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Inspection Summary


Overall summary & rating

Good

Updated 8 February 2017

The Whiteley Clinic, Bristol is operated by The Whiteley Clinic Ltd. which is an organisation consisting of clinics in three locations across England. The Whiteley Clinic, Bristol was governed by and follows protocols of The Whiteley Clinic Ltd. The Bristol clinic has no inpatient beds. Facilities include one operating theatre, a waiting/recovery room, a consultation room and a room used for ultrasound screening.

The service provides outpatients and diagnostic imaging in order to perform minimally invasive surgery for vascular conditions. We inspected outpatients and diagnostic imaging and day case surgery.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 October 2016.

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.

The main service provided by this service was outpatients and diagnostic imaging.

We rated this clinic as Good.

We found areas of outstanding practise within outpatients and diagnostic imaging service

  • The Bristol clinic was committed to providing a positive experience for patients with effective treatment for vascular conditions.

  • All incidents, comments and complaints were reported and investigated by the Bristol Clinic. Staff used all opportunities to provide learning and shared the outcomes with staff in each of the other two Whiteley clinics. Bristol clinic staff were always looking for ways to improve outcomes and experiences for patients. Any change in practice that could improve the experience for patients was trialled as soon as possible.

  • The Whiteley Clinic Ltd. was instrumental in creating a national database of outcomes for vascular surgery techniques and all staff at the Bristol clinic were aware of their contribution.

  • Staff were competent in their roles. Staff attended training and were fully supported to attend courses that would increase their skills. Staff performance was monitored and support was provided in a sensitive way for staff to improve in areas where they did not feel confident.

  • Patients were fully involved in decision making about their treatment, were informed of payment options and supported to provide relevant information to insurance companies.

  • Staff took time to get to know their patients, recognised patient anxiety and worked to ensure patients felt as comfortable as they could.

  • Staffing was managed in a way that ensured patients were cared for safely.

  • The vision for The Whiteley Clinic Ltd. was shared with Bristol clinic staff who found senior managers and executives visible and approachable.

We found areas of good practice in relation to outpatient and diagnostic imaging:

  • Processes were used that kept patients free from avoidable harm.

  • Infection prevention and control processes were monitored and improvement actions were taken when necessary.

  • Patient records were kept securely and were available for patient consultations.

  • GPs were kept informed of procedures performed on their patients.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service to improve. Details are at the end of the report and are regarding processes for ensuring accurate medicine administration and more secure transportation of patient records.

Professor Ted Baker

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 8 February 2017

We rated safe as good because:

  • Staff followed the principles of duty of candour, were open about incidents and made patient safety a priority. All incidents were investigated and learning from each was shared with staff across all of the Whiteley clinics. The team discussed unexpected patient outcomes in order to identify more effective treatments for complex conditions.

  • Equipment was serviced and maintained to ensure it was safe to use. Staff followed cleaning schedules and were aware of their own responsibilities for equipment they used. Audits of hygiene standards, including hand hygiene, were carried out to ensure any risks to patients were minimised. Staff followed recommended processes when using laser equipment to ensure there was minimal risk to patients and staff.

  • The clinic monitored the incidence of infections and had reported none for the 12 months before our inspection.

  • Nursing staff used safe practices for the delivery, storage and administration of medicines, which met the Nursing and Midwifery Council Standards for medicine management.

  • The clinic kept patient records confidential. However, these were in paper loose leaf folders. There was a potential risk that the paper record could fall out of the folder although there had been no incidents of lost records reported. There were no occasions when up to date records were unavailable for a patient’s appointment. A trial of electronic patient records was planned for November, 2016. This would reduce the risk of losing paper records, increase security, transport and availability of records across The Whiteley Clinic Ltd. locations.

  • All staff assessed risks and acted appropriately to minimise the risk to patients and staff. Patients had their medical condition assessed to ensure the clinic was a suitable place for them to receive treatment. Patients had local anaesthetic during their procedure which allowed them to be mobile as soon as possible. This reduced the risks associated with hospital stays.

  • All staff were up to date with their mandatory training ensuring they were using the most up to date practices including infection control, lifting and handling and basic life support. The clinic did not see people under the age of 18 years but staff who were in contact with adult patients had undertaken safeguarding children and young people training. This was to ensure they would be able to recognise and report concerns about any children who accompanied their parents to the clinic.

  • Specialist advice was available for patients following their procedure and any queries were responded to promptly.

Effective

Not sufficient evidence to rate

Updated 8 February 2017

We inspected the effectiveness of the service but do not have enough information to rate it.

We found the following areas of good practice:

  • There was no national database to record long term outcome measures for patients following vascular surgery. The Whiteley Clinic was taking steps to create a database for organisations to contribute their patient outcomes. The clinic was measuring outcomes from patients it treated and using success measures from international organisations. The clinic was undertaking research projects wherever possible to ensure methods they used were effective. Their protocols for treatment of vascular conditions followed national guidelines (National Institute of Health and Care Excellence) where they were available.

  • Staff used audit processes to monitor the effectiveness of other areas of practise in the Bristol clinic. This included infection control, record keeping and compliance with using the World Health Organisation’s checklist for safer surgery. Action plans were developed following any audit and steps were taken to improve results that were less than 100%.

  • During their procedure patients had their pain assessed, monitored and controlled. Patients told us their pain was kept under control

  • Staff attended training to ensure they were competent to perform their roles. This included ensuring those who needed practising privileges (authorisation to practise at the Whiteley Clinic Bristol from the senior executives) had met the criteria in the policy. For example, engaged in appraisal processes, were up to date with mandatory training, had relevant and recent surgical experience. Staff were encouraged to undertake further training to develop their skills and this was fully supported by the Whiteley Clinic Bristol. A member of unregistered nursing staff was completing a National Vocational Qualification (NVQ) and another was taking part in advanced training on infection control.

  • Staff ensured that documented patient consent was current and were aware of actions they should take if a patient changed their mind or if they became confused.

  • The team of nursing staff, sonographers, medical staff and managers worked together to help the patients’ appointments go as smoothly as possible. The Bristol clinic informed GPs of a patient’s attendance in a timely way.

Caring

Good

Updated 8 February 2017

We rated caring as good because:

  • Overall patients said staff at the Bristol clinic demonstrated compassionate care when treating patients. Patients told us they were treated as individuals and one patient stated “all of my needs were responded to”. Patients were treated with dignity and respect.

  • Patients were involved in making decisions about their treatment options. Staff ensured that patients understood their treatment options by discussion and providing further information in written format. Patient feedback was encouraged and surveys produced for the Bristol clinic showed a high level of patient satisfaction. 100% Rated their overall treatment as good to excellent.

  • Staff supported emotional needs of patients by using a variety of techniques to relieve anxiety. This included engaging patients in conversation, using music and stress balls. Relatives who accompanied patients were looked after and kept informed of progress of the procedure. They were provided with refreshments for the duration of their stay. In some cases they were able to stay with their relative for the whole procedure.

  • Staff ensured their patients were involved in their care and did not take any actions without assessing how the patient would be affected. Any concerns patients had were followed up promptly before and after the procedures.

  • Staff took the time to get to know their patients and ensure they felt at ease. Staff engaged them in conversation during their procedure as a distraction technique and provided clear explanations of progress. Patients could watch a screen showing progress of their procedure and staff explained the detail.

Responsive

Good

Updated 8 February 2017

We rated responsive as good because:

  • Facilities were arranged to make it convenient for patients to attend the clinic. There was adequate parking, facilities for patients with limited mobility and areas to wait at different stages of the procedure.

  • Appointments were arranged at a time that was convenient for the patient and waiting times from contact to first appointment was usually two to three weeks. Patients were given timed appointments and did not wait long once they arrived at the clinic.

  • Patients had their individual needs met as far as possible. Patients had their individual clinical condition assessed and if they wanted to and there were no clinical concerns, could have two procedures completed in one day. This meant fewer visits to the clinic and less interruption to everyday life or work commitments. The clinic supported patients with completing information for insurance companies.

  • All staff were committed to making the patient’s stay as comfortable as possible. Any patient concerns were investigated and discussed to assess any steps the clinic could take to improve their treatments. One action that had been instigated by patient comment was of skin problems from compression bandaging. The clinic was trialling an alternative compression bandaging technique to assess the effects on skin condition for more patients. Patients were contacted about any complaint and its progress in a timely way. Some responses we saw were the same day.

  • Patient information was comprehensive and provided at every stage of consultation.

Well-led

Outstanding

Updated 8 February 2017

We rated well-led as outstanding because:

  • Bristol clinic staff were aware of the vision of the organisation and constantly assessed how they could contribute to a high quality, person-centred service. They wanted to provide patients with varicose veins the best treatments using the latest techniques, safely and in a comforting environment. They did this by ensuring that up to date, research-based practice was implemented. Whiteley Clinic Ltd. protocols were updated according to latest research results and followed by staff at the Bristol clinic.

  • Staff were encouraged to contribute their Ideas for improvement and were recognised for their efforts. Ideas were discussed and acted upon. Developments were shared across the whole organisation to improve care for their patients.

  • The Whiteley Clinic Ltd. used research from international organisations and from its own research and development department which was a partnership with the University of Surrey. Learning and research results from the Whiteley Clinic Ltd. were shared internationally. Effectiveness of vascular surgery in England was limited and to improve data collection, staff at the Whiteley Clinic Ltd. were creating methods of recording outcomes for patients who have had vascular surgery. The chief executive of the company had set up a UK branch of the College of Phlebology to act as a resource for other vascular treatment organisations. This included information from the Bristol Clinic.

  • Governance procedures ensured that quality was maintained. Risks were monitored and staff were confident in raising any issues. These were discussed and steps were taken to reduce the risks as soon as possible in the Bristol clinic.

  • Any feedback from patients was used to improve the service. This could be from casual comments, written or emailed to any of the staff at the Bristol Clinic who would ensure it was discussed at governance meetings.

  • All staff at the Bristol clinic put the patient at the centre of their work. The recruitment process reinforced these values by assessing personal attributes of applicants.

  • Information of clinical and business developments was cascaded to staff for continuous improvement. Staff were able to view internet video links to presentations provided by chief executive of the Whiteley Clinic Ltd.

  • There was a strong emphasis on openness and honesty within the Bristol clinic. Patients were always kept informed of any delays or untoward events that may affect their care.

Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 8 February 2017

Outpatients and diagnostic imaging for surgery was the main activity of the clinic. Patients attended for consultation and minimally invasive surgical techniques for vascular conditions. First appointments were offered within two to three weeks of first contact with the clinic and procedures were organised to fit around the patient’s lifestyle in a way that would give the greatest benefit to the patient. Patient experience was the focus of the way treatments were delivered. Research and evidence led the techniques used in all aspects of the service and patients were offered monitoring of their condition over many years.

We rated this service as good because it was safe, caring, responsive and outstanding in well led. Effective was not rated.