Parkway

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.

At our last assessment we rated this key question as good. At this assessment the rating has remained good.

People who used the service were involved in assessments of their needs. Staff reviewed assessments and made sure service users understood their care and treatment, and they followed consent procedures.

However, arrangements for staff supervision were not always implemented and the service did not effectively record audits to monitor outcomes.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us people received an initial consultation to identify their surgical needs and preferences and to determine if they were eligible for surgery at this clinic.

In addition to the initial triage process, service users undergoing surgical procedures were provided by post with information and details about the procedure and invited to contact the service if they wanted to discuss this further. Service users were then assessed on the day of surgery to consider their needs, gain their informed consent, and confirm their suitability for surgery. Service users were also routinely reviewed following their surgical procedure.

Staff completed a comprehensive health assessment of the service user in a timely manner at, or soon after, admission. Staff followed service policies regarding initial consultations and during service users’ admission to the clinic on the day of surgery. Care records we reviewed included details of initial medical consultations and pre-operative assessments on the day of surgery. Records included information such as contact details, clinical details, medical history, and risk factors.

We reviewed six care records and saw these were complete and up to date. They included the surgical treatment plan and prescribed medicines for each service user. Records showed staff carried out observations before, during and after surgery.

Managers did not always provide staff with supervision where they could reflect on and learn from practice or discuss personal support and professional development. The percentage of healthcare assistant staff who had had an appraisal in the last 12 months was 43%.

We saw no evidence of any team meetings held for staff working in minor surgery and were advised that general information about the overall service was shared with staff in email updates. However, there was no system for confirming that staff had read and understood the content of these email communications.

Staff assessed and met service users’ needs. People told us they were given clear advice prior to undergoing surgery and were given clear information after their procedure was completed. Staff followed care pathways that were based on national guidance.

Staff participated in clinical audit, including for consent, pain scoring, histology reporting times, and waiting times. Staff in the service followed the ‘Minor Surgery Local Safety Standards’ (LocSIPPS) policy when carrying out minor surgical procedures.

Two consultants worked on a sessional basis as clinical leads in the minor surgery service, with support from nursing staff and healthcare assistants. The service had an induction form for new staff; however, we did not see any completed records of these in staff files we reviewed for staff working in the service. Consultants we spoke with told us their main roles were in NHS organisations where they were currently working and where they completed their appraisal and supervision. However, in the provider’s staff files we did not see copies of these records. Consultants we spoke with said that they informally discussed and reviewed cases, although this was not recorded formally and did not take place on a regular basis.

The clinic staff told us they worked well as a team. They told us they had a good relationship with the surgeons and regularly liaised with the administrative staff and consultants to plan and coordinate care and treatment. Staff we spoke with described how they were able to discuss any queries amongst themselves informally. We saw there was daily communication between different staff groups across the service.

The service had systems to communicate with GPs and other services, including for histology and other diagnostic test results.

Records we reviewed showed there had not been any regular multidisciplinary meetings held for staff in the minor surgery service.

The service supported people to manage their health and wellbeing and to live healthier lives.

People who used the service told us they received good support from staff and were provided with verbal and written information around healthier living. They told us they received routine advice and guidance from staff before and after their surgery.

We saw different information leaflets were available for service users giving specific advice about how to manage after their procedure. Leaflets were also available in the service and on noticeboards providing general health information.

Service users we spoke with told us they had positive experience of their surgery in the service and were satisfied with the outcome. The service collected details of the number of referrals and waiting times, who were mostly referred and accepted under NHS contracts. Clinical staff told us the number of service users who did not attend their appointments had reduced and nobody waited more than 6 weeks following a referral, and we saw the data that the service had used to establish this.

The service predominantly undertook minor excisions, cryotherapy, and drainage procedures. It did not appear to be engaged with the Private Healthcare Information Network (PHIN) in accordance with legal requirements mandated by the Competition Markets Authority (CMA). The service was not required to participate in any national audit programme, only conducting minor surgical procedures such as skin tag excision or cryotherapy; however, we found no other audit or performance information was available in other publicly available data sources.

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

Staff took all practical steps to enable service users to make their own decisions. Staff assessed and recorded capacity to consent appropriately. Service users we spoke with told us they had been provided with full information about their procedures and were asked to provide written consent on the day of surgery.

Staff we spoke with told us they had received training in and understood how to obtain informed verbal and written consent from people who used the service before providing any care or treatment. This included respecting people’s wishes if they refused treatment or withdrew their consent. In six care records we reviewed, consent was fully completed and accurately documented.