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The Hyperbaric Medical Centre - Plymouth (DDRC)

We are carrying out checks at The Hyperbaric Medical Centre - Plymouth (DDRC) using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Updated 8 February 2018

The Hyperbaric Medical Centre – Plymouth is operated by DDRC Healthcare. The facility has been operating in its current location since 1996.

The service provides hyperbaric oxygen therapy to patients with a range of conditions, including diving emergencies, complex wounds and those suffering from complications due to radiation treatment. Hyperbaric Oxygen (HBO) therapy is a means of providing additional oxygen to body tissues. During HBO treatment the patient breathes high levels of oxygen, usually through a hood or mask, whilst inside a pressurised chamber.

There are four hyperbaric chambers and nine clinical assessment, treatment and consulting rooms.

Most patients are from the South West, but some patients are from other regions. All NHS-funded patients have either been referred by a specialist consultant or attend as an emergency patient with decompression illness, a life-threatening condition usually affecting divers during which dissolved gases form gas embolisms inside the body. Emergency patients are assessed by a doctor prior to treatment.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 31st October 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services:

  • Are they safe?
  • Are they effective?
  • Are they caring?
  • Are they responsive to people's needs?
  • Are they well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We regulate hyperbaric oxygen therapy services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • The patients were put at the centre of care and their individual needs were met.
  • All areas of the facility were clean and well maintained.

  • Health and Safety procedures were robust.
  • The consent process was thorough and well-documented.
  • Patients received compassionate care and staff were respectful and professional.
  • There was a strong focus on audit, research and improvement.
  • Children and vulnerable adults were protected from abuse through clear reporting processes.
  • The service worked closely with local acute NHS Trusts and specialist services. They also collaborated well with the wider hyperbaric and research communities.
  • There was a good working culture and respect between work colleagues and towards managers.
  • Staff received ample training opportunities and professional development was encouraged and supported.
  • Communication was very effective and staff had the opportunity to contribute thoughts and ideas to the organisation.
  • There was a desire to improve and the organisation responded well to incidents and feedback.
  • Leadership at the service was strong and their vision and strategy was well-defined.

However, we also found the following issues that the service provider needs to improve:

  • There was no framework provided for assessing the level of harm caused by an incident. This was needed to ensure that the service was identifying incidents that met the criteria of a serious incident and managed them appropriately.
  • There was lack of clarity around the methodology used for investigation of serious incidents.
  • Drug allergies were sometimes not recorded on the patient’s drug charts.
  • Some employees had not received an annual appraisal.
  • The service did not give clear information to service users about where to go if their complaint was not resolved to their satisfaction.
  • The service did not actively promote its organisational values to the staff or service users.
  • Some non-clinical staff had not received safeguarding training.
  • The service did not have an organisational risk register through which senior managers and trustees could gain assurance that appropriate controls were in place to minimise risks to service delivery.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Amanda Stanford

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Inspection areas

Safe

Updated 8 February 2018

We do not currently have a legal duty to rate hyperbaric oxygen therapy services where these services are provided as an independent healthcare single speciality service.

We found the following areas of good practice:

  • The service had robust quality management systems in place.
  • Incident reporting was encouraged which led to a culture of openness and transparency in which the service can continuously improve.
  • Improvement logs were widely discussed and actions were taken to improve services following adverse events.
  • Protocols were in place and followed to prevent the spread of infection.
  • Staff were trained in the safeguarding of adults and children and effective procedures were in place.
  • Effective systems were in place for the testing and maintenance of the service’s equipment.
  • The service kept the risk of fire to a minimum and had effective procedures in place to respond to a fire.
  • Staff complied with the systems in place to protect themselves and the public from the risks of the hazardous environment.
  • The service was well-staffed and equipped to respond to patient needs.
  • Medicines were managed safely and in a way that met the needs of patients.
  • Patient records were completed to a high standard.
  • The service had provided the necessary training for staff to meet the requirements of their role. This enabled safe and high quality care.
  • The medical team ensured that patients received prompt attention if their condition changed.
  • The service had put appropriate plans in place to respond to changes in the patient’s condition.
  • Patients were carefully assessed and monitored when receiving treatment.
  • An effective 24 hour service was provided for emergency patients including telephone advice.

However, we also found the following issues that the service provider needs to improve:

  • There was no framework provided for assessing the level of harm caused by an incident. This was needed to ensure that the service was identifying incidents that met the criteria of a notifiable patient safety and managing them appropriately.
  • There was lack of clarity over the methodology the service intended to use for the investigation of serious incidents and how it was ensured that Serious incidents received an appropriate level of investigation.
  • Drug allergies were sometimes not recorded on the patient’s drug charts.
  • Some non-clinical staff had not received safeguarding training. 

Effective

Updated 8 February 2018

We do not currently have a legal duty to rate hyperbaric oxygen therapy services where these services are provided as an independent healthcare single speciality service.

We found the following areas of good practice:

  • Relevant and current evidence was used to develop services and care.
  • All staff were competent and well-qualified in their role and patients benefited from additional skills and knowledge that staff were continually encouraged to gain.
  • Staff worked closely with each other and communicated well to keep patients safe.
  • The service worked very closely with the local hospitals and specialist teams to ensure that patients were kept safe and moved between services in a way that ensured continuity of care.
  • There were effective systems of record keeping.
  • Patient outcomes were monitored and benchmarked against other HBO care providers.
  • Patient’s rights were protected under the Mental Capacity Act (2005).

However, we also found the following issue that the service provider needs to improve:

  • Some staff had not received an appraisal in the last 12 months.

Caring

Updated 8 February 2018

We do not currently have a legal duty to rate hyperbaric oxygen therapy services where these services are provided as an independent healthcare single speciality service.

We found the following areas of good practice:

  • Feedback from patients was overwhelmingly positive. They found that staff were helpful, friendly and professional.
  • The staff put patients at the centre of their care. Staff took a holistic approach to care and gave the patient their time and attention.
  • The service looked after those close to the patient, for example relatives and carers, and recognised that social and cultural circumstances were important to the plan of care.
  • Patients were given detailed information about what HBO therapy is, in order that they were prepared.
  • Staff were reassuring to patients and provided extra support if needed during their treatment. DDRC Healthcare paid attention to giving the patient a positive experience during their time with the service.

Responsive

Updated 8 February 2018

We do not currently have a legal duty to rate hyperbaric oxygen therapy services where these services are provided as an independent healthcare single speciality service.

We found the following areas of good practice:

  • The service provided HBO that met the needs of the local population.
  • The service provided a prompt and effective 24 hour service, including an out of hour’s response for emergency patients needing HBO and a telephone advice-line for diving emergencies.
  • The service worked closely with the local acute NHS trusts to ensure that the ongoing medical needs of the patient could be met, even when from other regions.
  • The service provided hyperbaric therapy for patients who were privately funded and involved with clinical trials for a broader range of conditions.
  • The service individually tailored treatment to meet patient’s individual needs and social circumstances.
  • The service responded well to the feedback it received from patients, seeking opportunities to improve the service where possible.

However, we also found the following issue that the service provider needs to improve:

  • The service was not clear with patients about where to go if their complaint was not resolved to their satisfaction.

Well-led

Updated 8 February 2018

We do not currently have a legal duty to rate hyperbaric oxygen therapy services where these services are provided as an independent healthcare single speciality service.

We found the following areas of good practice:

  • Managers were visible and approachable. Staff were well-supported in their roles and spoke highly of the leadership culture.
  • We saw a very friendly and respectful working environment. All staff we encountered were happy in their roles and spoke positively about their work and each other. Patient feedback suggested that this improved the care experience for patients.
  • There were clear systems of governance in place that focused on quality and safety.
  • There was a strong vision and strategy for the service and this was shared by the trustees, senior managers and staff. There were robust plans for the future which is likely to improve its sustainability.
  • DDRC Healthcare invested in its staff. They provided a culture where learning and achievement was encouraged and staff were supported to develop in their roles.
  • There was a commitment to building strong partnerships within the healthcare, academic and research communities.
  • There were effective risk and quality management systems in place which meant that there were opportunities to improve the quality of care.

However, we also found the following issues that the service provider needs to improve:

  • DDRC did not actively promote its organisational values to the staff or service users. These can form the culture and principles of an organisation and shape its identity as an employer and care provider.
Checks on specific services

Hyperbaric Therapy Services

Updated 8 February 2018

DDRC Healthcare provide HBO therapy as their main service. We do not have a legal duty to rate this service, but we highlight areas of good practice and areas that the service need to improve.