HEALTHCARE IN LONDON THIRD EDITION
Clinical excellence in the heart of London Guy’s and St Thomas’ Private Healthcare provides private patients with outstanding clinical care from world-class consultants delivered within comfortable facilities in central London. As part of Guy’s and St Thomas’ NHS Foundation Trust, one of the largest and safest NHS teaching hospitals in the UK, we have an unrivalled history of high quality patient care, clinical excellence and innovation. We offer an extensive range of specialist and complex care services and provide lifelong care for private patients at every stage of life – from before birth, through childhood and into adult life. Private healthcare you can trust.
Contact us to find out more about our specialist services T: +44 (0)20 7188 5197 E: privatepatientenquiries@gstt.nhs.uk www.guysandstthomasprivatehealthcare.co.uk
HEALTHCARE IN LONDON THIRD EDITION
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 Grafo S.A. | Cover image credits: Guy's and St Thomas' Hospitals; Imperial Private Healthcare; OneWelbeck; The London Clinic; The Royal Marsden; Howard de Walden Estate
Š 2020. 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.
CONTENTS INTRODUCTION
6
LONDON HAS EVEN MORE TO OFFER Lord David Evans of Watford
CHOOSING LONDON FOR HEALTHCARE
10
ENERGY AND INNOVATION David Hare, Chief Executive, Independent Healthcare Providers Network, NHS Confederation
12
HERITAGE BUILDINGS, 21ST-CENTURY HEALTHCARE The Howard de Walden Estate
16
MAYO CLINIC
20
BRINGING A NEW MODEL OF PRIVATE CARE TO LONDON Cleveland Clinic
24
ASSISTANCE FOR SAUDI PATIENTS VISITING THE UK Professor Abdulaziz Mohammed Aleisa, Health Attaché, Saudi Health Mission in the United Kingdom
26
ONE WELBECK
29
COMMITTED TO A BETTER PATIENT EXPERIENCE Professor Julian Teare, Consultant Gastroenterologist, OneWelbeck Digestive Health Centre
32
THE LONDON CLINIC
40
EASING ACCESS TO HIGH-QUALITY HEALTHCARE Romana Kuchai, Chief Medical Officer and co-founder, Lexihealth
44
LONDON WOMEN'S CLINIC
48
SERVING UP A FIVE-STAR MENU FOR PATIENTS Darren Passmore, Head Chef, Bupa Cromwell Hospital
52
HCA HEALTHCARE UK
ONCOLOGY
4
56
WORLD-LEADING CANCER TREATMENT The Royal Marsden NHS Foundation Trust
62
GENESISCARE in partnership with Bupa Cromwell Hospital
67
AT THE FOREFRONT OF ADVANCES IN CANCER TREATMENT Dr Nick Plowman, Clinical Oncologist
72
THE LATEST IN PROSTATE CANCER DIAGNOSIS AND TREATMENT King Edward VII's Hospital
78
ADVANCED ONCOTHERAPY
82
NEW PATHS TO PROTON THERAPY Nicolas Serandour, CEO, Advanced Oncotherapy
NHS PRIVATE PATIENT UNITS
86
THE BEST OF BOTH WORLDS Shams Maladwala, Managing Director, The Royal Marsden Private Care
88
LEADING THE WAY IN HEALTHCARE Marcel Levi, Chief Executive Officer, University College London Hospitals (UCLH) NHS Foundation Trust
92
CLINICAL EXCELLENCE IN THE HEART OF LONDON Guy's and St Thomas' Private Healthcare
96
WORLD-CLASS MEDICAL CARE Imperial Private Healthcare
102 SPECIALIST CARE IN THE HEART OF
LONDON'S WEST END University College London Hospitals NHS Foundation Trust (UCLH)
SHARING MEDICAL EXPERTISE
106 RESTORING LIVELIHOODS WITH HAND SURGERY
Donald Sammut, founder and team leader, Working Hands
YOUR STAY IN LONDON
112
ATTRACTIONS AND ACTIVITIES
120 THE LANGHAM, LONDON 124 CAPITAL CITY OF SPORT 139 SHOPPERS' PARADISE
5
INTRODUCTION
Lord David Evans of Watford
LONDON HAS EVEN MORE TO OFFER It is my great pleasure to welcome you to the third edition of Healthcare in London, focusing on the best in private healthcare options for patients visiting the UK. Healthcare in London is expanding with each edition, and we are delighted to feature even more of the capital’s most established and prestigious hospitals and clinics, as well as highlighting the latest arrivals to its fast-expanding range of private healthcare facilities.
1 Increasingly, international medical tourists are choosing London for their treatment, not only for the high standard of care, but also for the wealth of visitor attractions offered by the city, including the world-famous Tower Bridge (PHOTO: CHRIS HEPBURN/ISTOCK)
Every editorial contribution from the hospitals and clinics in this publication serves as a reminder of the breadth and depth of specialist private health services on offer to those visiting London, building on the city’s reputation for medical innovation and the highest standards in care. Many of the healthcare providers featured are located within the world-famous Harley
Street Medical Area (HSMA) and, once again, we have the privilege of the Howard de Walden Estate, owners of Harley Street and its environs, being one of the main supporters of the publication. Among the HSMA hospitals and clinics included are the London Clinic, profiling its cancer care, weight-loss and prosthetics services; the Mayo Clinic, which has partnered with Oxford University Clinic to open a premium preventative healthcare facility; and King Edward VII’s Hospital, explaining the latest in prostate cancer diagnosis and treatment. Plus London Women's Clinic highlights innovation in IVF treatment, and Bupa Cromwell Hospital explains how its award-winning food service is a vital element on patients' road to recovery. Harley Street is also the setting for exciting developments in the treatment of cancer. In an extensive section of Healthcare
7
INTRODUCTION
and research outlines its cutting-edge services and its expansion plans. The Royal Marsden is one of several hospitals in the capital offering topquality private healthcare that are also an important part of the UK’s National Health Service (NHS). As previously, this edition of Healthcare in London shines a spotlight on the ways in which private patients from home and abroad can benefit from the experience and expertise of the NHS, via its Private Patient Units (PPUs), which offer private facilities for international visitors. The revenue generated by these fee-paying patients subsidises the work of the NHS – providing healthcare services for the UK population, free at the point of delivery. Our section on PPUs includes contributions from University College London Hospitals (UCLH), Imperial Private Healthcare and Guy’s and St Thomas’ Hospitals – all among the world’s most renowned teaching hospitals.
Increasing provision Alongside well-established providers are new entrants to the capital’s private healthcare market, offering an even greater selection of best-quality care and facilities to visiting patients, both currently and in the near future. These include OneWelbeck, a provider of specialist day surgery that covers a wide range of specialities with an innovative approach in which its doctors are also partners in their clinics. Looking ahead, US provider the Cleveland Clinic has chosen London as the location for its new hospital and outpatient centre, which will become its first facilities in Europe.
2
in London dedicated to the wide range of world-class oncology services in the capital, Advanced Oncotherapy provides an update on the progress of its gamechanging LIGHT proton therapy system, which is set to dramatically increase patient access to the latest cancer treatments.
2 The world-class reputation of London's private hospitals and clinics is built on the excellence and dedication of its staff (PHOTO: STURTI/ISTOCK)
8
We also hear about Bupa Cromwell Hospital’s partnership with global healthcare provider GenesisCare, bringing an advanced radiotherapy centre to London that promises groundbreaking cancer treatments in five-star surroundings. London is also the home of the Royal Marsden, the world’s first hospital dedicated to the study and treatment of cancer. This world-leading centre for cancer diagnosis, treatment
As ever, our publication concludes with a view of the many attractions of London that make a medical stay more pleasant for both patients and their families. As well as highlighting the myriad tourist sights and experiences that the city has to offer – from Tower Bridge to the Tate Modern – we also turn a special focus on the worldclass events and venues that sports fans can enjoy in and around the capital. Our aim is that Healthcare in London will serve as an essential guide for patients and their companions when considering their location for private treatment. In addition to the best in medical care, visitors can also be assured of a warm welcome in the UK capital and an experience that is unmatched anywhere in the world.
Welcome to London’s only luxury hospital suites Expect the exceptional
The Royal Suite When it comes to your health, compromise is not an option. Bupa Cromwell Hospital delivers exceptional care through teams of leading consultants. Our Royal, Presidential, Ambassador and Executive suites offer a luxurious healthcare environment with outstanding customer service. For a confidential discussion about our exclusive suites, please call our International Marketing Manager on + 44 (0) 7592 775 036 or email luxury.suites@cromwellhospital.com Alternatively, you can visit us online at bupacromwellhospital.com/luxurysuites
The Presidential Suite
The Ambassador Suite
The Executive Suite
CHOOSING LONDON FOR HEALTHCARE
David Hare, Chief Executive, Independent Healthcare Providers Network, NHS Confederation
ENERGY AND INNOVATION London never stands still. The ancient city constantly renews itself. From our 15th-floor offices I can see literally dozens of cranes, hard at work building the London of tomorrow. It is this sense of energy and innovation built on old foundations that makes London such an exciting place in which to live and work. I have the privilege to lead the trade association for independent sector healthcare providers. The independent sector in the UK complements the huge strengths of the state-run system to deliver great care to patients from both the UK and overseas. And, like London itself, the independent health sector never stops changing and innovating, even though it is built on a heritage that goes back centuries. Our members include some of the most-established and best-regarded private hospitals in the country, but we also represent exciting newcomers to the sector. What all our members
10
have in common is the shared desire to deliver the best possible care and service – with investment and clinical innovation hallmarks of the whole sector. London’s independent health sector is a clinical community at the cutting edge of modern medicine. Leading physicians and surgeons work in fantastic facilities and with the best equipment to deliver diagnosis and treatment of unparalleled quality. There is a real focus on delivering individualised care based on the latest advances in clinical knowledge and medical technology. This individualised approach is reflected in the service ethos that runs through the whole sector. London’s independent hospitals are places where patients from around the world receive a level of service that supports them and their family through their clinical journey. International patients receive dedicated support, helping them make the right decisions for their care at every step of the way.
London is not just a destination of choice for patients, but for clinical staff too. The reputation of the sector and the attractions of London itself mean that the best clinicians from all around the world choose to work within the city’s independent healthcare providers. And it is not just doctors and nurses, but the whole teams of skilled healthcare professionals, that contribute to the great care delivered in the sector. The clinical workforce present in London truly makes the UK capital a special place to receive care. London’s independent health sector brings together providers that reflect the city’s past and present – long-established, but with an innovative, dynamic, modern outlook. Those providers deliver world-
class care, thanks to the presence of leading clinicians and support staff, and the foundation of some of the best healthcare facilities in the world. Of course, London is not just a place to receive treatment. The vibrant cultural and economic life of one of the world’s true global cities means that London continues to be a destination of choice for patients and their families. The opportunity to receive treatment while also enjoying all the wider benefits of this great city mean that London has formidable strengths in a competitive global market. I’m confident that the independent sector will continue to rise to the challenge of delivering great care to patients from all around the world.
London's independent health sector reflects the past and present of the city, building on a centuries-old heritage, and includes private patient facilities at National Health Service hospitals (PHOTO: THE ROYAL MARSDEN)
11
CHOOSING LONDON FOR HEALTHCARE
HERITAGE BUILDINGS, 21ST -CENTURY HEALTHCARE If, today, a group of forward-thinking experts started planning a modern medical campus from scratch – and right now, around the world, that is exactly what many governments and well-funded private institutions are doing – it is highly unlikely that it would end up looking much like the Harley Street Medical Area (HSMA), from the outside at least. But despite the logistical challenges caused by its attractive period buildings and highly regulated central London setting, the HSMA is managing to do more than keep pace with the glass towers and open spaces of the world’s new generation of out-of-town medical mega-complexes; it is, certainly in the depth and quality of its medical offering, beginning to lead the way. 1 At first glance, Harley Street seems an unlikely location for world-class hospitals and clinics, but the area is home to numerous top-quality private facilities (PHOTO: HdWE)
For well over a decade, in its role as the area’s landlord and steward, The Howard de Walden Estate (HdWE) has been slowly
improving its buildings and infrastructure, creating a strong HSMA brand and shaping a cohesive and well-balanced community of providers. In recent years, this hard work has led to a dramatic step-change in the HSMA’s global profile. There have long been world-class hospitals here – The London Clinic, King Edward VII’s Hospital and HCA among them – but the flow of new arrivals in the past few years means that these stalwarts now find themselves part of an increasingly impressive collective, unmatched anywhere else in the UK and far beyond. The USA’s two highest-performing and most forward-thinking non-profit academic medical centres are both on their way. As part of a wider collaboration with the University of Oxford, Mayo Clinic has opened a screening and diagnostics centre on Portland Place, and Cleveland
13
CHOOSING LONDON FOR HEALTHCARE
2
3
4
2 The Fortius Clinic specialises in orthopaedic care and sports medicine (PHOTO: FORTIUS | 3 The hospitals and clinics of the Harley Street Medical Area attract highly trained staff (PHOTO: HdWE) | 4 The da Vinci robotic surgical system at King Edward VII‘s Hospital (PHOTO: KING EDWARD VII‘S HOSPITAL) | 5-6 The facades of the Harley Street Medical Area‘s historic buildings hide a plethora of world-class medical facilities (PHOTO: HdWE) CLINIC)
14
5
Clinic has chosen to locate its diagnostic and outpatient facility, where most patients begin and end their treatment journeys, on the same wide Georgian street – the latter is due to open in October 2020. Similarly, one of Germany’s most respected hospital groups, Schoen Clinic, chose the HSMA as the site for the first clinic it has built outside of its home country, which opened last year. From closer to home, some of the biggest and most respected names in British medicine have either arrived recently or are on their way. Royal Brompton & Harefield Hospitals and Moorfields Eye Hospital have both set up private facilities here, and they will be joined in 2020 by
the private arm of The Royal Marsden NHS Foundation Trust – one of the UK’s leading cancer hospitals. The Priory has joined our impressive roll call of mental health experts. Advanced Oncotherapy, a pioneer in the field of proton beam therapy, is on its way. The list goes on and on.
Abundance of expertise This flow of expertise into the area has now developed a momentum all of its own. As the collective grows in strength and its profile rises accordingly, its appeal becomes further enhanced, and the cycle continues. The HSMA has so much going for it – located in the middle of one of the world’s best-connected cities, surrounded by universities, research institutions and
6
royal societies, with access to highly trained staff and a large population of potential patients – and clinics know that the nature of the collective means they can collaborate with each other and explore their mutual interests, without having to compromise their own individual identities. As a result of all this, the challenge for the HSMA now is not finding world-class providers to join the collective, it is finding the space to accommodate them.
Thriving collective Against a backdrop of intense competition from around the world, it is thanks to the impressive pulling power of its collective that the Harley Street Medical Area is able to thrive. Proven providers,
that cover a vast array of specialisms, employ some of the most respected practitioners in their fields, invest in cutting-edge equipment, contribute to game-changing research, provide a truly exceptional patient experience, and focus relentlessly on tracking, analysing and improving the quality of their outcomes. Nobody planning a modern medical campus from scratch would come up with anything that looks quite like the HSMA, but they would definitely hope to emulate the professionalism, resourcefulness and expertise found in the parts of it that really matter: the parts where patients and medical professionals come face to face.
15
A proactive approach to your health and wellbeing
When it comes to your health, you deserve the very best The world’s number-one organisations in healthcare and medical research, Mayo Clinic and Oxford University Clinic, have partnered to open a premium preventative healthcare facility in London’s prestigious Harley Street district. Delivered through the combined expertise of these worldrenowned institutions, the Health and Wellness Plan provides world-class preventative healthcare through a unique diagnostic and screening service. Our personalised health plans are tailored to your individual needs, enabling our clients to take a proactive approach to their health. Developed for discerning individuals who expect and deserve the very best, choosing the Health and Wellness Plan is all about convenience and efficiency.
The highest-quality personalised care The clinic’s team of world-renowned problem-solvers are experts in preventative healthcare and specialise in executive-related health concerns – from stress-related conditions to travel wellbeing. With access to an unrivalled network of over 4,500 global health experts from the world’s number-one organisations in healthcare and medical research, your total health and wellbeing is always in the best possible hands. We're experts in holistic health and wellbeing, and we take time to get to know you and understand your lifestyle, needs and aspirations. Then we identify any challenges that might impact your total health and deliver the bespoke advice and treatment that is right for you.
mch-ouc.co.uk
Whether you’re not getting enough sleep or are worried about your family medical history, the Health and Wellness Plan offers an opportunity for visitors to explore any health concerns. All clients who visit the clinic are guided through a preventative health assessment by a dedicated personal doctor, which will include:
•
A preventative health assessment, including a physical examination and a full range of preventative screening tests for early detection of cancer, heart disease and other serious conditions;
•
A comprehensive medical history review and update of your medications and immunisations, including those required for international travel; and
•
Lifestyle assessment, covering nutrition, stress management, alcohol and tobacco use, amongst other indicators, to help you meet your next challenge.
“Whether your goals are maintaining peak performance, addressing medical concerns, optimal wellness, or enhanced longevity, this focused experience can help enable the healthiest you” Dr Kevin Fleming, MD
World-class facilities Easily accessible, yet discreet, the clinic is located on Portland Place, in the heart of central London’s prestigious Harley Street medical district. The relaxing and comfortable space uses the latest cutting-edge technology to deliver an exceptional and highly personalised health screening service. The clinic is designed with the busy individual in mind, providing a suite of quality and well-equipped amenities, such as the on-site Executive Lounge and Business Hubs. Dedicated concierge staff are on hand to provide expert guidance on accommodation, restaurants, and the local area, ensuring that clients also enjoy a seamless and enjoyably stress-free experience.
Our team of world-class medical experts Our core medical team of four specialist doctors lies at the heart of Mayo Clinic Healthcare in partnership with Oxford University Clinic. The clinic’s physicians reflect the cultural collaboration of the partnership, with Dr Robert Orford and Dr Kevin Fleming joining from Mayo Clinic US, and Dr Sihame Benmira and Dr Sandeep Kapur joining from UK-based practices. Unlike many other US healthcare providers operating in the UK, the physicians at the new clinic will be salaried, as they are at Mayo Clinic in the US, as opposed to being paid per performance. Dr Stephen Cassivi, Medical Director at Mayo Clinic Healthcare in partnership with Oxford University Clinic, says: “People in the UK are living increasingly busy lives with demanding jobs. London is one of the world’s leading cities with a high proportion of potential clients looking to stay in the best health possible – for themselves and their loved ones. “Our exceptional team of physicians act as the integral force of the clinic, driving its commitment to excellence and delivering a truly unique
service to everyone who walks through its doors. Selected for their passion for preventative medicine and specialised expertise, each of the four clinicians contribute a unique set of experiences to our clinic.�
How to avoid burnout in 2020 As of this year, burnout is an officially recognised medical condition by the World Health Organisation (WHO), underscoring the gravity of this syndrome caused by excessive workloads, inefficient work processes, high clerical burdens, lack of input over schedule and emotionally intense work. The WHO announcement illustrates that burnout is something that workers and employees alike should be taking very seriously. While employers need to take responsibility in helping their employees prevent burnout, employees must also be more aware of the symptoms and take steps to prevent it. Symptoms of burnout syndrome include persistent fatigue, emotional exhaustion, reduced engagement, a sense of reduced accomplishment, and depersonalisation, which could mean becoming callous or even treating co-workers as objects rather than fellow humans. At Mayo Clinic Healthcare in partnership with Oxford University Clinic, we recognise the impact of burnout and other lifestyle stresses on the health of individuals. As such, our Health and Wellness Plan has been carefully curated to take into account these ever-increasing pressures of modern life. Screening for conditions commonly resulting from high stress environments, combined with tailored lifestyle advice to limit the risks of illness, ensures our clients can stay in the best health possible.
Our team Dr Robert Orford M.D., Director of the Executive Health Program at Mayo Clinic Dr Kevin Fleming Executive Health Program consultant at Mayo Clinic and expert in stress-related conditions Dr Sihame Benmira BSc MBBS MBA, specialist in workforce transformation and emergency medicine Dr Sandeep Kapur BSc MBBS MACP MRCGP, general practitioner holding over 15 years of experience in primary care
At Mayo Clinic Healthcare in partnership with Oxford University Clinic, we provide clients with the tools they need to take a proactive approach to their health. Through comprehensive and highly personalised screening and diagnostics services, we ensure no stone remains unturned. We provide clients with the knowledge necessary to take evidence-based action to both manage and mitigate the onset of serious health conditions.
Planning your visit We take a thorough approach, with unhurried yet efficient appointments that enable our team to provide the highest levels of attention. Depending on your options, your visit may extend across one, two or three days, and we’ll do everything to ensure that your time with us is as relaxing and productive as possible. To book an appointment or find out more, please contact us on appointments@mch-ouc.co.uk or call 0207 871 2575.
mch-ouc.co.uk
CHOOSING LONDON FOR HEALTHCARE
BRINGING A NEW MODEL OF PRIVATE CARE TO LONDON Cleveland Clinic is a leading provider of specialised medical care, internationally recognised for its doctor-led, patient-centred model of high-quality medical care. Voted amongst the top hospitals in the world by Newsweek, the Clinic is opening a new hospital at 33 Grosvenor Place, Belgravia, in 2021, preceded by the first Outpatient Centre at 24 Portland Place, in the Harley Street Medical Area.
1 An exterior view of Cleveland Clinic's new London hospital at 33 Grosvenor Place, Belgravia, which will open in 2021 (PHOTO: CLEVELAND CLINIC)
The London hospital will be Cleveland Clinic’s first facility in Europe, adding another international location to a health system that includes a 165-acre main campus near downtown Cleveland, Ohio; 11 regional hospitals throughout Northeast Ohio; five hospitals in Florida; a hospital in Abu Dhabi, United Arab Emirates; and facilities in Las Vegas and Toronto.
Exceptional facilities and quality of care Cleveland Clinic has been rated the top provider of heart care in the US for 25 years in a row (US News & World Report), and also ranks in the top five for gastroenterology and GI surgery, urology, rheumatology and gynaecology. Cleveland Clinic London will build on this foundation to deliver exceptional care in hi-tech facilities, where every detail is tailored to enhance the patient experience. Cleveland Clinic London hospital will have 185 beds; eight operating rooms; imaging suite; endoscopy and catheterization labs; day-case rooms for surgery, and a neurological suite with rehabilitation. A full range of medical services will be offered, including specialty services focusing on heart and vascular, orthopaedics, digestive diseases, neurosciences and general surgery.
21
CHOOSING LONDON FOR HEALTHCARE
Dr Brian Donley, CEO Cleveland Clinic London comments: “We are investing in London as it is one of the leading international healthcare centres, and represents a great opportunity to extend and improve our model of healthcare for patients. London is home to outstanding talent and world-leading research that we can learn from as we look to innovate and provide the very best care.
Dr Brian Donley, CEO Cleveland Clinic London
“We are always striving to learn and innovate, and have a strong focus on research and education, technology and leadership. Cleveland Clinic London hospital and our Outpatient Centres will be equipped with the best facilities and latest technology to enhance quality, safety and experience of care. “We will integrate the best of Cleveland Clinic from our experience (not only in the US, but also internationally), with the best of what we learn from the UK healthcare system. This will be one of the most technologically advanced hospitals in the UK. Cleveland Clinic is a global leader in specialised medical care, and our London hospital will enable patients from across the UK and beyond to access exceptional treatment that is based on nearly 100 years of research and innovation.”
“We want to develop the most digitally enabled hospital in the UK. Our technology strategy aims to improve our understanding of patient information” 22
One of the most technologically advanced hospitals in the UK Cleveland Clinic London will be at the cutting-edge of hospital design, creating an environment that reflects the needs of patients and the future of healthcare in the UK, while ensuring that the building’s environmental impact is limited. Sustainability is a priority, and the hospital will produce some of its own heat and power which, combined with efficient design, will enable a reduction in carbon emissions.
strategy aims to improve our understanding of patient information to improve care, the patient experience, and the abilities of the Caregiver. “Technological advancements allow the patient increased access to their data and to become a partner in their own care, as well as giving our Caregivers the information they need to make the right decision for the patient. Technology plays a vital role in clinical transparency and facilitates the sharing of research and learning to bring together the best of Cleveland Clinic in both the US and the UK.”
Doctor-led and research focused – a new model for UK private healthcare Another key differentiator for Cleveland Clinic London is that it is led by doctors, with care delivered by groups of doctors and clinicians working as a ‘team of teams’. Combined with digital medical records and other market-leading technology, this creates a ‘Patients First’ philosophy that puts the patient perspective at the heart of decision-making. Patient safety is prioritised every step of the way to provide the best possible care journey and minimise the risk of complications in the delivery of healthcare. Research and education are also critical to Cleveland Clinic, and the London hospital will leverage the world-leading Lerner Research Institute in Cleveland, delivering cutting-edge treatment and offering educational opportunities for Caregivers. Cleveland Clinic London will also form close ties with the UK’s clinical research institutes, to share knowledge and know-how.
Use of cutting-edge technology will be a key differentiator in UK private healthcare. The London hospital will be the first private provider in the UK to use electronic patient records, and the first hospital in the UK to use pharmacy barcoding and closed-loop medication administration to ensure that the patient quality, safety and care experience is exceptional.
Cleveland Clinic has great success in transferring ground-breaking discoveries from the laboratory to the bedside, from early breakthroughs in heart surgery to recent world firsts for face and uterus transplants. With nearly 1,400 researchers and support personnel in 180 laboratories across 12 departments, the Lerner Research Institute is one of the largest research institutes in the United States, consistently ranking in the top 10 in National Institutes of Health funding – a global benchmark of research success.
Dr Donley continues: “We want to develop the most digitally enabled hospital in the UK. Our technology
Dr Donley concludes: “Cleveland Clinic London is fully owned by Cleveland Clinic, which is a not-for-profit organisation.
2
We do not have shareholders, and any surplus is reinvested back into the organisation, in either healthcare services or into research and education. “We are extremely proud of what we’ve achieved in the US and our international locations, and building this fantastic new hospital and Outpatient Centres in London is an incredibly exciting step for all 66,000 of our Caregivers around the world. “We are building something truly different here – a new model of care for London, where doctors will mainly be
employed by the Clinic, working to our very high clinical standards, rather than working as independent consultants. The patient’s safety and exceptional standards of care will be the key priorities of everyone along the care pathway.”
2 Cleveland Clinic's first London Outpatient Centre will open at 24 Portland Place, in the Harley Street Medical Area (PHOTO: CLEVELAND CLINIC)
Cleveland Clinic London will welcome its first patients at the 24 Portland Place Outpatient Centre, five minutes’ walk from Oxford Circus. The hospital opens in Belgravia in 2021, and a second Outpatient Centre will follow thereafter.
www.clevelandcliniclondon.uk
23
CHOOSING LONDON FOR HEALTHCARE
Professor Abdulaziz Mohammed Aleisa, Health Attaché at the Saudi Health Mission in the United Kingdom and Ireland, explains the services that are available to help Saudi visitors to the UK for healthcare
ASSISTANCE FOR SAUDI PATIENTS VISITING THE UK The Saudi Health Mission in the United Kingdom and Ireland opened in 1974 to represent the Saudi Ministry of Health, under the umbrella of the Royal Embassy of Saudi Arabia in London. It is one of four Saudi Health Missions around the world and we provide services for Saudi citizens in both the UK and the Republic of Ireland. The services we provide for visiting Saudi patients divide into three categories. Firstly, we provide services such as medical supervision and case management for Saudi patients in the UK who are sponsored by the Saudi government. These are complicated or specialist cases in which the patient requires treatment abroad. More straightforward cases can be treated in highly equipped tertiary hospitals in Saudi Arabia for free.
24
For example, for a Saudi patient visiting the UK, we will select the right hospital and the best medical centre based on the tests or treatment that they require. Sometimes we will also find a specific doctor or consultant for more complex cases.
Assisting 'self-pay' patients In the second category are patients who choose to pay for medical treatment outside Saudi Arabia, even though the treatment is available within the Kingdom. The Saudi Health Mission assists these ‘self-pay’ patients in deciding the hospital or clinic to select, and also we can help with scheduling appointments and translating medical reports. The third category includes visitors who may not have a medical condition currently, but who wish to see a consultant or have a routine check-up while they are
in the UK on vacation. Some people may want to see a cardiologist or neurologist, for example, so we help them select which would be best, based on any medical reports and a brief history of their case.
Saudi Arabia also has a partnership with Oxford University for craniofacial procedures. The results of such surgery have been amazing, even with some of the most complicated cases.
guidance on British culture and conventions. These are only small details, but they can be very helpful for patients and their families during the period of their treatment and recovery.
In the past few years, on average, we have assisted just over 200 patients annually with their healthcare needs. The Mission also handles most emergency cases involving Saudi citizens during their trips to the UK. We covered almost 44 emergency cases in 2018.
In cancer care, while patients in Saudi Arabia have access to excellent oncology services at home, some choose to have their treatment in the UK. We have good relationships with many hospitals across the country, particularly in London, and refer such cases to the Royal Marsden or University College London Hospitals (UCLH), for example. The standard of the healthcare system in the UK is amazing and we are very happy with our collaboration with the hospitals here.
In addition to providing services for visiting patients, the Saudi Health Mission is also working on a number of projects with UK hospitals and medical centres to establish a strong collaboration between hospitals in the two countries. These collaborations take different forms, such as research partnerships or educational collaborations, including sending Saudi physicians, nurses and pharmacists for training in UK hospitals and colleges. We view this very much as a win-win situation for Saudi Arabia and the UK.
Although most medical treatments and procedures can be carried out in hospitals in Saudi Arabia, there are some cases where there is a need for the government to send patients to the UK. For instance, a patient requiring a bone marrow transplant will find it much easier to find a match donor and have their transplant in the UK. There is also a greater availability of hospital beds in the UK, which are required for transplant patients needing to be kept in isolation following their treatment.
Valuable advice and information As well as assisting people from Saudi Arabia with finding the right hospital or consultant for their treatment, we also offer advice to patients to help during their stay in the UK. When the patient arrives, we offer useful brochures and
The Mission also facilitates the process for some of the UK citizens who would like to work at hospitals in Saudi Arabia. This includes dealing with the initial contract before they travel, as well as helping with visas and transport.
25
Empowered doctors, exceptional healthcare
OneWelbeck is the capital‘s most accessible and advanced destination for world-class healthcare, operated by Welbeck Health Partners, a leading global provider of specialist day surgery. With nine floors hosting specialties from cardiology to gastroenterology and orthopaedics to ENT, we provide a one-stop shop for consultation, assessment, diagnosis and treatment. Equipped with the latest technology and teams of exceptional clinicians, our specialist centres of excellence combine services that are typically fragmented and shared across several sites in a single location. In doing so, we simplify the patient journey and enable patients to have their
initial consultation and treatment plan (if needed) with the right doctor, undergo a spectrum of diagnostic tests and receive their results all in the same day. If minimally invasive surgery is required, our model means patients can go home on the same day, too, where they can recover and get back to their normal lives as soon as possible. We pride ourselves on delivering a service that enables: Empowered doctors – our doctors are partners in our clinics and have a critical say in how they are run. They
have power and autonomy to deliver personalised healthcare by working collaboratively to solve complex cases. Exceptional outcomes – our day clinic model not only reduces the time between a patient’s first visit and their diagnosis and treatment, but also creates the very best clinical outcomes. No ordinary experience – we use technology to ensure a seamless, personal healthcare journey that doesn’t start and stop at the clinic doors. Our modern, stylish clinics provide patients with a warm and comfortable environment they will remember.
No ordinary experience Our location
OneWelbeck is situated at 1 Welbeck Street in the heart of London’s Marylebone area. Its convenient location, minutes from Bond Street and Oxford Circus, makes it easily accessible from all major central London destinations, from Heathrow and nearby Paddington to the west, and the City of London and Canary Wharf to the east. Occupying 50,000 square feet over nine floors, OneWelbeck‘s bespoke clinics are self-contained centres of excellence in their own right. Each medical specialty has its own dedicated space, designed with the look and feel of a cosmopolitan boutique hotel.
An innovative approach
Innovation is at the heart of everything we do, so we are always seeking ways to raise the bar of excellence, using technology to push boundaries. But it’s not just technology for technology’s sake – we’re revolutionising medical procedures, surgical techniques and computer systems for the benefit of patients. The result is that they are guaranteed a superior experience, from referral to discharge and beyond.
Convenience at your fingertips Our OneWelbeck app puts patients in control of their own healthcare. Using the app, patients can:
complete their pre-assessment survey on their device in their own time;
discover important information about their appointment, investigations and procedure;
meet their OneWelbeck clinicians;
access their tailored, postprocedure aftercare plan;
monitor their progress, with their clinician’s input;
stay on track with their recovery and rehabilitation.
Supplementing the app is our online patient portal, which enables patients to book and change appointments, view test results, and access information anywhere, at any time.
Screening & Prevention
Exceptional healthcare entails more than diagnosing and treating patients when they’re unwell. Health promotion and disease prevention are not just cost-effective, but also mean patients benefit from living healthier lives. At OneWelbeck, we offer a comprehensive screening service for a range of conditions, overseen by a team of internationally renowned experts: Colonoscopy – screening for bowel cancer and other bowel conditions, like polyps and ulcerative colitis. Cardiology testing – a range of heart health packages, including a full cardiovascular disease risk assessment and an assessment for a patient’s suitability to participate in a sports event. Lung cancer screening – using cutting-edge CT scanning technology to detect early signs of disease. Full body musculoskeletal check – a top-to-toe musculoskeletal health screen using an advanced MRI scanner.
Imaging & Diagnostics
OneWelbeck’s Imaging & Diagnostics Centre is a beacon of excellence, offering an array of investigations to support our clinicians in accurately and quickly diagnosing your condition.
Whether you’re visiting as a walk-in or outpatient, or for day surgery, you will benefit from our state-of-the-art imaging facilities and diagnostic services. And, because our services are consultant-led, you’ll be able to have any tests you need – and, in most cases, get the results too – on the same day.
Surgery Centre
The OneWelbeck Surgery centre spans 6,000 square feet and occupies the first floor of our flagship building. In our three spacious, state-of-the-art laminar flow theatres, our surgical team performs a range of minimally invasive day-case surgeries across all specialties: cardiac; respiratory; ear, nose & throat; endocrinology; gastroenterology, orthopaedic; and women’s health. Expert clinicians work together to devise comprehensive pre-assessment and postprocedure management plans.
Multi-modal anaesthesiology – where tailored, clinically advanced drug combinations are given to minimise pain and reduce side effects – means patients recover faster. Together with our advanced facilities, this expertise means we can often perform as day cases surgeries that are routinely carried out as inpatient procedures elsewhere. For patients, that means they’ll be recuperating in the comfort of their own home the very same day.
Digestive Health & Surgery
As the first of our clinics to launch, OneWelbeck Digestive Health is a centre of excellence in the diagnosis, treatment and management of all gastrointestinal problems and diseases, founded by a group of revered doctors, each of whom is an expert in their sub-specialist field. Our clinicians perform a range of tests, such as: anorectal manometry; endoanal ultrasound; helicobacter pylori breath test; and virtual colonoscopy. Most patients with a gastrointestinal condition don’t require surgical intervention. But, if surgery is needed, patients will have access to a group of 13 hand-picked surgeons at OneWelbeck. Making use of advanced technology, our surgeons can perform the latest minimally invasive procedures to treat many conditions, enabling patients to go home and recuperate the same day.
Endoscopy Centre
Set on the second floor of OneWelbeck is our bespoke Endoscopy centre, which opened as part of our Digestive Health centre of excellence in July 2019. It boasts four advanced procedure rooms, all of which are furnished with market-leading equipment to perform a full range of endoscopic procedures, including: colonoscopy; gastroscopy; flexible sigmoidoscopy; endoscopic ultrasound; and bronchoscopy.
Orthopaedics & Sports Medicine
At our Orthopaedics & Sports Medicine centre, we boast a truly integrated team of orthopaedic surgeons, sports medicine physicians and radiologists. This means that conservative treatment will always be tried first, where appropriate, and patients don’t have to travel between different sites and undergo multiple referrals. Our clinicians form sub-specialty teams focusing on particular areas, including: shoulder; hand and wrist; foot and ankle; hip and knee; pain management; spine; and sports injuries.
Cardiology
The doctors behind the OneWelbeck Heart Health centre have been assembled based on their hard-earned international reputations and expertise. Together, they cover the major London teaching hospitals and leading cardiac services, and make up the largest independent cardiology group in the UK. Our facilities are designed with patients’ needs firmly in mind, offering the majority of tests in a single visit and often making results available the same day.
Respiratory Health
OneWelbeck Respiratory Health is located alongside our Heart Health centre on the third floor to provide a fully integrated cardiothoracic centre of excellence. With a team of internationally renowned sub-specialists at the helm, we offer outpatient consultation and non-invasive testing for conditions such as: interstitial lung disease; cough and breathlessness; pulmonary hypertension and embolism; infectious disease; lung cancer; and obstructive sleep apnoea.
Ear, Nose & Throat
Endocrinology
The clinicians at OneWelbeck Endocrinology make up the largest group of sub-specialist leaders in the UK’s private sector. They are able to identify and treat the full spectrum of endocrine conditions, from the commonest to the rarest, such as: type 1 and type 2 diabetes; rare forms of diabetes; thyroid disease; adrenal conditions; pituitary gland disorders; and calcium, bone and metabolic disease. Same- and next-day access to clinicians with expertise in a range of conditions means patients have prompt treatment, backed up by state-of-the-art technology. This comes in the shape of a dedicated dynamic testing area, so patients can undergo tests in comfort, and during one visit. With our Imaging & Diagnostics suite on-site, we’ve designed the entire patient experience to be as seamless as possible.
Women’s Health (opening summer 2020)
We have worked tirelessly to ensure that having any endoscopic procedure at OneWelbeck is as comfortable and stressfree as possible. Thanks to significant input from our expert clinicians, the suite was designed and purpose built to deliver care that is patient-centric, safe and efficient.
The best ENT clinicians typically subspecialise in the ear, nose or throat, rather than broadly treating all three areas. The OneWelbeck ENT centre of excellence provides expertise across the entire breadth of all three fields. Our hand-picked team of sub-specialists comprises top physicians, surgeons, radiologists and therapists who are each renowned in their area of specialism and treat adults and children.
At our Women’s Health Centre, you’ll find a group of specialists in all gynaecological conditions and diseases, as well as those of the breast. The centre covers a range of services, including: preventative screening; cancer diagnosis and treatment; fertility and menopause management; aesthetics; minor breast and uro-gynaecological procedures; and day-case surgery. All of this is housed on the sixth floor at OneWelbeck, with stunning views over central London.
Contact us
OneWelbeck, 1 Welbeck Street, Marylebone, London, W1G 0AR 020 3653 2000 info@onewelbeck.com
CHOOSING LONDON FOR HEALTHCARE
COMMITTED TO A BETTER PATIENT EXPERIENCE Consultant Gastroenterologist Professor Julian Teare talks about how the OneWelbeck Digestive Health Centre is focused on providing the best possible patient experience
What is your medical specialty and on what areas are you focused? I am a gastroenterologist, so I have a special interest in diseases of the gut. My main interest is diseases of the stomach: stomach ulceration, reflux disease and diseases of the colon, colitis, Crohn's disease and bowel cancer. When we investigate for these diseases, we’re looking for signs of inflammation, for those with colitis and Crohn's disease, and for polyps and bowel cancer. One of the big developments over the past decade or more has been to screen people in their 50s to find polyps, because for 95% of people that have bowel cancer, it begins with a polyp. These polyps increase in size over many years and can turn into cancer, so if polyps are detected and removed then we can prevent the development
of the disease. In countries that have adopted screening programmes with colonoscopy – such as the United States, where about half the population has been screened – instances of colon cancer have fallen by more than 40%. I also have a research laboratory where we investigate what drives the formation of polyps and what leads some polyps to turn into bowel cancer. About 40% of people at colonoscopy have a polyp, and most of these will never develop into cancer. For those polyps that do develop into cancer, we are exploring why this occurs – for instance, something present in the gut or for dietary reasons. Statistics show that a case of bowel cancer is found in every 121 procedures, and that the disease is prevented with
29
CHOOSING LONDON FOR HEALTHCARE
1
2
every 28 procedures. One in 15 men and one in 18 women will develop bowel cancer during their lifetimes.
central London for having an endoscopy. We saw our first patient in July 2019 and, so far, we’ve seen more than 1,000 patients and carried out around 1,300 procedures. We’ve created a place that is calm, quiet and reassuring for patients.
What was the thinking behind the creation of the OneWelbeck Digestive Health Centre? In central London we have large groups of doctors working in this discipline. We all know each other, we have trained together, and some of the younger doctors have been trained within our group. An opportunity arose with OneWelbeck to look at how we could provide the best possible standard of care and patient experience. At many hospitals, we found that clinics were crowded and offered little privacy, where patients were waiting in a cubicle before going into the procedure room and didn’t have access to en suite toilet facilities. In exploring how to make the procedure as easy as possible, we visited various centres around the world, including the United States and Sweden. We met with Welbeck Health and started conversations about how we could work together to create something better, where our group could become investors in the centre and choose the doctors we wanted to work with – people we trust. We started with a group of five to 10, and this has now grown to 25 people providing what, I think, is the optimum experience in
30
Can you describe a typical patient endoscopy experience at OneWelbeck Digestive Health? The point in choosing the endoscopists we have is that they are adept and skilled. Many procedures can be carried out without sedation, so the patient can see what is happening on the screen as it happens. Our patient feedback tells us that people find this really interesting.
3
For patients who are nervous and would prefer to be sedated, an anaesthetist can administer a drug called propofol, which is a sedative agent from which people recover very quickly – within minutes you're awake and feel completely normal. It’s a very gentle experience. Discomfort and pain should not be part of the process. People might read about such procedures online and think it will be a horrible experience, but it doesn’t have to be. A key development in improving patients’ experience of such procedures is the technology we use. Our instruments work with an external scope guide – each has an electromagnetic coil within the shaft that enables us to see how
1-5 The facilities at OneWelbeck's Digestive Health Centre are designed to make patient visits as comfortable and pleasant as possible (PHOTOS: SIMON JARRATT)
CHOOSING LONDON FOR HEALTHCARE
4
the instrument is moving around inside, allowing us to keep the instrument straight and, therefore, reduce any discomfort.
5
hospitals around central London. We are all committed to the process, committed to trying to reduce the incidences of bowel cancer in our populations, as well as what we can do for individuals.
Are there alternative tests for detecting polyps? Most people, of course, would prefer not to have an invasive test if it can be avoided. Alternatives can include a blood-in-the-stool test, which can identify polyps so that we know whether the person coming for the procedure is likely to have the polyps that we could remove, as they are at higher risk of the polyps developing into cancer. There are also faecal immunohistochemical tests, where we can look for molecules that can identify risk and detect polyps. We can also find polyps with a virtual colonoscopy or CT colonography, which also allows for assessing structures outside of the colon.
How do you feel as the OneWelbeck Digestive Health Centre completes its first year in operation? Immensely proud. We have this enormous pride in our environment, as we have invested in the centre. We were involved at each stage of the design process to create the best experience for us and for the patients.
What does the future hold for the detection and prevention of bowel cancer in the UK?
It is a completely new model that is very exciting and works really well. One of the important things about working as a group is that we are now invested in each other's success. Often, doctors in private healthcare find themselves in competition with each other, whereas in this environment we’re in collaboration. We are enabling each other to flourish and supporting each other.
The goal, of course, is to reduce the likelihood or the incidence of colon cancer in the population, so faecal immunohistochemical tests will come in as there simply aren't enough people trained in a population the size of the UK’s to be able to provide the endoscopy required. One of our endoscopists is the head of the UK’s national background screening programme, and another two run the hub centres in different
The model extends throughout OneWelbeck, including heart and chest specialists, endocrinologists, rheumatologists, orthopaedic surgeons, sports medicine physicians, physiotherapists, women's health specialists, and ear, nose and throat clinicians. By summer 2020, we expect the OneWelbeck team to expand to around 200 people.
“We have this enormous pride in our environment, as we have invested in the centre. We were involved at each stage of the design process”
31
OUR VISION
is to be the most trusted hospital
World-leading cancer care with a charitable purpose People from global destinations are choosing The London Clinic because of the fast access to world-leading cancer consultants, pioneering cancer services and a clinical research centre that combine to offer innovative treatments A CHARITABLE HOSPITAL WITH A HISTORY OF PUTTING PATIENTS FIRST The London Clinic is a large, independent, charitable hospital in Harley Street, the heart of London’s medical district. Opened by HRH The Duke and Duchess of York in 1932, The London Clinic was granted charitable status in 1935 and, ever since, has been committed to reinvesting income to help improve healthcare for patients and advancing healthcare in the wider global healthcare community. In 2010, HM The Queen and HRH The Duke of Edinburgh opened The London Clinic’s cancer centre – the Duchess of Devonshire Wing. In that time it has become a leading global cancer care facility, winning the prestigious International Cancer Centre of the Year award in 2018 from the International Medical Travel Journal. In 2019, it received an overall score of 5 (excellent) in its first Quality Environment Mark by Macmillan Cancer Support, assessing the care and treatment of patients affected by cancer. The Macmillan standards acknowledge innovation and excellence in medicine and patient care, and were developed in collaboration with more than 400 people living with cancer.
The patients of a leading UK medical insurance provider, which refers patients to a number of London hospitals, also rated The London Clinic as the best for the quality of care provided.
A GLOBAL HOSPITAL Over 120,000 people from the Middle East, China, US, UK and Europe visit The London Clinic every year to see one of over 600 leading consultants, in fields as diverse as cancer care, digestive diseases, musculoskeletal and orthopaedics (including hips, knees, shoulders and fingers). These leading experts are supported by one of the best nursing teams available, an on-site physiotherapy rehabilitation service, with hydrotherapy, and an intensive care unit that is the envy of most top London hospitals.
LEADING HEALTHCARE EXPERTISE The London Clinic’s aim is to be the best hospital, trusted by patients to offer unrivalled service and standards, and by consultants and doctors as an essential healthcare partner. With access to over 600 internationallyrenowned consultants, specialist clinical nurses and a large support team with 34 different nationalities, we provide rapid access to the best treatment and care. As well as providing top consultant and nursing care, we also offer some of the very best facilities available. The London Clinic’s haematology facility – located in the cancer centre – is the largest stem cell collection centre in Europe. Working with charities including blood cancer charity Anthony Nolan, over 700 stem cell donations are collected every year and safely stored until needed by patients around the world. On 23 February 2017, The Duchess of Cornwall opened The London Clinic’s Intensive Care Unit, a specialist facility – unusual in private hospitals – that allows the treatment of patients with complex conditions. The London Clinic’s intensive care service is led by Dr John Goldstone, an internationally renowned consultant and expert in intensive care. With the growing demand for high-quality healthcare around the world, an advantage of The London Clinic’s charitable status is the ability to reinvest income in clinical training, enabling nurses to complete specialist degrees, and Fellows to become the next high-achieving Consultants. In 2018, The London Clinic funded 28 higher-level degree courses for clinical and non-clinical staff, which helps provide advanced, quality care for patients and assists The London Clinic in attracting and retaining high-calibre staff.
BEST-IN-CLASS SERVICE The London Clinic’s services are designed around patients, and form a vital part of diagnosis, treatment and recovery. We offer a bespoke, tailored in-house kitchen service that is centred on the nutritional needs of patients, with the aim of creating exciting meals that people want to eat. The London Clinic’s award-winning chefs strive to deliver the best for patients, visiting them regularly and talking to them about their appetite and possible menu options. Patients with a diverse range of tastes, needs and cultural backgrounds enjoy excellent food that provides physical, psychological and emotional nourishment – all served in the comfort of their rooms.
CLINICAL RESEARCH IN CANCER CARE The London Clinic’s Clinical Research Centre works with consultants and research partners to develop new treatment techniques to advance healthcare. The London Clinic is the only hospital research centre in the UK to take part in a landmark international clinical trial of a new radiation treatment for people with glioblastoma multiforme, an aggressive form of brain cancer with a high death rate. In this new clinical trial, after the brain tumour is removed, a high, focused dose of radiation is delivered directly to the tumour cavity to kill any microscopic cancer cells left behind.
INNOVATIONS IN CANCER TREATMENT In September 2018, The London Clinic became the first independent hospital in the UK to offer patients the latest diagnostic imaging with the new Siemens MAGNETOM Vida 3T MRI scanner. The scanner works by generating a powerful magnetic field that is twice the strength of the older 1.5 Tesla scanners – routinely found in other hospitals. The London Clinic’s 3T MRI produces exceptional image quality, supporting more precise diagnosis of cancers, as well as in other specialities such as orthopaedics, urology and neurology. Prostate cancer specialists in the UK are referring their patients to The London Clinic because the 3T MRI can help detect disease earlier.
Patients with advanced prostate cancer at The London Clinic have the opportunity to be treated with the innovative treatment Lutetium-177 PSMA therapy, a molecular radiotherapy treatment that targets and kills cancer cells precisely, avoiding damage to healthy cells and tissue. This treatment offers new hope of extending and improving quality of life, as clinical data shows Lutetium-177 PSMA therapy reduces prostate specific antigen (PSA) in up to 70% of patients. The London Clinic treated its first group of patients using this innovative treatment in 2019. More patients are scheduled to be treated, and referrers, including consultant oncologists, are being asked to put forward suitable patients. The London Clinic is one of the few sites in the UK to offer treatment for colorectal cancer with the Carl Zeiss Intrabeam® system – a miniaturised X-ray device that is located within its on-site operating theatres. Colorectal cancer is primarily treated with surgery but, in some cases, in order to help reduce the chance of recurrence, intra-operative radiotherapy treatment (IORT) can be given during the operation. Intra-operative radiotherapy involves giving a high dose of radiation at the same time as the surgical treatment.
A MULTI-DISCIPLINARY APPROACH Excellence in cancer care involves a multidisciplinary approach, a strength of The London Clinic’s cancer care. “Every two weeks at The London Clinic, everybody involved with a patient’s care – oncologists, urologists, radiologists and pathologists – meet to discuss their progress and plan the next move,” explains one of the Clinic’s consultants. “We discuss the scans and any biopsy results, and work out the options for the patient’s treatment. This multi-disciplinary approach is best for patient care and offers a personalised approach to their cancer treatment.”
We work in partnership to develop medical knowledge and expertise for the benefit of patients within our hospital and in the wider healthcare community CLINICAL SUPPORT SERVICES Patients being treated for cancer have specialist support services available, due to the large breadth of treatments and consultant expertise offered by The London Clinic. For example, The London Clinic’s Cardio-Oncology manages cardiovascular complications for cancer patients, as both chemotherapy and radiotherapy can potentially cause heart problems in some patients, especially if they have a medical history of cardiac issues. Patients also have fast access to cancer-focused complementary therapies, physiotherapy, psychological and counselling support. Our ‘Moving On’ workshops – hosted by our cancer nursing specialists – support patients from all cultures as they adapt to life after treatment.
TAILORED CARE AND SUPPORT The International Office works to ensure that every patient receives the highest standard of support before, during and after admission into The London Clinic. We speak to every patient prior to their admission, to check what support they require. This can range from ensuring access to interpreters, that their children have accommodation and schooling, that our chefs are aware of their cultural and religious needs for meals, or arranging a shopping trip for the patient’s family in nearby Oxford Street.
We also offer a concierge service to support family and friends who have travelled to London with their loved ones. Our team help book hotel accommodation, reserve tickets for theatre and sporting events, arrange schooling, and organise shopping requests.
AN ALTERNATIVE PERSPECTIVE We are finding an increasing number of customers asking us to comment on a treatment or diagnosis they have had from another hospital. Considering the complexity of treatments available, it is not unsurprising that people want some peace of mind that what they are being told is definitely the best for them. Our Second Medical Opinion service is growing in popularity for this reason. It includes a review of medical records, including scans, by The London Clinic’s leading consultants. Many patients who have been treated elsewhere first, have benefited from using this service.
WAYS TO ACCESS LEADING HEALTH SERVICES There are multiple ways to access the high-end services at The London Clinic. While the majority of international health insurance companies and governments will pay to send their customers, staff and even the general public to The London Clinic, it is possible to pay directly. We have flexible fixed-price packages available to those who want to pay for treatment themselves. Our International Office can explain the options available.
For more information visit thelondonclinic.co.uk/international or call +44 (0) 203 219 3266. If you have WhatsApp, WeChat, Viber or IMO, you can message the team on +44 (0) 7864 609017
Supporting people to lose weight with surgical and non-surgical innovations Mr Shaw Somers, a consultant who specialises in upper gastrointestinal and bariatric surgery, talks about how he and the specialist digestive health team at The London Clinic help people reach their weight-loss aims WHAT ARE THE MOST SUCCESSFUL WEIGHT-LOSS OPTIONS AVAILABLE? Each weight-loss procedure has its own advantages and disadvantages depending on the individual person. That’s why I spend time getting to know every patient and work with the wider team of experts at The London Clinic. Non-invasive treatments, where little or no surgery is needed, are becoming increasingly popular, mainly because of the lower risk of treatment complications, as well as less scarring. A good example is endoscopic sleeve gastroplasty, or ESG, which The London Clinic has recently started to offer. This procedure is an option for people with body mass indexes of over 30, as well as anyone who’s significantly overweight. An ESG reduces the size of the stomach using an endoscopic suturing device, without the need for surgery. By limiting how much can be eaten, patients can see significant weight loss. Like other weight-loss procedures, ESG requires commitment to a healthier lifestyle. The London Clinic support patients after their treatment for up to two years, something that sets us apart from many other hospitals. Our expertise in digestive health, across the key areas of endoscopy, clinical nurse specialists, bariatric dieticians and psychologists, offers patients a complete and thorough treatment plan, from pre- to post-treatment.
ARE WELL-KNOWN SURGERIES SUCH AS THE GASTRIC BAND AND BYPASS STILL POPULAR? Yes they are. The laparoscopic adjustable gastric band can be considered for patients with a BMI of 30 or greater. The band is inserted into place over the top of the stomach to restrict food intake. The surgery is done using keyhole techniques and is fully reversible. The gastric bypass, typically used with patients that are significantly overweight with BMIs over 45, is a more complex option. The surgeon creates a small stomach pouch and connects it to the lower small intestine, re-routing the path of food so that only small meals can be eaten. It also leads to reduced appetite, as patients’ hormones tend to change post-surgery.
ARE YOU SEEING MORE PEOPLE WORRIED ABOUT THEIR WEIGHT? Yes I am. It feels to me that our changing and busy lifestyles may be leading to more people seeking help for weight issues. Over 9,000 people have referred themselves or been referred to The London Clinic’s specialist digestive centre.
WHY IS THE LONDON CLINIC SET UP TO PROVIDE EFFECTIVE WEIGHT LOSS OPTIONS FOR PATIENTS? Good quality outcomes require a good rapport and understanding of the individual patient. At The London Clinic, I work with clinical nurse specialists, bariatric dieticians and psychologists – all trained to a high standard to understand weight loss and digestive health – to provide excellence in care for every patient. Pre- and post-surgical care is tailored to their individual needs, including up to two years of comprehensive aftercare that is available face-to-face or through digital video consultation.
The team and I are available to discuss the best options for every patient – please call us on +44 (0)20 3613 7750
0188_
YOUR WEIGHT LOST
The London Clinic is the UK’s largest independent private hospital, with a leading weight management unit, featuring some of the best medical experts, facilities and services available. Our expert team assess and treat each person individually, building a weight management plan that helps you achieve your goals.
To find out how we can help you, call +44 (0)20 8108 9699 or visit thelondonclinic.co.uk 0188_LCLINIC_Healthcare_in_London_Ad_D5.indd 1
06/12/2019 10:55
Leading immunotherapy cancer treatment The London Haematology group, based at The London Clinic, is London’s leading private care haematology group, with expertise in all aspects of stem cell transplants, leukaemia, myeloma, anaemia, coagulation and thrombotic disorders. Professor John G Gribben talks about immunotherapy and the impact it can have WHAT IS CAR T-CELL THERAPY AND HOW CAN IT HELP PATIENTS? The ability to adapt the patient’s own immune system to fight cancers is hugely exciting. CAR T-cell (chimeric antigen receptor T-cell) therapy is an exciting advancement in immunotherapy, offering a new, final treatment option for patients with diffuse large B-cell lymphoma and acute lymphoblastic leukaemia. These are aggressive forms of blood cancer, which can be resistant to other treatments.
Professor John G Gribben
WHAT INTERESTS YOU ABOUT CAR T-CELL THERAPY? We are in the very early days, but this could be transformative for cancer treatments. The concept of CAR T-cell therapy was born from the clinical community’s growing understanding of why T-cells – which our immune system uses to identify and fight infections – are not able to recognise and kill cancer cells. We now understand how cancers have developed to make themselves invisible to the immune system and actively switch off the T-cells and other immune cells that would attack them.
contrasts with the extremely poor outcome seen for patients who had a dismal prognosis before CAR-T cells became available, with an expected survival of only six months. Real-world data with CAR T-cell therapy is at an early stage, but consistent with this positive outcome. This is encouraging because, if patients respond as we hope, we are unlikely to see a late return of the cancer.
WHAT IS THE CLINICAL EVIDENCE FOR CAR T-CELL THERAPY?
We have started treating the first group of patients. As the treatment is relatively new, we are closely monitoring our patients and we are optimistic about the outcomes. We are in a position to help more patients who may be suitable for treatment with CAR T-cell therapy, fulfilling The London Clinic’s charitable purpose of advancing healthcare knowledge for the wider healthcare community.
So far, CAR T-cell therapy is showing promising outcomes for many patients. A phase 2 clinical trial of 111 patients with refractory lymphoma has shown positive outcomes, with 52% of patients treated with CAR T-cell therapy living for 18 months after treatment. This
HOW MANY PATIENTS ARE BEING TREATED AT THE LONDON CLINIC?
Professor John G Gribben, Consultant Haematologist and President of the European Hematology Association (EHA), specialises in haematological cancers including lymphomas, leukaemias and bone marrow transplantation. With a global reputation for his work in researching new drugs and forms of cancer treatment, Professor Gribben has authored more than 300 articles and chapters in peer-reviewed publications. He works alongside Dr Richard Kaczmarski, Dr Mike Potter and Dr Riaz Jan-Mohamed within the London Haematology group based at The London Clinic.
Advances in prosthetics and precision robotic surgery The London Clinic is committed to advancing new surgical techniques to improve outcomes within joint care and for amputees Innovation is happening at pace across all areas of healthcare, from new drug treatments to the growing use of robotic aids to surgery. With the vision to advance healthcare, The London Clinic recognised the need to be at the fore of robotic surgery, becoming the first private hospital in the UK to establish a robotic surgery cross-specialty group in February 2019. Robotic surgery at The London Clinic is performed by highly experienced and skilled surgeons using innovative techniques and equipment. An example of this is the introduction of the NAVIO robotic surgical system, which provides increased precision and accuracy during knee surgery, with the aim of faster recovery times for patients. The London Clinic launched a leading innovation in orthopaedics when it became the first independent hospital in the UK to offer osseointegration to above-the-knee and arm amputees. The aim of osseointegration is to improve the function of the limb, as well as reducing pain and skinrelated complications.
Mr Paul Culpan “There’s robust clinical evidence that osseointegration, a pioneering operation for patients with amputations that removes the need for a socket prosthesis, significantly improves quality of life and long-term health,” says Mr Paul Culpan, Consultant Orthopaedic Surgeon at The London Clinic. “As the prosthesis is directly connected to the bone it can dramatically improve limb function, as well as patient psychology, reducing dependency, improving lifestyle and providing an opportunity to return to work and a more normal life. We are proud to be able to offer patients from the UK and abroad the opportunity to undergo osseointegration by our experienced trauma surgeons in Harley Street and help to establish a worldclass osseointegration centre at The London Clinic,” adds Mr Culpan.
“My doctors, including Mr Culpan, saved my life. The nursing staff at The London Clinic were very friendly, supportive and kind. During those hard times the physiotherapy was so great and amazing” A patient and a member of the Egyptian military, who received limb salvage surgery
CHOOSING LONDON FOR HEALTHCARE
EASING ACCESS TO HIGH-QUALITY HEALTHCARE Lexihealth co-founder and Chief Medical Officer Romana Kuchai explains how her company helps patients navigate their healthcare journey in London, ensuring access to the city’s leading hospitals and specialists
For those seeking private healthcare outside their own country, there is usually a lot of work needed to make all the arrangements. From organising the initial appointment and investigations to following up on the results and making a decision on treatment, it can be a difficult set of tasks for people without the time to spare and in need of guidance. Lexihealth takes the strain out of this process, combining the entire journey into something that is time-efficient for the patient, designed to fit in with the individual’s work and lifestyle. Essentially, Lexihealth is a medical concierge service that ensures patients are assisted throughout their healthcare journey. We find the right hospital and specialist for each patient’s consultation or treatment, at a time that suits, with
40
transparency of pricing, fee structure and timeframe from investigation to treatments. We provide a bespoke service, tailored to the needs of the individual. Lexihealth provides a broad-spectrum service for those that are unfamiliar with healthcare and don’t have the time to commit to making what are, sometimes, complex arrangements. Even general practitioners, who offer a fantastic service, can need guidance on the specialists that their patients may require, so we can offer expertise and a wide-ranging directory of consultants that medical professionals can trust. Our patient liaison managers are the ‘gel’ that joins all of the different elements – the consultant’s team, the hospital admin team, the diagnostics team, and you. The patient has one port of call,
one phone number, to take care of everything. It’s like having a personal assistant for your healthcare. Our clients benefit from our in-house, peer-reviewed directory of over 350 clinicians, compiled by our medical advisory committee, which comprises the doctors they would recommend for their own families. In short, it is a ‘Who’s Who’ of medicine that, in effect, provides access to a virtual hospital around London with the best clinicians.
Addressing a need Lexihealth began when I and my business partner, Aaron Simpson, the founder of lifestyle concierge company Quintessentially, identified a need for quicker and easier access to healthcare. I am a consultant surgeon at Imperial
College – specialising in ear, nose and throat surgery – and it was through hearing about patients’ experiences that I felt that there was a need for London to make it easier for international visitors to access the city’s private health services. Patients were being very candid and open about London’s healthcare offering, praising both its world-class facilities and specialists, but wondering why it could be so complicated to access these. They had often found it easier to go to other countries, where a premium, end-to-end service was assured, from the point where they were greeted on arrival at the airport through to completion of their treatment at the hospital or clinic.
Romana Kuchai, Lexihealth co-founder and Chief Medical Officer
The journey starts before the patient comes to the hospital, in terms of
41
CHOOSING LONDON FOR HEALTHCARE
“During a time of great stress, Lexihealth took control and ensured that we would see a world-leading specialist in a matter of days, taking control of the situation and very much putting us at ease. The team’s efficiency, knowledge, compassion and ongoing support was invaluable during this difficult time. This is an unrivalled service. I could not recommend them enough – Lexihealth is the future of healthcare” Anonymous patient
organisation and advice. This is where Lexihealth comes in. We focus on the pre, peri and post experience of healthcare in London. Lexihealth extrapolated the philosophy of Quintessentially – which has organised holidays, flights, restaurant bookings, concert and theatre tickets for its clients for 20 years – into healthcare. We looked at what was required to create a sound model for such a service, consulting leading members of the medical fraternity to recommend the best people across 65 different specialties. Currently, we have 16 medical advisory committee members, who helped us build a goldstandard list of the UK’s best doctors to manage each and every case.
Lexihealth works with a very wide range of leading hospitals, clinics and specialists, so we are truly independent. We facilitate price comparisons, transparency in pricing and a really smooth journey throughout the entire process. Ultimately, it also is about access, because these consultants are overbooked and securing an appointment can often take weeks. However, with our connectivity, we can access what can otherwise be inaccessible – when we make a phone call to a clinician, who might booked up for the next three weeks, we will get an appointment within the next 48 hours. We can arrange for a second opinion, as well. Patients can receive a goldstandard opinion from a radiologist, oncologist, pathologist etc that can be carried out remotely, which saves time and the necessity to travel. If treatment is then needed, this can be organised around a timescale.
Travel and tourism Aside from being a hub for the best-quality healthcare, with practically every medical specialty available within a couple of square miles, London is also an excellent location for international patients from a leisure point of view. The many and varied attractions of London are a valuable bonus for international health tourists that many cities and countries are unable to offer. Lexihealth can also take care of the travel and tourism arrangements of its clients and their families, leveraging the expertise of Quintessentially, with which we work very closely. We offer a membership scheme that also incorporates Quintessentially, covering both healthcare and lifestyle,
42
and can also advise on an individual basis. Our membership has been based on word of mouth and I am pleased to say we have an impressive 45% return rate among people who use our services. We have also been making inroads into the corporate sector, for those with or without health insurance. We can assist smaller or larger businesses, helping employees navigate their healthcare journey, optimizing work-life balance and preventing unnecessary time off. Although many companies offer health insurance to their staff, the one service that insurance firms generally don’t offer is to hand-hold people throughout the medical process. They can advise and provide a list of clinicians that they cover, but beyond that patients are
often left to their own devices, which I often see in my own practice.
Building on our success Last year, Lexihealth won a prestigious award for being the best health concierge company, which we were very proud to receive. In 2018, we were one of only 10 companies selected by PwC from hundreds of start-ups to become part of their scaleup project, which was a superb validation of our business model and approach. For the future, Lexihealth is looking to create the best possible experience for patients on their healthcare journey in London, building on the foundations we have created and ensuring access to the ever-expanding wealth of medical facilities, new technology and specialists for international visitors.
Lexihealth 1 Welbeck Street, London W1G 0AR General Enquiries: +44(0) 207 856 0397 Memberships: memberships@lexihealth.com Health Management Team: concierge@lexihealth.com lexihealth.com
43
London Women’s Clinic offers patients the latest in modern technology within warm and contemporary surroundings
Innovation in conception London Women’s Clinic, number one IVF centre in London It has been more than 40 years since the birth of the world’s first ‘test-tube’ baby. While there have been few moments in the fertility landscape more ground-breaking than the arrival of Louise Brown, the advancements of the last four decades have seen a huge change in the way we approach fertility. Today, around 20,000 babies are born via IVF in the UK alone each year, with rising success rates due mainly to continuous innovation and improvement in areas such as the egg freezing process. A brief glance at the Human Fertilisation and Embryology Authority’s (HFEA) clinic rankings will show that the number one centre in London is London Women’s Clinic, with a clinical pregnancy rate of 45% for every embryo transferred in women under 35 years of age and 38% in those older.
The increase in the uptake and success of egg donation is due largely to developments over the last decade in the technology used to freeze eggs. The fast-freezing technique of vitrification, developed in Japan in the 2000s, is now used worldwide at clinics including the London Women’s Clinic and its Harley Street partner the London Egg Bank, with remarkable results. Vitrification is the preferred method for freezing embryos prior to transfer and for freezing eggs prior to fertilisation.
These impressive results – in routine IVF patients – were similarly found in treatments using eggs supplied by a donor. Egg donation is an increasingly common treatment for infertile women whose ovaries are unable to produce suitable eggs, perhaps because of an early menopause or ovarian problem. For these women, a donor egg is their only reasonable chance of having a baby.
For the London Egg Bank, the ability to freeze eggs without damage to their micro-architecture – which was for many years one of the greatest challenges of reproductive medicine – has been the defining principle for its recent range of treatments. Those treatments now include elective egg freezing for the preservation of fertility and the supply of frozen donor eggs, resulting in London
Senate_LWC_Article V6 ARTWORK.indd 1-2
Egg Bank being the largest bank in the country with around 5,000 eggs currently available for donation. Indeed, never before in the UK have donor eggs been more plentiful or from a more varied selection of donors.
A revolution in egg donation ‘Only a few years ago most egg donation patients from Britain had to travel overseas to Spain, Ukraine or Cyprus for their donor eggs,’ explains the London Egg Bank’s medical director Professor Nick Macklon. ‘There, donors were more numerous and the supply of eggs more abundant. But all that changed with vitrification and the technology to freeze and thaw eggs without damage.’ So the London Egg Bank, with a new generation of UK-based donors, is now the largest egg bank in the country, and able to meet the treatment demands of all its patients unable to produce their own eggs.
06/04/2020 15:11
No longer is overseas treatment necessary, no longer is there a need for long waitinglists or transfers in a ‘fresh’ treatment cycle. The bank of frozen donor eggs can be consulted in an online catalogue and personal preferences for ethnicity or background matched. Such a wide range of donors is reassuring to many infertile patients who need donor eggs, says the London Egg Bank’s director of nursing Mimi Arian Schad. ‘Egg donation is a big step,’ explains Mimi, ‘and can’t be undertaken lightly. Most egg donation patients have tried IVF before and are now at a stage in life when their ovaries are simply unable to produce the good quality eggs necessary for natural conception. We can remove many of the problems which egg donation patients used to worry about – long waiting lists, traveling abroad, selecting a suitable donor. And these patients are also gratified to know that all our donors are UK citizens and meet the donor requirements of the HFEA. That means a thorough screening procedure, and security for patients, who may not receive that same assurance from a foreign clinic.’ The regulatory requirements of the HFEA in Britain ensure that all treatments are carried out according to a nationally governed and evidence-based code of practice. Figures show that egg donation is now the most popular fertility treatment in Europe, with the latest figures showing higher live birth rates than those recorded for routine IVF and ICSI, where a woman has used her own eggs. The explanation is simply that donor eggs usually come from healthy young donors without fertility problems and before any age-related decline in their own natural fertility. This is reflected at London Egg Bank, where donors have an average age of 24. The latest European figures show that almost two-thirds of egg donation patient recipients are 40 years or older. In these women, ovarian function is often no longer what it was several years ago. But there is some good news for them, for what studies have shown beyond doubt – as in all forms of IVF treatment – is that success for the recipient patient depends more on the age of her donor’s eggs than on her own chronological age. For example, the rate of successful pregnancy for a 43-yearold woman is around 50-70% with donor eggs, but only around 5% with her own eggs. Coupled with various studies which acknowledge that frozen eggs perform just as well as fresh eggs in terms of producing a clinical pregnancy, a woman’s chances at starting a family using assisted reproduction are more hopeful than ever before.
Senate_LWC_Article V6 ARTWORK.indd 3-4
a woman’s chances at starting a family using assisted reproduction are more hopeful than ever before The rise in social egg freezing Another aspect of egg freezing which has gained traction in recent years is that of ‘social’ egg freezing, where women freeze their eggs in order to have a fertility backup plan if they find themselves struggling to get pregnant in future. ‘There is a huge increase in women choosing to freeze their eggs in order to try for a child at a later date – whether it be due to career commitments, financial reasons or finding a suitable partner. By freezing their eggs, our patients feel that they have a wider range of options when it comes to family planning.’ says Professor Macklon. Marta Wolska, LEB Operations Manager adds, ‘Social egg freezing is becoming increasingly common, with some companies such as Google, Apple and Facebook even offering it to employees so they can have greater control of their fertility options. This is due in part to the encouraging success rates seen regarding clinical pregnancy from frozen eggs, and underlines how far we have come from those initial pioneering fertility treatments of years gone by when routine egg freezing was still just an idea.’
What the future holds Reproductive medicine in the UK has come a long way since its early years. We are at a point in time where patients no longer need to travel abroad to find a suitable egg donor and where egg freezing and vitrification processes are more successful than ever before in helping to produce a clinical pregnancy. London Women’s Clinic predicts that more women will embrace social egg freezing as a back-up fertility option, while advances in the vitrification process can ensure continuous rising success rates for IVF patients.
As the largest egg bank in the country and the most successful IVF clinic in relation to pregnancy rates per embryo transfer, the London Women’s Clinic and London Egg Bank are at the vanguard of assisted reproduction. The sheer volume of egg donations and vitrification seen by the team ensures an ever-increasing expertise that cannot be matched by smaller clinics, which may only occasionally perform more technical procedures. Its ‘freeze and share’ programme – where donors can donate half of their eggs from a cycle in exchange for discounted IVF, allows women across the financial spectrum to access fertility treatment at a time in their life which suits them, and which can offer the best possible chances of starting a family. Much has been achieved, even in the past decade just with the introduction of vitrification alone. The next decade looks set to be just as innovative, if not more.
Professor Nick Macklon Medical Director of London Women’s Clinic Professor Macklon is a world-renowned expert in reproductive medicine. He has held professorships at the University Utrecht in the Netherlands, the University of Southampton and the University of Copenhagen, where he continues to hold an Honorary Chair. He has published over 200 scientific articles, edited several books and is an Editor of Reproductive Biomedicine Online.
A history of 113-115 Harley Street London Women’s Clinic’s Harley Street Headquarters have long been associated with medicine – in fact there has been a doctor in residence at 113 Harley Street since 1835, when the area was first becoming associated with medicine. Both buildings were built in the 1770s by the same architecture firm behind London’s iconic Somerset House. The address has been the residence of various doctors and surgeons including Edward Green (a naval surgeon during the Napoleonic wars) and Reginald Vick who ran a field hospital in Flanders during World War One. A dental surgeon named George Northcroft lived and worked at 115 for more than 40 years from 1896, while number 113 was simultaneously occupied by James Calvert, the Warden of Bart’s Medical College. Political residents of number 115 include Scottish MP David Scott in the late 1700s, who was also a director of the East India Company. Buckinghamshire MP Christopher Tower made 115 his home between 1845 and 1847. A somewhat more scandalous association was that of barrister Sir William Grove (resident at 115 between 1864 and 1896). Grove famously defended William Palmer, ‘the Rugeley Poisoner’, who was described by Charles Dickens as ‘the greatest villain that ever stood in the Old Bailey dock’. Since 1984, numbers 113 and 115 have been associated with reproductive medicine – first with Bourn-Hallam Medical Centre and then as the London Women’s Clinic. The site has been the home to many groundbreaking developments within assisted conception, including the world’s first baby carried as an embryo in two different wombs – a concept called shared motherhood.
Above: LWC Founders in 1995 (from left to right) Professor Sir Robert Edwards, Professor Howard Jacobs, Professor Sian Ling Tan and Professor Stuart Campbell
06/04/2020 15:11
48
CHOOSING LONDON FOR HEALTHCARE
Bupa Cromwell Hospital’s award-winning Head Chef, Darren Passmore from Medirest Signature, explains why good food is such a crucial part of a patient’s treatment and recovery
SERVING UP A FIVE-STAR MENU FOR PATIENTS How important is top-quality food to patients and what considerations do you need to make for nutritional and medical reasons? Food is an instrumental part of a patient’s journey at Bupa Cromwell Hospital. It is a key element in rehabilitation and recovery, meeting patients’ physical, mental and nutritional needs. Good food also helps to boost morale and motivation. If you're eating well, you will often start to feel better. Our service is geared towards meeting individual needs, so each meal is tailored according to the patient. I liaise directly with the hospital’s dietitians on each patient’s specific dietary requirements. This can vary from a patient allergy to an ingredient, or a need to introduce specific nutrients into a patient’s diet. Patients often have negative connotations about staying
in a hospital. However, at Bupa Cromwell Hospital, patients interact daily with our ward hosts and chefs to customise meal requests, giving a personal touch that makes a patient’s stay with us so special. We create a menu of dishes that patients can choose from, meeting all requested requirements, whether cultural, religious or dietary, and we go one step further to tailor these requests and give the fivestar treatment every patient deserves. I enjoy making time to speak to patients personally and learn their preferences. This is especially important when preparing meals for patients undergoing oncology treatment, as their dietary needs must complement their treatment plan, such as a need to maintain weight and the body’s store of nutrients. I love to interact with patients on a one-to-one
49
CHOOSING LONDON FOR HEALTHCARE
2-4 A selection of top-quality and nutrionally balanced dishes prepared by the catering team at Bupa Cromwell Hospital: roast chicken, chicken forestiere and tomato gnocchi
basis. Having a genuine conversation enables me to understand a patient’s individual tastes and whether these may have changed during their stay with us. It is such a rewarding feeling when I see the look on a patient’s face, once they realise that someone is taking the time to listen to their individual requests and create dishes tailored to them.
Typically, how many people does your team serve daily, and how many staff do you have in your team? On average, our team prepares meals for 100 patients daily. Many of our patients are accompanied by family or friends whom we also cater for, often meaning we prepare around 175 threecourse meals over each meal service. It is vital that we keep our hospital staff well-fuelled and ready to support the treatment of our patients; therefore, additionally, we prepare a daily buffet for upward of 200 nursing staff, consultant clinicians and hospital visitors who wish to dine in our recently refurbished Cromwell Restaurant. Typically, this consists of fresh salad, fruit and grain options to full meat and vegetarian hot courses and desserts. Our catering team is made up of six chefs and eight ward staff, who liaise with patients 2
3
4
50
daily. This level of interaction between our team and patients is crucial to their overall wellbeing during their stay with us. Having a daily visitor during meal service allows patients to break up their day and chat with a friendly member of the team.
How similar is running the kitchen at the Cromwell Hospital to providing food service at a five-star hotel? The level of service is very similar to catering at a five-star hotel, as our team provides round-the-clock food and beverage service. Rest and recuperation is the best way for a patient to recover, and our flexible meal service can meet this need. We aim to serve a meal within 10 minutes of a patient placing an order. We serve hot meals 24 hours a day, 365 days of the year, whereas some hospitals may only offer sandwiches or cold food during the night. We feel It makes such a difference to the patients to have a hot meal available to them.
What was your previous experience as a chef and what led you to become Head Chef at Bupa Cromwell Hospital? Prior to joining Bupa Cromwell Hospital, I had the honour of serving 26 years as a chef within the British Army, reaching the rank of Warrant Officer. I had the
CHOOSING LONDON FOR HEALTHCARE
“We are proud to play an integral part in a patient’s journey with us by serving high-quality, nutritious food” 5
pleasure of travelling worldwide, preparing meals and banquets for seniorranking military officers and royalty. Towards the end of my tenure in the British Army, my wife’s mother fell terminally ill and was hospitalised for six months. The food and service standard I witnessed her receiving did not match my standards and I was motivated to enter this industry and make a difference to patients’ lives. I am very passionate about food – in fact, a patient’s attitude, mood and wellbeing are directly related to the quality of food they are served. ‘An army marches on its stomach,’ as they say. Well, it is the same with our patients. A speedy recovery means less time spent in hospital, and we are proud to play an integral part in a patient’s journey with us by serving high-quality, nutritious food.
Do you also cater for international patients’ cultural or religious needs and preferences? Once a patient is admitted to the ward, I make a point to familiarise myself with their cultural and or religious preferences. I research and prepare national dishes; our menus are always evolving – as a passionate chef I am driven towards learning new dishes. I work closely with our International Patient Centre staff to better understand our
international patients’ needs in advance of them travelling to us for treatment or when they arrive. This proves very comforting for longstay patients who might relish a national dish away from home. We have a selection of halal choices available every day, and we receive regular requests from patients travelling from the Middle East – dishes that are now available on our menu. Favourites include biriyani, of which there are five varieties freshly made on site, as well as chicken machboos and spiced poussin.
6
Your hard work was recently recognised at the 2019 Food Service Management Awards, where you won ‘Unit Chef of the Year UK’. What does this accolade mean to you? I am one small cog in a much larger wheel – that is the full Bupa Cromwell Hospital catering team, in which each person plays their part during the patients’ stay with the hospital. I was delighted to receive this industryrecognised award as it highlights the quality of service we provide, particularly as hospitals don’t usually receive such accolades. Our goal is to give every patient the special service they deserve and put a smile on their faces when doing so.
5 The kitchen at Bupa Cromwell Hospital provides a full range of international dishes to order, such as lamb kofta | 6 Darren Passmore (right) was named Unit Chef of the Year at the 2019 Food Service Management Awards
51
CHOOSING LONDON FOR HEALTHCARE
THE CHANGING FACE OF HEALTHCARE… AT HCA UK The future of medicine is ever more personalised and minimally invasive. Techniques such as gene sequencing, selective internal radiotherapy and imaging, and robotics allow interventions and surgery that are tailored to the patient’s condition and speed up their recovery. In partnership with London’s world-class teaching hospitals and consultants, and by investing in the latest technology, HCA Healthcare UK, is at the forefront of medicine for the treatment of the most complex and rare conditions
World-leading hospitals and consultants As the UK’s largest private medical provider for complex conditions, HCA UK delivers the highest standards of healthcare across six hospitals and three NHS partnerships – soon to be four, with a new £100 million hospital on the campus of Queen Elizabeth Hospital Birmingham. 2,500 consultants from the UK’s NHS teaching hospitals and other prestigious institutions around the world help pioneer treatments that improve patient outcomes. HCA UK is committed to constant investment in the facilities and technology needed to support these consultants and the delivery of care at every step of a patient’s journey – from state-of-the-art hybrid theatres to Level 3 intensive care beds and the latest imaging technologies.
Our hospitals: The Harley Street Clinic | The Lister Hospital | London Bridge Hospital | The Portland Hospital The Princess Grace Hospital | The Wellington Hospital
Our partnerships: Private Care at Guy’s | The Christie Private Care | HCA Healthcare UK at University College London Hospitals
52
CHOOSING LONDON FOR HEALTHCARE
Advances in minimally invasive techniques Using robotic surgical technology, HCA Healthcare UK surgeons carry out minimally invasive procedures across a wider range of specialisms, making the latest techniques accessible to more and more patients Robotic surgical technology, along with options such as laparoscopic and endoscopic treatments, give surgeons a greater number of approaches. HCA UK aims to offer a minimally invasive option, where appropriate, so patients can recover more quickly, require less pain relief and return to their normal lives sooner.
Surgery using the da Vinci® robotic system There is no doubt that robotic surgery, already a force in urology, is being followed by other specialties as we add to the tools and approaches surgeons have for achieving better outcomes. This new generation of surgeons, uniquely skilled in robotic surgery, are changing the face of intervention and invasive surgery – radically reducing length of stay. Newer specialties include: Head and neck (Trans Oral Robotic Surgery - TORS) – The robotic technology allows surgeons to locate and remove small growths in the throat and mouth without invasive cuts in the neck and face (these are often hard-to-locate primary cancers). This significantly reduces the risk of damage to nerves and blood vessels, with the obvious benefits of no scarring. “If we can locate the primary cancerous tumour using the TORS technology we can potentially reduce or even avoid radiotherapy and chemotherapy treatments,” says Mr JP Jeannon, Consultant Head & Neck Surgeon. Thoracic – Thoracic surgery is traditionally performed via a thoracotomy – a large cut in the chest. As the chest is always
moving, recovery after a thoracotomy takes months and can result in extreme pain. As robotic surgical techniques reduce the size of that cut to less than 1cm, patients are in less pain and recover faster.
PCI in patients with coronary artery disease. They’re using technologies like lithotripsy to unblock coronary arteries where previously a sternotomy and coronary artery bypass graft might have been the only option.
Neobladder procedures – in appropriate bladder cancer patients, surgeons can reconstruct the bladder robotically using the bowel. “We’re able to perform complex reconstructive surgery in confined spaces such as the pelvis, so patients avoid larger incisions and wound complications, minimising post-operative pain,” explains Mr Rajesh Nair, Consultant Urological Surgeon.
Dr Jonathan Byrne and Prof Phil MacCarthy recently performed the UK’s first combined procedure to replace the aortic valve with a Transcatheter Aortic Valve Implantation (TAVI) and repair the mitral valve with a MitraClip – all through a small incision in the groin. The 87-year-old patient was breathing easily again and home in a matter of days.
Interventional cardiology in hybrid theatres Cutting-edge technology in HCA UK’s new hybrid theatres, with the latest image fusion and screen technology, allows ever more complex interventional cardiac and vascular procedures. Interventional cardiologists at London Bridge Hospital, The Wellington Hospital and The Harley Street Clinic use the latest complex Percutaneous Coronary Intervention (PCI) techniques to treat patients where neither cardiac surgery nor standard PCI techniques are an option, or when a less-invasive approach is preferred – and possible. Dr James Spratt and Dr Jonathan Hill lead the way in extending the role of complex
Greater precision in spinal and orthopaedic surgery Recently, Mr Khai Lam, Consultant Orthopaedic Surgeon at London Bridge Hospital and The Portland Hospital, performed the first robotically assisted spinal surgery in the UK using the ExcelsiusGPS® Robotic Navigation System. Capturing 3D images of the spine, he was able to place screws into the vertebra with much higher levels of precision. Also, The Princess Grace Hospital was the UK’s first hospital to offer orthopaedic procedures using the Mako robotic surgical system, in the hands of Professor Fares Haddad. This technology allows surgeons to place joint implants more accurately and carry out complex hip and knee surgeries. HCA UK have also introduced this technology to The Lister Hospital.
53
CHOOSING LONDON FOR HEALTHCARE
Advances in cancer: blending personalised medicine with intervention and surgery In recent years, a raft of new cancer treatments has emerged. HCA UK provides treatment options in rapidly evolving areas of medicine, including genomics, immunotherapy and CAR T-cell therapy, and interventional oncology Genomics: refining personalised medicine HCA UK’s molecular diagnostic laboratory is embracing genomics to improve understanding of what drives each patient’s cancer. Next-Generation Sequencing (NGS) technology is used to analyse a large number of genes within a tumour simultaneously. This analyses millions of fragments of DNA in parallel, to a high degree of accuracy, cost-effectively and within clinically appropriate timeframes. More detailed information about the molecular makeup of a patient’s tumour allows a greater choice of potential therapy and the most appropriate option for their cancer. “Powerful pathology is transforming the way we take care of people,” says Charles Percy, CEO HCA Labs. “Through Sarah Cannon Molecular Diagnostics, we can offer truly personalised medicine – which means the best possible outcome for each individual patient.”
The latest precision interventional oncology Interventional oncology is playing an increasingly prominent role in the care of patients with cancer. Using the latest imaging technology, these minimally invasive techniques pinpoint cancers and guide treatments. Interventional radiologists at HCA UK perform techniques such as Cryoablation,
54
Chemoembolisation (TACE) and Selective Internal Radiation Therapy (SIRT). In the case of cancer patients, these techniques allow consultants to treat tumours in confined and hard-toreach areas of the body, causing minimal damage to surrounding healthy tissue.
thymoma) – had such a radical response to immunotherapy that surgery to remove a 3mm residual in the lung was made possible.
Combining surgery with immunotherapy for lung cancer
Mr Andrea Bille, Consultant Thoracic Surgeon, was able to perform a complex surgical procedure to remove both cancers at the same time, through one incision. Just a few years ago, the outcome for stage 4 lung cancer patients was very different.
The prognosis for cancers such as lung and melanoma are changing, particularly through the exciting field of immune-oncology. With immunotherapy, stage 4 lung cancer patients can even achieve remission. In the past, such patients would not have qualified for surgery, and palliative chemotherapy only would have been offered. One such patient – with metastatic lung cancer (and a second synchronous primary, a
“Having been giving chemotherapy with bleak outcomes and no real clinical progress for decades, suddenly in the last two years since immunotherapy, prognosis has changed dramatically,” explains Mr Billie. “And the rate of change continues to accelerate, with surgery playing a crucial role for these patients in keeping them in complete remission.”
CHOOSING LONDON FOR HEALTHCARE
Paediatric care: using the latest technology to support the next generation The Portland Hospital and The Harley Street Clinic provide a wide range of complex maternal and paediatric medicine, while Lister Fertility Clinic specialises in the most complex fertility cases. Together they provide a full breadth of children’s, maternity and fertility services The procedures undertaken at The Portland Hospital and The Harley Street Clinic are changing children’s lives. For those with spastic diplegic cerebral palsy, selective dorsal rhizotomy (SDR) surgery can make it easier for them to walk. This neurosurgical procedure cuts selective nerve roots in the spinal cord to reduce muscle stiffness. The Portland Hospital offers a revolutionary treatment for children with early onset scoliosis. Implanting MAGEC® growing rods along the spine allows it to be lengthened and straightened without the need for multiple surgeries. The Harley Street Clinic is the only independent hospital in the UK that specialises in paediatric congenital heart treatments. Their state-of-the-art facilities allow the team to provide life-saving procedures to babies and children with complex cardiac needs. HCA UK has the country’s only private, on-site paediatric and neonatal intensive care units.
Giving families the best start Lister Fertility Clinic is regarded as one of the world’s foremost centres for fertility treatment. Its specialists consistently introduce proven
cutting-edge techniques and assisted reproductive technologies. As one of the first clinics in the UK to undertake egg donation, it now has one of the longest-running and most successful egg donation programmes in the country. The Clinic’s fertility specialists take a holistic approach to investigating and treating fertility problems. It offers the latest fertility treatments, including intracytoplasmic morphologically selected sperm injection (IMSI), which allows for better selection of sperm for treatment. Comparative genomic hybridisation (CGH) genetic screening is also used to check chromosomes in an embryo for abnormalities, which can either improve success rates or exclude known medical problems.
Investing in the future of healthcare HCA Healthcare UK is committed to investing in the people, technology and research that make these medical advances possible. By focusing on delivering care through integrated departments across the network and hospitals, HCA UK brings together the best and most experienced consultants for specialist care.
Tel: +44 (0) 333 0110 500 Email: global@hcahealthcare.co.uk hcahealthcare.co.uk
55
ONCOLOGY
WORLD-LEADING CANCER TREATMENT International patients are increasingly choosing London to access worldleading healthcare. In oncology, The Royal Marsden NHS Foundation Trust is a pioneering treatment and research centre that ranks among the best hospitals in the world
A unique history and heritage Founded in 1851, The Royal Marsden was the first hospital in the world dedicated to the study and treatment of cancer. HRH The Duke of Cambridge has been the president of The Royal Marsden NHS Foundation Trust 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 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.”
World-leading cancer experts under one roof The Royal Marsden – together with its academic partner, The Institute of Cancer Research – is Europe’s largest comprehensive cancer centre. The Royal Marsden Private Care, named ‘Best Private Hospital’ two years running
56
by LaingBuisson, is rated as one of the top three cancer centres globally, and is a world-leader for cancer diagnosis, treatment, care, research and education. With unrivalled cancer expertise, over 2,500 Royal Marsden consultants cover the rarest and most complex cases. Experts from The Royal Marsden regularly speak at international conferences, and are representatives on committees such as the European and American Societies of Clinical Oncology. The Royal Marsden Manual of Clinical Nursing Practice is used worldwide to define standards of nursing in cancer care.
Outstanding standards of clinical care Each year, The Royal Marsden sees and treats over 59,000 cancer patients from 62 nationalities. All patients are provided with the very best aftercare and support, and have 24/7 access to a Clinical Nurse Specialist. Patients also have access to a specially trained, multilingual team of
1
1 The Royal Marsden was the first hospital in the world dedicated to the study and treatment of cancer | 2 HRH The Duke of Cambridge has been the president of The Royal Marsden NHS Foundation Trust for over 10 years (PHOTOS: THE ROYAL MARSDEN) 2
57
ONCOLOGY
“By developing a system that can flag up sites of possible disease, and measure the amount of disease, we can get to work quicker on diagnosing and treating our patients”
staff that are on hand to offer support from the first point of contact, all the way through to the end of treatment.
and the UK’s only NIHR Biomedical Research Centre, The Royal Marsden is at the forefront of cancer research.
The Royal Marsden was recently rated ‘outstanding’ by the CQC, an independent regulator of health services in England. Private patients benefit from this unique value of an NHS hospital, including a robust system of governance that ensures treatments are safe and effective, and that patients receive the best quality of care. All revenue from Private Care services goes back into The Royal Marsden; this integrated Private Care-NHS model means that all patients benefit.
Experts at The Royal Marsden are exploring the latest advances in technology to help diagnose cancer earlier. Part of a ground-breaking project, Dr Christina Messiou, Consultant Radiologist, is working with researchers from Imperial College London to develop machine learning that will assist radiologists in reporting whole-body magnetic resonance imaging (MRI) scans in patients with myeloma. “By developing a system that can flag up sites of possible disease, and measure the amount of disease, we can get to work quicker on diagnosing and treating our patients, guided by extremely precise measurements,” says Dr Messiou.
Patients with private healthcare also have additional benefits, such as a hotel-style service, single en-suite rooms and direct access to their treating consultant.
A multidisciplinary team approach like no other Personalised care is at the heart of The Royal Marsden’s approach; cancer is a complex disease, and so a wide range of experts is needed to provide optimum care for each individual. A treatment plan unique to each patient is discussed and agreed on by a multidisciplinary team of experts, including medical oncologists, radiotherapists, pathologists, radiologists, nurses and allied health professionals.
Pioneering tomorrow’s cancer treatments today The Royal Marsden has an international research reputation, continuing to invest in and introduce the latest treatments and technology. With over 800 clinical trials open at any one time, a unique partnership with The Institute of Cancer Research, London,
A ‘liquid biopsy’ test developed at The Royal Marsden and The Institute of Cancer Research, London, was found to detect the return of the disease nearly 11 months earlier than hospital scans. The research found the personalised blood test worked in all types of breast cancer and could detect the early spread of the disease. Further work is being done to understand how the test can be translated into clinical use. Surgical teams at The Royal Marsden are innovators in their field. Consultant gynaecological oncology surgeon Mr John Butler is a key figure in the application of cutting-edge technology to treat hard-toreach ovarian cancers. With PlasmaJet, it is now possible to treat some patients with this tumour type. He also led the introduction of PINPOINT, an exciting new device that offers high-definition and advanced fluorescence imaging in real time. The Royal Marsden was also the first Trust in England to invest in the da Vinci Xi robotic surgery, and is now a national leader, offering a comprehensive service across multiple tumour types.
Cutting-edge technology 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 3
58
4
image-guided radiotherapy (IGRT); intensity-modulated radiotherapy (IMRT); stereotactic body radiotherapy (SBRT); and volumetric modulated arc therapy (VMAT). Medical Director and Consultant Clinical Oncologist Dr Nick van As recently led research that demonstrated a targeted radiotherapy technique could cut treatment time for some prostate cancers from two months to two weeks. The results of the trial, PACE-B, demonstrated how developments in technology – such as SBRT – mean that clinicians can target tumours more effectively and with fewer side-effects. 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. With this new technology, clinicians 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.
Part of an international research consortium, The Royal Marsden is 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. Having treated the first patient in the UK and the third in the world on the MR Linac in September 2018, The Royal Marsden has started to treat patients across different tumour types, with a new trial for rectal cancer patients opening soon.
Cavendish Square The Royal Marsden Private Care is due to expand its presence in London, with a new diagnostic and treatment facility opening on Cavendish Square. Located between Oxford Street and Harley Street, the new outpatients centre will offer patients fast and direct access to worldleading diagnostic experts, in an easily accessible and reassuring environment. Multiple tumour types will be treated, including breast, urology, gynaecology
5
3 Patients have access to a specially trained, multilingual team of staff that are on hand to offer support | 4 The hospital is a leader in robotic surgery | 5 Personalised care is at the heart of The Royal Marsden’s approach (PHOTOS: THE ROYAL MARSDEN)
59
6
7
8
6-8 At The Royal Marsden Private Care, Cavendish Square, patients will have access to better and more rapid diagnostics in the heart of London’s most respected healthcare district (PHOTOS: THE ROYAL MARSDEN)
and skin cancers. Patients can expect to have an appointment booked following their initial enquiry, with direct access to diagnostic services. There will be next-day appointments and sameday scans and results. In addition to consulting rooms, chemotherapy chairs and a minor procedure suite, the new centre will also have state-of-theart imaging facilities, including MRI, ultrasound, computerised tomography (CT), mammography and X-ray.
predisposition to certain cancers. With the latest technology, clinicans can also carefully monitor patients for signs of relapse: the earlier clinicans pick up a recurrent cancer, the better the chance of successfully managing it.
Improving patient access to better and more rapid diagnostics is a priority at The Royal Marsden, and Cavendish Square fits into a broader strategic priority to diagnose cancer faster and earlier. When a patient’s cancer is diagnosed at an early stage, there is a much greater chance of being able to treat the disease successfully, often with less invasive procedures and fewer long-term side effects.
Shams Maladwala, Managing Director, The Royal Marsden Private Care, says: “Cavendish Square is an exciting new development and will allow us to offer world-class standards of cancer care in the heart of London’s most respected healthcare district.
Further information For more information about The Royal Marsden Private Care or to refer a patient, please: Visit: www.royalmarsden.nhs.uk/ private-care Email: int@rmh.nhs.uk Call: +44 (0)20 7808 2063
60
Experts at The Royal Marsden are continually working to improve diagnosis – for example, pioneering genetic sequencing to identify targetable mutations, and regular screenings of those with a genetic
This research backing really sets Cavendish Square apart – patients can feel reassured in the knowledge that their treatment and care is based on the latest advances in oncology.
“As a specialist cancer centre, Cavendish Square will have the clinical expertise, facilities and technology to provide a leading service. Our multidisciplinary teams will be on hand to offer a personalised treatment approach; patients can be confident they will be seen in the right place, by the right person, at the right time.”
Rapid diagnostic breast care service Bupa Cromwell Hospital offers an end-to-end care pathway for the assessment, diagnosis and treatment of breast cancer • Fully integrated service under one roof with rapid access • Appointment with breast consultant, mammogram, ultrasound and biopsy (if required) all take place on the same day • Led by breast consultants and supported by dedicated breast care nurse specialist • Expert multi-disciplinary cancer care on site in the event of a cancer diagnosis • Service available to everyone, whether using health insurance or self funding
Call our appointments team on 020 7460 5700 or email appointments.team@cromwellhospital.com to discuss your healthcare needs bupacromwellhospital.com/breast Bupa Cromwell Hospital registered office 164-178 Cromwell Road, London SW5 0TU, United Kingdom. Bupa Cromwell Hospital Trading Companies: Medical Services International Limited, registered in England and Wales number 01416977 • Cromwell Health Group Limited, registered in England and Wales number 05687373.
ONCOLOGY
EUROPE’S MOST ADVANCED PRIVATE RADIOTHERAPY CENTRE The leading private provider of cancer services in the UK has opened Europe’s most advanced radiotherapy centre in London. GenesisCare is a modern healthcare provider that specialises in cancer care and is building a global network of treatment centres that is second to none. In the UK, GenesisCare has 14 outpatient oncology centres, including Oxford, Cambridge and Windsor. Now the company is bringing its unique cancer service to the heart of London’s medical district in a partnership with the prestigious Bupa Cromwell Hospital. The £20m flagship radiotherapy facility in Kensington has all the hallmarks of a GenesisCare treatment centre – equipped with the latest and most sophisticated technology and situated in a calm and uniquely patient centric healthcare environment.
62
When completed at the end of this year, it will house three of the world’s most advanced radiotherapy machines: the MRIdian MR-linac, the Gamma Knife Icon and the Varian Edge. The centre will specialise in neuro-oncology (cancers of brain and spine), complex and difficult-to-treat tumours in the abdomen and lung, as well as offering the latest techniques for common cancers, such as breast and prostate.
London’s latest cancer radiotherapy centre – and how it will meet the needs of patients from across Europe, Asia and the Middle East: “Our company ethos is to change the way people experience cancer treatment and care, understanding what it takes to achieve the best possible life outcomes and going further to provide it.
Patients will also have access to groundbreaking treatments available through the GenesisCare national network, including Theranostics, which uses radioactive drugs called radionuclides to seek out and destroy advanced metastatic cancers that have spread within the body.
"The GenesisCare global network is built on a simple business model – to offer fast access to world-class cancer care – and we invest early in new evidencebased modalities that hold potential for improved life outcomes. The strength of our relationships with oncologists is key to our success, enabling us to build a strong governance framework and to be the first to introduce many new cancer treatments safely and effectively.
James McArthur, General Manager UK, GenesisCare, explains the vision for
"In practice, this means advanced cancer techniques as standard, with
Groundbreaking treatments
treatment starting within days or even hours of diagnosis and a personalised care plan that ensures access to a team of leading experts. As a patient, you can also expect to receive lifechanging therapies, such as wellbeing and exercise medicine – techniques that are proven to help our patients through their cancer, recovery and beyond. "Last year, we treated more than 160,000 patients worldwide across cancer and cardiac care and we’re consistently rated in the top 1% of healthcare providers worldwide, based on our net promoter score, which measures patient satisfaction across a range of parameters. "London is an important move for us and we’re delighted to partner with Bupa Cromwell Hospital to offer an exceptional cancer care service. It has a reputation as one of London’s leading private
hospitals for complex and high-acuity care and has a 10-bed Adult Intensive Care Unit, advanced cancer diagnostics, chemotherapy and robotic surgery. At the same time, Bupa Cromwell has an international patient centre and houses four luxury suites, with all standard rooms recently refurbished to the high standard expected by our national and international patients. "GenesisCare has invested in three of the most advanced radiotherapy machines and, together with the Bupa Cromwell Hospital, we are working with many of London’s leading oncologists and cancer surgeons to provide a leading-edge cancer service.”
James McArthur, General Manager UK, GenesisCare
To enquire about GenesisCare radiotherapy services at the Bupa Cromwell Hospital, please call +44 (0)20 7460 5626 or visit genesiscare.com
63
ONCOLOGY
Advanced radiotherapy is improving cancer outcomes Radiotherapy is one of the most rapidly advancing ways to treat cancer. Recent breakthroughs have led to techniques that can improve treatment outcomes by controlling localised tumours and reducing the need for surgery – at the same time limiting side effects and shortening treatment times from weeks to just a few days for some tumour types. GenesisCare is the largest private provider of specialist radiotherapy in the UK and their doctors are leading specialists in using radiotherapy to treat advanced cancer. Their new £20m radiotherapy centre at the Bupa Cromwell Hospital in London will offer the most advanced radiotherapy treatments available today, including Gamma Knife Icon for brain and spinal tumours and Varian Edge for breast, prostate, lung, bowel, head and neck, and pelvis. The centre will shortly also house the MRIdian, a stateof-the-art system that combines an MRI scanner with a radiotherapy machine, making it possible to treat inoperable tumours in the liver, pancreas and other organs with extreme precision.
GenesisCare has the first MRIdian in the UK and a pioneering partnership with the University of Oxford for clinical trials.
Varian Edge state-of-theart radiotherapy This is designed for stereotactic brain and spinal surgery, as well as stereotactic ablative radiotherapy (SABR), which is used for small tumours elsewhere in the body. Varian Edge can also perform
Brain-sparing tumour treatment Stereotactic radiosurgery (SRS) uses powerful beams of radiation to destroy cancer cells in a few short treatments. It is often called ‘brain-sparing’ surgery because of its ability to protect healthy brain tissue and preserve quality of life in people needing treatment for brain tumours. GenesisCare is a centre of excellence for SRS treatment of brain metastases, as well as other types of brain tumour. The new Gamma Knife Icon is one of the most advanced systems for this type of inter-cranial surgery.
MRIdian targets moving tumours MRIdian allows clinicians to ‘see as they treat’, using live images of the tumour and surrounding tissue to continually adjust the radiation beam for movements and more precise treatment targeting. MRIdian is widely used for gastrointestinal, lung and prostate cancer, as well as difficultto-reach tumours that are partly hidden behind sensitive organs such as the heart.
64
Intensity Modulated Radiotherapy (IMRT), a highly versatile treatment for a wide range of cancer types. Together with these technologies, the new radiotherapy service includes innovative organ-sparing treatments, advanced computer imaging and sophisticated AI planning systems, which means personalised treatment plans can be started within days of diagnosis for all cancer types. To find out more about advanced radiotherapy at GenesisCare, please call +44 (0)20 7460 5626 or visit genesiscare.com
Below: MRIdian enables the targeting of moving and hard-to reach tumours, allowing for more precise treatment
Pioneering Robotic Surgery: Changing the future of medicine With the introduction of medical robots, an increasing amount of surgical procedures are being performed through robotic-assistance.* At Bupa Cromwell Hospital, we are expanding our surgical programme to include robotics. A recent addition to our robotics offering is the da Vinci X Robot, which provides surgeons with enhanced vision, greater precision and control. It can also have significant benefits to patients, like faster recovery time.
To keep up to date with our robotic investment and other news, please visit our media centre at bupacromwellhospital.com/about-our-hospital/latest-news * The Medical Futurist. (2019). From Surgeries To Keeping Company: The Place Of Robots In Healthcare. [online] Available at: https://medicalfuturist.com/robotics-healthcare/
ONCOLOGY
Dr Nick Plowman Clinical Oncologist
AT THE FOREFRONT OF ADVANCES IN CANCER TREATMENT Everyone knows there have been advances in cancer, but most people are unaware of the truth behind the discoveries of recent years, from which cancer sufferers will benefit. Exceedingly few know the optimal order of various treatment options that are best for individual people. Indeed not all experts agree themselves! The baseline shifts. What is clear is that there are now more cancer treatment options, and that all-important cancer prevention programmes are no longer confined to cervical screening, faecal blood testing and mammography, but are often based on genetic predisposition and ‘high-risk screening’ individuals (for example, low-dose CT on the lungs of heavy smokers) and even blood testing for circulating ‘cell-free’ mutated DNA fragments – a signature of cancer.
For established cancer, the staging of the disease is paramount. Not only do we now have advanced anatomic imaging (notably CT/MR), but also functional imaging, notably PET scanning (often more sensitive for diagnosing the extent of the cancer) and where the individual characteristics of particular cancers can be used for specificity (a good example being PSMA-PET scanning for prostate cancer). In cancers that grow slowly over time and spread to distant sites (‘metastasise’) later in their natural history (eg cancers of the head and neck, such as larynx, mouth, pharynx), regional treatment for early cases – predominantly surgery and radiotherapy – is attended by high cure rates. Advances in surgery usually hit the press, but advances in radiotherapy are often overlooked. The introduction of charged particle beam radiotherapy ▸
67
ONCOLOGY
(at present, protons in UK) is of great importance. This type of radiotherapy is important as it markedly reduces collateral damage in structures adjacent to the tumour. Although the UK has commissioned two cyclotronbased centres, London will see the introduction of linear acceleratorbased proton beam radiotherapy in 2021 – an advance in technology and dosimetric accuracy that may eventually supplant all other radiotherapy methods, and at significantly lower price. For cancers that have spread to distant body sites or for higher-risk cases despite apparently being early-stage, patients have to be managed with therapy that reaches all body parts. These used to be chemotherapy, or anti-hormonal therapy for some breast and prostate cancers. However, immunotherapy and genomically targeted therapy, using drugs that block the abnormal protein/enzymes encoded by the mutated DNA, have added significantly to the impressive prolongation of life in those presenting with metastatic cancer. Often there are predictive tests that can be carried out on tissue (biopsy) specimens from the cancer, which will allow the clinician to know the therapeutic potential of new drugs. Importantly, some of these
68
mutations can be treated by ‘smart’ drugs that block the downstream transcription/ translation protein enzyme products of the DNA mutation – the driving oncogenic stimuli to the cancer cells to relentlessly go on dividing beyond the requirements of the body. This is called genomically targeted therapy prediction and has become very important in modern oncology. In other words, by analysis (by nextgeneration sequencing – NGS) of the cancer’s genomic make up, we can select appropriate drug therapy (so-called ‘personalised cancer therapy’) for blocking the oncogenic stimuli generated by the mutations – the cause of the cancer. ‘Smart drugs’ are now in routine use and are highly effective in the therapy of lung, kidney, some breast and colon cancers, melanoma and an increasing number of other cancer types; indeed, the remissions accruing from their usage often exceed that by more conventional therapies. It is the genetic mutation that predicts their usefulness, rather than the tissue of origin of the cancer. Sometimes analysis of the blood, where DNA fragments from dying cancer and normal cells circulate for a short halflife and the mutated DNA fragments ▸
“We are fortunate in the capital to have advanced cancer screening”
KC W Today April 2019
A seamless pathway for prostate care Get quick diagnosis and tailored treatment for prostate cancer Prostate cancer affects more men in the UK than any other cancer, but with quick diagnosis and tailored treatment there is a very good chance of beating it. Bupa Cromwell Hospital offers a quick, easy patient pathway, with leading urologists providing: • Seamless transition from GP appointment or health assessment (if abnormal PSA detected) onto the pathway for diagnosis and treatment • Experts in the field who guide you through each step • Swift and accurate diagnosis, including quick test results • Services accessible to all, whether using health insurance or self funding. Available to UK and international patients
Call us on 020 7460 5700 or email appointments.team@cromwellhospital.com to discuss treatment details and book an appointment Bupa Cromwell Hospital registered office 164-178 Cromwell Road, London SW5 0TU, United Kingdom. Bupa Cromwell Hospital Trading Companies: Medical Services bupacromwellhospital.com/prostate International Limited, registered in England and Wales number 01416977 • Cromwell Health Group Limited, registered in England and Wales number 05687373.
ONCOLOGY
can be sorted from the normal by NGS and probed for the aforesaid mutations. Such a technique can also be used for monitoring the response of cancer by looking for the disappearance of such mutated DNA fragments from the blood. Immunotherapy has been shown to enhance control rates when added to or sequenced with chemotherapy – eg for cancers of the head and neck, and lung cancer – that have spread/metastasised. The rationale of immunotherapy is also based on cancers being the product of mutations in DNA. Another consequence of this is that the abnormally coded proteins (consequent upon mutations) lead to new antigens (neo antigens) on the cell surfaces. In foetal life, the developing immune system, which makes us reject transplanted kidneys from a stranger due to their foreign antigens, learns to ‘accept’ the different potential antigens on the body’s organs (a process known as ‘selftolerance’), so that there is no immune attack on them in later life. Occasionally, this self-tolerance goes wrong and the various autoimmune diseases, such as Hashimoto’s thyroiditis, result. Conversely, and cancer is particularly adept at this, developing tumours express markers that interact with surface markers on the lymphocytes (and particularly their PD1 receptors) that mediate immune attack on such foreign tissues. This
confuses the immune attack by ‘fooling’ those lymphocytes that the tumour is actually a normal tissue for which there is self-tolerance. The present success of immunotherapy in cancer therapy is based on the ability of the new burgeoning line of drugs that ‘tear down’ that smokescreen and allow the immune system to see the neo antigens on the cancer and thereby lead to its rejection – just as it does to a transplanted kidney to a foreign donor (that is without added immunosuppression by the clinician). Immunotherapy, using PD1 and PDL1 inhibitors, is now mainstream therapy for lung cancer, melanoma, kidney cancer and some breast and colon cancers, with many other cancers being explored for susceptibility – once again, this susceptibility is primary tissue organ agnostic, implying broad utility. How the new genomically targeted group of drugs and immunotherapy ‘interdigitate’ with chemotherapy, where they overlap and where they are most usefully used together, are all hot topics for trials at present. Recently, it has been shown that the addition of immunotherapy to lung cancer chemotherapy augments the response and, in kidney cancer, the combination of genomically targeted therapy with immunotherapy has become the prime first treatment for metastatic kidney cancer patients. Indeed, similar inroads are being made in uterine cancer with just such a combination. Soon, this combination approach will surely gain traction for other cancers. Clearly, all this is important in choosing the correct first-line treatment for patients presenting with advanced cancer. There has also been a conceptual shift in the classification of cancers from, say, ‘lung’ cancer to one that classifies cancer by its genetic mutations (ie its genetic signature). In London, multiple cancer units are looking at new optimisation of treatment schedules for patients with cancer. We are fortunate in the capital to have advanced cancer screening and many institutions with high-resolution scanning and staging procedures, easy availability of laboratory testing, front-line access to all genomics by NGS technology for tissue circulating free DNA and prediction for immunotherapy. Many advances in our subject are taking place in London, with world-class research and clinicians practicing these modern approaches in our city.
70
ONCOLOGY
THE LATEST IN PROSTATE CANCER DIAGNOSIS AND TREATMENT King Edward VII’s Hospital is one of the UK’s leading centres for urology, bringing together an exceptional multidisciplinary team of consultant urologists who are all leaders in their field. Having recently welcomed world-renowned prostate cancer specialists to an already impressive consultant group, the hospital invested heavily in technology to ensure their patients can access the latest, minimally invasive prostate cancer treatments.
1 The main reception at King Edward VII's Hospital (PHOTO: KING EDWARD VII'S HOSPITAL)
72
The hospital was the first in the Harley Street area to acquire the latest da Vinci xi© robot, allowing its surgeons to perform precise, minimally invasive robotically-assisted laparoscopic prostatectomies. Patients can also benefit from focal therapy treatment using high-intensity focused ultrasound (HIFU) or Nanoknife, the minimally invasive qualities greatly reducing the side effects of prostate cancer treatment.
Professors Mark Emberton and Caroline Moore explain more about the latest diagnosis and treatment techniques at King Edward VII’s Hospital:
Transperineal MRI-guided prostate biopsy The most important way to get an accurate assessment of your prostate cancer risk is to have a high-quality MRI (magnetic resonance imaging) scan, followed by a biopsy if needed. Suspicious areas on the MRI, and sometimes the areas where cancers are commonly seen, will need to be sampled using a biopsy needle. Traditionally the biopsy needle was passed through the back passage into the prostate. Not surprisingly, this could be associated with infections after the procedure, as it is difficult to clean the rectum. A transperineal biopsy – passing the needle through the perineum (the
ONCOLOGY
2
2 The elegant waiting area | 3 The hospital's London urology specialists (PHOTOS: KING EDWARD VII'S HOSPITAL)
Professor Mark Emberton
Professor Caroline Moore
area between the back passage and the scrotum) is much cleaner and the risk of infection is greatly reduced. An ultrasound probe in the rectum is used to view the prostate in real time during the procedure.
helped by using computer software to fuse the MRI image showing a suspicious area onto the ultrasound image used during the procedure.
The accuracy of targeting the MRI lesion depends upon the skill of the person doing the procedure. It can be
Such MR-US fusion techniques are now regularly in use at King Edward VII’s Hospital.
High-intensity focused ultrasound The aim of focal HIFU treatment is to preserve quality of life, including erectile function, without sacrificing control over the cancer. The minimally invasive qualities of this procedure help to reduce the impact of the side effects that commonly occur after major prostate surgery. HIFU uses sound waves, produced from high-frequency vibrations originating from a transducer, to create localised cell kill. Temperatures of up to 80-100ËšC are reached in the tissue at the focus point, resulting in cell death through necrosis and cavitation. Since its development in the 1940s, it has been used to treat benign and malignant lesions within a number of solid organs, including the uterus, brain, kidney and liver, with the addition of prostate from the 1990s. The procedure involves delivery of treatment using a transrectal probe, usually under general anaesthetic, with real-time monitoring of treatment effect on an ultrasound platform. The area to be
3
74
ONCOLOGY
4
treated is chosen by the surgeon, based on the prostate MRI and biopsy results. HIFU is a means of delivering ‘focal therapy’, with treatment targeted to cancer lesion(s) rather than to the whole prostate. Preservation of some ‘normal’ prostatic tissue and surrounding neurovascular structures potentially reduces the sideeffect burden associated with standard radical therapies. The outcomes of longer-term studies are now awaited. HIFU is considered an alternative primary treatment option to traditional radical therapy (radical prostatectomy, external beam radiotherapy, seed brachytherapy). The advantages of HIFU as a prostate cancer treatment is that it is minimally invasive, delivered in the day-case setting, only requires one hospital visit for treatment, and is repeatable if needed. Furthermore, additional prostate treatment – such as cryotherapy, radiotherapy or surgery – is not precluded if cancer recurrence occurs following HIFU, albeit with a higher risk profile than in the
treatment-naïve gland. HIFU treatment is limited to prostates of a moderate size that can be covered by the focal length for treatment, as the anterior aspect of the gland cannot be reached in large glands.
4 A prostate lead nurse guides patients every step of their journey (PHOTO: KING EDWARD VII'S HOSPITAL)
Medium-term outcomes for HIFU have been published, reporting both cancer control and the effect on sexual and urinary function. Biochemical diseasefree survival rates of 75-84%, 63-72%, and 45-68% in low, intermediate and high-risk groups, respectively, were demonstrated over five to eight years of follow-up in recent publications involving a large UK cohort. Around one in four men will have a second HIFU treatment by five years, and one in 15 men will have radical treatment with surgery or radiotherapy. In terms of functional outcomes, 1% of men have some urine leakage after HIFU, which compares very favourably with radical treatment. Of men who have good erections without the need for tablets before HIFU, two in three will continue to have these after treatment, and one in three men will need to have tablets to
75
ONCOLOGY
5
“Nanoknife is especially useful as it can help maintain the prostate’s important functions”
76
support the erections. The majority of men will notice a reduction in the volume of ejaculate, and fertility can be reduced. HIFU also has a place as a salvage treatment in cases of recurrent disease following both external beam radiotherapy and seed brachytherapy.
Nanoknife Nanoknife, also referred to as irreversible electroporation therapy for prostate cancer, is a focal technique used in the treatment of prostate cancer. It is used particularly for small cancers in the anterior prostate. In irreversible electroporation, quick electrical pulses are administered, with the use of electrodes, around and into the tumour to kill cancerous cells. The name ‘Nanoknife’ is derived from the fact that these electrical pulses effectively cut open the cells’ membrane.
The advantages of Nanoknife treatment for prostate cancer include a short hospital stay and recuperation period, a painless procedure that has minimal side-effects, and that the procedure can be repeated. Disadvantages include a catheter being required for a few days, some men may be infertile due to decreased/ absent ejaculatory fluid, and, currently, there is no long-term data available on side-effects and outcomes.
Robotically assisted laparoscopic prostatectomy Radical prostatectomy is a well-established treatment for prostate cancer. It has evolved over the years from open surgery into laparoscopic (key-hole) and, currently, robotic-assisted laparoscopic (RALP). In terms of cancer control, it has been shown to have excellent outcomes.
6
Prostate cancer treatment using the da Vinci xi© robot The operation is performed using a keyhole technique utilising the latest da Vinci© robot to aid the surgeon. Through small incisions, a special 3D camera and robotic arms are placed into the pelvis, which are then controlled by the surgeon from a separate console within the theatre. This set-up offers a very high-definition view of the prostate (magnified, very well-illuminated 3D, double HD) and surrounding structures, along with highly accurate and versatile movements within the body, allowing the prostate, seminal vesicle (tubes which help produce semen), and occasionally lymph nodes to be removed. The robotic method has revolutionised radical prostatectomy, as it has led to a significant reduction in blood loss and reduced the length of hospital stay for the
patient over open surgery, whilst giving the surgeon a precision of movement not previously possible by either the open or laparoscopic techniques.
5 Professor Mark Emberton performs the Nanoknife technique | 6 The da Vinci xi© surgical system (PHOTOS: KING EDWARD VII'S HOSPITAL)
The procedure used today is called an ‘anatomical approach’, which is designed to reduce blood loss and tissue trauma, and can also reduce damage to the nerves necessary for erections. With thanks to Prostate Matters – prostatematters.co.uk If you are concerned about your prostate health, or you have received a diagnosis for prostate cancer and are considering private treatment, call a member of the dedicated patient services team at King Edward VII’s Hospital to discuss your options: +44 (0)20 7467 4344, Mon-Fri 9am-5pm www.kingedwardvii.co.uk
77
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 using beams of high-energy X-rays – external beam radiotherapy. Radiotherapy is one of the three main modalities for treating cancer, alongside 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.
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
* The LIGHT Proton Therapy System is still subject to conformity assessment by Advanced Oncotherapy's Notified Body as well as clearance by the USA-FDA
78
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.
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 critical organ.
1
2
Proton therapy is an alternative radiotherapy modality that spares 60% more 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.
tissues typically receive two to three times less radiation. Side effects can then be reduced to a minimum. As growing tissues are more sensitive to radiation, proton therapy is the therapy of choice in childhood cancers. However, despite clinical benefits, the high cost of proton therapy has hindered its uptake. Many hospitals do not have the budget required to invest in highcost treatment options. There are approximately 14,000 radiotherapy systems in use, equating to roughly 1.9 systems per million people. By contrast, there are approximately 90 proton therapy systems globally or 0.2 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 the actual three-dimensional shape of tumours, such that surrounding
Bragg Peak
Dose (%)
100
X-rays (Photons)
80
Focussing the proton radiation effect to the tumour's location 60
1 Radiation can damage DNA through two
40 Protons 20
Tumour 0
10
20
30
40
Energy deposition as a function of depth
Depth (cm)
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
79
ONCOLOGY
X-rays
Protons
Advanced Oncotherapy’s disruptive technology is expected to substantially alter this picture and make proton therapy far more accessible.
Advanced Oncotherapy Current proton therapy systems, where protons are accelerated in a circular fashion, have cost and clinical limitations. Advanced Oncotherapy is developing a solution based on a linear accelerator, which provides more flexibility at a significantly lower cost. The prototype system was assembled on the Research and Development facility that is located on the CERN campus. 3
Separately, the first medical system is being assembled at the Science and Technology Facilities Council at STFC's Daresbury Laboratory, where Advanced Oncotherapy established its assembly and testing centre. Through these partnerships, Advanced Oncotherapy can benefit from the knowledge of experienced physicists and engineers in the development of its technology.
LIGHT Advanced Oncotherapy’s LIGHT (LINAC Image Guided Hadron Technology) system is designed to provide next-generation solutions to patients and hospitals alike. It stands apart from 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:
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
4
80
Superior efficiency – LIGHT has a transmission of more than 95%. In contrast, the transmission of a circular accelerator is less than 50%. This feature directly allows to decrease the insulation, and therefore the footprint, of sites equipped with LIGHT;
Greater adjustability of energy – Electronic energy modulation at high repetition rate is important and an essential feature of the LIGHT system, with one pulse of protons delivered every 10ms. In contrast, legacy systems can change the energy only once or twice per second. This is particularly relevant when treating moving organs; Much smaller beam size, at 0.3mm per pulse vs 3mm for competing systems – This brings significant advantages for patients in terms of conformality. Put it simply, the deposition of the radiation is significantly more precise, which is important when treating moving targets and treating the “edge” of the tumours. These technical features are expected to result in improved clinical outcomes, reduced treatment-related side-effects and lower costs associated with the extensive shielding requirements. The shielding and building costs contribute to the high cost of buildings in proton projects (two-thirds of the upfront investment). A major expected clinical advantage for LIGHT is the superior ability to deliver FLASH therapy with protons. Still in its experimental phase, FLASH could prove to be the delivery method to decrease treatment costs the most.
What it means for patients – Non-invasive treatment; – More accurate tumour targeting; – Reduced side effects; – Safer treatment
What it means for operators – A complete, compact, turn-key solution with minimal footprint; – Enhanced efficiency; – Operational excellence
The London Clinic – On 11th February 2020, Advanced Oncotherapy and The London Clinic announced a partnership for the site located in Harley Street. Queen Elizabeth Hospital Birmingham – On 20th February 2020, Advanced Oncotherapy and University Hospitals Birmingham (left) announced a research collaboration, as well as a lease for installing LIGHT in Birmingham. The Mediterranean Hospital of Limassol – On 17th February 2020, Advanced Oncotherapy and the Mediterranean Hospital (Cyprus) announced a €50m purchase order.
Operators are very sensitive to the flexibility offered by Advanced Oncotherapy and its LIGHT system. Between December 2019 and February 2020, four partnerships were announced:
West Midlands – University Hospitals Birmingham NHS Foundation Trust
− It is a centre of medical excellence; − It has medical practitioners
University Hospitals Birmingham (UHB) and Advanced Oncotherapy have reached an agreement to install a LIGHT system on the UHB premises. As part of the collaboration, Advanced Oncotherapy and UHB will also work together on various research and development activities associated with the use of LIGHT to increase the awareness of proton therapy for the treatment of cancer.
with expertise across the full range of disciplines; − Provides access to advanced treatments and services; − Operates like one large virtual hospital, with referrals across clinics and hospitals; − Situated in central London, with its amenities and attractions.
UHB is one of the largest teaching hospital trusts in England and one of the largest regional centres for nonsurgical cancer treatment serving a regional, national and international population. The hospital group sees and treats more than 2.2 million patients every year across its sites.
London – Harley Street Advanced Oncotherapy’s first site for the innovative LIGHT system is the worldrenowned Harley Street Medical Area. Harley Street provides an ideal location:
Cyprus – The Mediterranean Hospital of Limassol The Mediterranean Hospital of Limassol has agreed to purchase a LIGHT system for €50 million. The installation of the three-treatment room system is due to commence before the end of 2023, to coincide with the completion of construction works being carried out at the hospital. The Mediterranean Hospital of Limassol is the first health centre integrated with the newly created National Health System (NHS) of Cyprus, the ambition of which is to modernise and upgrade the health sector into a more streamlined and cost-effective system, bringing Cyprus on a par with its European peers in terms of efficient and affordable public healthcare.
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
81
ONCOLOGY
NEW PATHS TO PROTON THERAPY Advanced Oncotherapy CEO Nicolas Serandour provides an update on the development of the LIGHT proton therapy system
1 An artist's impression of the LIGHT proton therapy treatment room (IMAGE: ADVANCED ONCOTHERAPY)
For those who are not yet aware, what is proton therapy and the LIGHT system? In the treatment of cancer with radiotherapy, radiation is largely delivered through X-rays, using photons. However, patients can often experience side effects, as this method doesn’t discriminate between cells at different depths. This limits the ability of physicians to deliver enough radiation and kill the tumour. In contrast, proton therapy deposits most of the radiation at a particular depth within the body, which can be tuned to the tumour itself to preserve healthy tissue. The development of the LIGHT system deals with one of the main problems historically in delivering proton therapy – the need for expensive and large infrastructure to house proton accelerators.
The design of LIGHT avoids the large space and cost required, making proton therapy more accessible to patients.
Advanced Oncotherapy has grown tremendously over the past year, with more than 100 employees across three sites. How close is the company to obtaining regulatory approval for LIGHT? Currently, we are in the process of assembling the different components of the machine at our assembly site in Daresbury, on the campus of a UK Government organisation called the Science and Technology Facilities Council (STFC). We are very much in the latter stages of completing the project, and our aim is to finalise the first system by the beginning of 2021 for subsequent approval. This involves a rigorous regulatory process of
83
“Proton therapy doesn’t have to be reserved for a few ‘elite’ patients; it can be democratised and made much more widely available” verification and validation, and we are very fortunate to have a strong and experienced team to assist with this.
Advanced Oncotherapy unveiled significant partnerships recently. Could you tell us more about these? We’re very proud and excited to install a LIGHT system at three different sites, two in the UK and one in Cyprus. These operators are outstanding institutions with superb track records across a range of therapies. These are the London Clinic in London, the University Hospitals Birmingham NHS Foundation Trust (UHB) in Birmingham and the Mediterranean Hospital of Limassol in Cyprus. Beyond these installation projects, we have also established scientific partnerships with UHB and the Cleveland Clinic. Our research collaboration with the Cleveland Clinic will essentially assess the extent to which the much smaller proton beam of the LIGHT system benefits patients receiving treatment. Clear medical benefits of the system include the ability to adjust, at a very fast rate, the depth in the body at which radiation is deposited,
up to 200 times per second, as well as the significantly smaller size of the proton pulses that are damaging cancer cells. This offers physicians many benefits, as it becomes easier to deliver a treatment that conforms better to the irregular shape of a tumour, and a lot more healthy tissue can be spared. This can be achieved if the size of the beam is much smaller – something called Mini Beam, which is 10 times smaller than those produced by legacy systems. These collaborations further establish our network of scientific partners, positioning Advanced Oncotherapy at the forefront of clinical innovation. It not only strengthens our leading position as technology disruptor in proton therapy, but also demonstrates our strong momentum and the clear opportunity to address a significant unmet medical need. Being associated with such world-class names is a great recognition of all the work of our employees and scientists over many years.
Talking about the London Clinic, what progress has been made on construction of the Harley Street site? The building was handed over to us last summer and we are now finalising the last step of the fit-out process. This reflects the fact that – together with the London Clinic – we have decided to treat patients in two separate rooms. To do so, the London Clinic has granted access to part of the neighbouring building that is on their premises. Usually, such a project consists of excavating a very large space in which the machine is situated, and then the entire facility is built around the machine. The LIGHT system differs in that it is compact and modular, which provides us with a great deal of flexibility during the installation. Each module can be transported through conventional lifting methods, as opposed to other projects that are based on legacy technologies.
2 The facade of the Harley Street building that has been transformed internally to house the LIGHT system | 3 Part of the assembly site in Daresbury, on the campus of the Science and Technology Facilities Council (PHOTOS: ADVANCED ONCOTHERAPY) 2
84
ONCOLOGY
3
What are Advanced Oncotherapy’s priorities for the year ahead? There are huge opportunities to upgrade the LIGHT system to make it smaller, cheaper and with better medical features, but our priority at this stage is to finalise and complete the project. As we complete the verification and validation process, we will also be looking at broadening our commercial relationships with a number of hospitals and universities. Also, we will continue to spread the word that proton therapy doesn’t have to be reserved for a few ‘elite’ patients; it can be democratised and made much more widely available. This is only possible with a new type of technology and a new accelerator. Such treatment should be for everyone.
Obviously, a project such as LIGHT is very costly. What is your vision for Advanced Oncotherapy’s future financing? Setting up a proton therapy centre is expensive, not just in terms of the acquisition of the system itself, which forms a relatively small fraction of the overall cost, but also the cost of setting up the entire clinical site. Such expenditure can be a barrier to smaller hospitals and clinics, but our vision is to make setting up a proton therapy centre much more affordable and, by implication, reduce the cost per treatment. In order to achieve this, city-centre healthcare centres need to be provided with a range of financing solutions, thereby avoiding the need for significant
upfront investment from customers. At the same time, this allows Advanced Oncotherapy to accelerate production, to address more quickly the large unmet need and to create significant cost savings through economies of scale. If we achieve this, then we can really democratise proton therapy. It is an absurd situation that, given all the benefits of proton therapy, there are currently only 90 centres worldwide that offer it, with approximately 230 treatment rooms. Globally, there is a need for more than 10,000 treatment rooms, so, to bridge that gap, it is important to have not only the latest technology, but also the right financing tools and strategies for our customers.
85
NHS PRIVATE PATIENT UNITS
Shams Maladwala, Managing Director, The Royal Marsden Private Care
THE BEST OF BOTH WORLDS Private Patient Units (PPUs) within the UK National Health Service (NHS) offer a service like no other. This integrated model of care aims to provide the best of both worlds for patients and clinicians: NHS scale, specialism, research and governance delivered with private-sector service standards. It is because of these benefits that we have seen the NHS PPU model growing quickly, outstripping other private hospitals in the market. As a result, patient demand has increased considerably over the past five years. This growth means we can increase provision and access for all patients, and NHS Trusts have responded by expanding their facilities and introducing new pioneering technology. For example, at The Royal Marsden we are looking forward to opening our new diagnostic and treatment facility in Cavendish Square in central London, and St Mary’s
86
Hospital, which is part of Imperial College Healthcare NHS Trust, is opening a new ‘hybrid’ theatre suite to treat patients with blood-vessel problems. Importantly, some NHS PPUs have a unique integrated model in which all revenue generated from private care goes back to the Trust. This symbiotic relationship aids the sustainability of such Trusts and also means that all patients benefit.
Rigorous standards Governance is increasingly a priority for patients and their consultants – and rightly so. We need to ensure that patients receive safe, high-quality treatment that adheres to the very best regulation. This is particularly important for accessing drugs that might not yet have received approval by the National Institute for Health and Care Excellence (NICE).
(PHOTO: DOMINICK TYLER 2019 VIA THE ROYAL MARSDEN)
NHS Trusts are regularly inspected by the Care Quality Commission (CQC). The UK Government body publishes the ratings they give to Trusts, highlights those that are performing well and makes recommendations for those that need to improve. Integrated Private Care NHS-PPUs are held to the same rigorous standards – for example, at The Royal Marsden NHS Foundation Trust, where we recently received an ‘outstanding’ rating. This transparency in standards empowers patients to choose the highest quality of care, delivered safely by the best teams.
Close ties to research Close links with research enable clinical teams at NHS PPU models to deliver treatment based on the latest pioneering advances in healthcare. At The Royal Marsden, we have over 800 clinical trials open at any one time, a unique partnership with The Institute of Cancer Research (ICR), London, and the UK’s only NIHR Biomedical Research Centre. This places our clinicians at the forefront of cancer advances.
These relationships are echoed at other Trusts across the capital and the UK. We see leading NHS Foundation Trusts partnering with the UK’s top science research centres to deliver major advances, which are then translated into treatment. King’s College London Hospital recently received approval to provide chimeric antigen receptor (CAR) T cell therapy, an approach that uses the body’s own immune cells to fight cancer. Along with the ICR, we treated the first patient in the world with pioneering new technology, which uses microscopic clusters of bubbles and liquid droplets to enhance the delivery of chemotherapy drugs to tumours. Great Ormond Street Hospital for Children opened a brand-new medical facility: the Zayed Centre for Research into Rare Diseases in Children. Aiming to bring together pioneering research and clinical care under one roof, clinicans are driving forward new treatments and cures for seriously ill children in the UK and around the world. These national and
international networks of researchers and clinicians encourage the sharing of knowledge and best practice.
International outreach NHS Trusts are known throughout the world for their expertise, with some installing satellite centres in international markets. Moorfields Eye Hospital NHS Foundation Trust opened a service in Dubai in 2007. Having treated more than 150,000 patients, it has now started delivering paediatric ophthalmology services for other hospitals in the region. The Royal Brompton & Harefield NHS Foundation Trust, a specialist centre for the treatment of heart and lung disease, has lectured in Egypt, Libya and the United Arab Emirates. Internationally renowned, and nationally treasured, the NHS in the UK strives to provide safe, compassionate and leading care. Private Patient Units within NHS Trusts inherit these values, and patients can feel reassured coming to the UK that they will be treated with the latest treatments at the highest standard.
87
NHS PRIVATE PATIENT UNITS
Marcel Levi, Chief Executive Officer, University College London Hospitals (UCLH) NHS Foundation Trust
LEADING THE WAY IN HEALTHCARE In 2017, the UK was rated by the Commonwealth Fund as having the best healthcare system out of a pool of 11 developed countries – including the United States, Canada, Norway and Germany – an award it retained from the previous survey in 2014. With the lion’s share of all UK healthcare being delivered by the National Health Service (NHS), this is a ringing endorsement for the quality of the treatment that Private Patient Units in an NHS hospital can provide.
1 University College Hospital, located on Euston Road, is part of the University College London Hospitals NHS Foundation Trust (PHOTO: UCLH)
Being able to offer private care to patients who would not otherwise be able to access our extraordinary health service in the UK is a real privilege, and we are delighted to be able to treat and support international patients on this basis. For example, at UCLH, being able to offer our state-of-the-art teenage cancer service privately has meant that children
from all over the world are now able to receive cutting-edge treatment, such as the latest CAR-T cell immunotherapy for cancer, that is not available in their home countries. It also means that our worldclass neurologists and neurosurgeons at the National Hospital for Neurology and Neurosurgery (Queen Square) can care for many more patients than if we were limited to only treating those eligible for NHS care.
Strong academic links There are so many benefits for patients who choose to have their care in an NHS Private Patient Unit. For example, NHS teaching hospitals in London are affiliated with some of the world’s most highly regarded medical research centres, with some consultants employed by both institutions in a dual clinical and research role. These consultants can run clinical trials within the NHS environment, resulting
89
NHS PRIVATE PATIENT UNITS
2
“NHS hospitals are able to tailor treatment plans extremely effectively”
90
in new techniques, approaches and treatments rapidly becoming available to patients. In these hospitals, private patients are more likely to have access to the most cutting-edge treatment options. London has leading centres for research and, at UCLH, we work in partnership with University College London (UCL) and our biomedical research centre to takes pioneering research from bench to bedside. This speed of access to new treatment options is something we can offer only because of the close relationship between our hospital and the academic sector in the UK.
Sub-specialists can then work together as part of a multi-disciplinary approach to care, with each team member able to provide a different perspective on the patient’s condition. This holistic approach means that NHS hospitals are able to tailor treatment plans extremely effectively, leading to a better patient experience and improved outcomes.
Multidisciplinary approach to care
Patients with additional health complications or co-morbidities can also have straightforward access to specialists from other clinical backgrounds. For example, a neurology patient who may also have problems with diabetes would be able to access the most appropriate specialists for their needs.
Having a Private Patient Unit within a large, multi-specialty NHS hospital also brings about other benefits. The high degree of specialism and complex work in areas such as neurological conditions, cancer and paediatrics attracts many consultants, nurses and allied health professionals to the workforce. This, is turn, supports the development of a highly specialist and, in fact, sub-specialist, team.
And, of course, NHS hospitals also have a high level of back-up emergency support – 24 hours a day, seven days a week – including on-site intensive care and high-dependency facilities, if required. Many private patients find such a level of support very reassuring, and it makes an NHS hospital one of the safest places to choose for private care.
3
Modern private facilities NHS Private Patient Units across London continue to invest in improving the physical environment for patients, providing a space to recover that is of a comparable standard to other private facilities. Modern, en suite bedrooms are available and Private Patient Units offer all the expected hotel services expected of a private provider, including a variety of menu options (with halal, kosher, vegan and vegetarian options) and in-room entertainment. For international patients, we understand that providing a home away from home is a key part of recovery. Advocacy services, where a dedicated team member will
support patients with translation, pastoral support and navigation through their care in the UK, are available in many hospitals. Spiritual care, specially adapted menus and translation services for other languages are also a staple part of patient care in NHS Private Patient Units.
2-3 NHS Private Patient Units aim to provide a home away from home for international patients (PHOTOS: UCLH)
There is one final benefit of choosing an NHS Private Patient Unit. All profits made by these units are reinvested in NHS services, meaning that your investment goes much further than treating the paying patient. It means that, as well as being able to treat patients from overseas, we can also develop innovative services and better healthcare for all our patients, which really is something we can be proud of.
91
NHS PRIVATE PATIENT UNITS
CLINICAL EXCELLENCE IN THE HEART OF LONDON
1 The friendly and dedicated international patients team welcomes patients of all ages from around the world
92
Guy’s and St Thomas’ NHS Foundation Trust comprises two of the world’s most prestigious and respected teaching hospitals. We have a proud history of high-quality care, clinical excellence and innovation that dates back more than 900 years. Guy’s and St Thomas’ is also part of King’s Health Partners, an Academic Health Sciences Centre that pioneers health research and provides high-quality teaching and education.
patients. Our life-changing breakthroughs include the first blood transfusion in 1818 to the world’s first mitral heart valve replacement on a beating heart in 2014.
Our Private Patient Services, as part of Guy’s and St Thomas’, provides private patients with a unique combination of world-class complex care and exceptional medical services with the comfort of a private facility, conveniently located in central London, close to many of the city’s iconic landmarks.
Exceptional patient care
International reputation Our ground-breaking research drives forward innovations that benefit all
We employ world-renowned consultants and specialist staff with a huge breadth and depth of experience across multiple clinical services. Our teams have access to the latest technology and deliver outstanding clinical care tailored to individual needs.
We welcome patients from around the world and offer an extensive number of services to provide lifelong care for the whole family. From routine to specialist services, we support patients from before birth to childhood and into adult life. The co-location of Evelina London Children’s Hospital with St Thomas’ Hospital means we can care for pregnant women and offer neonatal services –
1
providing full support to parents and baby and delivering continuous care. Private patients benefit from consultantled care, supported by multidisciplinary teams of specialists and nurses, and access to the full range of National Health Service (NHS) facilities. 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. Our private facilities offer a welcoming, modern and comfortable environment. Our inpatient rooms afford stunning views across the River Thames, the Houses of Parliament and many of London’s stunning landmarks.
International patients We work with numerous leading private medical insurance companies, embassies and third-party referrers. Our aim is to provide a seamless process for international patients, from initial enquiry to treatment and recovery. Our international team works closely with embassies to organise treatment and offer bespoke healthcare packages to meet the specific needs of patients. We understand that coming to another country for treatment can be daunting. That is why our dedicated team go the extra mile to ensure the needs of patients are met with sensitivity and understanding. Our friendly onsite Arabic-speaking team provide a translation and liaison service to ensure regular communication with health officials, consultants, patients and their families to ensure a smooth and professional service at every stage.
“Guy’s and St Thomas’ Private Healthcare offers a unique combination of world-class clinical services, delivered by internationally recognised clinicians. Both UK and overseas private patients benefit from the highest standards of care from one of the largest and safest NHS Trusts in the UK” Dr Ian Abbs, Chief Executive and Chief Medical Officer, Guy’s and St Thomas’ NHS Foundation Trust
93
NHS PRIVATE PATIENT UNITS
“The experience I had at St Thomas’ was excellent and the care was beyond words. Thanks to all the clinical and non-clinical staff”
Our centres of excellence Complex paediatric care Evelina London Children’s Hospital provides outstanding clinical services for children. Our vision is to improve the lives of children and young people by putting our patients and their families at the heart of everything we do. This means providing consistently outstanding and life-enhancing healthcare; educating and training staff to deliver effective child-centred care and treatment; and undertaking research to improve child health. Evelina London has a long and proud history, and celebrated its 150th anniversary in 2019. The hospital is honoured to have received several royal visits, starting in 1890 with the Prince and Princess of Wales, and in 2018 the Duchess of Cambridge became Patron of Evelina London.
International patient
2 The Duchess of Cambridge became Evelina London’s Patron in 2018 | 3 The Westminster Maternity Suite provides families with top-quality care in the heart of London | 4 Private patients benefit from the expertise of one of the UK's leading teaching hospitals (PHOTOS: GUY’S AND ST THOMAS’)
Evelina London provides complex private paediatric care and is one of only two specialist children’s hospitals in London. It was the first children’s hospital in the UK to be rated as ‘Outstanding’ by the Care Quality Commission. We offer a comprehensive range of clinical services, from routine to specialist services for babies and children who require complex multidisciplinary care. Evelina London Children’s Hospital is colocated with St Thomas’ Hospital on the same site and is, therefore, able to provide lifelong care from fetus to adulthood. Evelina London has a well-deserved reputation for offering world-class expertise in fetal cardiology, cardiac intervention, cardiac magnetic resonance imaging (MRI), specialist echocardiography and complex cardiac surgery. It hosts the oldest, and one of the largest, fetal cardiology units in Europe and is one of the first centres in the UK to offer many
cardiac surgical procedures. It started paediatric cardiac surgery in the UK with the first Blalock-Taussig (BT) shunt outside the US in 1947; pioneered the first repair of tetralogy in infancy in 1960; developed the Ross operation (1967); and more recently led the development of the Norwood procedure in the 1990s. Cardiology at Evelina London has produced many major innovations and other world firsts, including interventional catheter techniques, advanced cardiac imaging and fetal cardiac intervention. We have ambitious plans for our future growth and are investing significantly in the development of new cardiac and critical care wards, together with an expanded ambulatory unit and a new combined interventional catheter/ MRI suite. We continue to build on our history of innovation and are pioneering new techniques, such as fetal cardiac MRI and the use of artificial intelligence in advanced cardiac imaging. 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. Our centre provides a diverse range of clinical services and has been a leader in kidney care since the 1970s. Our 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. It was the first in the UK to offer robotic transplantation, and is recognised for transplanting complex and high-risk patients, both adults and children. Our vascular access operations include radio-cephalic and brachiocephalic fistulae, grafts and complex cases where access is difficult. Our 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. Specialist respiratory services Guy’s and St Thomas’ Intensive Care Unit offers support for patients with acute severe heart or lung failure. We have a variety of life-support technologies, including basic
2
94
3
NHS PRIVATE PATIENT UNITS
and advanced conventional ventilation, as well as extra-corporeal support. Extra-corporeal Membrane Oxygenation (ECMO) is derived from cardiac bypass technology and allows short-tomedium term support for patients with devastating heart or lung failure. Many patients with severe lung failure have a lung infection (pneumonia) and require approximately 10-14 days of ECMO before their condition improves. There is a group of patients (approximately one in eight) who appear to have pneumonia, but actually have an acute autoimmune lung disease. The multidisciplinary team at Guy’s and St Thomas’ has significant expertise in all forms of acute lung pathology, combining novel treatment approaches with rehabilitation on ECMO that has enabled many patients who require ECMO to survive. In recent years, recognition of the chronic critically ill has risen. These patients often have long intensive care stays and have severe ICU-acquired weakness as part of their problem. Guy’s and St Thomas’ intensive care unit (ICU) can provide full multiple organ support to patients with a variety of medical and surgical problems and accommodate in-ICU rehabilitation as part of their stay. Care is provided by an experienced multidisciplinary team with expertise in the management of such patients. Cardiovascular services Guy’s and St Thomas’ has one of the largest cardiovascular centres of excellence in the country, providing comprehensive cardiology, cardiac and vascular services. Our unit is home to multidisciplinary teams of expert consultants, researchers, allied healthcare practitioners and nurses, all of whom have access to the latest clinical equipment. It has built an international reputation and welcomes patients from around the world. Our unit is at the forefront of pioneering cardiovascular treatment, leading the way in a number of procedures, including the use of transcatheter aortic valve implantation (TAVI). This minimally invasive way of treating a heart valve greatly improves recovery time and endovascular thoracoabdominal aortic aneurysm repair, which again is a minimally invasive procedure that involves a bespoke graft tailored for the patient’s aneurysm anatomy.
4
Our use of new treatments is built on expertise, with the cardiology 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. Fertility The Assisted Conception Unit at Guy’s and St Thomas’ is known worldwide as an innovator in fertility treatments and is one of the leading providers of assisted conception techniques in the UK. We offer a full range of fertility services, from initial investigations and gynaecological surgery through to treatment. We pride ourselves on the highest standards of care and our results exceed the national average for all common assisted conception techniques, including in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Our team of consultants, specialist nurses, embryologists and counsellors all work together to provide expert help throughout a patient’s fertility journey. Our pre-implantation genetic diagnosis (PGD) service is one of the largest in the UK and we are licensed to carry out stem-cell
research. We are dedicated to improving treatment outcomes and run an extensive research programme that includes academic and commercial clinical trials. Maternity The Westminster Maternity Suite has been offering private maternity services for over 20 years. Each year, we deliver more than 7,000 babies in the St Thomas’ maternity unit, including more than 400 deliveries in the private unit. As part of one of the UK’s most comprehensive, safest and highly regarded NHS teaching hospitals, our highly skilled team deals with both straightforward and complex pregnancies. Our expert obstetricians, midwives and neonatologists work together to deliver the highest standards of private maternity care. We offer parents a complete service from before birth, throughout pregnancy and after delivery, so patients are assured of continuity of care at every stage. Our proximity to Evelina London Children’s Hospital means that babies have access to the best specialist care from our consultant neonatologists, who treat premature babies and those requiring complex care. Whatever the circumstances, our trusted consultants have the expertise to provide exceptional medical and surgical support.
To find out more about our specialist services, contact us: T: +44 (0)20 7188 5197 E: privatepatientenquiries@gstt.nhs.uk www.guysandstthomasprivatehealthcare.co.uk
95
NHS PRIVATE PATIENT UNITS
WORLD-CLASS MEDICAL CARE With Imperial Private Healthcare, patients experience the best of both worlds – internationally renowned consultants providing care in modern, private facilities, all within some of London’s most trusted NHS hospitals
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-theart diagnostics, specialist care of complex, long-term diseases, as well as maternity services, which were the first in London to receive an ’outstanding’ rating in 2019 from the Care Quality Commission (CQC).
Translating research into practice 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 and every medical, diagnostic and surgical specialty. With partners Imperial College London, The Royal Marsden NHS Foundation Trust and Royal Brompton & Harefield NHS Foundation Trust, we form Imperial College Academic Health Science Centre. This is one of six academic health science
96
centres in the UK working to ensure the rapid translation of research for better patient care and excellence in education.
A highly experienced team 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. 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. Imperial Private Healthcare hospitals boast consultants with enviable reputations across many specialisms – from cancer, ▸
1
1 Families benefit from more than 60 years’ experience in maternity at St Mary’s Hospital
|
2-3 Compassionate staff ensure that patients are fully supported throughout their treatments (PHOTOS: IMPERIAL PRIVATE HEALTHCARE)
2
3
97
NHS PRIVATE PATIENT UNITS
“Everything from the high medical standards to the attention to detail and a personal friendly approach was excellent” Patient from The Thames View, 2019
4
5
6
“Absolutely amazing care from every member of the team” Patient from The Lindo Wing, 2019
4 Imperial Private Healthcare patients receive the attention of caring and experienced staff during their stay | 5 Professor Christina Fotopoulou | 6 The Clarence Wing of St Mary's Hospital | 7 Consultant Zaid Awid and patient (PHOTOS: IMPERIAL PRIVATE HEALTHCARE)
7
98
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.
Sir Stanley Clayton Ward, Queen Charlotte’s and Chelsea Hospital World-renowned maternity hospital Queen Charlotte’s and 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 major teaching centre of the Western Eye Hospital offers a comprehensive service for all sophisticated investigations now available in eyecare – from common eye problems to complex ophthalmic issues. Services include weekly clinics on conditions such as macular degeneration and diabetes. Stateof-the-art equipment includes the latest optical coherence scanner, which provides high-quality images of the retina.
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.
99
NHS PRIVATE PATIENT UNITS
GULNAR REMU’S STORY When Gulnar Remu developed leukaemia in her home country of Kenya, her local consultant recognised that the best place for treatment would be in the UK, with the haematology team at Imperial Private Healthcare
“I was at home in Nairobi, Kenya, when I developed a throat infection, which continued to persist despite antibiotics. My husband took me to the local hospital, where I was admitted and underwent several blood tests that showed my white cell count was abnormally high. I would never have imagined that, 48 hours later, I would be in an air ambulance to the UK, having been diagnosed with acute myeloid leukaemia (AML). “Treatments for leukaemia (especially bone marrow transplants) are not widely available in Kenya. Fortunately, my haematologist, Dr Malkit Riyat, had trained under Dr Jiri Pavlu at Hammersmith Hospital and he highly recommended that I receive private treatment under Dr Pavlu’s care in the UK. “My daughter travelled from Vancouver to London to be there with me. As soon as I arrived at Hammersmith Hospital, I was taken for tests and, within a few hours, I started my first chemotherapy session. Dr Pavlu was wonderful; he made me feel completely comfortable with his expertise, patience and compassion. He took the time to ensure that I understood all aspects of my treatment and answered all of my questions in a manner that put me at ease.”
“It has now been almost eight years post-transplant and I am living a full life in Kenya with my family. I am delighted to say that my leukaemia is now in remission. Although I often get minor infections, I am fortunate that Dr Pavlu is only a phone call away and is happy to talk to my doctors in Kenya to ensure that I continue to receive the best treatment.”
High-level expertise “One of the struggles I face post-transplant is a condition called Graft versus Host Disease (GvHD), which has affected my eyes. Dr Pavlu introduced me to his colleague, Mr Ali Mearza, who is a consultant ophthalmologist at Imperial Private Healthcare, and I have benefited tremendously from both his high level of expertise and compassionate care. Mr Mrearza is also in touch with my doctors at home in Kenya, so my care continues even though I am not physically living in the UK. “I continue to travel to the UK every four to six months for follow-up treatment with both my doctors. On each visit, as I board my flight back home, I feel a deep sense of gratitude and comfort that I have had, and continue to have, the best treatment and care. I wouldn’t hesitate to tell anyone who needs treatment to talk to Imperial Private Healthcare.”
Comfortable and supported “For the first seven months while I was undergoing chemotherapy, I lost all my hair, required constant blood transfusions and platelets, struggled to eat food and felt very weak and tired all the time. I also spent a few days in the intensive care unit. But, through all this, the staff at Hammersmith Hospital made me feel comfortable and supported with their kind and caring attention. “Unfortunately, my leukaemia was aggressive, and chemotherapy alone wasn’t the complete cure. I underwent a bone marrow transplant, which was the toughest phase in my journey. I lost over 10 kilograms and was extremely weak. The physiotherapy team was excellent, though – they were instrumental in helping me to regain my strength and learning to walk again. “When you spend a year in a hospital, smiling faces and thoughtful gestures are so important and all the staff we encountered – phlebotomists, nurses, cleaning staff, those that delivered meals, senior nurses, counsellors, physiotherapists and consultants – were always so encouraging and compassionate towards me and my daughter. Hammersmith Hospital became a second home and the staff became like family. In fact, I am still in regular contact with my nurse, Angela, who has become a dear friend.
100
Dr Jiri Pavlu
NHS PRIVATE PATIENT UNITS
8
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 NHS clinical guidelines, ensuring that patients’ needs are met by doctors and surgeons with the most appropriate expertise.
Round-the-clock support Each hospital’s consultants, doctors and nurses have the skill 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.
8 Imperial Private Healthcare has more than 500 expert consultants, covering every medical, diagnostic and surgical specialty (PHOTO: IMPERIAL PRIVATE HEALTHCARE)
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, all of which are prepared on site. 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.
T: +44 (0)20 3311 7700 E: imperial.private.healthcare@nhs.net www.imperialprivatehealthcare.co.uk
101
NHS PRIVATE PATIENT UNITS
SPECIALIST CARE IN THE HEART OF LONDON'S WEST END University College London Hospitals NHS Foundation Trust (UCLH) is an internationally recognised hospital group renowned for high quality specialist patient care, education and research
Based across a number of hospital sites in close proximity to Oxford Street and the West End of London, UCLH offers a wide range of services, with highly specialised staff supporting patients in purposebuilt, modern clinical surroundings. At the centre is University College Hospital, a large multi-speciality hospital providing acute and long-term care for a wide range of conditions. The hospital group also comprises a number of very specialist hospitals, including the National Hospital for Neurology and Neurosurgery and the Royal National ENT and Eastman Dental Hospital, among others. Neurology, neurosurgery, ear, nose & throat services, teenage cancer and nonmalignant haematology, maternity and an infectious disease clinic are offered privately through UCLH’s own private healthcare
102
service. Patients come to UCLH with conditions ranging from the most common such as recurrent migraines or balance disorders, to very complex teenager cancer cases or neurosurgical needs. The hospital group also works in partnership with other private healthcare providers, including HCA Healthcare (UK), which runs adult haematology and oncology services at University College Hospital, and Queen Square Enterprises, which provides neurological imaging and outpatient services at the National Hospital of Neurology and Neurosurgery. From 2021, another partner, Proton International, will also be providing proton beam therapy at UCLH. As well as offering robust evidence-based treatment for complex conditions in some of the UK’s top hospitals, UCLH also
1
provides all the additional benefits that come with private care, including modern en suite private rooms, specially selected patient menus, access to a preferred consultant and appointment times that suit. All profits from hospital-run private services are reinvested in the wider organisation, which helps to develop innovative services and better healthcare for all patients.
World-leading innovators Many of UCLH’s world-leading clinical consultants also hold dual academic contracts with University College London (UCL) and are at the cutting edge of translating laboratory research into treatment. They are often internationally recognised specialists in their field, providing pioneering treatments within their area of expertise and caring for the most complex clinical cases.
In partnership with UCL, UCLH is one of the UK’s five comprehensive biomedical research centres and is also a member of UCL Partners, which brings together some of the UK's world-renowned medical research centres and hospitals to look at new approaches to care. At the heart of the service, all treatment options are based on the latest clinical evidence and subject to the stringent clinical guidelines and oversight expected from an NHS hospital group. The expertise of the team feeds into the continual evolution of these guidelines, ensuring best practice is always at the top of the agenda.
Holistic care from an expert team As UCLH is a tertiary centre for many conditions, its consultants are supported by doctors, nurses and allied health professionals with highly specialised skill sets.
1 Private patients benefit from the expertise of UCLH‘s team of health professionals (PHOTO: UCLH)
103
NHS PRIVATE PATIENT UNITS
Specialist care in London All UCLH hospitals are based in and around leafy Bloomsbury; a short walk from Oxford Street and the West End, with quick and easy transport links, including buses and underground and mainline stations. The area has a huge variety of shops and restaurants to choose from, and has easy access to London’s finest retailers, vibrant nightlife, cultural centres and quiet green spaces. Here is a brief guide to some of the UCLH sites: The National Hospital for Neurology and Neurosurgery, sometimes referred to as Queen Square after its location, has been providing care for people with neurological conditions for nearly 160 years and is one of the leading clinical neuroscience centres in the world. The hospital provides comprehensive services for the diagnosis, treatment and care of all conditions that affect the brain, spinal cord, peripheral nervous system and muscles, in state-of-the-art facilities. Together with its neighbour, the UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery is a major international centre for research and training. Inpatient treatment is provided in a purpose-built private ward with a dedicated specialist nursing team. In addition, all allied health professions, including occupational therapists and speech and language therapists are specially trained to support patients with neurological conditions. The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG
University College Hospital is a state-of-the-art hospital equipped with cutting-edge technology. Located on Euston Road, within walking distance of Euston mainline train station, it offers spectacular views across London. The hospital houses our highly specialised haematooncology service, for patients aged 13-18 years old who are diagnosed with cancer. The team also cares for patients undergoing cellular therapies (alloHSCT and gene therapy) for primary immunodeficiencies, and red cell disorders, including sickle cell anaemia and thalassaemia.
The Royal National ENT and Eastman Dental Hospitals is a brand-new world-leading centre for the diagnosis and treatment of conditions affecting the ear, nose, throat and mouth, including dental, hearing, speech and balance services. Opened in October 2019, the new centre has been carefully designed to specifically support patients with these conditions, and is the new home for the Royal National Throat, Nose and Ear Hospital, which has been delivering world-class ENT treatment since 1874. Private patients are seen in a modern, purposebuilt environment and are supported by a specialist team of nurses and allied health professionals, with several members of the team trained in British Sign Language to assist patients with hearing problems. Royal National ENT and Eastman Dental Hospitals, Huntley Street, London WC1E 6DG
The Hospital for Tropical Diseases is a global centre of excellence in tropical medicine and infectious diseases. The hospital offers comprehensive pre-travel advice, an emergency walk-in clinic open to anyone unwell after travel, and a tropical infection screening service. The specialist pre-travel service offers a comprehensive package that includes an assessment of the health risks of any travel itinerary and recommendations around reducing the chances of illness during that journey, including travel vaccinations and protection against malaria. A consultant-led service offers advice to those with additional health problems that may make travel advice and the administration of vaccines more challenging.
The hospital provides all aspects of state-of-the-art cancer care and is a highly specialist centre for specific treatments, including haemopoietic stem cell transplantation, CAR-T cell therapy and, shortly, proton beam radiotherapy.
The Hospital for Tropical Diseases emergency walk-in clinic sees thousands of travellers per year, providing a ‘while-youwait’ service of assessment, diagnosis and treatment. It is open to anyone who has travelled within the last six months and has a new medical problem, such as fever, rash or diarrhoea.
The specialist ward has private rooms, complete with all the equipment a teenager needs to make their stay in hospital as comfortable as possible, and a parent or carer is able to stay in the private rooms overnight with their child, when required.
Because infections may be detected in people who do not have any symptoms after travelling from abroad, the hospital also offers infection screening for people without any symptoms who want to ensure they have a clean bill of health.
University College Hospital, 235 Euston Road, London NW1 2BU
Hospital for Tropical Diseases, Mortimer Market, Capper Street (off Tottenham Court Road), London WC1E 6JB
104
NHS PRIVATE PATIENT UNITS
3
2
As an example, at the National Hospital for Neurology and Neurosurgery the team includes specialist radiographers, speech and language therapists and physiotherapists, who are all highly skilled in pre- and post-operative care for patients with neurological conditions. Within the team there are also subspecialists at all levels for every neurological condition, from epilepsy to stroke recovery. Patients will also benefit from the team’s advanced diagnostic expertise around neurological conditions, from neuroradiologists to pathologists to neurophysiologists, and a dedicated neurological intensive care team. This level of specialism means that patients can expect an exceptionally high level of holistic care tailored to support their condition and recovery.
State-of-the-art hospitals UCLH hospitals are among the most modern NHS hospitals in London. A multi-billion pound estates investment programme has taken place over the past 15 years, including the brand-new Royal National ENT and Eastman Dental Hospital, which opened its doors in 2019. This is soon to be followed by a new facility for cancer and surgery, which will be opening in 2020. These bright, modern hospitals are purpose built to support 21st-century patient care, with state-of-the-art facilities
to facilitate the care and treatment of even the most complex specialist cases.
Emergency support 24/7 Private patients at UCLH also have access to the high-level back up support expected of a large central London NHS hospital with a full accident and emergency department, including intensive care or high-dependency units if needed, making it one of the safest environments for private care. Private patients can also be reassured that there will be medical support on site at all times, at an appropriate specialty level.
Offering a home from home Staying in hospital can be daunting, especially for patients coming from overseas, so making rooms feel a little more like home can make a real difference. UCLH’s en suite private rooms have all the modern amenities you would expect in a private hospital. Patients can also choose from a wide range of specialist catering options during their stay, including vegan, vegetarian, halal and kosher meals. For patients looking for spiritual support, a multi-faith chaplaincy team is available to visit on a one-to-one basis, providing a compassionate source of support. There is also a multi-faith room on each site. The hospitals also offer an advocacy service for Middle Eastern patients, and interpreting services are available on request for other patients who may not have English as a first language.
4
2 One of UCLH‘s many world-class clinical consultants | 3 The National Hospital for Neurology and Neurosurgery in Queen Square | 4 University College Hospital is at the heart of London‘s West End (PHOTOS: UCLH)
Get in touch For further information about private healthcare at UCLH, please visit www.uclhprivatehealthcare.co.uk or email the team at uclh.private.enquiries@nhs.net
105
SHARING MEDICAL EXPERTISE
Working Hands transforms the lives of people in Nepal that have suffered hand paralysis due to leprosy. The charity’s founder and team leader, consultant hand surgeon Donald Sammut, describes the work and aims of the project
RESTORING LIVELIHOODS WITH HAND SURGERY
106
I've been doing this work for about 20 years, first in India and then in Nepal, travelling to reanimate hands paralysed by leprosy and to teach the local medical personnel. Some six years ago, the charity ‘Working Hands’ was founded to fundraise and coordinate this work.
Working Hands started with one small step – I bought two flight tickets for myself and a nurse to visit a village in India, where there were about 2,000 people affected by leprosy. All were working and integrated in the village society, but most had hands weakened by leprosy.
I am a plastic surgeon and a specialist hand surgeon. My main interests lie in the reconstruction of hands following trauma or degeneration, nerve and tendon surgery, and the reanimation of the paralysed hand. I was a Bristol consultant plastic and hand surgeon for 10 years; since 2003, I have worked freelance. I now work mostly in Bath, where most of my patients are National Health Service patients treated in the private setting. I also have a London practice. About half my time is spent on teaching and training of juniors in the UK and internationally.
Leprosy paralyses nerves, causing weakness and paralysis of the muscles animating the hand. The vast majority of our patients are illiterate farmers and manual workers, whose livelihood depends on what they can dig, carry and handle in a day. There is no state-provided healthcare in Nepal. It is possible to restore strength in affected hands by ‘stealing’ muscles that are still active and powerful, but that are less essential to hand function. For example, we can make a thumb stronger by transferring a muscle from one of the fingers. We
1 The Working Hands team, pictured in November 2019 | 2 A child's bandaged hand is examined post-surgery 1
2
SHARING MEDICAL EXPERTISE
“Standing and teaching amongst the Nepali surgeons, surrounded by pairs of clever eyes eager to learn, is one of the real gifts of one’s profession” 3 A lecture takes place in Kathmandu | 4 Surgeons receive training in essential skills as they observe an operation | 5 An endvisit ward round, when all patients are given laminated copies of their operative drawings | 6 A young patient is examined during an outpatient appointment
3
also deal with burns, which are common tragic occurrences in Nepal since many use open fires for cooking. The hospital treats leprosy patients at no charge, while all other conditions are charged a modest amount. Our team offers services for free. We visited India for nine years and, by the end of that time, I had operated on most of the 2,000 people in the village. We then moved on to Nepal, to the main leprosy hospital in Kathmandu. The main difference was the fact that no doctors were available to teach in the Indian village while, in the Nepali hospital setting, one was quickly surrounded by many eager to learn. It soon became obvious that this was the more valuable and lasting benefit of our work. We have since grown to a team of eight or nine, which includes four surgeons, an anaesthetist, a theatre nurse and two therapists. Our working model is to identify a hospital that requires kit and training, and has patients who need the care. On our visits we aim to carry everything that we might need, leaving any surplus behind. This could include virtually anything from syringe needles, right up to splint material, sutures, all dressings. In addition, each visit generates a wish list of required kit – such as instruments, sterilisers etc – which, funds permitting, we purchase and carry on the following trip.
4
108
Many of the patients are now operated on by local surgeons, with the assistance of our team, and this is the lasting effect of our work. All of the treatment is free – none who volunteer on our team receive a penny for their work and all generated funds find their way into the field and to meet trip expenses The team also consists of less-experienced UK surgeons who are being taught technique, organisation and conduct of this work. This, too, ensures ongoing sustainability. We have also been able to bring some Nepalese surgeons and therapists to the UK for six-week periods to shadow our work here. The main aim is to train these local surgeons and therapists in diagnosis and treatment, and make them autonomous and capable of performing. One could say that our work is done when we become redundant. When we feel that a hospital is able to carry out the work without supervision and it is well kitted out, we move on to another. We are now working in our third, fourth and fifth hospitals, where we will probably stay for quite some time because there is an ongoing need. Two of these hospitals have a very large rural leprosy catchment area. The third is in Kathmandu and is, relatively, more sophisticated and has more facilities,
5
but the large team of doctors still benefit from training and equipment. Among the UK sponsors associated with Working Hands is Welbeck Health, which has been supportive of our work from the start and has helped sponsor our most recent visit. I work closely with Welbeck Health, which, in its initiation, invited me to assemble a team of hand surgeons for its new orthopaedics unit at One Webeck Street, London. This hand surgery team is headed by Sam Gidwani, who is also a member of our team to Nepal. Each year the hospital at which I am based in Bath, Circle Bath, kindly provides consumables for the trips. This can come to a sizeable expense and considerable weight – some 150kg on the last trip. Our major sponsor and supporter is Etihad Airways, which has provided our flights. Without their support over the past eight or nine years I don’t think the project would have survived, as the flights represent our single largest expense. We have a very good working relationship with Etihad and I am extremely grateful for all their help.
The viability of the project depends entirely on the support and funding of kind benefactors. Throughout the year, I approach sponsors for funds, and it is also humbling that many of our patients are inspired to give, often entirely unsolicited. I lecture in schools and church halls, raising funds from those who are moved to support us, while unsolicited cheques arrive from time to time. The main aim of the project is the training and teaching of local medical personnel. These will continue to treat patients long after we have flown home. It is an abiding and ongoing pleasure, and a privilege, to place sound principles in the mind of a person who will then go on and treat far more than one could achieve. Standing and teaching amongst the Nepali surgeons, surrounded by pairs of clever eyes eager to learn, is one of the real gifts of one’s profession. The reward is the knowledge that we are leaving behind a body of professionals who will continue with this work and will themselves teach others.
6
For more information on Working Hands and how to make a donation, please visit: www.workinghandscharity.org
109
Senate_LWC_Advert V5 ARTWORK.indd All Pages
the number one centre in London for fertility care (based on HFEA verified data for 2017 – 2018 for IVF pregnancy rates per embryo transferred)
londonwomensclinic.com londoneggbank.com
06/04/2020 15:13
112
YOUR STAY IN LONDON
For patients and their families visiting London, there is a vast wealth of exciting things to do and interesting places to see across the busy capital
ATTRACTIONS AND ACTIVITIES One of the key advantages of choosing London as a location for healthcare is the wide range of attractions and activities for patients between their treatments, as well as to keep their accompanying families entertained. As one of the most vibrant and busy cities in the world, London has plenty to offer visitors of all ages – from historical buildings and landmarks to cultural collections.
High-rise views Since opening to mark the new millennium in 2000, the London Eye quickly became an iconic landmark of London and is one of the most popular attractions among visitors to the city. The big wheel provides a sedate viewing experience as passengers ride in pods that take around 30 minutes to make a full rotation.
1 The passenger pods of the London Eye provide a truly panoramic view of the city (PHOTO: KICKSTAND/ISTOCK)
For the widest view over the city, head to The Shard – at 244m, it measures up as Western Europe’s tallest building and provides a 360-degree vista over the city from its dedicated viewing floors at the peak of its glazed spire.
As well as providing the highest vantage point over the city, The Shard also has a selection of high-rise restaurants and bars that offer the best in food and drink, combined with spectacular views. Further elevated dining experiences abound in the City of London, home of the capital’s financial district and also many of its tallest buildings. Skyscrapers where diners can enjoy panoramic views include Tower 42 (Old Broad Street), 20 Fenchurch (commonly known as the Walkie Talkie, on Fenchurch Street) and Salesforce Tower (Bishopsgate).
Tower Bridge Among the nearest and most striking sights to be viewed from The Shard is one of its most recognisable – Tower Bridge. Built in 1894, the bridge now provides its own attraction, The Tower Bridge Experience, which allows visitors to explore its history and view the Victorian engines that raise the two halves of its span. Adventurous people with a head for heights can also traverse the glass floor of the bridge’s 42m-high walkway.
113
YOUR STAY IN LONDON
1
2
The building that gives the bridge its name, the Tower of London, is one of the capital’s most popular visitor attractions. The historic castle, part of which dates back to 1078 and was built for William the Conqueror, was a royal residence until the 17th century and then served as a prison, until as late as the Second World War. The Tower of London has also long been the home of the spectacular Crown Jewels, part of the Royal Collection, the most powerful symbols of the British monarchy that are still used in regal ceremonies today. 3
Today’s official London residence of the monarch is Buckingham Palace, recognisable from countless state occasions when the royal family gathers on the balcony to greet celebrating crowds gathered on the Mall. A daily
114
draw for tourists is the ceremony of the Changing of the Guard, a superb display of British pageantry. During the summer and early autumn, the palace’s State Rooms are opened to the public, allowing visitors to experience the splendour of its interior and the art works that form part of the Royal Collection. Only a short walk from Buckingham Palace is another familiar sight from special royal occasions – Westminster Abbey, the setting for national commemorations and celebrations, including royal weddings. The famous dome of St Paul’s Cathedral, also a regular venue of royal events, has been a fixture of London’s skyline since the early 1700s, following the Great Fire of London, and both churches offer guided tours for those keen to discover the history of the Anglican Christian tradition.
4
Heart of government Close to Westminster Abbey is the UK’s seat of government, the Houses of Parliament, comprising the House of Commons and the House of Lords. Guided tours revealing the history of these buildings and exploring the traditions of British politics are available on Saturdays and most weekdays when Parliament is in recess.
In contrast, for a more modern take on government in the capital, head back towards Tower Bridge to visit City Hall, headquarters of the Greater London Authority, comprising the Mayor of London and the London Assembly. Designed by acclaimed architect Norman Foster and opened in 2002, this distinctively shaped building hosts various exhibitions and events that are open to the public.
2 Many of the City of London's skyscrapers offer high-rise views of landmarks such as Tower Bridge (PHOTO: JOHN KELLERMAN/ISTOCK) | 3 The Changing of the Guard at Buckingham Palace is one of London's most enduring traditions (PHOTO: CHALABALA/ISTOCK) | 4 The Palace of Westminster is the seat of the UK's government (PHOTO: BRIAN A JACKSON/ISTOCK)
115
YOUR STAY IN LONDON
5
Galleries and museums Art lovers are spoilt for choice in London, with an array of world-renowned galleries across the capital. Foremost among these is the National Gallery, which houses one of the most famous collections of European art, including works by Leonardo da Vinci, Rembrandt, Van Gogh, Gainsborough, Turner, Botticelli and Renoir. Adjacent to the National Gallery on Trafalgar Square is the National Portrait Gallery, the world’s largest art collection of personalities and faces, which displays works from the late Middle Ages to the present day. Exhibiting both the traditional and the modern are London’s two Tate galleries. Situated on Millbank, on the north side of the River Thames, Tate Britain focuses on the best of British art, including regular special exhibitions. Further west along the river, on the South Bank opposite St Paul’s Cathedral, Tate Modern showcases modern art from around the world. A frequent boat service links the two galleries to provide a unique experience for visitors. 5 The elegant courtyard of the Victoria and Albert Museum (PHOTO: STOCK IN ASIA/ | 6 The Turbine Hall at the Tate Modern gallery, which occupies a former power-station building (PHOTO: ANDRES GARCIA/ ISTOCK) | 7 The Great Court of the British Museum with its spectacular glass-and-steel roof, added in 2000 (PHOTO: INFOMODS/ISTOCK)
ISTOCK)
116
London’s famous museums also offer the chance to explore human history, art, culture and technology, and three of the best-known are clustered to the west of the city in Kensington. The Victoria and Albert Museum – popularly known as the V&A – celebrates art, design and creativity, with
special exhibitions alongside permanent collections that include fashion, jewellery, sculpture, textiles, glass and ceramics. Just across the road from the V&A are two of London’s most fascinating museums. Interactivity is at the heart of many of the exhibitions at the Science Museum, with numerous opportunities for visitors to demonstrate key scientific principles for themselves via handson activities. The history of space is also explored with an absorbing collection of exhibits from the US and Russian space programmes, including the Apollo 10 command capsule. Adjacent to the Science Museum, the Natural History Museum is a must for anybody interested in the natural world, past and present. Collections highlighting today’s wildlife and environmental issues combine with exhibits from all eras, including one of the best-known assemblies of artefacts from the prehistoric world. In Bloomsbury, the British Museum is a magnet for tourists clamouring to see historical exhibits from all around the world, including displays of items from ancient Egypt, Greece, the Middle East and Europe. For those that would like a more private viewing, the museum also offers out-of-hours guided tours.
6
7
117
8
“The northern section of Regent's Park is dedicated to London Zoo, where visitors can get a close-up view of around 750 species� 118
YOUR STAY IN LONDON
9
Regent’s Park
A river of lights
London’s Royal Parks provide some respite from the busy city streets and provide a connection with nature in the heart of the capital – none more so than Regent’s Park, only a short distance from the Harley Street area. The northern section of Regent's Park is dedicated to London Zoo, where visitors can get a close-up view of around 750 species – including big cats, monkeys, apes, giraffes, penguins and lizards – as well as finding out about the conservation work of the Zoological Society of London.
As night falls over the city, a recent addition to the visual delights of the capital becomes evident, as the bridges of the Thames are illuminated with an array of coloured lights that bring the river alive after dark.
Regent’s Park also has plenty to offer culture followers in the form of the Open Air Theatre. The theatre stages productions from June to September, with performances ranging from Shakespeare to musicals and children’s plays.
8 Built in 1837, the Giraffe House at ZSL London Zoo is one of the world's oldest zoo buildings still in use (PHOTO: LEON MORAN/ISTOCK) | 9 Southwark Bridge was one of the first crossings to be lit up as part of Illuminated River, a spectacular art project on the Thames (PHOTO: ALI DONALD/ISTOCK)
Illuminated River is described as the "longest public art project in the world" and, when completed, will transform the capital at night, lighting up to 14 bridges along 2.3 miles of the Thames. The project is expected to be seen more than 130 million times each year of its decadelong lifespan, and is perhaps best viewed from the water itself – river buses and tourist cruises, many of which offer dining, are an ideal way to experience a unique and dazzling display of architecture.
119
TIMELESS ELEGANCE Opened in 1865 as Europe’s first ‘Grand Hotel’, The Langham, London has an unrivalled location at the top of Regent Street, a mere five-minute walk from the Harley Street medical area. The Forbes five-star hotel offers 380 beautiful guestrooms, of which 41 are luxurious suites, classically styled and evoking a warm residential feel and offering flawless service. Located in the heart of the West End, The Langham, London is close to a great selection of well-known sights. Marylebone, our charming neighbourhood can be considered as one of London’s best-kept secrets and boasts some delightful attractions and experiences that can be enjoyed all within ten minutes of the property. These include a cheesetasting at La Fromagerie – an iconic cheese room showcasing over 250 cheeses from the British Isles, Europe & the US; a guided tour of the Wallace Collection, offering an outstanding residential collection of paintings, sculptures, arms and armours and porcelain; or perhaps a wander to the heritage perfumer Floris, purveyor to Her Majesty the Queen.
EXQUISITE DINING The Langham, London is a true destination hotel with an extremely varied culinary offering. Palm Court, the birthplace of afternoon tea, upholds this quintessential British tradition, yet reinvents itself continuously by incorporating the best seasonal ingredients in its sweet and savoury dishes. Roux at The Landau creates fabulous modern French cuisine with a focus on seasonal ingredients. The restaurant equally prides itself on offering a fantastic selection of more than 525 different wines, all available by the glass. The Wigmore, a pub-luxe recently named the best pub/bar at Harden’s London Restaurant awards, is the ideal place to enjoy a craft beer and some delicious, hearty food. Artesian is the perfect combination of London sophistication and fun. In 2019, it was nominated as Food & Travel’s best bar and also entered the prestigious selection of top 50 bars in the world. It offers a sublime menu based on the principles of minimalism, where unique flavour combinations are the star of the show. The Langham, London has also recently opened its very own cookery school, Sauce by The Langham. Tucked away in the heart of the five-star hotel, Sauce’s top-of-the-range kitchen is where trade secrets are shared and the best ingredients are prepared. Classes at Sauce will be interactive, inspiring and, most importantly, fun. The school is a space to create great memories and gain priceless knowledge from leading experts within their field.
LUXURIOUS TREATMENTS For some well-deserved self-care and relaxation, the spa Chuan Body + Soul aims to provide a journey encompassing total wellness, focusing on treatments that nurture, balance and restore. The spa features male and female saunas, steam rooms, a swimming pool and a fully equipped gym with the state-of-the-art ARTIS range of cardio and strength equipment from Technogym. Award-winning skin care from Jacqueline Piotaz Switzerland, is now available for the first time in the UK, exclusively at Chuan Body + Soul at The Langham, London. The range is a combination of natural extracts, with Jacqueline’s family secrets from the Swiss Alps, together with the latest advanced Swiss Bio High Technology. Furthermore, the spa offers a broad selection of Chuan Body + Soul signature treatments based on the principles of Chinese medicine, ranging from massages, body therapies and facials, to foot and nail care.
THE LANGHAM CLUB Finally, the hotel has the city’s most extensive Club Lounge. The Langham Club is an exclusive homeaway-from-home experience that is available to guests in Executive rooms or above, who can access privileges such as complimentary breakfast, canapÊs, all-day refreshments and free-flowing champagne.
1c Portland Place, Regent Street, London GB W1B 1JA T 44 (0) 20 7636 1000 F 44 (0) 20 7323 2340 E tllon.info@langhamhotels.com W langhamhotel.com/london
YOUR STAY IN LONDON
With a plethora of worldclass events and iconic venues, London and its surroundings provide the perfect location for sports fans, whatever the time of year
CAPITAL CITY OF SPORT London is one of the most attractive cities in the world for sports fans, hosting some of the world’s best-known events and boasting numerous iconic and well-appointed venues, offering superb sporting and hospitality experiences. From football to tennis, horse racing to rowing, there are top-class sporting occasions to excite fans of every age.
Football Regarded as the ‘home of football’, England is the country where the first modern set of rules for the game were agreed in 1863, and the sport remains almost a national obsession. Since 1923, the game’s spiritual home has been Wembley. The original stadium was rebuilt and reopened in 2007, becoming the largest stadium in the country and second biggest in Europe, replacing its famous twin towers with an equally iconic arch.
1 Chelsea and Tottenham Hotspur are two of the biggest Premier League clubs in London, offering visiting football fans a memorable matchday experience (PHOTO: STEFAN CONSTANTIN/SHUTTERSTOCK)
124
Wembley is the setting for many of the big occasions that take place annually in English football, including the FA Cup, League Cup, Community Shield and the Football League play-offs. The
England national team also plays the majority of its competitive and friendly matches on Wembley’s hallowed turf. Visitors to Wembley during summer 2021 will also have the opportunity to see matches in the rescheduled UEFA men’s European Championship (Euro 2020) – including group matches, a match from the round of 16, plus the semi-finals and final. England will also stage UEFA Women’s Euro 2021, with Wembley hosting the tournament final. As one might expect of the country’s flagship stadium, Wembley offers some impressive matchday hospitality options. These range from premium seats and exclusive bars to fine-dining experiences and private boxes. London is also home to several Premier League clubs, with teams including some of the biggest stars in world football. The capital’s clubs also provide some of the best football hospitality experiences, and notable among these is Tottenham Hotspur and its new, state-of-the-art
125
YOUR STAY IN LONDON
2
stadium, which is regarded as one of the best in the world. Among the premium matchday packages on offer are private suites, Michelin-calibre restaurant Galvin and the unique Broadcast Booth, which allows guests to watch the big match in the company of a former Spurs star.
3
126
has the additional appeal of a luxury hotel within the stadium complex. Matchday packages include a stay at the Millennium & Copthorne Hotel and dining at its restaurant.
American football
A short distance from Tottenham is the Emirates Stadium – home of Spurs’ north London rivals, Arsenal. Among the premium matchday experiences on offer is Club Level VIP, which includes a prematch reception in the Directors’ Box and five-course a la carte meal, as well as the all-important match seats on the halfway line. The club also offers pre-match dining experiences in its exclusive restaurants.
Both Wembley and the Tottenham Hotspur stadiums also host football of a different kind as the venues for four matches in the annual NFL International Series, featuring several of the top American football teams. The Series first took place in 2007 and, since its inception, has attracted capacity crowds for competitive games that are part of the road to the planet’s biggest individual sporting occasion, the Super Bowl.
In the south-west of the city is Stamford Bridge, the home of Chelsea FC, which
Spectators are guaranteed to witness an entertaining and exciting spectacle,
4
full of the glamour and razzmatazz of the United States’ favourite sport, and featuring some of the world’s finest (and best-paid) athletes in full flight. These family-friendly events often provide fans with the chance to get close to the players for autographs and photos, and there are stalls and shops offering fans American-style food and drink, as well as souvenirs and team merchandise.
In recent years, followers of US sports have also had the opportunity to experience NBA regular-season games at the O2 London, featuring America’s leading basketball stars. Tickets for these events at the 20,000-capacity arena are snapped up quickly by eager fans. The London Stadium, in the Queen Elizabeth Olympic Park, has also played host to Major League baseball games.
2 Wembley is England's largest stadium and the flagship of the Football Association | 3 Hospitality options at London's stadiums include fine dining and exclusive bars (PHOTO: PIT STOCK/ SHUTTERSTOCK) | 4 American sports, including NFL regular-season games, have become a regular fixture of London's sporting calendar (PHOTO: ANDREYKRAV/ISTOCK)
(PHOTO: MITCH GUNN/SHUTTERSTOCK)
127
5
5-6 Lord's and the Oval are London's two major cricket grounds, hosting international matches, domestic finals and county games over the course of the summer (PHOTOS: MITCH GUNN/SHUTTERSTOCK) 6
128
YOUR STAY IN LONDON
7
Cricket Those seeking a somewhat slowerpaced, but no less competitive, sporting experience have many options in London. Cricket devotees can spend the day at one of the capital’s two international cricket grounds, which stage England test matches and top domestic fixtures. Regarded as the home of cricket, Lord’s is situated in the St John’s Wood area of the city and is the home ground of Middlesex County Cricket Club. As well as hosting top-class matches, Lord’s is also home to one of the world’s oldest sporting museums, established in 1864, where the exhibits include the famous Ashes urn, for which England and Australia compete in their Test series. To the south of the River Thames in Kennington, the Oval has been home to Surrey County Cricket Club since it opened in 1845. It was also the first ground in England to host international Test cricket in 1880 and traditionally stages the final Test match of the English season.
Tennis London’s extensive sporting history also includes the world’s oldest tennis tournament, Wimbledon, which is held in early July in the city’s south-western
suburbs. The Championships have been held at the All England Club since 1877 and are the only tournament of the four Grand Slams to be played on grass. The addition of retractable roofs on Centre and Number 1 Courts in recent years has ensured that tennis fans can enjoy action that is virtually uninterrupted by the vagaries of the English summer weather. Also, no Wimbledon experience would be complete without a taste of the tournament’s traditional treat – strawberries and cream! 8
Outside of the Championships fortnight, tennis enthusiasts can enjoy a comprehensive tour of the All England Club, including access to the famous Centre and Number 1 Courts. The tour package also includes a visit to the Wimbledon Lawn Tennis Museum to view the famous tournament trophies and a collection of the sport’s most valuable artefacts. Some of the world’s leading male players can also be seen in grass-court action during the annual ATP tour event at Queen’s Club in West Kensington. This prestigious event takes place in mid June and serves as a pre-Wimbledon warm-up for many of the top names in men’s tennis.
7-8 Tennis fans flock from around the world to visit the All England Club in Wimbledon for a unique sporting experience (PHOTOS: COLDSNOWSTORM/ ISTOCK; ALISON YOUNG/SHUTTERSTOCK)
129
9
Racing The ‘Sport of Kings’ provides some of the best opportunities to enjoy top-class sporting occasions in luxurious surroundings, while enjoying superb hospitality and fine dining, all within in an hour or two’s travelling distance from London. Early summer offers one of the most thrilling events in the racing calendar, as Epsom Downs plays host to the Derby Festival. Held on the first Friday and Saturday of June, the Festival opens with Ladies’ Day, when fashion is at the forefront. Saturday sees the running of Britain’s richest horse race, the Derby, which was first staged in 1780.
10
9 Royal Ascot combines top-class horse racing with the opportunity to enjoy one of the country's most prestigious social occasions (PHOTOS: JOHN BEASLEY/ALAMY)
|
10 Henley Regatta keeps spectators entertained with high-quality rowing events on a scenic stretch of the River Thames (PHOTOS: MITCH GUNN/SHUTTERSTOCK)
130
The Derby meeting is followed soon afterwards by one of the most prestigious dates in the sporting and social calendar – Royal Ascot – a short distance to the west of London. Held in mid June, this unique combination of top-quality
racing, heritage, pageantry and high fashion is attended by Her Majesty the Queen and members of the royal family across all five days of the meeting. Completing racing’s spectacular set of social occasions is the Qatar Goodwood Festival, traditionally known as ‘Glorious Goodwood’, in the south of England. Set among the picturesque surroundings of the South Downs, the West Sussex racecourse stages five days of elite racing, with all the hospitality packages one would expect from such a high-quality event. The first week of July provides a further highlight of the summer social season, when the annual Henley Regatta sees some of the world’s best rowers among the athletes taking to the River Thames in more than 300 races. Taking place over five days, the Regatta attracts thousands of visitors who enjoy restaurants, bars and shopping, as well as the international sport on offer.
Life’s clock is ticking – loudly Naturally, we desire to live healthier and longer! And as life continues its relentless journey – youth fades away and the signs of mortality begin to show. For some, as early as their 30s; for others not till the big 60; for all – sooner or later.
Vitality
Energy
Focus
Concerns about strength and stamina
Levels slowly but certainly decreasing
Sometimes slips and others notice
Is there a solution to this ‘age-old’ problem? Fortunately, there is…
The Whitecalm Wellbeing System
The day will come when we take control of our wellbeing – or the day will certainly come when we wish we had At last, a personally designed programme, sensitively considering:
• Your life and lifestyle
Now, would be a good time to examine how The Whitecalm Wellbeing System works for you…
• Your current health • Your health experiences • Your routines and habits • Your ‘almost indefinable’ uniqueness • Your challenges • Your future wellbeing goals and desires
The Three Essential Points on Your Wellness Journey 1
2
3
Your Starting Point
Your Goal Agreement
Your Wellbeing Journey
A full private and discreet examination of your current health and lifestyle. Tests and assessments by key specialists
A meeting with your personal health coach to fine-tune your sustainable health plan
Maintaining health, prevention strategies, adjusting to progress
• Analysis of your assessments and results
• Gaining immediate and long-
• DNA Health: gene variations associated
with metabolic and biological processes, looking at risk factors for different diseases
• DNA Diet: genes that impact
metabolism, diet and exercise
• Nutrition • Full blood tests • Stress, sleep and recovery review • Home-based, online and private hospital consultations
• Agreeing your short-, medium- and long-term wellbeing goals
• Details of your ongoing support and gaining clarity on actions
term wellbeing improvements
• Vibrancy, zest, radiance • Ongoing monitoring of your physical
and emotional responses to triggers impacting your health – by our worldclass team of health practitioners
• Empowering, transformative lifestyle routines
The Whitecalm Wellbeing Concierge Mission With You – Every Step of the Way Providing a complete concierge service as your partner in your long-term health and wellbeing
• Tracking your lifestyle routines and transforming unhelpful
• Multi-faceted, bespoke health and wellbeing service, designed
• Empowering, tangible and manageable methods to immediately
• Fully and sensitively monitoring every aspect of your physical
• Your Whitecalm Concierge Team accompanies you
around you, your life and your desired outcomes
and emotional responses to the triggers that positively or negatively impact your health
• Constructing your personalised plan, which supports you, your uniqueness and creates immediate and long-term wellbeing benefits
• Your team of world-class health practitioners, healers and nutritionists deliver ongoing expert treatment, therapies and personalised advice
• Collaborating on practical methods fitting with you, your family, your work and social activities
habits into positive rituals
tackle any health challenges you may encounter
throughout your life. They follow your progress and adjust your wellbeing programme to account for your live results, life changes and goal revisions along the way
Your introductory tests taken in your home, private hospital or online are the kick-start to your new health regime. This totally transforms the way you feel, look and live – now, and for years to come. As an individual committed to living life to the full, only you know when the time has come to take yourself forward to the next steps to your lifetime wellbeing goals - especially if this reduces any anxiety about energy levels, appearance or health.
www.whitecalmconcierge.com
The CORE Programme
Here is what is Included for you in your ‘CORE’ Whitecalm Wellbeing Programme. This comprises a suite of initial ‘relevant to you’ tests and assessments, followed by ongoing analysis, consultations and advice Initial Assessments • DNA health test looking at risk factors for cancer, cardiovascular disease and diabetes – carried out in the comfort of your own home • Your ‘Well Person Medical Assessment’ by a private GP at
Fees are only £499 a month + VAT or £5,600 a year + VAT (Plus the costs of your initial tests)
or You can opt for the six-month programme, for only £2,995 + VAT or £550 a month + VAT (Plus the cost of your initial tests)
a top London hospital
• A Vitamin D blood-spot test, carried out in the comfort of your home • Your Holistic Nutritionist (HN) 90-minute consultation to understand your goals, health history and concerns
• Your HN analyses your test results, consults with the GP and produces your Personalised Protocol (see below)
Your Ongoing Wellbeing Programme • Your follow-up consultation with your Holistic Nutritionist is to monitor your nutrition and lifestyle plan progress. This takes place within a couple of weeks of this plan being agreed.
• In a 60-minute consultation, you and your HN discuss your Personalised
• Your dedicated Health Coach works with you to maintain
• Within six weeks you have two further sessions of 45 minutes to ensure
• You also have 3 sessions of 60-minutes with your Health Coach. These
Protocol and agree your plan of action
that you are on track with your protocol
progress to your stated wellbeing and health goals.
will be booked in advance to secure the dates/time you require.
• Access to specialist consultants via the private GP as and when required • You will also be assigned a personal Wellbeing Manager. • Your Wellbeing Manager is your point of Your Personalised Protocol
contact at all times every weekday.
• Your 360 Nutrition and Lifestyle Plan looks at your
• Contact your Wellbeing Manager for any help you
• Your 360 Nutrition and Lifestyle Plan offers a road map on
• Your Wellbeing Manager can order tests, upload results, book
genetics, health history, current status and goals
how to reach your health goals in a safe, effective way
• Your personal Health Coach, working in conjunction with your HN, helps you put your Personal Protocol into practice
• An initial 30-day Nutrition and Lifestyle Recommendation Plan to start your health journey
• An initial 30-day suggested Food Plan • Detailed Shopping List, so you can jump-start your health journey • Recommended supplements to support your nutrition plan
need with your Wellbeing Programme.
appointments and answer questions for you and find information you may need - between your Health Coach sessions.
• You also enjoy Membership to our Private Online Portal where
your results are securely stored. From your secure login you can access reports from your consultants, private GP, health coach and functional nutritionist. You can also track your progress towards the achievement of your health and wellbeing goals.
• Enjoy CORE Member privileged rates at the Whitecalm
handpicked wellbeing hotels globally. And special rates at any Whitecalm wellbeing days in the UK. This applies for you, your family members and selected friends.
The CORE PLUS Programme
Here is what is Included for you in your ‘CORE PLUS’ Whitecalm Wellbeing Programme. This comprises a suite of initial ‘relevant to you’ tests and assessments followed by ongoing analysis, consultations and advice As the ‘CORE’ programme, plus: • These six sessions of 60 minutes with the Health Coach are arranged for mutually suitable dates and times
Additional fee-based services organised by your Wellbeing Manager:
• Access to your Personal Trainer, who will coach you in person (or via the Internet when you’re travelling)
• Access to Whitecalm yoga, mindfulness and meditation teachers
• Access to mental health specialists, if required • Eradicating toxic chemicals: a specialist can
test and analyse the toxic chemicals in your home and provide recommendations for replacement ‘clean, chemical-free’ products that your Wellbeing Manager can order and organise to be delivered to your home
• Your Wellbeing Manager can organise
weekly food shopping, based on your ongoing test results and updated nutrition plan
Fees are only £800 a month + VAT or £8,800 a year + VAT (Plus the costs of your initial tests)
or You can opt for the six-month programme, for only £4,995 + VAT or £845 a month + VAT (Plus the cost of your initial tests)
• Enjoy ‘CORE PLUS’ Member privileged rates at
the Whitecalm handpicked wellbeing hotels globally
• Included for you are three Whitecalm Wellbeing
Days in the UK. Your family and selected friends can also benefit from special rates at these days
www.whitecalmconcierge.com
The ELITE
Programme
Here is what is included for you in your ‘ELITE’ Whitecalm Wellbeing Programme. This comprises a suite of initial ‘relevant to you’ tests and assessments followed by ongoing analysis, consultations and advice Initial Assessments
• DNA, diet and health tests – carried out in the comfort of your own home
• Your Executive Medical Assessment by a private GP at a top London hospital
• A highly qualified phlebotomist
Fees are only £1,690 a month + VAT or £18,900 a year + VAT (Plus the costs of your initial tests)
or You can opt for the six-month programme, for only £9,995 + VAT or £1,995 a month + VAT (Plus the cost of your initial tests)
carries out functional blood tests to include B12, D3 and homocysteine
• Your Holistic Nutritionist (HN) 90-minute consultation covering your holistic health and nutrition
• Your HN analyses your test results, consults
with the GP and produces your Personalised Protocol (see right)
Your Personalised Protocol
• Your 360 Nutrition, Health & Lifestyle Plan, taking consideration of your genetics, health history, current status and goals
• In a 60-minute consultation, you and your HN discuss your
• Your 360 Health Plan provides a clear road map, so you can
• Two follow-up sessions to check that you are on track
• An initial 30-day Lifestyle recommendation, tailored to
• An additional 10 sessions over the remaining 10 months
• An initial 30-day Food Plan
Personalised Protocol and agree your plan of action
with your protocol
• 12 health-coaching sessions over the year to ensure behavioural change – to be taken at convenient times over the year
achieve your goals in the fastest and smoothest way possible
your immediate needs
• Detailed Shopping List, so you can jump-start your health journey • Where necessary, a comprehensive list of recommended supplements
All Whitecalm Wellbeing Concierge services remain subject to our terms and conditions. Services are subject to availability, which may vary. Please note that Whitecalm Wellbeing Concierge is not a substitute for medical advice, and you are advised to seek the advice of your medical practitioner prior to subscribing to our services if you have any medical queries
• Access to specialist consultants via the private GP, as and when required
• You are assigned a personal Wellbeing Manager, who is your point of contact at all times every weekday
• Between your Health Coach sessions, your Wellbeing Manager can order tests, upload results, book appointments and answer questions for you and find information you may need
• You also enjoy Membership to our Private Online Portal,
where you results are securely stored. From your secure login, you can access reports from your consultants, private GP, health coach and Holistic Nutritionist. You can also track your progress towards the achievement of your health and wellbeing goals
• Additional fee-based services organised by your Wellbeing Manager
• Access to your Personal Trainer (PT), who coaches you in person (or
online when you’re travelling). Your Wellbeing Manager liaises with your PT to ensure activities are aligned with your overall goals
• Access to Whitecalm yoga, mindfulness and meditation
teachers. These activities are integrated into your ongoing wellbeing programme and based on your test results
• Access to mental health specialists, if required • Access to global wellbeing travel (including flights) through
a Whitecalm sister company, Whitecalm Signature Wellness Travel and Retreats, which holds an ATOL certificate and has financial failure insurance for your protection
Your Ongoing Wellbeing Programme
• Your follow-up consultation with your Holistic Nutritionist to
monitor your progress with the lifestyle and diet plan. This takes place within a couple of weeks of this plan being agreed
• Your dedicated Health Coach works with you to maintain progress to your stated wellbeing and health goals, focusing on any required behavioural change
• These 12 sessions of 60 minutes with the Health Coach are arranged for mutually suitable dates and times
• Your best results are achieved by working with your Holistic Nutritionist on a regular, ongoing basis
• Where necessary, ongoing investigations to address the underlying causes of any symptoms you may be experiencing. Your protocols will be adjusted and regular contact keeps you accountable and helps you reach your goals as smoothly as possible
• Additional laboratory tests and supplements will be recommended, where necessary
• As an ‘ELITE’ client, you receive regular contact for the first month after the protocol has been created, followed by your Monthly Wellness Check-In for the rest of the year to keep you on track
• A ‘Jet Lag Protocol’ can be organised for you when you travel frequently between time zones
• Eradicating toxic chemicals: a specialist can test and analyse the
toxic chemicals in your home and provide recommendations for replacement ‘clean, chemical-free’ products that your Wellbeing Manager can order and organise to be delivered to your home
• Your Wellbeing Manager integrates your nutrition plan into your travel by phoning ahead to your hotel to ensure you have the food you require, both on arrival and during your stay
• ‘The Detox Kitchen’ menus can be integrated into your nutrition plan by your Wellbeing Manager and delivered to your door
• Your Wellbeing Manager can organise weekly food shopping, based on your ongoing test results and updated nutrition plan
• Enjoy ELITE Member privileged rates at the Whitecalm handpicked wellbeing hotels globally
• Benefit from Whitecalm privileged partner rates for ‘ELITE’
Members only. The products are ‘clean, chemical-free, environmentally friendly’ across our range for body, skin and hair, as well as for the home
• Also included are six Whitecalm Wellbeing Days in the UK. Your family and selected friends can also benefit from special rates at these days
www.whitecalmconcierge.com
Compare our programmes Components
CORE
CORE PLUS
ELITE
Yes
Yes
Yes
Wellperson
Executive
Executive
Only vitamin D blood spot
Only vitamin D blood spot
Full test
Follow-up sessions on the protocol
2
2
2
Health-coaching sessions
3
6
12
Initial assessments DNA diet DNA health Medical assessment Phelbotomist for functional blood tests 90-minute consultation with functional nutritionist Personalised protocol – 360 nutrition and lifestyle plan 60-minute consultation on personalised protocol
Additional sessions with the Holistic Nutritionist
12
30-day food plan Detailed shopping list Recommended supplements to support nutrition plan Access to specialist consultants, when required Personal wellbeing manager Private online portal Additional fee-based services organised for you by your wellbeing manager
CORE
CORE PLUS
ELITE
Personal trainer Yoga, meditation and mindfulness experts Mental-health specialists Global wellbeing travel with selected partners Jet-lag protocol Travel-fit programme Eradicating toxic chemicals at home
Included no extra cost
Organisation of weekly food shopping Privileged rates at Whitecalm handpicked global hotel Privileged partner rates from wellbeing product suppliers Not included, but privileged rates
Three included at no extra cost
Six included at no extra cost
Annual cost exc vat
£5,600
£8,800
£18,900
Monthly cost exc vat
£499
£800
£1,690
Whitecalm wellbeing days included
The Next Step Book your private Wellbeing Assessment with one of our professional Health Coaches. Discover how The Whitecalm Wellbeing System gives you that feeling of being in control of your wellbeing and ongoing health and its impact on every area of your life. You’ll be so pleased that you did.
Book online at: www.whitecalmconcierge.com/contact To book a free consultation with one of our specialists, please email: hello@whitecalmconcierge.com Phone: +44 (0) 20 7971 1000 and speak to our Wellbeing specialists
SHOPPERS’ PARADISE Boasting iconic stores and the world's biggest brand names, London has more than enough to satisfy every shopper
1 Bond Street is the London home of many of the world’s most famous designer fashion brands (PHOTO: RAY LIPSCOMBE/ISTOCK)
If the UK capital’s many tourist attractions are not enough to convince potential visitors to choose London as their destination for healthcare, then its reputation as a magnet for those seeking luxury goods in the finest settings will be highly persuasive. The city offers myriad retail experiences that will satisfy even the most demanding of shoppers. Perhaps the biggest draw for those seeking designer brands is Bond Street, in the heart of the historic Mayfair area of London’s West End, where most of the big names in fashion have their own stores. More than 300 years after its foundation in 1700, Bond Street remains a focal point for the stylish and the wealthy, frequented by celebrities and socialites.
Among the classic fashion brands represented on this avenue dedicated to all things luxurious are Chanel, Dolce & Gabbana, Ralph Lauren, Louis Vuitton and Burberry. Bond Street also plays host to some of the most famous names in jewellery, including Asprey, Cartier, De Beers and Tiffany & Co. For the most individual of high-quality shopping experiences, Bond Street also offers custom-made shopping tours, during which a specialist guide will share their expertise on the retailers, restaurants and hotels in the area. The bespoke, personalised service is an ideal way for the first-time visitor to acquaint themselves with one of London’s most historic and sophisticated districts.
139
YOUR STAY IN LONDON
A session of retail therapy in London wouldn’t be complete without a visit to its department stores
2
Piccadilly arcades
2 Visitors strolling throgh Burlington Arcade can experience the elegance of its 19th-century architecture (PHOTO: TUPUNGATO/ISTOCK)
140
A truly unique retail experience awaits just a short walk from Bond Street, where an interesting aspect of London’s history can be explored in the Piccadilly area. Dating as far back as the 19th century is a small collection of shopping arcades that retain their period charm and feature a selection of exclusive stores, ranging from high-quality clothing retailers to antique dealers.
Among the oldest of these heritage malls is Burlington Arcade, which was opened in 1819 and provided elegant shoppers with a covered walkway to protect them from the elements as they browsed a collection of 72 small shops. The nearby Royal Arcade was built 60 years later and acquired its name after being visited by Queen Victoria. Two more recent examples are the Piccadilly Arcade and Princes Arcade, opened in 1910 and 1933 respectively.
3
Department stores A session of retail therapy in London wouldn’t be complete without a visit to its department stores, many of which are located in the environs of key West End shopping areas Oxford Street and Regent Street. At the Marble Arch end of Oxford Street is Selfridges, which occupies one of the most imposing buildings in central London. As well as a plethora of departments ranging from fashion to food, the store also attracts visitors with its trademark window displays, particularly during the Christmas shopping season. Further along Oxford Street, between Bond Street and Oxford Circus, is a cluster of three more department stores, also offering top-quality fashion and luxury goods – Debenhams, House of Fraser and John Lewis – each of which has been a fixture on this famous shopping thoroughfare for decades. A stone’s
throw from Oxford Circus, just off Regent Street, is a favourite haunt for lovers of high-end clothing, beauty products and homeware – Liberty, which famously occupies a distinctive mock Tudor building constructed in the 1920s. Without doubt the most recognisable of London’s department stores is Harrods, the world-famous emporium located on Brompton Road in Knightsbridge, in the west of the city. A tourist attraction in its own right, the store building dates back to 1849 and is home to 330 departments across seven floors, so Harrods certainly lives up to its motto: omnia omnibus ubique – “all things for all people, everywhere”. As well as being a place to find the world’s top fashion brands, the store is also renowned for its opulent food hall, offering the best in fresh produce and artisan creations, such as speciality breads and patisserie.
4
3 Selfridges department store dominates the Marble Arch end of Oxford Street | 4 A nighttime view of Harrods, which lights up Knightsbridge (PHOTO: KILLERBAYER/ISTOCK)
(PHOTO: AMANDA LEWIS/ISTOCK)
141
YOUR STAY IN LONDON
5 Hatton Garden is the heart of the country’s jewellery trade (PHOTO: NANDO MACHADO/ SHUTTERSTOCK) | 6 Busy Oxford Circus is the meeting point of Oxford Street and Regent Street (PHOTO: WILLY BARTON/SHUTTERSTOCK) | 7 The characterful interior of Liberty (PHOTO: ALENA KRAVCHENKO/SHUTTERSTOCK)
5
6
7
142
8
Bespoke service For those seeking formal wear, there really is one destination to head for in London’s West End – Savile Row, the home of the capital’s most accomplished tailors and numerous designer menswear brands. This modest Mayfair street is the country’s undisputed centre for bespoke, madeto-measure and ready-to-wear suits, and its association with tailoring dates as far back as the beginning of the 17th century. Look out for classic British names in tailoring, such as Gieves & Hawkes, Hardy Amies and Dege & Skinner.
Another London street dedicated to a particular luxury product can be found further east in the Holborn area, close to the capital’s financial district. Hatton Garden is the hub of the city’s jewellery businesses and the centre of the UK’s diamond trade.
8 Savile Row in Mayfair is the traditional home of London’s finest tailors (PHOTO: TUPUNGATO/ISTOCK)
Currently, the street hosts 300 firms from the jewellery industry and 55 shops, making up the country’s largest collection of jewellery retailers. The surrounding area is also well worth a visit for its selection of coffee shops, restaurants and street food stalls in nearby Leather Lane.
143
UNITING TOP HEALTHCARE TALENT AROUND THE GLOBE
As market leaders in permanent healthcare staffing solutions, we are there to support you in finding the right specialists for your organisation. Myse & Vast. The Power People.
MYSE & VAST
THE WINDS OF CHANGE SENSING THAT THE HEALTHCARE STAFFING MARKET WAS IN NEED OF RADICAL CHANGE, MYSE & VAST GROUP COMBINED TWO LEADING SPECIALIST HEALTHCARE PARTNERS TO PROVIDE UNRIVALLED STAFFING SOLUTIONS. VRX Recruitment specialized in executive and senior-level UKexperienced and trained Consultants, and Fidelitas Consulting were experts in sourcing doctors from shortage occupation specialties. Joining forces, we are now able to specialize in finding the doctors that are often impossible to find through traditional advertising methods.
INSTRUMENTAL IN EXPANDING OUR WORKFORCE... THEY HAVE BEEN EXTREMELY HELPFUL IN NARROWING CANDIDATES TO FIT OUR SPECIFIED CRITERIA... WE CONTINUE TO WORK WITH THE GROUP AND WOULD RECOMMEND AS OUR EXPERIENCE HAS BEEN NOTHING BUT POSITIVE, SUPPORTIVE AND PROFESSIONAL WITH ATTENTION TO DETAIL... - ROYAL FREE LONDON NHS FOUNDATION TRUST
How it began...
WHY CHOOSE MYSE & VAST? • Existing network of over 10,000 qualified healthcare professionals within every specialty of medicine • 75% of our active Consultants are on the Specialist Register • 6,500 UK-trained and experienced specialists • Exclusive access to specialist registered UK Consultants and Clinical Leads • Reduction in reliance on temporary labour to reduce costs • Securing senior doctors for clients, allowing for reduction in outstanding gaps and growth opportunities • Tailored head-hunting solutions • 96% retention rate for the first 12 months of employment
"
Staffing levels are at the root of most Trusts’ issues. The closure of critical departments, increased waiting times, decreased morale, overworked substantive doctors, plus temporary doctors earning multiple times more than permanent doctors, add pressure to the situation. Moreover, coupled with a shortage of doctors going through the training routes, it was easy to see why the locum spend on doctors alone exceeded several billion pounds per year. Most staffing companies claim to have a division dedicated to securing permanent staffing, but the reality is that, in a company where temporary labour makes up the majority of the revenue, there is a bias against truly helping to secure permanent staff, as it would have an impact on profits. Understanding the need for change within the industry, Myse & Vast Group are proud to be dedicated to providing only permanent solutions. With our existing UK network of thousands of doctors, we are positioned to be able to provide the highest quality of doctors, whilst saving our clients hundreds of thousands in locum fees per year. Having partnered with the most prestigious Trusts around the country, it is clear from the testimonials why we are a clear choice in sustainable long-term solutions and reduction in costs.
ALL CANDIDATES HAVE BEEN OF A VERY HIGH CALIBRE, WHICH THEREFORE HAS ALLOWED US TO REDUCE RELIANCE ON AGENCY LOCUM DOCTORS.
"
WE HAVE FOUND THEIR SERVICE TO BE PROFESSIONAL, EFFECTIVE AND WITH A GENUINE PASSION FOR HELPING SOLVE THE STAFFING CRISIS - OXFORD UNIVERSITY HOSPITALS NHS TRUST
How does this benefit our private clients? Seen as the pinnacle of worldwide healthcare, the UK is one of the most attractive destinations for patrons, both domestic and foreign, looking for world-class private medical treatment. Private healthcare providers are often held to an extremely high standard. This sets the bar for expectations not only of the quality of care provided by the hospital, but also the seniority and experience of the Consultant physician. Additionally, if there is a shortage of available Consultants, this will naturally result in fewer clinics being run. This, is turn, naturally leads to reduced or missed cash flow. Often our private clients’ expansion plans are hindered due to being unable to secure suitable staffing levels. Working alongside leading private healthcare providers, Myse & Vast Group are suitably qualified to be able to help resolve that issue, even for the most specialized of requirements.
CASE STUDY Myse & Vast Group were approached in early 2018 by a leading London hospital that had experienced an increase in demand for their Paediatric services, but unfortunately lacked the required amount of in-house specialists to fully optimise this new growth. After struggling to recruit Paediatric doctors through their traditional methods of candidate search, we were able to provide them with a shortlist of suitable specialists that matched their exact requirements, including Consultants with experience in Neonatal Medicine and Paediatric Nephrology. Our clients were extremely satisfied with the quality of the candidates and, as a result, have since been able to fulfil demand for the increased business within their Paediatrics department. As a result of the successful recruitment drive within Paediatrics, we have since been asked to provide support in increasing the capacity of their Acute, Emergency Medicine, Geriatrics, Paediatric A&E, Pathology and Radiology departments.
MYSE & VAST For more information on our services, please contact us on +44 (0)20 3971 5409. Alternatively, please visit us at www.myseandvastgroup.com
INDEX OF SPONSORS Advanced Oncotherapy ........................................................................................... 78-85 Bupa Cromwell Hospital ......................................................... 9, 48-51, 61, 66, 69, 151 Cleveland Clinic .......................................................................................................... 20-23 GenesisCare .......................................................................................................... 62-65, 71 Guy's and St Thomas' Private Healthcare ........................................................2, 92-95 HCA Healthcare UK ....................................................................................................52-55 Howard de Walden Estate .........................................................................................12-15 Imperial Private Healthcare.....................................................................................96-101 King Edward VII's Hospital......................................................................................... 72-77 The Langham London .......................................................................................... 120-123 Lexihealth .....................................................................................................................40-43 The London Clinic ......................................................................................................32-39 London Women's Clinic ............................................................................44-47, 110-111 Mayo Clinic ................................................................................................................... 16-19 Myse & Vast .............................................................................................................. 144-149 OneWelbeck ................................................................................................................. 26-31 The Royal Marsden Private Care ............................................................................56-60 UCLH Private Healthcare.......................................................................................102-105 Whitecalm – The Wellbeing Company ............................................................. 131-138
150
No point in sugar coating it The Middle East is the second highest region worldwide to be affected by obesity, with as much as 75% of the population being obese or overweight1. According to data from the World Health Organisation (WHO), obesity rates among adults are exceptionally high in the region, at more than 37% in the UAE, almost 40% in Kuwait and more than 42% in Qatar2.
Weight management services at Bupa Cromwell Hospital At Bupa Cromwell Hospital we take the time to understand the patient’s individual circumstances and work together to help achieve their goals. For some people this will be through having bariatric (weight loss) surgery. For others it may be possible through lifestyle changes or medication. The Weight Management team, led by Consultant Bariatric Surgeon Mr Ahmed Ahmed, is committed to delivering the best care and providing expert, personalised treatment. Patients are given all the information needed to help them make decisions about their future health. Patients are supported by the team throughout their weight loss programme. Additional services such as home visits from a personal trainer or dietitian can be provided. We also offer therapies including pulmonary rehabilitation for people with breathing difficulties and alternative therapies, such as massage. The relationship between obesity and diabetes is now referred to as diabesity. For procedures requiring surgery - our team adopt a near-scarless approach using 2mm incisions as opposed to commonly used 12mm incisions. Post surgery, patients exeperience an immediate improvement in the management of type 2 diabetes. If patients choose to have surgery, they can be confident in the expertise of the consultant team who pay close attention to pre and post operative care. Consultants are supported by experienced bariatric nurses. We also have a paediatric weight loss service and the team offer online consultations with our experts as well as translation services. Our team also runs satellite clinics in the Middle East and Egypt. Patients with weight-related health problems can be reassured that they are being treated in a hospital which provides high quality care through advanced treatment technologies and highly experienced and skilled experts.
To book an appointment to see Mr Ahmed or the weight management team, please call Bupa Cromwell Hospital on +44 (0) 20 7460 5700 or email appointments.team@ cromwellhospital.com
Bupa Cromwell Hospital, 164 – 178 Cromwell Road, London SW5 0TU bupacromwellhospital.com 1 Renewbariatrics.com. (2019). [online] available at: https://renewbariatrics. com/obesity-rank-by-countries/ [Accessed 28 Oct 2019]. 2 Euiperspectives.economist.com. (2019). [online] available at: https://eiuperspectives.economist.com/sites/default/files/ ConfrontingobesityintheMiddleEast_0.pdf [Accessed 28 Oct 2019].
www.senatepublishing.co.uk +44 (0) 20 7723 9825 info@senatepublishing.co.uk
