St Clare Medical Centre

On this page

• 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

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated Requires Improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of Regulation 11: Need for consent, because patients were not consistently provided with information about the risks, potential complications, and alternative options for anaesthesia or sedation. This omission compromised informed consent and patient autonomy in decision-making about their care.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 8 patient records during our assessment, and we found gaps in the service’s consent process. Records showed every patient attended an initial consultation where staff assessed their needs and discussed the proposed treatment plan which was personalised to meet specific and individual circumstances, however, we found no evidence the risks specifically associated with the anaesthesia or sedation were discussed with sufficient time ahead of the day of the surgery. Patients were not always given enough time or support to read and understand the anaesthetics consent form. Records showed staff explained the risks of the surgery, the alternatives to the procedure, the costs, and gave advice on what the patient needed to do before surgery. Records showed surgical procedures were explained clearly to patients, sometimes using diagrams or drawings made during the consultation to aid understanding. The clinic facilities were designed to meet the needs of different people. There were wheelchair-accessible areas, and a designated refuge area in case of fire. The service also had access to an online translation service to support patients who did not speak English.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service worked with patients to plan their care and treatment, making sure it reflected what was important to them. Policies used to guide care were up to date and available electronically; some were also available in paper form. At the time of our inspection, the registered manager was working with an external advisor who was providing support to the service reviewing their policies and procedures. We checked a sample of their policies and found they were in date, however almost all the policies we reviewed mentioned role names or departments not relevant to the service.

Staff held regular meetings to review training requirements, governance, and safety. These included discussions which were attended by the external consultant, who encouraged learning and sharing of good practice. Meeting records showed the service checked compliance with the latest guidance and standards.

Staff were experienced and qualified to meet the needs of patients. Surgeons had the skills and competence to perform the procedures offered and worked in the NHS and other independent hospitals. New staff received a thorough induction when joining the service which included a period of supervision signed off by a senior staff member to confirm they were safe to work independently. Staff took part in audits and quality improvement initiatives. At the time of our visit, the service was recruiting an additional full-time staff member to meet the recent increase in demand for its services.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

All treatment provided at this location was consultant-led. Staff held regular meetings to review patient safety and requirements to meet needs. These meetings included discussions which were attended by the external consultant, who encouraged learning and sharing of good practice. If a patient needed to be transferred to an NHS hospital, the service used emergency services (999) to transfer to the nearest NHS service. Staff shared important information about patients during admission and surgical list review meetings to maintain continuity of care.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service helped patients manage their health after surgery so they could recover safely and maintain independence. Patients were given written advice about wound care and the need for specialised clothes to support recovery. Patients were given guidance on when and how to reintroduce physical activity after certain procedures. We also saw information provided to help reduce bruising and aid recovery. Patients were told about common side effects and had access to a 24-hour advice line for any questions or concerns. Staff also offered home visits during the initial post operative period in cases of concern. This meant issues could be identified early and prevented from becoming more serious. To support recovery, patients were expected to attend at least two follow-up appointments with a nurse or consultant after surgery. These checks helped ensure healing was progressing well and gave patients the chance to discuss any concerns. The average discharge time after surgery was approximately 1 year.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service regularly checked the quality of care and treatment to make sure it met both clinical standards and patients’ expectations. This helped ensure outcomes were positive and consistent. There were no waiting lists in this service.

Staff used recognised tools to monitor patients and spot early signs of a patient’s condition worsening, which is an important part of keeping patients safe and improving recovery. However, there was not an effective policy to guide staff. The service held regular audit meetings to review performance and there was evidence of quality improvement, support, and training. Patient outcomes were very positive and seem to meet patients’ expectations. Patients were asked to complete questionnaires after surgery, and the service reviewed results at different stages of recovery. Patients were discharged a year after their surgery and during this time, they had an open appointment with the service. The consultant was responsible for discharging patients once they were satisfied recovery was progressing well.

We scored the service as 1. The evidence showed significant shortfalls. The service did not tell people about their rights around consent or respect these when delivering care and treatment.

The service did not consistently provide patients with information about anaesthetic risks within an appropriate timeframe, which limited patients’ ability to make informed decisions about their care. This practice was not compliant with guidance from the Association of Anaesthetists of Great Britain and Ireland, which states information about anaesthesia and its associated risks should be provided as early as possible—preferably at pre-assessment or at the time of booking—and in a format patients can retain for future reference. Our review of evidence indicated these discussions typically occurred on the day of surgery, which is not considered acceptable for elective procedures. The service did not supply a dedicated leaflet or patient information booklet detailing the chosen anaesthetic, alternative options, and associated risks.

We also reviewed the consent process and found gaps in how anaesthetic risks were communicated and documented. Some surgery consent forms only listed risks associated with general anaesthesia, which the manager confirmed is not used at this location. This information could cause confusion as they would not receive this type of anaesthesia at this location. The surgery consent document did not include potential complications of conscious sedation or local anaesthetic, which are the methods used at this location. The service manager confirmed a separate consent form for anaesthesia was not used during pre-operative consultations. Evidence in some patient records documented consent to anaesthesia as “verbal consent.” This demonstrates the absence of an effective process for recording these discussions, which is integral to ensuring patients are fully informed and safely admitted to theatre. The Royal College of Anaesthetists’ Guidelines for the Provision of Anaesthetic Services state all discussions about anaesthetic risks, benefits, and alternatives should be documented in the patient’s notes, even if formal written consent is not obtained. The absence of this documentation during the pre-operative process does not meet best practice and increases the risk patients may not receive all the information they need to make an informed decision about their care.

However, the service used very detailed consent form templates for each type of surgical procedure carried out at the clinic. These documents provided patients with a thorough explanation of the surgery, possible complications and informed patients about the high potential of requiring further surgical procedures to achieve desired results. The form covered at a high level of detail the possible complications from a surgical perspective.