Archived: Blue Sky Orthopaedic

Updated 8 February 2018

Blue Sky Orthopaedics Limited is a limited company formed in 1999. It specialises in hand surgery such as carpal tunnel decompression, trigger finger, trigger thumb and Dupuytren’s disease. It outsources nerve conduction tests (neurophysiology). There are five directors – three consultant orthopaedic surgeons, one associate specialist in orthopaedic surgery and one operating nurse specialist. They employ a practice manager and an operating theatre assistant. The company is registered with Companies House in 2003. It moved to its current location in 2008. It registered with the Care Quality Commission in September 2016 for diagnostic and screening procedures, and surgical procedures and treatment of disease, disorder and injury.

The clinic has had a registered manager in post since September 2016.

Updated 8 February 2018

Blue Sky Orthopaedic Limited is an independent orthopaedic clinic specialising in hand day surgery. It has no overnight beds. The company rents the facilities from a local GP practice in Syston, Leicestershire. Facilities include an operating theatre, a consulting room, office, utility and store rooms. The service provides hand surgery to adults, specialising in carpal tunnel decompression, trigger finger and thumb and Dupuytren’s disease surgery.

We inspected this service using our comprehensive inspection methodology on 28 and 29 June 2017. As a result of our findings we issued a warning notice served under Section 29 of the Health and Social Care Act 2008.

The full report of this inspection can be found on the CQC website: http://www.cqc.org.uk/location/1-2860593165

In order to follow up on progress against this warning notice we carried out a short notice announced focused inspection on 29 November 2017.

As this inspection was a focused inspection, we looked at the well-led domain only.

Services we do not rate

We regulate single speciality surgery services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the provider had partially met the requirements of the warning notice. There were still some areas that required further improvement:

• Continuing to embed the new governance framework and understanding of the new protocols and policies
• Agreeing an internal and external audit plan which informs the service about areas to celebrate or improve, including a proposed NICE guidance audit.
• Reviewing management capacity and cover for the registered manager.

However we also found the following areas of good practice:

• Blue Sky Orthopaedic had developed a governance and policy framework, which included a strengthened approach to clinical governance.
• Leadership meetings were formatted so that important aspects of governance could be regularly monitored.
• Blue Sky Orthopaedic started to monitor their own dashboard of safety and quality measures, monthly. This included patient feedback, infection rates, process complaints and audit outcomes and management.
• Policies and procedures to support medicines management and stock control were in place.
• Processes for incident reporting, investigating and sharing learning had been developed and were well understood.
• The service had arrangements in place for identifying, recording, managing and mitigating risk and monitored these at their leadership meeting.
• Clinicians systematically used the World Health Organisation Five Steps to Safer Surgery checklist.
• Safeguarding policy guidance was in place and staff had received safeguarding training
• The service had its own appraisal forms and carried out appraisals in line with its own objectives.Training and appraisal files we reviewed were complete.
• There were new policies for consent, duty of candour and the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and staff understood and had received training on these topics.
• The provider had audits in place for patient outcomes and the quality of sutures (stitches).

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Heidi Smoult

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Deputy Chief Inspector of Hospitals (Central), on behalf of the Chief Inspector of Hospitals