Dr Ito Clinic

Statement ofPurpose

Published
01/05/2008

Reviewed
30/06/2022

Reviewed by
Kayo Koitabashi

Authorised by
Dr Takashi Ito

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic
Contents
Introduction ............................................................................................................................................ 3
Part 1. The provider’s Details .................................................................................................................. 4
Relevant Qualifications & Experience of Responsible Individual ....................................................... 4
Professional fellowship and Membership of Dr Ito ............................................................................ 4
Part 2. Aims & Objectives ....................................................................................................................... 5
Involvement & Information: ............................................................................................................... 5
Personalised care and Treatment: ...................................................................................................... 5
Safety, Safeguarding and quality: ....................................................................................................... 5
Accountability ..................................................................................................................................... 5
Consistency ......................................................................................................................................... 5
Referral & backup: .............................................................................................................................. 5Part 3. Details of the location ................................................................................................................. 5
The premises and the area around the location ................................................................................. 6Disability Access ............................................................................................................................................ 6

Facilities and equipment at Dr Ito Clinic ............................................................................................. 6The relevant qualifications and experience of the staff ..................................................................... 7
Organisational structure ..................................................................................................................... 7
Patient profiles .............................................................................................................................................. 8Equality .......................................................................................................................................................... 8Children ......................................................................................................................................................... 8

The CQC service type(s) provided at this location .............................................................................. 9Regulated activity(ies) carried on at this location ............................................................................ 10
Treatment & Service Provided .......................................................................................................... 11
Treatments Offered ..................................................................................................................................... 11Part 4. Registered Manager details....................................................................................................... 12
1. Manager’s full name .................................................................................................................... 12
2. Manager’s contact details ............................................................................................................ 12
3. Locations managed by the registered manager at 1 above ......................................................... 12
4. Regulated activity(ies) managed by this manager ....................................................................... 12
5. Locations, regulated activities and job shares ............................................................................. 12

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic
Introduction
At Dr Ito Clinic we recognise our duty of care to our patients to provide a service that;• Involves patients in their care and treatment• provides patient centred care and treatment• provides a safe and effective treatment
This Statement of Purpose sets out the way in which we manage our practice ensuring patient
centred care, safe and high quality service. The Statement of Purpose is drawn up in accordancewith;• the Health and Social Care Act 2008(Regulated Activities) Regulations 2014
• the Care Quality Commission (Registration) Regulations 2009This document states how we implement our policies, procedures and protocols to ensure ourservices are safe and effective.
This information is reviewed at least once a year; the last annual review was June 2022 and no
notifiable amendment was made.
Dr Ito Clinic is an independent healthcare provider, providing a Pain Management service to thewhole population range except children (under the age of 18 years old).
The practice of Dr Ito is to relieve and manage pain with conservative surgical procedures andmedication along with life style choices. He takes a holistic approach to assessment andconsideration of underlying factors caused by other diseases.

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic
Part 1. The provider’s Details
1. Provider’s name and legal status
Full name1

Takashi Ito

CQC provider ID

1-101634276

Legal status1

Individual✓

Partnership

Organisation

2. Provider’s address, including for service of notices and other documents
Business address2

96 Harley Street

Town/cityLondon

CountyPost code

W1G 7HY

Business telephone

020 7637 5560

Electronic mail (email)3t.ito@dritoclinic.co.uk

Relevant Qualifications & Experience of Responsible Individual••••••Dr Takashi Ito M.D. Ph.D.
An Anaesthetist. Specialised in Pain Management
Full UK GMC registration (GMC Ref No. 2876702)
Japanese Qualification: Medical Practitioner and a Pain Management Specialist
Considerable experience of over 30 years medical practicing including;o a “Chief Consultant Anaesthetist” in Japano a “Visiting Professor“ at Cairo University in Egypto a “Director” at Japanese Hospital in the UK
o a single-handed practitioner in the UK
Broad knowledge of all aspects of General Practice, ER, A&E, ICU and Anaesthetics withparticular expertise in Pain Management (Especially Musculoskeletal disorder) making themost of conservative surgical procedure such as Nerve Block Therapy. Special interest in
Chronic Unbearable Pain treatment with Spinal Cord Stimulation.

Professional fellowship and Membership of Dr Ito•
•
•••
•
•

Royal College of Anaesthetics
Royal Society of Medicine
Regional Anaesthesia UK
European society of regional Anaesthesia
Japan society of Pain clinicians
International association of pain study
British Pain SocietyDr Ito Clinic Statement of Purpose
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Dr Ito Clinic•••

Independent Doctors Federation
Faculty of Medical Leadership and Management
Medical Support Union

Part 2. Aims & Objectives
Dr Ito recognises his obligations under the Health and Social Care Act 2008 to have in placeappropriate safeguards and quality assurance arrangements for patients in his care.
In keeping with the aims of the Act – putting patients first and their rights, patient involvement, herecognises the fundamental principles that guide the policies and the procedures in place and uponwhich the day-to-day operation of Dr Ito Clinic will depend.
These key values will ensure that we provide-Involvement & Information:−−−

Patients have clear and accurate information about the Clinic and our procedures. The
information can easily be accessed via our web site (www.dritoclinic.co.uk) or provided with ahard copy.
We provide a clear and transparent pricing policy. The service fee is on our clinic web site and an
estimated fee is advised to the patient at the time of appointment.
Dr Ito always listens to and publishes feedback from patients.

Personalised care and Treatment:
We provide patient centred care and a focus on individual needs.

Safety, Safeguarding and quality:
We always put the safety of patients and delivering a quality service first.

Accountability
Dr Ito is committed to ensure that regulations and standards are complied with. Patients who
receive treatments/services are able to raise any concerns about the care they receive.

Consistency
We provide and maintain appropriate medical facilities to deliver an excellent level of clinical care toall patients in comfortable surroundings.

Referral & backup:
We provide and maintain back–up facilities to ensure the wellbeing of patients in the event of anemergency and ensure procedures are in place for patient transfer to more appropriate medical
facilities if necessary.
Dr Ito Clinic has referral arrangements with The Harley Street Clinic, London Bridge Hospital,
Cromwell Hospital, London Clinic, Professor Nadey Hakim, Portland Hospital and Princess Grace
Hospital.

Part 3. Details of the location

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic
The information below is for location no.:1of a total of:Name of location
CQC Location IDAddress
Postcode

Dr Ito Clinic
1-3099161449
96 Harley Street London
W1G 7HYTelephone
Email020 7637 5560
info@dritoclinic.co.uk

1locations

The premises and the area around the location••Access
Underground:o Oxford Circus (12 minutes' walk)o Baker Street (10 minutes' walk)o Regent’s Park (7 minutes' walk) – step free access NOT available
o Great Portland Street (10 minutes’ walk) – Step free access NOT available
Bus stops: Harley Street(300m)
Car:
No Allocated Parking available
Street parking (pay and display), NCP London Harley Street (6-7 Weymouth Mews)
The clinic is located on the GROUND FLOOR (rear suite)

Disability Access
Dr Ito Clinic is situated on the ground floor. For those who have difficulties with walking, Dr Ito andhis staff assist the patients from the main entrance to the clinic, which has three stairs. A wheelchair
and a portable ramp can be provided. Dr Ito can also offer home visit or refer to a private nonemergency ambulance service if necessary.
Since a disabled toilet facility is NOT available at the premises, Dr ITO Clinic “Environment Risk
Assessment Disable Discrimination Act Compliance” outlines our duty to inform the patients onToilet facility conditions at the time of making an appointment.

Facilities and equipment at Dr Ito Clinic
Facilities at Dr Ito Clinic and 96 Harley Street Building include:
Communal• Shared Reception Area with helpful staff• Shared Large Waiting Room
• 2 Toilets (NOT disabled toilet)• Portable wheelchair ramp
Dr Ito Clinic• Private Consultation Roomo Hand wash basin
o Ultrasoundo Couch bedo AED
o Medicine shelfo Medicine fridgeo Office furniture• Treatment/Recovery Roomo Emergency Cart

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic•o Monitoro Suctiono Oxygen supply
o Couch bedo Hand wash basino Clinical and sharp waste binso Disposable surgical instruments
Office, hallway, receptiono Stationary
o Office furnitureo IT facilitieso Fire extinguisherso Wheelchair

The relevant qualifications and experience of the staff••••

Dr Ito is a “Single-Handed Practitioner” at Dr Ito Clinic (please see part 1 for his qualificationsand experience).
Dr Ito employs a general admin manager, a healthcare assistant and an administrator on afull time basis.
The reception is shared with other residents and services in the building and are provided
and managed by the landlord.
Dr Ito can provide a female chaperone to meet a patient’s needs.

Organisational structure
Dr Ito Clinic is a private medical practice with a Single-Handed Practitioner, Dr Takashi Ito. Dr Ito
employs a general admin manager and two healthcare assistants.

Dr ITO Clinic

Dr T. Ito

Employees- General Adminmanager- Healthcare Assistants(Female)Contractor-Medical Legal Advisor(ad-hoc)-Accountant

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic
CQC service user bands
Adults aged 18-65✓

Mental health
Physical disability✓

Adults aged 65+✓

Sensory impairment✓

People detained under the Mental Health Act

Dementia

People who misuse drugs or alcohol

People with an eating disorder

Learning difficulties or autistic disorderChildren aged 0 – 3 years

Children aged 4-12

The whole population

Other (please specify below)

Children aged 13-18

Patient profiles− The patient profile is diverse and ranges from the patients who seek consultation for their ongoing dull pain to the serious pain.
− Majority of the patients are expected to be Japanese (expatriates, their spouses, students,tourists and residents in UK, EU and Middle East etc.) who would feel more comfortable to betreated by a Japanese doctor and the rest are the general public who seek treatment for pain
management/control.
− Most of the patients are self-referral and some are referred by other Japanese doctors orprofessionals.
− Dr Ito does not treat children (under the age 18 years old.)− The patients are seen on an appointment basis.
Equality
Dr Ito Clinic can assure 100% not to discriminate against age, race, religion, gender, disability orsexuality.
There are no circumstances where race or cultural circumstances would cause Dr Ito Clinic to refuse
treatment, however, language can form a barrier to understanding that may compromise theindividual’s ability to provide the informed consent necessary. In this case Dr Ito clinic will arrange an
outside source for translation during consultation where necessary.
Children
Dr Ito Clinic does NOT treat or see children and adolescents.
Patients are requested NOT to bring his/her children to the clinic. The arrangement is requested at
the time of making an appointment.

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Dr Ito Clinic
The CQC service type(s) provided at this location
Acute services (ACS)
Prison healthcare services (PHS)
Hospital services for people with mental health needs, learning disabilities, andproblems with substance misuse (MLS)
Hospice services (HPS)
Rehabilitation services (RHS)✓Long-term conditions services (LTC)
Residential substance misuse treatment and/or rehabilitation service (RSM)Hyperbaric chamber (HBC)
Community healthcare service (CHC)
Community-based services for people with mental health needs (MHC)
Community-based services for people with a learning disability (LDC)
Community-based services for people who misuse substances (SMC)
Urgent care services (UCS)
Doctors consultation service (DCS)✓

Doctors treatment service (DTS)✓

Mobile doctor service (MBS)
Dental service (DEN)
Diagnostic and or screening service (DSS)✓Care home service without nursing (CHS)
Care home service with nursing (CHN)
Specialist college service (SPC)
Domiciliary care service (DCC)
Supported living service (SLS)
Shared Lives (SHL)
Extra Care housing services (EXC)
Ambulance service (AMB)
Remote clinical advice service (RCA)
Blood and Transplant service (BTS)Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic
Regulated activity(ies) carried on at this location
Personal care
Registered Manager(s) for this regulated activity:

Accommodation for persons who require nursing or personal care
Registered Manager(s) for this regulated activity:

Accommodation for persons who require treatment for substance abuse
Registered Manager(s) for this regulated activity:

Accommodation and nursing or personal care in the further education sector
Registered Manager(s) for this regulated activity:✓Treatment of disease, disorder or injury
Registered Manager(s) for this regulated activity: Takashi Ito

Assessment or medical treatment for persons detained under the Mental Health Act
Registered Manager(s) for this regulated activity:

Surgical procedures✓Registered Manager(s) for this regulated activity: Takashi Ito

Diagnostic and screening procedures✓

Registered Manager(s) for this regulated activity: Takashi Ito

Management of supply of blood and blood derived products etc
Registered Manager(s) for this regulated activity:

Transport services, triage and medical advice provided remotely
Registered Manager(s) for this regulated activity:

Maternity and midwifery services
Registered Manager(s) for this regulated activity:

Termination of pregnancies
Registered Manager(s) for this regulated activity:

Services in slimming clinics
Registered Manager(s) for this regulated activity:

Nursing care
Registered Manager(s) for this regulated activity:

Family planning service
Registered Manager(s) for this regulated activity:

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic

Treatment & Service Provided
Dr Ito provides private medical services to patients for the management and relief of their pain. This
includes assessment and diagnosis as well as treatment plans.
Patients are seen in a private consulting room and the treatments carried out in a separate
treatment room to ensure their privacy and dignity are maintained in comfortable surroundings. The
patients are always kept informed regarding the arrangements of their consultations via
appointment email and also throughout their visit.
Some diagnostics tests such as X-Ray and MRI are carried out in other nearby facilities; 108 Harley
Street, London Imaging Centre and the Princess Grace Hospital. The facilities in above locations are
suitable for disabled and less able people.

Treatments Offered
Investigations− Blood and Urine and Pathology services (by The London Clinic Pathology Dep.)− Ultrasound, ECG− X-ray, Chest X-ray, Echocardiogram, CT scans, MRI and MRA (MR Angiography) test can bescheduled at Princess Grace Hospital, 30 Devonshire Street, 108 Harley Street or at London
Imaging Centre, 11-12 Wimpole Street.
Pain Management Consultations− Lower back pain
− Limb pain and/ or a sense of numbness such as Sciatic Neuralgia− Frozen shoulder and shoulder pain
− Neck pain and/or Arm pain/numbness− A complex regional pain syndrome (CRPS) such as so-called Phantom Pain
− Herpes Zoster and painful peripheral vascular disease− Sudden hearing loss
− Headache− Any kinds of neuralgia− Fractures, Dislocations and Sprains− Alleviating pain from skin problems such as Skin/ Subcutaneous infections
Treatment OfferedRegional Nerves Block Injection− Nerve blocks: regional nerve blocks including Epidural injection− Most of the Peripheral nerve blocks− Joint injections including Facet joint, Knee joint, Shoulder joint injection− Trigger point injection− Epidural injections/block− Caudal injection/block− Intra-venous sympathetic nerve block for CRPS
Wound Care Treatment to control/manage pain
Medical and pharmaceutical treatment of pain management
Dr ITO Clinic provides medicines; such as painkillers, muscle relaxants to control/manage pain;

Dr Ito Clinic Statement of Purpose
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Dr Ito Clinic
Part 4. Registered Manager details
The information below is formanager number:

1of a total of:

1Managers working for the provider
shown in part 1

1. Manager’s full nameTakashi Ito

2. Manager’s contact details
Business address
Town/city

96 Harley StreetLondon

CountyPost code

W1G 7HY

Business telephone
Manager’s email address

020 7637 5560
1

t.ito@dritoclinic.co.uk

3. Locations managed by the registered manager at 1 above
Name(s) of location(s) (list)
Dr Ito Clinic, 96 Harley Street London W1G 7HY

Percentage of timespent at this location
100%

4. Regulated activity(ies) managed by this managerPersonal care
Accommodation for persons who require nursing or personal care
Accommodation for persons who require treatment for substance abuse
Accommodation and nursing or personal care in the further education sector
Treatment of disease, disorder or injury✓

Assessment or medical treatment for persons detained under the Mental Health Act
Surgical procedures✓Diagnostic and screening procedures✓Management of supply of blood and blood derived products etc
Transport services, triage and medical advice provided remotely
Maternity and midwifery services
Termination of pregnancies
Services in slimming clinicsNursing care
Family planning service

5. Locations, regulated activities and job shares
Where this manager does not manage all of the regulated activities ticked / checked at 4 above at all of
the locations listed at 3 above, please describe which regulated activities they manage at whichlocations below.
Please also describe below any job share arrangements that include or affect this manager.
n/a

Dr Ito Clinic Statement of Purpose
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