13 High Street

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 staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive assessment of each patient in a timely manner when they attended the ear wax removal service. Staff completed an assessment at the beginning of each patient’s visit to the service and reviewed the information at any subsequent visit. This included identifying the presenting complaint; the person’s medical history, potential infections or other risks; and their preferences regarding treatment. The provider explained the treatment processes as part of the assessment and gave the patient sufficient information to enable them to give informed consent.

The provider used an online system for recording notes of each procedure. This was completed with the patient throughout the appointment. Following the procedure the provider recorded a summary of the process, the tools used, the outcome, and if there had been any conditions identified that needed further action or follow up. For example, if the patient was advised to visit their GP or if the use of ear sprays was recommended. When necessary, pictures of the inside of the ear were attached to the record and could be shared with the patient’s GP.

Patients who wished to use the weight loss programme were sent a link via the National Medical Weight Loss Programme, so they could complete and return the pre-assessment documentation. This included a full medical history, allergies, GP details and consent to share information, current diet, and strategies the patient

had previously tried to reduce their weight. All potential patients were seen and assessed prior to being offered treatment. Staff checked the accuracy of the information given, assessed the level of motivation to reduce weight, discussed side effect management and recorded a full set of observations and photographs (fully dressed with consent). Patients who did not meet the criteria or chose not to consent to information sharing with their GP were declined entry into the programme. Any medical queries were followed up with the patient’s GP to gain assurances that it was safe to prescribe the medicine. The provider did not prescribe the weight loss medicines but carried out the follow up assessments and observations as outlined within the programme.

Patients were advised to visit their GP if their observations were outside of the normal range, for example blood pressure. The provider shared an example of a patient who was identified with extremely high blood pressure and advised to see their GP. The provider also shared the information with the patient’s GP. The patient was subsequently started on appropriate medicines to reduce their blood pressure.

The service planned and delivered patients’ 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.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Policies followed national and recognised guidance, including from the National Institute of Clinical and Healthcare Excellence (NICE). The provider had links to a forum for healthcare professionals providing ear wax removal services who were registered with the Care Quality Commission. The members of the forum supported each other by sharing information on relevant articles or research they had read.

The provider followed guidance provided by the National Weight LossProgramme for patients on the programme. The programme used standardised documentation, guidance and good practice, and shared new information via the website or through webinars.

The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

If there were problems that required further attention, the provider advised the patient to attend their GP. If a patient needed to be seen by a secondary care specialist, they would be referred by their GP. The provider wrote a supporting letter, with information about their findings and photographs if necessary.

The provider had a standard template letter for GP referrals, which ensured they contained key information, and which additional information about the patient’s condition was added. The provider had direct email links to 2 local GP practices and would send referrals directly. Letters for other GP practices were printed off and given to the patient to take to their GP.

The provider told us they regularly referred patients back to their GPs. They told us they had plans to audit their referrals.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

The provider advised patients that the production of ear wax was normal and healthy. However, for some patients it could build up and cause problems such as hearing loss or be a sign of other conditions such as infection. There may be limited actions a person could take to stop the problematic build-up of ear wax. However, the provider advised patients about what may help (such as ear sprays and oils), and what may make the problem worse (such as inserting cotton buds into the ear canal and putting one’s head under water).

The provider supported patients who wished to reduce their weight through the NationalMedicalWeightLossProgramme. Patients were supported through the first 12 weeks with regular reviews, which included repeat observations. Patients were referred back to their GP if any observations were outside of the normal range, for example raised blood pressure. The provider told us patients who do not wish to take weight loss medicines could also participate in the weight loss programme.

The service routinely monitored patients’ 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 patients themselves.

The provider told us that the outcome of the treatment was usually immediate and obvious, as the patient could see that the wax had been removed from their ears. Patients were asked for verbal feedback at the time of treatment, and to review the service afterwards. Online reviews of the service were positive.

The provider used information from the audits to improve care and treatment. For example, an audit of trauma following treatment. The audit demonstrated no injuries had been caused during treatment and any trauma noted was usually redness due to the removal of hard wax.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Staff took all practical steps to enable patients to make their own decisions. As part of the assessment process the provider explained to patients what the treatment involved, potential risks, and the success of the outcome. Patients under 16 years old usually attended appointments with a parent or guardian, staff would always ensure that consent was obtained initially from the young person to ensure they wanted the treatment. Consent was clearly recorded in patient records, although the person giving consent was not recorded for children under 16 years old.

For patients who may have impaired mental capacity, staff told us they assessed and recorded capacity to consent appropriately. The provider told us that some patients may have dementia or a learning disability. They would usually have someone with them to support them, such as a family member or carer. The provider had a good understanding of capacity and had completed appropriate training.