Highfield ENT Clinic

Highfield ENT Clinic is operated by Widnes Highfield Health Ltd. The service holds a contract with Warrington and Halton NHS Trust to provide an ear, nose and throat service. The service employs two ear care nurses that provide nurse led clinics during the week, and one health care assistant. There are two consultant led clinics provided two days per week, and the consultants are employed by Warrington and Halton NHS Trust. The service takes referrals from GPs and aims to see patients within two weeks of referral. The service accepts both adults and children, however the numbers of children seen are low.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit on 4 March 2019. The consultants were not providing clinics on the day of inspection, and there was one ear care nurse on duty. We spoke to the ear care nurse, health care assistant, administrative staff and the registered manager. We spoke to three patients who attended the clinic.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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

Services we rate

The service has not previously been inspected or rated.

We found the following areas of good practice:

• The service provided a wide range of mandatory training and had systems in place to ensure this was completed.

• Staff understood their safeguarding responsibilities and information was shared during team meetings and on the staff bulletin.

• The service used an electronic system for patient records which meant staff, patients and GPs had access to important information when they needed it.

• There were enough staff who were competent in their roles and had good support and mentoring from managers.

• Staff treated patients with compassion and patients’ dignity and privacy was respected.

• The service established good links with the local area to help plan the service to meet the needs of local people.

• The service had clear admission and exclusion criteria.

• The service could offer patients an appointment within one to two weeks of referral and patients did not have to wait long in the waiting area.

We found the following issues that the service provider needs to improve:

• There was not always a suitable clean space for cleaning used equipment. This could pose a risk to the spread of infection. The service amended this immediately.
• Paper records were not always completed in line with best practice guidance. This was because entries were not always signed by the person making the entry which was not in line with the Royal College of Physicians record keeping standards 2015.
• The consent policy was not in line with general medical council guidance, putting both patients and staff at risk of not having proper discussions about treatment or documenting consent. It is important for patients to be fully informed of the associated benefits and risks, before agreeing to treatment. However, when we discussed this with managers the service amended the policy immediately.
• Although the provider had a duty of candour policy this did not fully meet national guidance or legislation as it did not outline the relevant person should be notified of a moderate harm safety incident in writing.
• The service did not monitor outcomes of care and treatment. This meant the service missed opportunities to identify where the service could improve.
• The service did not have a system to highlight individual needs such as whether a patient had a sensory impairment or disability. The service was reliant on the GP referral form for information. This meant the service may not effectively plan for and meet the individual needs of patients.

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. We also issued the provider with three requirement notice(s). Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals