Archived: The Hospital Group - Newcastle Clinic

Updated 18 October 2016

We carried out an unannounced focussed inspection on 2 August 2016. The inspection team consisted of two CQC inspectors and a GP specialist advisor. As no clinical staff were available at the Newcastle Clinic on the 2 August 2016 a CQC inspector carried out a further visit on the 10 August 2016.

To get to the heart of patients’ experiences of care and treatment, we usually ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

Although these questions inform the framework for the areas we look at during the inspection the unannounced inspection carried out on 2 and 10 August 2016 focussed on the safe and well-led domains.

Updated 18 October 2016

We carried out an unannounced responsive focussed inspection on 2 and 10 August 2016 to establish whether services delivered by the The Hospital Group - Newcastle Clinic were safe and well-led.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 following concerns around post-operative care.

The Hospital Group Newcastle Clinic is based on the outskirts of Newcastle City Centre. There are good public transport links within the area and railway and Metro underground stations are located within short walking distance of the clinic. Car parking is available nearby.

The Hospital Group operates from 16 different clinics across England which are used for initial consultations between patients and surgeons as well as post-operative care. The location at Newcastle provides consultation for cosmetic, weight loss and dental surgical procedures, pre-operative assessment and post-operative care. Surgery is not carried out at the the Newcastle clinic. All surgical procedures are carried out Dolan Park Hospital, Bromsgrove, Birmingham.

This service is registered with CQC under the Health and Social Care Act 2008 to provide diagnostic and screening procedures, surgical procedures and for the treatment of disease, disorder or injury. At The Hospital Group – Newcastle Clinic the aesthetic cosmetic treatments that are also provided are exempt by law from CQC regulation.Therefore we were only able to inspect the processes associated with cosmetic, weight loss and dental surgical procedures.

There are seven members of staff working regularly at the clinic, including a clinic manager/patient care co-ordinator, a dental/non-surgical procedure advisor, a clinic nurse, a dental nurse and receptionists. Surgeons and dentists who have practicing privileges with the Group visit the clinic as and when necessary dependent on patient need.

The clinic manager/patient care co-ordinator is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered Providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The clinic is open from 9am to 7pm on a Monday to Friday and on occasional Saturdays and Sundays. The Hospital Group telephone contact centre is open from 8.30am to 7.30pm on a Monday to Friday and from 10am to 4pm on a Saturday and Sunday.

As this was an unannounced inspection we did not canvass any patients for feedback in advance of, or during the inspection.

Our key findings were:

• The Hospital Group – Newcastle Clinic had an incident reporting policy and procedure which was accessible to staff on the Provider’s intranet system. However, there was no local oversight or analysis of significant events or incidents or of identifying trends and themes or lessons learned following incidents.
• The Hospital Group policy for reporting incidents included the categorisation of clinical incidents. However, the Newcastle Clinic was not recording post-operative complications or infections as incidents
• The Provider had a complaints policy which was also available to all staff on their intranet system. However, details of how to make a complaint were not advertised in the Clinic or in the patient information booklet and were difficult to find on the website. There was no local oversight of complaints received regarding the Clinic.
• Recruitment arrangements for staff were in line with recommended guidance. References, proof of identify and poof of qualifications, where necessary, had been sought.
• Staff had not undertaken recommended mandatory training. For example not all staff had undertaken infection control, basic life support, safeguarding, health and safety or fire safety training. Records for staff who had undertaken this training showed that they had not received refresher training within expected timeframes.
• Chaperones were available if requested. The registered manager and clinic nurse acted as chaperones and both had undergone Disclosure and Barring Service (DBS) checks. However, the registered manager had not received any specific chaperone training.
• Arrangements to gain and record patient consent were in place. The Newcastle Clinic had a system in place to ensure that relevant information in pre surgery assessment questionnaires was followed up with relevant medical professionals.
• The clinic generally had satisfactory arrangements in place for post-operative follow up and care. However, we were concerned that there may be some delay should a patient require a prescription following surgery for post-operative complications or infections as these had to be issued, by post, from head office.
• The Newcastle Clinic had a supply of emergency medicines and equipment. However staff members had not been trained in how to administer emergency medicines.
• The premises were clean and regular deep cleans and cleaning audits were completed. However, Legionella tests on the premises had not been carried out nor was there a risk assessment as to why not.
• Infection control audits were carried out on an annual basis and action points identified. However, there was no evidence to show action had been taken to address the points identified.

We identified regulations that were not being met and the Provider must:

• Ensure that there is local oversight, recording and monitoring of significant events and incidents and lessons learned from them.
• Ensure that all clinical incidents such as post-operative infections or complications are recorded as incidents in line with the Provider’s incident reporting policy
• Ensure staff receive training in basic life support, infection control, health and safety, fire safety, and adult safeguarding
• Ensure relevant staff are trained in the administration of emergency medicines
• Ensure staff acting as chaperones receive appropriate chaperone training
• Ensure that the registered manager is involved in the day to day running of the Newcastle Clinic and in assessing risks to the health and safety of patients receiving care and treatment to ensure compliance with the Health and Social Care Act 2008 and associated regulations

You can see full details of the regulations not being met at the end of this report.

There were areas where the Provider should make improvements. The provider should:

• Review premises management arrangements and ensure that legionella testing is carried out or a risk assessment recorded detailing why this is not felt to be necessary.
• Review the process of issuing prescriptions for post-operative patients to ensure there is no delay in treatment for any post-operative complications or infections
• Review the complaints process so that there is local involvement in the analysis of trends, themes and lessons learned.
• Ensure that information for patients on how to make a complaint is readily available in the clinic waiting room and more transparent on the group website.
• Introduce a procedure so staff are aware of when and how to refer patients experiencing post-operative complications to their GP, or to a local hospital if necessary.

• Introduce a local procedure for monitoring staff training requirements and renewal/update dates
• Hold formal, minuted staff meetings where issues such as learning from significant events, incidents and complaints are discussed.