Health First Surrey

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked to see if the service had a proactive and positive culture of safety and learning.

This is the first assessment for this service. This key question has been rated requires improvement. This meant people were not always safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service did not always have a proactive and positive culture of safety based on openness and honesty. The registered manager did not always recognise risks to safety. Lessons were not always learnt to identify and embed good practice.

There was a system for reporting safety incidents using a service incident book, however, this related specifically to incidents affecting people, of which there had been none. There was not a process for recognising incidents potentially impacting the service, for example, through risk assessment processes.

We observed risks to patient confidentiality and health and safety during our visit to the service. While there was a safety check list carried out on an annual basis, this process did not direct the user to consider new or potential risks within the service through a comprehensive risk assessment process. This meant that learning and improvement was limited as a result.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. They ensured continuity of care, and pathways and transitions to ensure blood samples were appropriately processed.

There were arrangements to ensure that blood samples were appropriately packaged, labelled and transported to the relevant laboratories. This included some tests that were transported by post and other’s that were transported by couriers. In some cases, the patient themselves posted or transported the blood sample to the relevant laboratory. This included where samples had to be taken to a laboratory to be frozen and flown overseas.

There were clear arrangements and protocols for dealing with blood samples, including agreements with the relevant laboratory on how samples were collected and processed.

There were arrangements with the referrer to ensure that blood test results were sent directly to them, as well as the patient. If a patient was not referred to the service by a professional, the registered manager / phlebotomist requested contact details for the patient’s GP and permission to share results with them. Alternatively, patients were referred to a private GP for follow up where necessary.

The service had processes in place to work well with people and healthcare partners to understand what being safe meant to them, how to achieve that and to share concerns quickly and appropriately. The service had policies relevant to both adult and child safeguarding procedures. However, child safeguarding training was not up to date.

Policies included clear processes for escalating concerns, such as contacting local authority safeguarding teams. The registered manager had completed adult safeguarding training and was able to describe the action they would take in the event of safeguarding concerns. However, they had not completed up to date child safeguarding training. While arrangements for escalating concerns for any children accompanying an adult within the service, it was not clear that staff would recognise such concerns without completion of the relevant training.

The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe.

There was an emergency policy that was overdue review. The policy detailed emergency medicines kept by the service; however, we were told these medicines belonged to a private GP practice who rented a room in the building. In addition, the registered manager was no longer a registered nurse and had completed basic life support rather than advanced life support training. This meant they were unable to provide assurance they were competent to administer these medicines in an emergency. In addition, there was no risk assessment in place identifying the required level of life support based on the nature of the service and the likely risks to patients.

The service did not always detect and mitigate potential risks in the healthcare environment. Staff did not always make sure facilities supported the delivery of safe care.

We found risk assessment processes were not fully implemented. While there was a health and safety check list that was undertaken annually, this did not include the identification of potential new risks within the service. We saw risks during our inspection which included a window held open with a plant pot that presented a potential risk of falling and causing injury. There were additional fire safety risks relating to how kitchen equipment was arranged. There was an emergency pull cord tied up and potentially out of reach in the bathroom. There were expired consumable equipment items, such as 8 blood bottles, a blood collection kit and a tube of numbing cream used to numb the skin prior to blood taking.

The registered managed did not have assurance from the landlord that fire safety and water safety risk assessments had been carried out at the time of our visit. However, they provided these from the landlord following the visit.

There was a sample fridge available for the storage of blood samples requiring refrigeration. However, records of temperature checks to ensure the fridge was working properly were incomplete. We saw that clinical equipment was safety checked and calibrated as appropriate.

The service made sure there were enough qualified, skilled and experienced staff. However, the phlebotomist was working in isolation and did not have practical supervision or support around the lead role within the service. Not all mandatory training had been completed.

The registered manager was the phlebotomist working within the service. They had completed appropriate competency-based training for their role in the form of phlebotomy training and updates. However, mandatory training modules had not been identified. We found there was no evidence of information governance training, mental capacity act training, child safeguarding training, manual handling training, learning disability and autism awareness training, and equality, diversity and inclusion training. There was also only limited evidence of training or understanding for lead roles such as infection prevention and health and safety.

The service did not always assess or manage the risk of infection. Staff did not always take appropriate measures to detect and control the risk of infection.

There was no established process for auditing infection prevention and control measures within the service. The infection control policy stated that audits should be carried out, but they were not.

We were told there were no defined cleaning schedules but that cleaners attended the service weekly. The waiting area was visibly clean. However, we observed issues within the treatment room of the clinic. There were pillows on top of a waste bin and sharps bins were overflowing with used blood taking equipment visible outside of the bin. Sharps bins were not appropriately labelled. Clinical waste was not appropriately segregated; we observed non-clinical waste in clinical waste bins. There had been no internal audit of clinical waste.

We observed the phlebotomist using appropriate personal protective equipment which included using alcohol-based hand gel when changing gloves, in between each patient. We saw there were no hand washing facilities in the clinical room where phlebotomy was carried out and this had not been recorded within a risk assessment, with clear mitigating actions identified. We saw that the nearest hand wash basin to the phlebotomy room was within the toilet room in the clinic had loose taps and visible limescale. This toilet room was used by patients and members of staff from all co-located services.

Health First Surrey is an independent health service. They provide a phlebotomy service where they carry out blood tests to support the diagnosis of a wide range of health symptoms and characteristics. This quality statement is not relevant for this service, as they did not hold or prescribe medicines and were not involved in or registered for the treatment of disease, disorder or injury.