Focus Medical Services Limited

Focus Medical Services (FMS) is operated by Focus Medical Services LTD. The service has seven lithotripsy units, which comprise of a lithotripter, ultrasound machine, mobile image intensifier and treatment table.

Focus Medical Services provides a mobile Extracorporeal Shock Wave Lithotripsy (ESWL) service to hospitals throughout the UK and Republic of Ireland. Lithotripsy is a treatment using electromagnetic shock waves, by which a kidney stone or other calculus is broken into small particles that can be passed out by the body. ESWL is a non-invasive procedure.

The head office is based in Exeter where one of the directors and an office administrator are based. The service provides treatment to adults most but do occasionally also treat children.

From September 2018 to August 2019, the service carried out 5,819 lithotripsy treatments for adults and seven treatments for peyronies (inside scarring of the penis) in England. In the same period, the service treated 17 children between the ages of one and 17 years of age.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection with a short announced part of the inspection on 22 to 25 September and 1 October 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We rated it as Requires improvement overall.

We found areas of practice that require improvement:

• There was no training policy providing guidance to staff about when mandatory training needed to be completed to support safe practice.

• Staff received adult safeguarding training but did not receive any child protection training.There was a safeguarding adults policy but there was no child safeguarding policy providing guidance for staff if they had concerns about children’s safety.

• There was an inconsistent use of infection control measures to protect patients, themselves and others from infection.

• Equipment was mostly maintained but some equipment had not been serviced to ensure their safety.

• There was no lone worker policy for staff required to work on their own.

• Decisions to justify radiation were not clearly documented. The service did not check if referrals for lithotripsy was in accordance with care and treatment based on national guidance and evidence-based practice.

• Staff did not have access to picture archiving and communication systems in NHS locations where they delivered lithotripsy. They used NHS employed staff’s access to log in.

• There were systems to report an incident, but these were not always clear. There was no incident reporting policy to provide guidance and consistency of reporting. Staff recognised and reported incidents. Managers investigated incidents and shared lessons learned with the whole team.

• The service carried out radiation exposure audits, but it was not clear how the results were used to ensure/improve patient safety.

• There was no specific policy, guidance or protocols relating to treatment of kidney stones in children.

• The service did not monitor the effectiveness of care and treatment.

• Additional radiation training was not given to operating department practitioners who occasionally had to use image intensifiers to carry out procedures. Staff did not receive formal training in the use of ultrasound to locate kidney stones.

• The service did not have a formal vision or strategy but aims and progression of the company were discussed informally with staff during appraisals.

• Governance structures needed to be strengthened. There was insufficient oversight of performance and audits.

• The service collected reliable data but did not analyse this to identify where service improvements could be made.

However:

• Staff completed and updated risk assessments for each patient and removed or minimised risks.

• The service had enough staff with the right skills and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely.

• Staff assessed and monitored patients during procedures to see if they were in pain.

• Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

• Staff worked alongside medical and nursing staff from the hosting NHS locations. They supported each other to provide good care.

• Staff confirmed consent had been sought before carrying out lithotripsy procedures.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients and made sure patients understood their care and treatment

• The service planned and provided care in a way that met the needs of local people and the communities it served.

• The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. People were booked to attend pre-booked sessions delivered by the provider and received the right care.

• The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.

• Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for staff. They supported staff to develop their skills and take on more senior roles.

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.

• Directors identified and escalated relevant risks and issues and identified actions to reduce their impact.

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. We also issued the provider with nine requirement notices that affected Focus Medical Services. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South)