together primary research with a clinical setting allows consultants to quickly translate research into practice so that patients receive the most up-to-date treatment. From diagnosis until discharge, patients and their families experience exceptional levels of discretion and care, with advanced clinical facilities and accommodation to help ensure that treatment and recovery is as safe, straightforward and comfortable as possible. Imperial Private Healthcare hospitals also offer flexibility to enable patients to meet their consultant at a time that is convenient, to fit in with work and home commitments. As well as providing patients with outstanding private healthcare, all Imperial Private Healthcare’s profits are reinvested into local NHS services, enabling the hospitals to care for other patients in the community.

1 Families benefit from more than 60 years’ experience in maternity at St Mary's Hospital

2 Patients at all five hospital sites can expect a comfortable stay with a wide range of facilities | 3 Compassionate staff ensure that patients are fully supported throughout their treatments (PHOTOS: IMPERIAL PRIVATE HEALTHCARE) 2

NHS PRIVATE PATIENT UNITS

IMPERIAL PRIVATE HEALTHCARE HOSPITALS The Thames View, Charing Cross Hospital A dedicated private facility on the 15th floor of Charing Cross Hospital, with inpatient facilities consisting of single en-suite rooms with additional access to specialist areas. Day-case rooms cater for short stays, and there is also a private outpatient department and a dedicated chemotherapy day unit. The hospital is a leading centre for neurosciences, neuro-rehabilitation, complex surgery, elective orthopaedics and cancer care.

“The level of service and patient care has been first-class. I would highly recommend this hospital to friends and family” Patient from The Robert and Lisa Sainsbury Wing, Hammersmith

Sir Stanley Clayton Ward, Queen Charlotte’s and Chelsea Hospital World-renowned maternity hospital Queen Charlotte’s & Chelsea offers an excellent level of care for women and their babies through specialist obstetricians, paediatricians and midwives – an expert team working together within a single unit. The hospital is a tertiary referral maternity unit with a nationally celebrated centre for fetal care. It is the largest neonatal intensive care unit in the country and its labour ward has two fully equipped operating theatres with adjacent high-dependency care facilities.

Western Eye Hospital

The Lindo Wing, St Mary’s Hospital The Lindo Wing of St Mary’s provides the highest quality of care for surgical, medical and obstetric patients. With over 60 years’ experience in maternity, St Mary’s has neonatal services and critical care facilities, so is equipped to deal with all pregnancies and deliveries. The unit also specialises in complex, robotic and trauma surgery, as well as other disciplines, such as bariatric surgery, vascular, gynaecology, urology, ear, nose and throat, and general surgery. A private paediatric service is also available for certain specialities, including an internationally recognised haematology service.

The Robert and Lisa Sainsbury Wing, Hammersmith Hospital A dedicated private facility within Hammersmith Hospital, offering modern, private en-suite rooms for inpatient and day care, as well as eight centrally monitored private cardiac beds. Outpatient facilities are also offered. The unit specialises in cardiology, cardiothoracic

surgery, cancer care, renal and hepatobiliary conditions, as well as providing general clinical services.

The major teaching centre of the Western Eye Hospital offers a comprehensive service for all sophisticated investigations now available in eye care – from common eye problems to complex ophthalmic issues. Services include weekly clinics with on conditions such as macular degeneration and diabetes. State-of-theart equipment includes the latest optical coherence scanner, which provides high-quality images of the retina.

NHS PRIVATE PATIENT UNITS

4 Imperial Private Healthcare has more than 500 expert consultants, covering every medical, diagnostic and surgical specialty | 5 St Mary’s neonatal services and critical care facilities mean the hospital is equipped to deal with all pregnancies and deliveries (PHOTOS: IMPERIAL PRIVATE HEALTHCARE)

Imperial Private Healthcare is backed up by comprehensive NHS medical support, with the expertise of specialist doctors around the clock, operating within large, acute hospitals, including one with its own trauma centre.

NHS clinical guidelines, so patients’ needs are met by doctors and surgeons with the most appropriate expertise.

In-depth and tightly governed clinical management processes help embed best practice across each of the sites and medical units. For instance, multidisciplinary teams made up of around 30 experts – from nurses and therapists to pathologists and radiologists – meet weekly to review evidence around complex diseases, using their different insights and perspectives to make the best decisions for individual cases.

Each hospital’s consultants, doctors and nurses have the skills and experience to support patients through their treatment. As well as providing high-quality medical care, the understanding and sympathetic staff ensure that patients feel relaxed and comfortable throughout their stay. Imperial Private Healthcare makes patients’ health, wellbeing and comfort a priority, offering private, modern rooms with en suite facilities across all its inpatient sites. A choice of suites or deluxe accommodation is on offer, including satellite TV, WiFi, radio, a bedside phone and a refrigerator.

Imperial Private Healthcare hospitals boast consultants with enviable reputations across many specialisms – from cancer, renal and gynaecology to neurology, cardiovascular and haematology – with many known internationally as leaders in their field. Their practices are rigorously managed and monitored within stringent

Overseas patients have access to a variety of additional services, including translators, foreign-language newspapers and a multi-faith worship room. An extensive menu caters for special dietary, cultural and religious requirements, including vegetarian, kosher and halal meals, which are all prepared on site.

Tel: +44 (0)20 3311 7700 Email: imperial.private.healthcare@nhs.net www.imperialprivatehealthcare.co.uk

NHS PRIVATE PATIENT UNITS

PIONEERING HEART AND LUNG CARE Royal Brompton & Harefield Hospitals Specialist Care is the largest specialist heart and lung centre in the UK. The hospitals are known throughout the world for their expertise, standard of care and research success. Highly skilled consultants see their patients in the hospitals’ private facilities, managed on a day-to-day basis by a nursing team trained in cardiothoracic care. Every patient can be confident that they will have access to the most comprehensive range of advanced surgical, medical and diagnostic facilities that are only available from a large, specialist NHS hospital. Based across three convenient London locations, patients can choose to be treated at the Royal Brompton Hospital in Chelsea, Harefield Hospital in Middlesex, or at a dedicated outpatients and diagnostics facility in the Harley Street Medical Area.

Specialties include:

− − − − − − −

cardiology cardiac surgery respiratory medicine thoracic surgery vascular surgery paediatric care diagnostic services and outpatients clinics − comprehensive clinical support As a large post-graduate teaching centre, Royal Brompton & Harefield hospitals can offer the very best care, 24 hours a day, with the benefit of on-site support services uncommon in other hospitals. The main point of difference is the hospitals’ expertise and multi-disciplinary team – looking after the patient’s full journey of care. The clinicians are the

leading experts in their fields and the hospitals have a worldwide reputation for heart and lung research.

Sydney Wing, was opened in 1991 by Her Majesty The Queen. In the same year, the hospital was granted a Royal Charter.

World-class facilities

The hospital has an international reputation for the treatment of lung disease – the result of over 170 years’ experience. It is also an international leader in the treatment of heart conditions, with large research trials leading to significant developments.

Patients from around the world regularly travel to London to receive expert care and treatment from Royal Brompton & Harefield Hospitals Specialist Care, at three locations. Each site features smart and comfortable facilities for patients and their relatives, in an environment well suited to their needs.

Royal Brompton Hospital Situated in Chelsea, Royal Brompton Hospital has been treating patients since the 1840s. In its first decades, the hospital was supported by kind benefactors, including the Royal Family and the author Charles Dickens. Royal patronage has continued and the main building,

On the private Sir Reginald Wilson Ward, dedicated staff care for cardiothoracic surgery patients, cardiology and respiratory patients in 29 rooms, with en-suite bathrooms. “We have dedicated inpatient and outpatient facilities for private patients,” explains general manager Fred Sendaula, “with access to some of the most advanced diagnostic equipment and medical devices in the world.”

1 Clinicians are leading experts in their fields and the hospitals have a worldwide reputation for heart and lung research | 2 Staff provide the highest standards of patient service (PHOTOS: ROYAL BROMPTON & HAREFIELD HOSPITALS SPECIALIST CARE)

NHS PRIVATE PATIENT UNITS

Harefield Hospital As a centre of excellence, Harefield Hospital has offered expert heart and lung care for many years. It has a long history of treating international patients. In fact, it was originally established in 1915 to treat injured soldiers from Australia and New Zealand. Professor Sir Magdi Yacoub established the largest heart and lung transplantation programme in the world at Harefield Hospital. The current hospital building is a late Art Deco design, opened in 1937 by the Duke of Gloucester. Over the years, the hospital has increased in size and been completely refurbished with state-of-the-art facilities.

patients: “Patient service is at the heart of our new facility. We have the leading cardiac and respiratory specialists working here and we are committed to delivering world-class care.” Patients benefit from the convenience of having a consultation and multiple diagnostic tests scheduled on the same day, in the same location. The 'onestop' approach removes the burden of having multiple appointments in different places with unnecessary travel. The following services are offered for same-day or short-notice appointments:

− consultations for respiratory

Hashem regularly liaises with embassies and international contacts, and advises on referrals – such as which consultant is most appropriate for a patient’s needs – and also provides support with arranging appointments and admission to the hospital.

Inpatient facilities Private patients enjoy freshly prepared meals from the dedicated catering service at the hospitals. The menu is translated into Arabic, and always includes vegetarian and heart-healthy options. The hospitals provide Halal and Kosher meals, and will cater to special requests wherever possible. Patients receive a complimentary daily newspaper, including a range of international titles, and each patient has their own television, with UK and international channels to choose from.

Harefield Hospital boasts new private inpatient and outpatient areas with diagnostic suites, overseen by Gerri Hamer, general manager for private patients. “Everything we offer is based on the needs of our patients,” explains Hamer. “We can arrange same-day or short-notice appointments with our respiratory and cardiac consultants. Our rapid diagnostics service offers MRI, echocardiography, CT, lung function and non-invasive tests.”

and cardiac conditions − the latest imaging scans, including PET-CT, CT and MRI − non-invasive cardiology including cardiac monitoring, exercise tolerance tests and ECG − other diagnostic tests such as echocardiography, lung function and chest x-ray

Juniper Ward is the dedicated private inpatient ward, offering 16 rooms with en-suite bathrooms. “The rooms are very pleasant, and as they are all southfacing, patients can enjoy plenty of natural light, in the comfort of their own space,” says Hamer. “Harefield is unique, as it offers world-class care in a quiet and beautiful setting situated in the greenbelt of London.”

“We know that patients come a long way... We try to make them feel like they are at home” International patients

77 Wimpole Street outpatients and diagnostics Based in the renowned Harley Street Medical Area, the Wimpole Street facility is Royal Brompton & Harefield Hospitals Specialist Care's central hub, offering outpatient and diagnostic care for patients with heart and lung conditions. In addition, practicing privileges are offered to other physicians and physiotherapists, who are not normally based at Royal Brompton and Harefield hospitals. The building blends historic and modern architecture, and has been completely refurbished to a high specification, with smart patient waiting areas, spacious consulting rooms and easy lift access. Zohreh Palmer, general manager, ensures 77 Wimpole Street is a top location for

Being away from home in a different environment can be worrying and stressful, so Royal Brompton & Harefield hospitals ensure that international patients and their families are well looked after. A dedicated team of international patient coordinators is fluent in Arabic, and help ensure that the patient’s cultural, religious and language needs are met. If other languages are required, a professional interpreter is present. “We know that patients come a long way from their home country. We try to make them feel like they are at home,” says Afnan Hashem, international patient manager. “We take responsibility for them – like it’s a new member of the family who has joined us. If there are any problems, they can depend on us to sort it out.”

Support for loved ones Visitors benefit from generous visiting times and comfortable waiting areas with free refreshments. “Much of the signage

on the wards is in both English and Arabic. This makes it easy for Arabic-speakers to find their way around,” Hashem says. “For relatives of embassy-sponsored international patients receiving treatment at Harefield Hospital, we offer a complimentary daily return taxi service from central London to the hospital.” With this service, relatives can enjoy the capital’s hotels and amenities, yet quickly and easily visit their loved ones.

Spiritual care Each hospital also offers support for the religious and spiritual needs of patients, their relatives and friends. A chaplaincy team can visit the ward to provide pastoral support and information, listen in confidentiality, pray if requested, or arrange for the appropriate faith leader to visit. A multi-faith prayer room offers quiet

NHS PRIVATE PATIENT UNITS

spaces to pray or reflect, with prayer mats and a male/female divider available. There is a chapel at each hospital, and weekly services and prayers are held for Christians or Muslims who wish to attend them.

the wards; I have only seen textbook examples. This is a chance I never imagined I would have, so thank you Royal Brompton Hospital” says Dr Aliah Khesroh, Clinical Fellowship Program in Adult Congenital Heart Disease from Kuwait

3 RB&HH Specialist Care has a wide range of specialists, who are leaders in cardiothoracic care | 4 Patients have access to same-day appointments and the most up-to-date diagnostic capabilities (PHOTOS: ROYAL BROMPTON & HAREFIELD HOSPITALS SPECIALIST CARE)

Developing expertise Royal Brompton & Harefield Hospitals NHS Foundation Trust provides a range of programmes designed to share our world-renowned expertise with overseas partners. These include intensive clinical education programmes to overseas physicians wishing to further develop their expertise in certain interventional specialities. Programmes are designed to help training clinicians integrate into the team so they can maximise their learning outcomes and meet development needs. The bespoke international programmes are typically tailored to the physician’s level of expertise, their development goals and current available opportunities within the hospitals. Those who have General Medical Council (GMC) registration will have access to the clinical fellowship programme, which range between two to six months in duration. Applicants without GMC registration will have the opportunity to apply for the clinical observership programme, the duration of which varies according to development goals. “Back home we don’t have such a variety of congenital heart disease cases on

Visiting doctor programme Royal Brompton & Harefield hospitals’ consultants are committed to broadening overseas teams’ clinical knowledge, actively participating a visiting doctor programme to share their expertise and develop local teams’ clinical skills. Following an invitation from the local hospital, a consultant will undertake a short visit. During this time, they may be expected to work alongside local consultants, share clinical knowledge, hold outpatient clinics, operate on any appropriate cases, participate in clinical discussions and/or undertake lectures.

Sharing best practice and collaboration Royal Brompton & Harefield Hospitals have a strong interest in helping other hospitals and healthcare providers develop best practice in key clinical areas. Its clinicians look to transfer knowledge in core clinical operational areas such as operating theatres, catheter labs and intensive care, to lead clinicians in-county, helping the teams achieve best practice and develop their own centres of excellence.

Royal Brompton & Harefield Hospitals Specialist Care Telephone: +44 (0)20 3553 3180 Email: privatepatients@rbht.nhs.uk Web: www.rbhh-specialistcare.co.uk

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

Hadley Wood Hospital is a dynamic new private day-case, outpatient and 24-hour care unit located in North London, easily accessible and close to a wealth of shops, restaurants and other local amenities. The unit has been opened by the Royal Free London Private Patients Unit allowing us to offer our patients direct access to London’s top consultants in a discreet, tranquil setting. All of our Consultants hold senior positions in London teaching hospitals or primary healthcare trusts and have admitting privileges at the Royal Free London NHS Foundation Trust. We offer diagnostics, imaging and surgery to both self-paying and insured patients, with all profits generated by the unit invested back into the NHS. All diagnostic facilities, from a simple blood test to the most complex diagnostic scans, are available under one roof, allowing us to diagnose and treat our patients quickly and efficiently. At our hospital, each patient is cared for individually and treated with dignity, compassion, kindness and respect. Patients’ experience of care is our key priority and we ensure that each of our patients receives the highest possible standards of quality care by our efficient and competent staff, both clinical and non-clinical.

Boasting eight consulting rooms, a minor treatment room, a dental room, an endoscopy suite, a radiology suite and two day-case theatres, we are able to provide the very best environment to ensure our patients experience the world-class care that is synonymous with the Royal Free London.

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

EXCELLENCE AND INNOVATION

Consultant plastic surgeons Mr Norbert Kang and Mr Alex Woollard describe how the Royal Free is employing new surgical techniques to improve the quality of life for amputees INTERVIEW

ADVANCES IN PROSTHETICS What are the traditional options available to amputees and what problems do they face? The majority of patients who lose a major limb, whether that’s an arm or a leg, will have to resort to reconstruction using a prosthetic device – an artificial leg, an artificial arm, or something of that kind. And that's been the case for literally thousands of years, as there are historical precedents of patients having artificial limbs as far back as Ancient Egypt. However, trying to fix an artificial limb to an amputation stump is really difficult, because the body was never designed for it. Although we try really hard to create a comfortable, form-fitting, prosthetic socket, it often ends up causing problems that can be painful. It hurts because the fit has to be tight in order for the artificial limb not to move around in a way that is then functionally useless. 1 Consultant plastic surgeons Mr Norbert Kang and Mr Alex Woollard (PHOTO: ROYAL FREE HOSPITAL)

Pain can also be caused because nerve stumps in the residual limb are often

sensitive and are now being squashed inside the socket of the prosthetic limb. Friction between the skin and the socket of the prosthesis can also cause infections due to skin ulceration or inflammation of irritated hair follicles. In the case of a lower-limb amputee, walking can be very restricted, sometimes to just a few hundred metres, or the patients may only be able to wear the device for half the day. Likewise, with the upper limb, as well as the problems of attaching the prosthesis, the majority of the prostheses we have at present are very poor in terms of their function. With current technology, it's impossible to have an artificial limb that reproduces exactly the movements and abilities of a missing hand.

What new technologies are now available to patients? At the Royal Free, we've taken advantage of revolutionary developments in both surgical and prosthetic technology, which

EXCELLENCE AND INNOVATION

At the Royal Free, we've taken advantage of revolutionary developments in both surgical and prosthetic technology

2-3 Osseointegration, in which a piece of metal is placed into the residual bone in an amputation stump, enables a prosthesis to be attached more securely (PHOTOS: ROYAL FREE HOSPITAL)

have come about over the past decade. One of these is osseointegration, in which a piece of metal is placed into the residual bone in an amputation stump. The bone then accepts the metal as if it was part of itself. Such technology has been around for 50 years, but mainly in the context of artificial teeth. We don't really understand why this process occurs, but it's something that we can exploit and reproduce time and time again, to the extent that it is now so widespread in dental treatment that there are probably upwards of 75,000 dental implants inserted every year in the UK. We are now able to use the same technology to put an implant into the bone within the amputation stump. A small part of the implant protrudes through the skin to provide a secure point of attachment for the prosthetic limb that does not rely on the use of a socket, straps or anything of that nature. All the patient has to do is attach or detach the prosthesis from the bone anchor, using a simple clickoff/click-on or screw mechanism. As the forces that are applied to that limb are now traveling through the bony skeleton, rather than through soft skin and muscle, it is biomechanically easier for the patient to use their prosthesis in a way that approaches normal. For example, in the upper limb, because it is so much more secure, you can do things like lifting the prosthesis above your head – if you try to do something like that with a conventional socket-fitted prosthesis attached over the shoulder, the prosthesis falls off because it's just not designed to cope with that.

What advances have there been for amputees experiencing nerve issues? The other big revolutionary step occurred back in 2004, with the introduction of a surgical technique called targeted muscle reinnervation, which is a completely radical departure from anything that has been done before. Amputees experience two major problems as far as the nerves are concerned. The first is called phantom limb pain. It is a symptom that can be quite hard to describe. Nearly all amputees 2

experience some sensation of the limb being present, although obviously it has been amputated. In some patients this sensation develops into pain, typically a crushing, cramping, or burning sensation, and the perceived position of the missing part can be very abnormal. Every second of every day, we all receive feedback that tells our brains what our limbs are doing and where they are in space, but when you amputate a limb, that feedback disappears. The brain then starts to scrabble around looking for feedback from the missing limb. Instead, what happens over time is that the perception becomes distorted and changed because the feedback is no longer there. Targeted muscle reinnervation (TMR) is a procedure to reconnect the nerve stumps in the amputated part to muscles within the amputation stump, which are currently redundant. We can use those muscles to provide a target for those nerve endings which then provides feedback to the central nervous system, tricking the brain into thinking that the limb is present. When the nerves grow through and that feedback starts to kick in, the phantom limb pain either diminishes or disappears altogether. This is the first time that there's been a reliable surgical technique for addressing phantom limb pain. The second issue that the TMR procedure deals with is neuroma pain. After amputation, nerves try to grow, but can't make contact with the amputated part because it isn’t there. Instead, they can form a ball of scarred nerves that are very sensitive, so that when patients have their amputation stump touched it is often so uncomfortable that they can't wear a socket-fitted prosthesis. Targeted muscle reinnervation helps to instruct the nerves not to grow this ball of scar tissue, taking away this element of the pain. A third benefit of the surgery is that, by repurposing those muscles in the amputation stump, we can provide the patient with the means to control a prosthetic limb much more easily. Currently, this is mainly applicable in the context of upper-limb amputees, but it may be extended to lower limbs in the future.

What is the typical assessment, surgical and rehabilitation timeframe for visiting patients? We have a regular monthly clinic where we, the physiotherapists, the prosthetists, psychologists, and anaesthetist ascertain whether somebody would be a good candidate for these kinds of treatments.

For someone who is visiting from abroad for treatment, that kind of clinic would be very suitable as it also enables the patient to have carry out all of their scans and tests during a single visit. We would have an answer on whether or not the patient is suitable for surgery – if so, they could go ahead with surgery in a relatively short period of time.

Patients receiving surgery should expect to be in hospital for three to five days, followed by a period of residential rehabilitation. The duration of rehab depends on whether the surgery is for an upper or lower limb problem, the patient’s bone density and the complexity of the procedure, but this would range from a few weeks up to one-year after surgery.

World-leading cardiac care

Deep within The Harley Street Clinic, one of the most prestigious and respected private hospitals in London, is the Paediatric Intensive Care Unit. The largest facility of its kind in Europe, it offers the highest level of one-to-one intensive care to children and infants

Inside the unit, premature babies just a few hours old recover from complex life-saving operations. Caring for them is a team of world-leading surgeons, intensivists, nurses, physiotherapists and pharmacists. They’ve worked together for a decade. Each team member knows how the others think, move, operate and stitch. They know each other’s strengths and weaknesses. And they know how to get the best from one another. Nearby at The Harley Street Clinic’s sister hospital, The Wellington, 20 clinicians meet to discuss a patient’s case. They scrutinise the evidence, review images, and debate diagnosis and treatment. Decades of experience, gained treating thousands of patients, are channelled into making the best decision for one individual. Across London, at London Bridge Hospital, a team of seven surgeons works together to repair a thoracoabdominal aneurysm. It takes them seven hours. Three cardiac surgeons and three vascular surgeons perform intricate procedures to repair the wall of the aorta that extends from the chest into the abdomen. One consultant oversees the entire operation, like a conductor leading an orchestra.

Each hospital is a centre of excellence, known for pioneering cardiac care Each hospital is also part of HCA Healthcare UK, a group of outstanding healthcare facilities including GP practices, urgent care centres and research labs, alongside globally renowned hospitals. Practising across these hospitals is a set of world-leading cardiologists and cardiac surgeons. From the first person to perform non-contact mapping to treat heart arrhythmia, to the professor who advises the UK Government on preventing heart disease, they’re some of the foremost minds in medicine. Uniquely in a private setting, HCA UK brings the work of these consultants together into one joined-up clinical department. Across the department, consultants are performing huge volumes of procedures and treatments – something that’s proven to deliver better outcomes for their patients. Working together so frequently also helps them innovate together – whether that’s developing an approach or improving a technique. Among the department’s consultant cardiac electrophysiologists is one of the first people to perform cryoablation treatment of atrial fibrillation, using a balloon catheter to locate and freeze the heart tissue that causes an irregular heartbeat. Another consultant carried out the world’s first ablation without X-rays, using non-fluroscopic computerised 3D mapping to guide catheters towards the heart without any exposure to radiation.

This kind of complex medicine is only possible with the best facilities, teams and equipment Technology helps to speed up diagnosis: for example, the Heartflow FFRct creates a digital colour-coded model of a patient’s arterial blood flow, reducing the need for invasive testing. Technology also helps consultants plan procedures. FEops technology uses clinical images to build a computer model of an individual patient’s heart valve. It then models how a replacement valve device will fit, sit and work in that patient’s heart. Computational fluid dynamics uses technology to apply millions of complex equations to look at how heart fluids interact with structures. It is similar to the technology used to design Formula 1 racing cars and in the aeronautical industry. Technology helps consultants perform the procedures too. One surgeon uses the da Vinci robot to perform coronary artery bypasses. The robot’s four arms have a greater range of motion than human wrists, and the processors eliminate any natural hand tremor.

The latest procedures

Dealing in millimetres

With this level of support – and levelone Intensive Care Units in every hospital – consultants can offer their patients the latest procedures and techniques.

Back at The Harley Street Clinic, a team of paediatric cardiac surgeons is performing the Norwood Stage 1 procedure. It’s a highly complex reconstruction of the aortic arch, performed on neo-natal babies born with only one working ventricle. Without open heart surgery, the babies would die. As they’re so young, and their hearts are so small, the surgeons deal in millimetres. After each operation, patients stay in intensive care for 72 hours with their chests open. They then need weeks of care from paediatric anaesthetists, physiotherapists and dieticians until they can breathe and feed by themselves. Within six months, they’ll return for a second operation; within five years, a third, all under the care of the same team. As they grow older and become healthier, they’re supported by teachers and play therapists too, while psychologists work with their families. Once they become teenagers and young adults, they receive yet more specialised care from the team that’s looked after them since birth. In the 1960s, children born with heart defects were likely to die before reaching their first birthday. Today, eight out of 10 survive.

Transcatheter aortic valve implantation (TAVI), for example, is a minimally invasive procedure to replace the aortic valve. A team of cardiologists, anaesthetists, nurses and surgeons guide a tube from the top of the leg to the heart. This acts as a railroad, delivering the new heart valve to exactly the right place. When it reaches its destination, it’s unfurled, or expanded into place using a balloon – without a single stitch. PEARS – Personalised External Aortic Root Support – is used to treat patients with a dilated aorta. A CT scan is taken and used to construct a 3D aortic root model, and then a bespoke aortic root support. Surgeons place this around the aortic root, to stop it dilating any further. Without the procedure, patients would face open heart surgery and a lifetime of anticoagulant medication.

It seems extraordinary – but in HCA UK hospitals, it happens every day Patients from across the world come to London for their treatment. They’re cared for by consultants who’ve dedicated their lives to understanding the human heart. Every day, they work together to keep it beating. They pioneer procedures and perfect others. Their work doesn’t change patients’ lives today. It changes lives for generations to come. For more information, please visit: www.hcahealthcare.co.uk

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21/01/2019 10:09

EXCELLENCE AND INNOVATION

Julius Patrick, Senior Clinical Physiologist, explains why he chose to progress his medical career at Bupa Cromwell Hospital

A FULFILLING CAREER IN MEDICINE I began working at Bupa Cromwell Hospital in 2011 and soon developed a passion for the combination of clinical expertise and patient interaction. I found purpose and meaning in positively contributing to the patient's pathway – providing a smooth healthcare journey along the way.

1 Julius Patrick has made the most of the opportunity to develop his career since joining Bupa Cromwell Hospital in 2011 (PHOTO: BUPA CROMWELL HOSPITAL)

My first year was devoted to learning how to interact with different patient groups by rotating across multiple departments in the business; however, it wasn't until my placement in the Bupa Cromwell Lung Centre that I discovered a specialty that I wanted to pursue professionally. In 2013, I embarked on a hospital-funded longdistance degree, whilst simultaneously working full-time in the department. In 2016, I qualified with a first-class honours in Healthcare Science, specialising in Respiratory and Sleep Physiology.

Today, I work as a Senior Clinical Physiologist in the Lung Centre. As part of my role, I carry out a variety of conventional and complex lung function and sleep diagnostic tests. I work with both adult and paediatric patients, including patients in the intensive care setting. Bupa Cromwell Hospital’s Lung Centre first opened its doors nearly seven years ago. Initially, we treated up to 20 patients a month; today we welcome up to 400 patients a month. The majority of our patients have or are experiencing common respiratory symptoms. These include: coughing; wheezing; shortness of breath; difficulty breathing and allergies. We have also witnessed an increase in patients with sleeping disorders. Sleep apnea is characterized by periods of shallow breathing and/or pauses in breathing during sleep. We have a wide

EXCELLENCE AND INNOVATION

I am always struck by how caring and passionate the frontline staff are about their work and patients alike, something you sense strongly upon first entering the building

variety of different treatment options for this patient group, the outcomes of which have been very positive.

consultations in which we address not only clinical matters, but also have the space and time to talk through the personal effects of an untreated condition.

We are a close-knit team with an in-built culture of mentorship. I work closely with the newer members of the team, who are keen to develop their skill set within the hospital. In turn, I am also mentored by a Head of Department to ensure the correct balance is struck between my theoretical and practical learning.

Working at Bupa Cromwell Hospital, I am always struck by how caring and passionate the frontline staff are about their work and patients alike, something you sense strongly upon first entering the building. There is an inherent team ethos – it’s very professional.

I am situated in the Clinical Investigation Centre, which houses a physiology centre, with lung, neurology and cardiac all under one roof. I enjoy both the clinical and non-clinical aspects of my work. I have the opportunity for one-on-one

Bupa Cromwell Hospital is internationally renowned and we welcome many new patients from as far as the Gulf region. I work closely with language interpreters when consulting patients about the nature of our clinical tests. We also

have multilingual staff throughout the hospital, which helps patients to feel more at home. It’s comforting that you can put someone at ease in advance of any testing, knowing that they might be slightly nervous in a clinical setting. The hospital has continued to invest in infrastructure as well as its staff. We have a brand-new, spacious reception, with concierge staff to welcome and guide patients to the correct department within the hospital. We have also refurbished the patient rooms and, more recently, relaunched our dedicated Paediatric Department – Skyline. Work on a brand new Intensive Care Unit will soon be under way.

I am personally very dedicated to furthering my expertise and, with the continued support of the hospital, would like to pursue further study to enhance my knowledge in my field and eventually progress into hospital management, with the aim of further providing our patients with the best possible care and services.

2-5 Bupa Cromwell Hospital boasts many new and renovated facilities, from the refurbished reception area and rooms to new clinical centres (PHOTOS: BUPA CROMWELL HOSPITAL)

I wouldn't be here if Bupa, as an organisation, didn't offer me the opportunity to grow and develop. For anybody who is interested in entering the world of medicine, Bupa Cromwell Hospital is committed to developing its staff. I believe this has reflected positively on my interaction with patients who realise that I am fulfilled in my career.

Innovations in treatment for multiple sclerosis

Recent clinical trials of a new treatment for Multiple Sclerosis – now available privately at London Bridge Hospital – suggest vastly improved outcomes compared to standard drug-based treatment

Multiple Sclerosis, the debilitating neurological condition affecting the brain and spinal cord, is thought to affect over 2.3m people worldwide. Of the 80% of people with Multiple Sclerosis who go on to develop a progressive disability, almost half will require a wheelchair within 10 years of diagnosis. However, exciting research has found “game-changing” improvements in quality of life for people living with the condition. The findings, from the largest-ever randomised clinical trial into Autologous Haematopoietic Stem Cell Transplantation (aHSCT) treatment for Relapse Remitting Multiple Sclerosis, have recently been presented at the American Academy of Neurology annual meeting. Results suggest that its progression could reduce or even stop in 70% of patients using aHSCT treatment, compared to 30% for users of the standard drug-based treatment. Traditionally used to fight blood cancers, aHSCT has been performed on a trial basis for thousands of patients with Multiple Sclerosis across the world. Treatment has been so successful that, in some cases, it has even reversed disability.

Consultant Haematologist Dr Majid Kazmi is Clinical Director at Guy’s and St Thomas’ NHS Foundation Trust and has the largest UK experience in HSCT for Multiple Sclerosis, dating back to 2010. “This treatment, although intensive, is a one-off procedure that can leave patients drug free for years. The earlier we treat patients the better the outcome in the longer term. We’re almost at a tipping point where, in the next five years, we can confidently say that no patient with MS should end up in a wheelchair – and I think that’s a game-changer,” says Dr Kazmi. “No other treatment to date has been shown to do that.” One of the few private hospitals in the UK to offer aHSCT treatment is London Bridge Hospital, part of HCA Healthcare UK, where Dr Kazmi treats his international patients. “For patients whose first-line therapies have failed, aHSCT is incredibly exciting,” says Janene Madden, CEO of London Bridge Hospital. “People travel from all over the world to benefit from the clinical expertise of consultants such as Dr Kazmi and his team,” she adds.

A referral from a Consultant Neurologist specialising in Multiple Sclerosis is required to discuss treatment options. Call HCA UK on +44 (0)207 234 2009 or email global@ hcahealthcare.co.uk for more information t

Dr Majid Kazmi, Consultant Haematologist at HCA Healthcare UK

Case study Jodie’s marathon journey Jodi was juggling a career in events management with three young children. So she didn’t think it strange that she often felt tired and fuzzyheaded. However, she knew something was wrong when, stepping into a bath, she realised she only felt heat in one leg. After ruling out a stroke, doctors revealed Jodi has Multiple Sclerosis and that she could be in a wheelchair within a year. She couldn’t bear the thought of how this would affect her children. Through her research, Jodi discovered aHSCT treatment at London Bridge Hospital. “For me,” she says, “it was the only option”. Although the treatment came with serious risks and side effects, she never doubted that it was the right choice. “I’d do it all again, without question,” she adds. Before her treatment, she marked her symptoms, which ranged from pins and needles to paralysis – from one to 10. All were eight or above. Five months after treatment, none scored higher than three, and most were zero. She’s doing spin classes three times a week, and is now planning to run the New York City Marathon.

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

EXCELLENCE AND INNOVATION

Mr Charles Imber INTERVIEW

DEALING WITH LIVER DISEASE Mr Charles Imber, Consultant Surgeon at the Royal Free Hospital, explains how effective treatment for liver disease involves a team effort

1 Mr Charles Imber, Consultant Surgeon at the Royal Free Hospital (PHOTO: ROYAL FREE HOSPITAL)

Please tell us about yourself and the work that you do. I am a hepatopancreaticobiliary (HPB) consultant surgeon, with an added interest in liver transplantation. These complement each other well because many of the more complex procedures around cancer HPB surgery relate, technically, to the procedures we carry out in liver transplantation. For example, advanced pancreas cancer operations often require removal of major blood vessels (portal vein/ superior mesenteric artery) close to the cancer to enable complete clearance, and I’m very used to dealing with that because of my clinical experience. We currently perform about 125 liver transplants a year – from both cadaveric donors and also from live, related donors – and we operate on more than 400 patients a year for both benign and malignant liver and pancreas conditions. We are one of the biggest liver and pancreas surgical units in the country.

At what stage would a patient be referred to you? Would they have seen another specialist previously? There is a range of referral pathways – from local general practitioners, where patients may present jaundice or weight loss/abdominal pain, or from allied healthcare professionals such as gastroenterologists and oncologists, where a diagnosis has already been made. We aim to see all HPB referrals, especially if a cancer diagnosis is suspected, as early as possible through their clinical journey. In that way, through a multi-disciplinary discussion (MDT), the correct investigations can be instigated as quickly as possible, enabling treatment options to be discussed with the patient at the earliest opportunity. A large number of our patients come from abroad. The medical community treating this type of disease is surprisingly small, so referral pathways become established, hopefully after the referring team are happy with the clinical care that has been provided to their patient in the UK. Patients

EXCELLENCE AND INNOVATION

We work well as a team at the Royal Free – it’s not just about the individual doctor being referred an individual patient

are also increasingly doing their own research via the internet and choosing to come to London for their treatment.

What is the typical diagnostic and treatment process for one of your patients? As I alluded to earlier, every cancer patient we see in the UK goes through a multidisciplinary meeting where their past medical history, presenting complaint and investigations are discussed amongst a group of allied specialists, so that the opinion you get is not just that of one doctor, but a team. This would be made up of HPB surgeons, hepatologists, radiologists, oncologists, cancer nurse specialists and, if required, palliative care. As we are a teaching hospital with a worldrenowned scientific profile, some members of that team will have an academic interest and be able to recruit specific patients into clinical trials, if relevant. Localised adjuvant treatment options, such as SIRT, Nanoknife and thermal ablations, can also be offered with the skill mix available, if surgical resection is not an option.

2-3 Mr Charles Imber and colleagues at work in the operating theatre. (PHOTOS: ROYAL FREE HOSPITAL)

We work well as a team at the Royal Free – it’s not just about the individual doctor being referred an individual patient. What is important is that any given patient has a seamless pathway through the allied hospital specialists to achieve optimal clinical outcomes rapidly, efficiently and with thorough understanding of the journey. The clinical nurse specialist (CNS) will often provide the emotional support during their time at our hospital, so that the holistic aspects of care are also brought into sharp focus. Having the opinion of a team with a great deal of

experience gives a patient not only the peace of mind that the treatment they are receiving is correct, but also that it is as up-to-date as it can possibly be.

What range of procedures would be considered for a patient with liver disease? If one looks at primary liver cancer (Hepatocellular cancer) as an example, this is most commonly seen in people with concomitant chronic liver disease. The treatment options for this are clearly complex and diverse. These patients need to be managed jointly between surgeons/ hepatologist and, potentially, oncologists to assess the severity of liver disease, irrespective of the tumour, so that the ability of their liver to cope with different treatment options can be predicted. In such cases, the surgical options would be either resection or transplantation, and in our unit these patients need to go through not only standard blood tests, but also ICG (indocyanine green) clearance, and hepatic venous wedge pressure measurement to assess the significance of the patient's portal hypertension. These investigations, together with very detailed examination of their liver imaging, indicate whether a patient could undergo a resection, whether they would be better served with liver transplantation, or whether other local ablative therapies, such RFA or embolisation, should be offered in conjunction with our radiological team. Various factors determine the nature of the treatment, from the age and fitness of the patient to the extent and

severity of their liver disease. There is no ‘one-size-fits-all’ approach to liver cancer. It requires a complex diagnostic algorithm prior to initiating treatment. At the Royal Free, we can offer a full range of investigations and treatment options. We're one of the few centres in the UK to have a joint medical/surgical/ oncological “one-stop” HCC clinic, where the patient can see all the relevant specialists, rather than going from place to place for different tests and opinions.

What advances in technology and procedures in recent years are now making a difference to your work? Surgical planning has benefitted considerably through improvements in detailed imaging reconstruction, working jointly with our radiological colleagues. We now have the ability to

create 3D reconstructions from CT and MRI scans, allowing us to plan complex operations much more safely. Likewise, volumetric analysis of the liver gives accurate calculations for residual liver following complex resections. Such techniques allow a better prospect of preserving liver volume and function when carrying out liver-sparing surgery. There is also a growing trend towards minimally invasive surgical techniques, such as laparoscopic (keyhole) and robot-assisted liver surgery, which allow for faster recovery times without compromising on surgical quality or safety to the patient. There are national ongoing trials to determine which patients most benefit from these advances, so that we can provide patients with a realistic and transparent evidence base when offering different surgical techniques.

All patients are entered into our Enhanced Recovery ( ERAS) programme, where dedicated nurses specialising in perioperative care – including adequate pain relief, but minimising opiod usage, early mobilisation and intensive physiotherapy – all benefit the patient and have been shown to not only shorten hospital stay post-op, but lead to a dramatic reduction in complications such as chest infection and venous thrombosis, which used to be exacerbated by prolonged periods of bed rest. The days of 'one-size-fits-all' or surgeons operating with little practical benefit are thankfully long gone, and significant prognostic benefit can now be achieved in the face of complex HPB cancer by incorporating a dynamic team approach to the diagnosis and treatment of each patient.

EXCELLENCE AND INNOVATION

Mr Alex J Shortt INTERVIEW

SWIFT SOLUTIONS FOR BETTER VISION Mr Alex J Shortt, Consultant Ophthalmic Surgeon at Optegra Eye Hospital London, in the Harley Street district, explains the latest treatment options available for patients seeking vision correction surgery

What are the most common conditions for which people visit Optegra for surgery? Optegra provides the full spectrum of eye healthcare, but one of our main requests is for vision correction, which is my particular focus. Basically, these are patients who wear glasses or contact lenses and want to get rid of them. The majority of people who wear glasses haven't had treatment. Across the country, the industry only treats about 2% of people in the UK who wear glasses, so we've barely scratched the surface of the patient group that we can help. And for those who do have treatment, they say their life is transformed!

What does a vision correction procedure involve? 1 State-of-the-art equipment enables Optegra to provide a full range of vision correction treatments (PHOTO: OPTEGRA)

Typically, people tend to think of laser eye surgery, which is how such procedures started in the 1980s and 1990s. But laser vision correction is now only one small

part of vision correction. Depending on your age, your prescription and what we're trying to achieve, the best option may be laser eye surgery, or it could be lens implant surgery, or lens exchange surgery. We've moved away from talking about laser eye surgery to talking about vision correction surgery. A younger patient, by which I mean under 40 years of age, who has only a mild to moderate prescription, is a great candidate for laser eye surgery. An older patient, over 50, is more suited to lens exchange surgery. Between these ages, there is a crossover period, where you're dependent on the guidance of your consultant about whether you're better off having laser or lens exchange. In that range, it very much depends on the severity of the prescription. All of the vision correction procedures are day-case procedures, with patients typically in and out within two hours. Both eyes can be treated in the same

2 The patient experience of vision correction surgery is similar to that of a dental treatment (PHOTO: OPTEGRA)

day if the patient requests that. It is on the same level of experience as going for a dental procedure, though less painful! Visual recovery is pretty much instant so, for many, within 24 hours you should have outstanding vision, and will notice improvements over coming days and weeks.

Previously, we used to do something called Lasik, which was effectively open laser surgery with a flap on the surface of the eye. ReLEx SMILE is available at Optegra Eye Hospital London and works in the same way, but uses a small keyhole incision. Patients have a very strong preference for this when the difference between the two techniques is explained.

What other developments in vision correction technology have occurred in recent years and what has been their impact?

There's a second type of laser eye surgery for patients who are not keen on having a lens exchange procedure – a method that can correct both your distance vision and your reading vision, called PRESBYOND, which focuses one of your eyes. All of us have one eye that is our strong eye, our dominant eye. This surgery focuses that eye from distance into intermediate – a two-to-three metre range of vision.

There are two types of laser eye surgery, which are quite new and which very few clinics can offer. The first is called ReLEx SMILE, which stands for Refractive Lenticule Excision, and Small Incision Lenticule Extraction. Effectively, it is keyhole laser eye surgery.

EXCELLENCE AND INNOVATION

Visual recovery is pretty much instant so, for many, within 24 hours you should have outstanding vision been the new generation of multifocal lens implants. The surgery to swap the lens is not new, but what has evolved is the quality and complexity of the optics used in these multifocal lens implants. We now have two excellent multifocal lens technologies that are clear market leaders: Extended Depth of Focus multifocal lenses and Trifocal multifocal lenses. All types of glasses prescriptions can benefit from this technology, but the group of patients who really love this surgery are those who may not have worn glasses for most of their lives, but then in their 40s to 50s notice that their reading vision deteriorates, and then that their distance vision also deteriorates. These people are great candidates for refractive lens exchange, with multifocal lens implants.

For how long is such treatment effective? The other eye is focused from intermediate range into reading range, and the brain uses this slightly varied vision in the two eyes to create a 3D world. It's a remarkably effective treatment for older patients who do not want to wear reading glasses, and who want their distance and reading vision corrected, but who prefer not to undergo the lens exchange procedure. Lens exchange surgery is a keyhole surgery procedure involving a tiny two-millimetre incision. We remove the natural lens and replace it with a plastic lens. The artificial lens has a very clever technology built into it to enable different ranges of vision and restore a patient’s reading vision. Lens exchange surgery became popular in the UK and US about 10 years ago, but what has made it a game-changer has

These lens implants will outlive the patient – they will never need to be changed. Very rarely we will see normal changes in vision with ageing, but they are easily corrected. For the one-in-500 people for whom this occurs, it is possible to refocus the eye with a very minor laser procedure. If you were to have laser surgery in your 20s or 30s, you would have outstanding vision until you hit ages 45 to 50. Then your reading vision may begin to deteriorate. It is then possible to boost your reading vision by having the PRESBYOND treatment.

What factors prevent more people from considering vision correction surgery? The biggest factor is fear. There are so many myths about laser eye surgery

in the public psyche and the myth that surgery is dangerous is the biggest of all. Also, the other great myth is that laser eye surgery is the best way to correct vision is also untrue. This fear and anxiety is totally unnecessary – these are tried-and-trusted treatments. There is also a common perception that such treatment is a one-shot, and if this goes wrong, then you're stuck with the problem for life. Nothing could be further from the truth. It's entirely possible to have two or even three laser eye surgery treatments if adjustment is needed. It's very rare to need more than one treatment, but occasionally we'll have a patient who had surgery in their 20s, who comes back to us when they're 45 and asks us to boost their reading vision.

What new developments in vision correction surgery can we expect in the future? We will see further evolution of the treatments we have, specifically with lens implants. We are likely to see electronic lens implants, in which the focusing mechanism is electronically controlled. That is likely to be 30 years in the future. But for potential patients to put off having a treatment from which they could have 30 years of excellent vision in order to wait for the next evolution, that, to me, is not worthwhile. I think the treatments we have now are outstanding and there’s nothing in the immediate future that's going to be better than what we have now. www.Optegra.com For more information, please call 0808 159 9580

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 and deserve 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 district, unique in that it is dedicated eye health. It is leading the way with the trend towards specialist, focused clinics, where every member of staff is specifically trained in eye health. As part of an international eye hospital group, Optegra not only invests in the latest, safest and most efficient technologies, it also provides access to over 100 leading Specialist Consultant eye surgeons and can treat the A to Z of eye health under one roof. So no matter what your diagnosis following thorough review and consultation, your treatment can be provided in one place.

In 2017 Optegra acquired Arnott Eye Associates, a UK and internationally recognised centre for ophthalmic excellence established over 40 years ago. Arnott has now moved to Optegra’s purpose designed eye, five star hospital in Queen Anne Street. So, 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 and Arnott@Optegra have all the experts to hand. Every Optegra consultant is NHS trained and a Fellow of the Royal College of Ophthalmologists (RCO). They are from world-renowned teaching hospitals and are specialists in their field as well as in general ophthalmology. They are all committed to providing patients with first-class eye treatment and have carried out thousands of eye treatment surgeries.

Access to over 90 leading eye surgeons

0800 231 3760

Flagship Hospital Queen Anne Street, London Optegra’s Queen Anne Street hospital opened in 2016 and is a five-star environment as visitors step into the latest, high tech, fully equipped hospital in the Harley Street district. Patients say the 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.

www.optegra.com

State of the art equipment

EXCELLENCE AND INNOVATION

Michael Bradfield INTERVIEW

IMAGING REIMAGINED Michael Bradfield, CEO of Fairford Medical, talks about his company’s innovative approach to Diagnostic Imaging

Michael Bradfield is a successful businessman, well-known by those in his field and an active investor in cutting-edge medical and computer technology. He became a computer programmer in the late 1960s, when computers ran on punched cards. Leaving university with a law degree from LSE, Michael was a founder and CEO of Hospital Plan Insurance Services (HPIS) set up in 1971 after decimalisation came in at the same time as the Direct Debit system. Michael designed and wrote the ground-breaking insurance management computer system and direct marketing operations for HPIS. He went on to create the largest consumer marketing database in the UK to support the HPIS business. As a result, in late 2000, HPIS was sold to AIG, where Michael continued to work for a number of years. With his medical, computer and technology background, Michael went on to invest directly in Medical, Computer, Agriculture, Sustainable and related technologies.

What Inspired you to set up Fairford Medical? Our story began in 2016, when the opportunity to help transform patient care by providing flexible, mobile services first became apparent. I had become a Director and a major investor in the Proton Therapy equipment developer Advanced Oncotherapy Plc (AVO), which is developing an affordable, next-generation proton therapy system in conjunction with CERN in Geneva. Protons are generations ahead of Radiotherapy, but hitherto it has been extremely costly to install. The main advantage of Protons is that they use low power to hit a target in the body, then rise in power and stop dead after hitting the target. This creates almost no side effects and allows much faster and more safe treatment plans. AVO’s goal is to provide local Proton treatment at Radiotherapy prices. This will allow healthcare providers and hospitals to expand their repertoire of radiation oncology treatments, ensuring clinicians and patients have increased choices.

1 One of Fairford’s new Siemens relocatable MRIs | 2 Fairford’s new compact and comfortable CT ScanBox (PHOTOS: FAIRFORD MEDICAL)

EXCELLENCE AND INNOVATION

I’m delighted that Fairford’s systems are providing vital scanning facilities where there would otherwise be none

AVO is now building the London Proton Therapy Centre in Harley Street, which will showcase AVO’s new technology. It aims to open its doors for Proton treatment in the third quarter of 2020. Through this exposure to the healthcare sector and having met with many healthcare professionals who highlighted the importance and woeful shortage of Diagnostic Imaging systems in the UK, it became obvious that the sooner a tumour is identified, the quicker and more successfully it can be treated. Unfortunately, there is a serious lack of CT and MRI equipment throughout the UK, which means often cancers and other conditions cannot be treated for many months ahead. Whilst there is a recognised need within the healthcare industry for high-quality Diagnostic Imaging, the cost of scanners together with the expense of altering existing facilities often makes this impossible. There has to be a cheaper and more flexible way to obtain and install this vital resource within the NHS and in private facilities.

3-4 CT and MRI scanners can be easily mobilised in bespoke trailers, in which they can be moved frequently, or units designed to stay in place for longer periods (PHOTOS: FAIRFORD MEDICAL) 4

This is why I decided there was clearly a need for an innovative, disruptive and fresh approach to increase the provision of Diagnostic Imaging throughout the UK. By gathering a team of experienced professionals with a track record of imaginative thinking and success in various fields, together with a fleet of high-quality mobile scanners, Fairford has brought a new and refreshing approach to Diagnostic Imaging. As a result, Fairford Medical Limited and its group of companies has become the UK’s fastest growing supplier of affordable mobile MRI and CT scanners and the backup services required to support them.

What was it about Diagnostic Imaging that caught your imagination? All too often we hear the words “if only we’d known sooner”, and that is the real issue for me. Take lung cancer, for example, which sees over 45,000 people diagnosed in the UK

EXCELLENCE AND INNOVATION

each year. Although in its early stages it often doesn’t produce any symptoms, lung cancer can be treated successfully if found early enough, and screening can identify cancer before it spreads. Similarly, for heart conditions, the British Heart Foundation recently highlighted a worrying lack of CTCA (Computed Tomography Coronary Angiography) provision, citing the shortage of modern CT scanners and trained radiologists as a contributing factor to thousands of unnecessary deaths, simply because tens of thousands of patients with chest pains are unable to access recommended checks. In short, the earlier a condition is diagnosed, the more likely it is that treatment will be successful, and that was something that I felt needed energising.

Is providing more mobile Imaging systems facilitating early diagnosis for patients? It is certainly a big part of the solution. Over recent years, there have been rapid improvements in Diagnostic Imaging technology, leading to significant breakthroughs in quality, reliability and efficiency. The trend in MRI is towards increasing the speed of exams while maintaining image quality and ensuring patients are comfortable. For example, work is currently under way to develop an MRI scanner that cuts scanning time to around 15 minutes or less, which is particularly valuable for patients with conditions that make it difficult to remain still, such as Parkinson’s disease, or for anxious or claustrophobic patients. CT technology continues to progress at a fast pace, with faster, more automated, easier to use scanners and ever-increasing dose efficiency. These advances are transforming patient care and reducing the need for exploratory surgery by allowing for non or minimally invasive diagnostics Fairford has found that smaller, lighter and more powerful CT and MRI scanners are ideal for mobilising, either in bespoke trailers, where they can be moved each day, or more permanent relocatable units, which tend to stay in place for months

or years at a time, are generally larger, ground-based and more comfortable for patients and radiographers. We are particularly proud of our new CT ScanBox, which is a high-quality, compact, drop-in CT solution that is both affordable and deliverable. We can deliver it to sites where space is an issue and add modules to provide a range of additional uses to suit.

Is mobile imaging the way forward for accessibility to services? There will always be a need for hospitalbased scanning, especially so where highrisk patients need to be as close as possible to emergency care.

project-managed removal, maximising the return on redundant equipment that still has a value in other parts of the world. This added value not only maximises budgets, but it offers a one-stop solution to equipment replacement. We remove and buy the outgoing equipment, we supply interim scanning to keep patient scanning lists ticking over and we can supply the new scanner in a fully-serviced relocatable and modular solution as required, all fully project-managed and financed to suit the budget of our customer. Fairford and Quest Medical’s synergy provides an end-to-end solution that fits with health-provider needs.

Where next for Fairford? However, many scans can instead be carried out away from a hospital, reducing the pressure on those scanners and resources. In our short history we have certainly found that there is a ready market for instantly available, flexible imaging solutions, and investing in mobile units has been central to our success. Whether it’s a mobile unit at a GP Practice, a trailer in a supermarket car park or a hospital-based temporary unit to maintain the level of service while new facilities are being built upgraded or move, I’m delighted that Fairford’s systems are providing vital scanning facilities where there would otherwise be none.

Is it easy to deliver and install mobile units? From the beginning we recognised the importance of providing health providers with a turnkey solution, and that’s where our service partner, Quest Medical, comes in. Quest will project-manage all aspects of the delivery and implementation, including ground works, delivery method statements and liaising with hospital estates departments. Quest delivers units to site using their own transporters, sets the units up and hands them over. They then take care of the service and maintenance of the units, clinical cleaning, arranging OEM servicing, and generally keep the systems running at optimum performance.

Our sector is constantly moving forward, and Diagnostic Imaging technology is evolving at an ever-increasing pace, along with advances in IT technology. For example, whilst some fear that Artificial Intelligence (AI) will replace human intelligence, we see it as an opportunity for growth in our sector by augmenting human intelligence, and we are looking forward to integrating this in our future offerings. AI, together with advances in the gathering and analysis of large and complex data sets, “Big Data”, and allied to the power of new scanning technology, has the potential to introduce incredibly improved diagnostic capabilities and dramatically transform patient outcomes. Fairford is a forward-thinking company. By embracing these new developments in our field and integrating them in the expanding range of solutions we offer, Fairford Medical will continue to grow as a patient-centred, innovative and ambitious group of companies, offering value-based Diagnostic Imaging.

Where a hospital is replacing older technology, Fairford will now also guarantee a buy-back price, including fully

YOUR STAY IN LONDON

Bespoke packages for patients and their families – combining medical, travel and accommodation requirements – are an increasingly popular choice for visitors to London

MEDICAL CONCIERGE SERVICES As the many examples featured in this publication demonstrate, there is a wealth of world-leading hospitals, clinics and medical specialists from which international patients can choose when planning a visit to London. In fact, the options are so numerous that making a decision can be quite daunting – from choosing the most suitable place for treatment to selecting where to stay.

1 Medical concierge services cater not only for the needs of international patients, but also make sure that their families have a comfortable and enjoyable stay (PHOTO: LEVRANII/SHUTTERSTOCK)

Medical concierge services are a valuable aid to patients and their families, navigating the often complicated range of options to take the pressure and uncertainty out of planning a visit to London. Most concierge services can draw upon an extensive network of medical specialists and are working with a wide range of the city's bestknown hotels to ensure that every stay is as comfortable as possible.

London Medical Concierge (LMC) is among the leading providers of such services in London, offering personalised concierge services to design a bespoke package specifically for the patient and their family, with support that continues during the course of their stay. The company was founded by CEO Kirsty Ettrick, who realised the necessity of such a service after spending many hours searching for experts and treatment options after her husband had been diagnosed with a complex and aggressive cancer. Following her difficult experience, Ettrick dedicated herself to building a network of experts highly regarded in their fields to help other people to avoid similar difficulties. Each potential patient is assessed by LMC’s team to create an individual

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clinical pathway, connecting the patient to the most appropriate medical specialist for their needs. Where this may be of most value is in the treatment of cancer, where connections with London’s globally renowned oncologists and researchers into immunotherapy ensure that patients can find the cancer care that is most appropriate. Of high importance to patients considering treatment outside their own country is the sense of discretion that being treated in London can provide. For example, couples experiencing fertility issues and reproductive health problems are, understandably, dealing with a problem that is a very private and sensitive matter. Similarly, somebody seeking assistance with an addiction or mental health issue may also seek privacy when receiving treatment for a difficult problem.

2 Medical concierge services can assist with finding the best treatment for patients young and old (PHOTO: ART_PHOTO/SHUTTERSTOCK)

In such cases, receiving treatment away from home in different surroundings might be an ideal option for patients. The personal services offered by medical concierge companies also make sure

that patients are guided in their treatment choices and with the utmost discretion. Seeking specialist medical services for children is also an area that can be made much easier with the help of a medical concierge, which can also provide dietary, emotional and behavioural support. Also, as in the case of LMC, its network enables patients to access maternity services and obstetrics at some of the UK’s most highly regarded private maternity facilities. As well as advising on the best pathway for medical treatment for patients visiting London, medical concierge services also cater for the needs of their families, who may be accompanying them for a long period, especially over the summer months. Accommodation options that can be organised by a concierge range from rooms and suites in London’s impressive range of top-quality hotels to private apartments and family houses, with the aim of creating a ‘home away from home’ in the city. Further support services that patients and their families might select include individual nursing, chefs, housekeeping, childcare and home assistance. Many patients benefit from being able to recover from their treatment in their own accommodation, or to receive some ongoing treatments that may not necessitate a regular visit to hospital. As part of their package of services to make a visit to London as smooth as possible, concierge services can also arrange flights, airport transfers, private drivers and the secure transfer of medical records. Understanding the often complex information from a medical consultation can be intimidating, even for those already fluent in English. Translators can also be provided to make sure that patients and their families are kept fully informed at every stage. It is little surprise that increasing numbers of visitors to London for specialist treatment are turning to medical concierge services for assistance in arranging their stay in the capital. During a period that can obviously be stressful for patients and their families alike, having a helping hand for both medical and practical daily matters provides obvious benefits to make their time in London the best it can be.

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London is one of the world's most vibrant cities, where there is certainly no shortage of sights and activities to keep families amused

LONDON'S ATTRACTIONS During periods when patients are between treatments, or when their accompanying families are looking for things to do, London is the perfect place to keep entertained. From its famous buildings to a wide range of cultural attractions, the city offers plenty to keep visitors occupied. Among the most iconic and most recognised of London’s landmarks is Tower Bridge, the most famous of all the crossings over the River Thames in central London. As well as admiring this astounding Victorian construction from nearby, or perhaps from the river itself via one of the many cruises, visitors can also see inside its magnificent engine rooms and walk across its high-level walkways, which include glass floors allowing a view of the traffic below.

Built between 1886 and 1894, Tower Bridge crosses the River Thames close to the historic Tower of London (PHOTO: ISSAREE PRUKTHICHAIPAT/SHUTTERSTOCK)

For a sense of history dating back further, the historic Tower of London is an essential stopping point nearby. London’s ‘castle’ was founded in 1066 and has served as a fortress, royal palace

and an infamous prison. The Tower also houses the priceless Crown Jewels – a breathtaking collection of 23,578 gemstones that are the most powerful symbols of the British monarchy.

Royal residence Heading west, followers of the royal family can also visit the Queen’s official London residence, Buckingham Palace. The palace is recognised around the world as the backdrop for national and royal celebrations, while the daily Changing of the Guard ceremony is a popular draw for tourists. Visitors to Buckingham Palace can also take the opportunity to explore its State Rooms, when the doors are opened to the public for 10 weeks during summer and early autumn. A short distance away lies Westminster Abbey, another frequent focus of royal occasions, such as the wedding of the Duke and Duchess of Cambridge, and national commemorations. Another of London’s famous churches, the spectacular St Paul’s Cathedral, with its

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famous dome, is a popular attraction for visitors to the City of London – the capital’s traditional financial district. The UK’s seat of government – the Houses of Parliament in Westminster – have drawn international attention in recent years, highlighting the processes and traditions undertaken by the country’s lawmakers. Guided tours are available to visitors on Saturdays and most weekdays when Parliament is in recess, revealing the hidden history of one of the world’s most recognisable buildings.

2 Throughout its history, the Tower of London has served as a royal residence and is now the home of the Crown Jewels (PHOTO: JMBF/ SHUTTERSTOCK) | 3 Buckingham Palace is a traditional focal point for national celebrations in the UK (PHOTO: PHOTO STELLA/SHUTTERSTOCK)

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Those seeking a panoramic perspective on the city can board the instantly recognisable Coca-Cola London Eye, which has been presenting passengers with spectacular bird’s-eye views since opening in 2000 to mark the new millennium. An even more recent addition to London’s ever-expanding skyline is the 95-storey Shard, Western Europe’s

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tallest building, which offers views from up to 244m – twice the height of any other vantage point in the city.

Indoor attractions On occasions when the weather isn’t suited to outdoor pursuits or high-level views across the city, London also has plenty of indoor attractions to offer. Only a short distance from the Harley Street Medical Area is Madame Tussauds, the famous collection of more than 300 wax figures of celebrities, politicians, royalty and sports stars. The attraction houses 14 interactive areas, including a Marvel Super Heroes 4D movie and the chance to get up close to the heroes and villains from the epic Star Wars film series. For those interested in the darker side of the capital’s history, the London Dungeon steps back into the city’s gruesome ancient past with special effects, live actors and themed rides. While not for

the squeamish, this popular attraction allows visitors to experience the horrible side of London’s history, including Vengeance – a high-speed interactive ride that takes passengers on what is described as the “ultimate ghost hunt”. One of the world’s most famous collections of European art can be found at Trafalgar Square, also famous as the location of Nelson’s Column. The National Gallery houses works by the likes of Leonardo da Vinci, Van Gogh, Rembrandt, Gainsborough, Turner, Botticelli and Renoir. During 2019, the National Gallery will also stage the first UK exhibition of Spanish impressionist Joaquin Sorolla for more than a century. Adjoining the National Gallery is the world’s largest collection of personalities and faces – the National Portrait Gallery – which displays works from the late Middle Ages to the present day. Both

4 The Coca-Cola London Eye offers stunning panoramic views of the city

| 5 The impressive Turbine Hall of the Tate Modern (PHOTO: MISTERVLAD/SHUTTERSTOCK)

(PHOTO: AIJA LEHTONEN / SHUTTERSTOCK)

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galleries are free to enter, with additional charges for special exhibitions.

Free activities can be found in London’s world-renowned museums 104

Also exhibiting its permanent collection for free is the Tate Modern, London’s national museum of modern and contemporary art, housed in the former Bankside Power Station on the River Thames. The vast Turbine Hall that runs for the length of the building is an impressive attraction in itself, and the museum boasts works by Picasso, Matisse, Dali, Warhol, Cezanne and many more.

Enthralling museums Further free activities can be found in London’s world-renowned museums. The British Museum, in Bloomsbury, is dedicated to human history, art and culture. Established in 1753, its exhibits include artefacts from ancient Egypt, Greece, the Middle East and Europe, as well as rare objects from the prehistoric period.

Three of the world’s best-known museums can be found in a cluster in Kensington, in the west of the city. The Natural History Museum presents exhibits from all eras of the natural world in the impressive surroundings of one of London’s most beautiful buildings, where visitors are greeted by the sight of a real 25.2-metre whale skeleton as they enter. Nearby, the Science Museum is the place for space enthusiasts, with its showpiece collection including the Apollo 10 command capsule and original items from both NASA and Russian space missions. Children and the young at heart are assured of great fun with the many interactive exhibits explaining scientific principles. Completing Kensington’s trio of museums is the Victoria and Albert Museum – the V&A. The recently renovated museum is dedicated to art, design and human

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creativity, with collections of fashion, jewellery, sculpture, textiles, paintings, glass and ceramics from down the ages.

6 Children get a close-up view of the sharks at SEA LIFE London Aquarium (PHOTO: GIDEO | 7 The Shard offers London's highest viewpoint over the metropolis (PHOTO: TAMAS GABOR/SHUTTERSTOCK) | 8 Sprint legend Usain Bolt is one of the many celebrities immortalised in wax at Madame Tussauds MENDEL/GETTY)

Encounter wildlife For those seeking a connection to the natural world, the SEA LIFE London Aquarium on the South Bank houses one of Europe’s largest collections of marine life. Visitors take a journey along the Great Oceanic Conveyor, before entering an awe-inspiring glass tunnel to stroll underneath a tropical ocean. The 350 species on display include sharks, seahorses, octopuses and clown fish.

(PHOTO: ANTON IVANOV/SHUTTERSTOCK)

For an even bigger collection of animals, visitors should head to Regent’s Park and the ZSL London Zoo. Animal lovers can get up close to lions, tigers, monkeys, gorillas, penguins and lemurs – to name just a few of the 750 species that reside at this working zoo, with conservation at its heart. 8

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London’s reputation as one of the best cities in the world to visit is enhanced by its top-class hotels and restaurants

HOTELS AND HOSPITALITY Hospital stays and visits may not be the most pleasant of reasons to come to London, but the burden of receiving treatment can be eased by enjoyment of the surroundings of the city's luxury hotels, as well as their fine-dining experiences. Many of London’s top-rated hotels can be found clustered in the Park Lane area of the city's West End, along the thoroughfare that runs adjacent to Hyde Park. Among the most famous of these is The Dorchester. One of London’s most famous hotels, this landmark of glamour and sophistication has been a fixture on Park Lane since 1931.

1 Claridge's in Mayfair is a favourite of visiting celebrities and royal guests (PHOTO: ALEX SEGRE/SHUTTERSTOCK)

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Classically English in its style, its rooms continue to possess a traditional, opulent feel, with deep marble baths and stylish mirrored cabinets. Dining options include Cantonese restaurant China Tang, Alain Ducasse (the UK’s only hotel restaurant to possess three Michelin stars) and The Grill, serving modern British cuisine.

Those looking for a more flamboyant experience with a more modern feel will appreciate The Dorchester’s sister hotel, 45 Park Lane. The art deco-themed establishment combines 1930s flair with modern trappings, such as tabletcontrolled lighting and electric blinds. Adding to the hotel’s flair, the lobby, restaurant and other public areas are lined with contemporary British art. Situated on Old Park Lane, COMO Metropolitan London also offers a clean and modern approach. In common with 45 Park Lane, the surroundings are adorned with artwork, including bespoke works in the white-walled rooms, and touchscreens to control lighting. For dining, the hotel hosts Nobu, which serves Japanese and Peruvian cuisine, and also the recently unveiled Gridiron, a new “live-fire” grill that offers an experience combining flames with high-end cooking as diners look in on an open-fronted kitchen. Boasting impressive city views, the Four Seasons London Hotel at Park Lane offers

2 Opened in the 1930s, The Dorchester is among London's most prestigious and expensive hotels (PHOTO: CHRISPICTURES/SHUTTERSTOCK) | 3 Rooms in the Shangri-La at the Shard offer incredible views over the city (PHOTO: SHANGRILA INTERNATIONAL HOTEL) | 4 London's luxury hotels also offer a wide variety of gastronomic experiences (PHOTO: MICK FLYNN/ALAMY) 3

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Many of London’s top-rated hotels can be found clustered in the Park Lane area of the city’s West End

luxury with an Eastern feel. Recently refurbished suites include balconies that overlook the busy city outside, while visitors to the hotel’s luxury spa can enjoy views over London’s greenery while they sample a range of relaxing treatments. Well-known in the capital for hosting highprofile events in its Great Room, the city’s largest ballroom, the grand surroundings of the Grosvenor House include a mix of traditional and contemporary-style rooms. Dining options include chef Richard Corrigan’s Mayfair and the JW steakhouse. Only a short distance from Park Lane, but still in the Mayfair district, the globally renowned Claridge’s dates back to the mid 1800s, when William and Marianne Claridge opened their luxury hotel. During the 1950s, the hotel welcomed numerous Hollywood stars and retains the same glamour to this day. For food and drink, the Foyer and Reading Room offer classic and contemporary cuisine in art deco surroundings, accompanied by music from a grand piano.

Among the newest and most spectacular hotel experiences to grace London in recent years is the Shangri-La at The Shard – Western Europe’s tallest building, which rises like a spire above the city. Close to London Bridge, this luxurious hotel occupies floors 34 to 52 of the glass-clad skyscraper, presenting its residents with stunning views over the metropolis through the floor-to-ceiling windows that can be found in every room. In total, the Shangri-La features 202 uniquely designed rooms and suites, decorated in an Asian style. The hotel’s top floor houses a bar, fitness room and even a swimming pool – also the highest in Western Europe. Dining includes the Ting restaurant, which presents a modern British menu with Asian influences.

Class and convenience For patients receiving treatment within the Harley Street Medical Area, there is a wealth of luxury hotels to choose from – each only a short distance away from the many hospitals and clinics. The elegant

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5 The luxurious surroundings of London's top hotels is a key attraction for visitors from all over the world (PHOTO: ARCHIMAGE/ALAMY)

Marylebone area is also close to the best of London’s shops and theatres, and well connected to the city’s numerous tourist attractions, providing an ideal location for patients and their families. Situated close to the shopper’s paradise of Oxford Street and Bond Street, the Langham also sits a short distance from the BBC’s New Broadcasting House and is a popular choice for celebrities visiting the studios to take part in television and radio broadcasts. Aside from the opportunity to spot famous faces, this stylish hotel, which has been established more than 150 years, features elegant rooms decorated with dark woods, marble and luxurious fabrics. Dining experiences at the Langham Hotel include Roux at the Landau, a partnership between internationally famous fatherand-son chefs Albert and Michel Roux Jr. Their menus provide a contemporary take on European dishes, accompanied by a diverse wine list, all presented in one of London’s most beautiful dining

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spaces. The hotel also features cocktail bar Artesian, which was voted the world’s best bar for four consecutive years. There is a further opportunity to spot celebrities at another of Marylebone’s hotels, the Chiltern Firehouse, which occupies a Grade II-listed former fire station building that dates back to 1887. The hotel is a popular haunt of the rich and famous, attracted by the smart, retro-style rooms and highly regarded restaurant overseen by head chef Nuno Mendes. Irish-owned The Marylebone lies at the heart of the village that gives the hotel its name. Modern and stylish, it features 257 rooms including 44 suites, three of which have terraces that offer an outdoor area to relax during the summer months. Three restaurants offer a variety of dining, including a British-based menu. Children are also well catered for with special menus and, at night, “tepee beds” that can be provided on request, with cookies and a flask of milk!

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Visitors to London with a penchant for shopping will relish the opportunity to explore one of the best collections of iconic stores and brand names anywhere

A PERFECT LOCATION FOR RETAIL THERAPY London is renowned as one of the globe's most desirable areas for shoppers, with a vast selection of stores, ranging famous emporiums to select boutiques. Famed worldwide for its abundance of stores selling designer fashion, fine jewellery, art and antiques, Bond Street is the first stop for the discerning shopper. In the heart of the upmarket district of Mayfair, the street is one of the most glamorous locations in London and is a popular stop for global celebrities visiting the UK capital. Walk down Bond Street admiring the stores and their world-famous brands and you will be following in the footsteps of the authors, poets and influential people that have resided there since its foundation in 1700. Previous residents have included Admiral Horatio Nelson and

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Lady Emma Hamilton. More than three centuries later, Bond Street is the most stylish thoroughfare in London’s West End – a magnet for the rich and famous, as well as those who want to experience a modest slice of the same glamour.

Famous brand names A list of the stores that grace Bond Street reads like a roll call of the world’s most famous brands. Fashion lovers are spoilt for choice, with designer labels such as Chanel, Dolce & Gabbana, Louis Vitton, Burberry, Jimmy Choo and Ralph Lauren all represented. Those with a penchant for the finest jewellery will gravitate towards the likes of Asprey, Bulgari and Tiffany & Co for their elegance and luxury. People with a passion for acquiring fine art and antiquities can spend time at one of the world’s most esteemed

1 Shoppers in London's busy West End, the location for many of the city's finest stores (PHOTO: WILLY BARTON/SHUTTERSTOCK)

2 Harrods is a focal point of the exclusive Knightsbridge area (PHOTO: BBA/SHUTTERSTOCK) 2

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Head a short distance north, off the beaten track for many tourists, and the delights of Marylebone Village await

auction houses, Sotheby’s. While the majority of auctions focus on works of art, Sotheby’s also hosts sales of jewels, watches, wine and more.

An urban village retreat Head a short distance north, off the beaten track for many tourists, and the delights of Marylebone Village await. Situated between Mayfair and the green expanse of Regent’s Park, the area is the setting for a collection of boutique shops, luxury stores, cafes and restaurants – many of which are situated on Marylebone High Street, the focus of the village. Despite its proximity to busy Oxford Street, the area retains its warmth and charm, creating an oasis of relative calm in an otherwise bustling city. For patients receiving treatment within the Harley Street Medical Area, Marylebone Village is likely to become their very own neighbourhood for the duration of their stay. The area has a strong community feel and offers an incredible range of diversions, particularly for those seeking some retail therapy. The High Street plays host to a wide array of designer stores and well-known British and international brands, as well as numerous small stores that are synonymous with the village. Among the traditional shops that attract visitors as much for their ambience as the

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goods they sell is Daunt Books. The bookseller occupies Edwardian surroundings and houses row upon row of books on dark oak shelves – a must for any lovers of literature. Among the British names that have set up shop on Marylebone High Street are homeware and fashion brand Cath Kidston, men’s and women’s fashion retailer Whistles, and pottery designer Emma Bridgewater. A more rustic experience can be found each Sunday when the Marylebone Farmers Market welcomes customers in the open air. Established in 2003, the market provides an opportunity for purveyors of fine foods – including bakers, butchers, cheese-makers and fruit and vegetable growers – to sell their wares to an enthusiastic public.

Deluxe department stores For many people, a visit to London wouldn’t be complete without calling in to one of the city’s famous department stores. Without question the most famous of the city’s stores is Harrods, situated on Brompton Road in exclusive Knightsbridge. Founded 170 years ago as a family shop in East London, Harrods now occupies seven floors with 330 departments selling everything from designer goods to the finest food and drink.

Harrods is graced by all the leading international designer brands, including 17 boutiques in its luxury womenswear department, featuring such iconic names from the world of high-end fashion as Prada, Dior and Valentino. Another department store, Selfridges remains one of the biggest draws to London’s premier shopping street, Oxford Street. Opened in 1909 by Henry Gordon Selfridge, the store has six floors that provides 10 acres of shopping space – second only in size to Harrods as the

UK’s largest retail premises. In the past decade, Selfridges has been twice voted the world’s best department store, so customers are sure to leave satisfied.

3 Fortnum and Mason is an essential stop for lovers of fine foods (PHOTO: WILLY BARTON/ | 4 Shoppers on Bond Street are bombarded by a succession of designer brands (PHOTO: ALEX SEGRE/SHUTTERSTOCK)

SHUTTERSTOCK)

Shoppers wishing to inject a touch of sophistication into their London retail experience should head to Piccadilly, where Fortnum and Mason takes visitors into food heaven. Elegant restaurants and tea rooms take customers back in time to a traditional style of service, with staff in smart uniforms and surroundings with a sense of history.

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Mental health awareness and disability confidence for employers Mental Health & Disability Confidence

Teresa Scott OBE, CEO of multi-award winning consultancy Kennedy Scott, explains how her company helps government and businesses to support people with mental health issues in the workplace

Mental health problems appear to be on the increase, with severe mental illness on the rise in the UK since the early 1990s. Approximately one in four people in the UK will experience a mental health problem each year and, in England, one in six people will report experiencing a common mental health problem (such as anxiety and depression) in any given week (NHS Digital, 2014). Conditions range from low mood, stress and anxiety disorders to bipolar disorder, schizophrenia or psychosis, and can appear suddenly or gradually over time. Mental health problems can also exacerbate physical illnesses, with 30% of people with a long-term physical condition also having a mental health problem (Centre for Mental Health 2015). Not surprisingly then, mental health problems are the leading cause of sickness absence from work – costing the UK the loss of 91 million working days per year (Centre for Mental Health, 2017). The Chartered Institute of Personnel and Development study into Mental Health in the Workplace (2018) highlighted the additional impact that mental ill health can have on organisations, finding that:

• 80% of sufferers find it difficult to concentrate

• 62% take longer to do tasks • 57% find it harder to juggle multiple tasks • 50% are potentially less patient with customers/clients

• 37% are more likely to get into conflict with colleagues

At Kennedy Scott, we have spent the past 29 years helping individuals who have experienced long-term unemployment back into sustainable jobs, including people who have had their lives changed as the result of physical or mental health conditions. 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 enabled thousands of people to be supported within their workplace with the right specialist help, small adjustments within the workplace, and better understanding from their peers. Through this we have developed strong working relationships with employers across the UK ranging from small local businesses to national organisations. A key emerging concern is the impact of mentalhealth-related staff absence, particularly for smaller businesses. Employers have also expressed concerns that some sickness absence is not reported as being due to mental ill health, as there is a perceived stigma attached. This prevents effective ‘return to work’ planning and implementation of preventative measures to stop recurrence. Employers earnestly want to have the best processes in place to support their staff with mental health issues, properly trained managers so that any issues can be dealt with, and a supportive working environment where mental health issues are not stigmatised.

As a level 3 Disability Confident Leader, and an IIP gold standard organisation, we at Kennedy Scott are best placed to support other companies in their own quest to end the stigmatisation and discrimination of individuals who suffer from mental health problems, as well as those with physical challenges. Our Mental Health and Disability Confidence (MHDC) consultancy enables employers to develop an inclusive approach to mental health and disability management, implementing a programme that is relevant to their size, industry, budget and need. We help employers to develop the processes, tools, skills and organisational culture necessary to effect the changes required – changes that help improve incidence reporting and the overall management of mental health conditions at work. Our consultancy framework operates on 3 levels:

1. Policy and systems – establishing

a company-appropriate approach to the mental health of employees

2. Skills – ensuring managers have

the skills and tools necessary to identify and manage mental health issues within the workforce

3. Culture – developing a workplace

culture where there is improved mental health literacy, thereby enabling staff to discuss mental health issues

This is underpinned by our experience, support and guidance to help organisations achieve the nationally recognised Disability Confident status (https://disabilityconfident.

campaign.gov.uk/), as well as our delivery of accredited Mental Health First Aid (MHFA) England, training and bespoke Mental Health Awareness courses that can be tailored to reflect specific sector or organisational issues (eg Mental Health Awareness for employees working within the care sector). MHFA is an internationally recognised mental health awareness and skills programme that helps people to spot the signs and symptoms of a range of mental health issues, provide help on a first-aid basis and effectively guide the person towards the right support services. MHFA training has been shown to drastically increase the knowledge, confidence and help-giving of peers around an individual experiencing a mental health issue. This means that our entire workforce is dedicated to improving the awareness of mental health issues, as well as openly challenging misconceptions and stigmas surrounding mental health in the workplace, particularly amongst young people starting out on the career ladder, with all the inherent pressures in the world of work today.

It is our belief that raising awareness and ending discrimination against those who suffer from physical and mental health issues will improve bottom lines for businesses now and in the future, laying a solid foundation built on respect and understanding. If you would like more information about our Employer Consultancy, Mental Health First Aid/ Mental Health Awareness Training or support in achieving Disability Confident Level 1, 2 or 3 please contact:

Teresa Scott OBE

Teresa@kennedyscott.co.uk or telephone our office on 01923 712817

www.kennedyscott.co.uk

INDEX OF SPONSORS Advanced Oncotherapy plc ................................................................ 36-39, 40-43 Bupa Cromwell Hospital .......................................................................20-23, 72-75 EY ................................................................................................................................111 Fairford Medical ..................................................................................................92-95 Guy's and St Thomas' Private Healthcare ......................................................48-51 HCA Healthcare UK ...................................................... 13, 28-31, 68-71, 76-79, 99 Howard de Walden Estate ................................................................................ 16-19 Imperial Private Healthcare ..............................................................................54-57 Kennedy Scott ..................................................................................................116-117 King Edward VII's Hospital ................................................................................ 32-35 Optegra ...............................................................................................9, 84-87, 88-91 Royal Brompton & Harefield Hospitals Specialist Care ..............................58-61 Royal Free London ...................................................... 52-53, 62-63, 64-67, 80-83 Royal Marsden Private Care.............................................................................. 24-27

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