Archived: AIG Aesthetic Care

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Clinical treatment was not assessed or benchmarked against national standards. The provider did not hold accreditation or certification with any professional standards organisations. Care was led by financial decision-making and not patient-led outcomes or individual needs. Care was not evidence-based, and doctors had limited knowledge of national standards of practice. The service worked in isolation from other providers and patients told us they found it difficult to understand who was responsible for their care. The provider did not formally monitor outcomes. Consent processes were in place, but the provider was inconsistent in their use.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff who worked for another organisation carried out pre-operative assessment processes, including a brief medical history, and discussion of whether the patient could adhere to post-operative care guidance. We spoke with 2 patients who had recently undergone this process. They said the focus was on securing payment and a deposit and staff who carried out the assessment did not look at their medical history form, which patients completed themselves. Patients said staff were dismissive when asked questions about treatment and did not discuss any potential risks or side-effects. There was limited communication between the referral organisation and the provider although doctors said they would contact patients in advance if they believed the procedure was risky. While this reflected good practice, patients told us the lack of a refund policy or cooling off period meant they could not make balanced decisions based on their needs.

Doctors stopped treatment and referred patients to their GP if they found high blood pressure on the day of treatment. High blood pressure presented a risk of harm to patients because it could contribute to a cardiac event during treatment. The delay of treatment was an improvement on previous practice in the clinic.

Staff did not adequately assess patients’ mental health or emotional needs as part of the pre-operative process. Staff told us it was common for patients to experience anxiety prior to a procedure, in which case they would administer medicine. Staff did not recognise the risk of vulnerable patients seeking treatment under pressure or coercion from others and were not trained to recognise mental health conditions that could impair judgement and reduce the ability for a person to fully understand the pros and cons of treatment.

While the provider had implemented a follow-up protocol for doctors to follow, there was limited assurance this acted as an assessment of needs.

Staff were unfamiliar with guidance from the National Institute for Health and Care Excellence, NHS England, or professional standards organisations that could help to underpin and guide treatment. Doctors told us standards of practice were based on their own practices and experience. However, their misuse of a protected professional title combined with very limited training, meant the provider did not have assurance that standards of practice were evidence-based.

Staff were unfamiliar with policies and standard operating procedures (SOPs). For example, they did not know the provider had policies relating to the use of personal mobile phones to carry out post-operative consultations and did not know the provider had a policy on the administration of adrenaline or Diazepam. Policies and SOPs listed sources as an evidence base for their content, but these were often irrelevant or out of date. For example, a policy updated in late 2023 for adherence to confidentiality referenced an NHS trust’s confidentiality policy that was over 12 years old.

Staff did not benchmark standards of practice or patient outcomes, which meant there was no system in place to identify how well services met individual need. Doctors told us they worked independently of each other and did not carry out peer reviews or other strategies to share good practice.

The clinic offered platelet-rich plasma (PRP) injections in addition to hair transplant surgery. Patients told us doctors offered PRP after surgery, at significant additional cost, to reduce bleeding and pain. However, PRP is not associated with these uses and staff could not provide their evidence base for using the treatment for such purposes. This meant patients were at risk of harm from the inappropriate use of treatment.

A separate organisation carried out first contact with patients, including a pre-operative assessment. There was little transparency between the referring organisation and the provider. Staff said other organisation was simply a referral agency and had no responsibility for care or treatment. However, branding of the service did not refer to the provider and named only the referral organisation, which was not registered with CQC to provide treatment. Patients told us the referring organisation had refused to tell them who was responsible for care and treatment. Patients also said doctors had refused to tell them which organisation was responsible for treatment when they made a complaint.

Doctors told us they would actively avoid referring patients to NHS urgent care services in the event of a post-operative complication, unless it was an emergency. They said as the clinic was focused on private healthcare; post-operative complications would be managed in the clinic. However, patients told us they found it challenging to access post-operative care from the provider and instead doctors provided reassurance only in a messaging app.

The provider had no links to, or working relationships with, other healthcare services in the area. There were no referral pathways or agreements, and staff were unfamiliar with local NHS services that could provide support to patients post-operatively.

Staff told us they worked well together as a team and could access mutual support whenever needed. While we saw this in practice during our onsite assessments, teamwork did not drive safe standards of clinical practice or consistent standards of practice. For example, there were gaps and omissions in daily environmental checklists and inconsistencies in information staff gave us about the frequency and purpose of team meetings. Technicians carried out clinical tasks for which they were unqualified whilst doctors were detached from much of the process.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

There was no formal system in place to monitor and improve outcomes. All outcomes were defined by patients. While the use of patient-defined outcomes promoted individualised care, the lack of a measurable audit system in addition to this meant the provider did not have assurance that treatment was effective and met individual needs.

Doctors did not record the outcomes of treatment in a way that could be audited or measured. There were gaps and inconsistencies in recording contact with patients, which meant there was no system in place to accurately identify if improvements could be made in the service.

Doctors met patients to establish treatment goals but told us they were there to “supervise” technicians, who carried out most treatment. This was an informal arrangement without a risk assessment or SOP, and we could not establish why doctors were not active in surgical procedures themselves.

Communication standards did not contribute to good outcomes. For example, doctors showed us examples of communications between them and patients. They encouraged patients to send photographs of their post-surgical sites to check on healing and progress. Where patients expressed concern, doctors were reassuring in their approach but did not attempt to carry out an in-person assessment. Instead, they based their advice solely on photos taken by the patient. This meant the provider did not have assurance of effective follow-up, which meant the service may have missed signs of infection or other problems.

Staff told us they had improved post-operative follow up procedures and tracked this for assurance. While an audit demonstrated 100% compliance, this was not reflected in the patient record system. We looked at 20 electronic records for patients treated in the previous 3 months. These were inconsistent, with some missing follow-up details and others with partial information.

Patients consented to care and treatment twice; once when they met the referral agent in a separate company, and once on the day of treatment when they attended the provider’s clinic for surgery. The consent process followed standard practice, but the provider did not always communicate transparently with patients. There were often lengthy periods of time between the first consultation and the start of treatment, in some cases over 3 months.

The provider did not provide patients with details of a cooling-off period, refund policy, or details of what they had consented to. Patients we spoke with described significant challenges in obtaining this information from the provider. This did not reflect the consent policy and cooling off period policy sent to us by the provider.

The lack of information and transparency given to patients meant they did not have all of the information needed to make a fully informed decision about treatment.

Processes for managing paper records were not fit for purpose. A doctor told us the clinic operated on a paperless basis and that only electronic records were used in the care of patients. However, we found partially completed and discarded paper records in various areas of the clinic. Technicians told us they used paper records during treatment and this information was then transferred on the electronic record system. Doctors added notes post-operatively, sometimes days after treatment took place. While this in itself was not poor practice, the lack of safety measures and checks and balances in place meant there was limited assurance that documentation practices contributed to patient safety.