You are here

Focus Medical Services Limited Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 3 January 2020

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)

Inspection areas

Safe

Requires improvement

Updated 3 January 2020

We rated it as Requires improvement because:

  • There was no training policy setting out expectations of completion of mandatory and statutory training.

  • There was a safeguarding policy for adults (2018) but there was no child safeguarding policy providing guidance for staff.

  • There was an inconsistent approach to hand hygiene and equipment was not always cleaned between patients.

  • Equipment was not always regularly maintained in accordance with manufacturer guidelines.

  • There was some ageing equipment as five pieces of equipment were more than 12 years old.

  • The design of the environment was not always in adherence with national guidance as not all NHS locations had a warning light outside the room to warn people that radiation was in progress.

  • Staff carried out daily safety checks of specialist equipment on the days we inspected the service. However, it was difficult to gain an overview of when and if these were always completed on all of the days the equipment was used. This was because equipment was used in different locations.

  • There was no standard operating procedure to provide guidance to staff to summon help in the event a clinical emergency of patients under their care.

  • The rationale to justify the use of x-ray during treatment sessions for individual patients, was not always documented accurately.

  • The service audited exposure time when treatment was carried out using x-ray and if this exceeded the alert levels set by the radiation protection advisor. However, it was not clear how this information was used to improve services and there were no national standards to benchmark against.

  • Staff did not have direct access to NHS hospital picture archiving and communication system (PACS) but used NHS hospital staff login details to access this information.

  • There was no incident reporting policy to provide guidance for all staff including definitions of incidents and near misses they should be reporting. External regulators were not always informed of incidents relating to radiation.

However:

  • Staff had an awareness of how to protect patients from abuse.

  • There was a procedure staff followed when equipment was faulty.

  • All company vehicles were serviced regularly including safety testing of tail-lifts, which were serviced every six months in line with Lifting Operations and Lifting Equipment Regulations (LOLER, 1998).

  • The service had enough suitable equipment to help them to safely care for patients.

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

  • Checks were completed to make sure the right patient attended for treatment.

  • The service had enough staff with the right qualifications, skills, training 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 and easily available to all staff providing care.

  • Staff knew what incidents to report and how to report them and the directors felt there was a good reporting culture among staff.

Effective

Updated 3 January 2020

Caring

Good

Updated 3 January 2020

We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff were discreet and responsive when caring for patients. Staff took time to interact with patients and those close to them in a respectful and considerate way.

  • Patients said staff treated them well and with kindness.

  • Staff provided emotional support to patients.

  • Staff understood the impact a patient’s care, treatment or condition had on their wellbeing and on their relatives, both emotionally and socially.

  • Staff made sure patients understood their care and treatment.

  • Staff talked with patients, families and carers in a way they could understand.

  • Patients could give feedback on the service and their treatment and staff supported them to do this. Feedback showed patients were treated with dignity and respect.

Responsive

Good

Updated 3 January 2020

We rated it as Good because:

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.

  • The service was flexible to accommodate additional service delivery requests from the hosting NHS locations.

  • The service was able to adapt treatment techniques to take account of any special needs patients may have.

  • The service had not received any complaints in the period between 25 July 2018 and 24 July 2019. However, there were processes to ensure complaints were dealt with in a timely manner in accordance with their complaints policy.

Well-led

Requires improvement

Updated 3 January 2020

We rated it as Requires improvement because:

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

  • There was a clear set of values for the service, although not all staff were able to recall these.

  • The service did not report workforce equality standards data in line with the national NHS standard contract.

  • Governance structures needed to be strengthened. There was limited scrutiny of performance and auditing of processes to provide sufficient oversight and assurance of the services provided.

  • There were also a number of key policy/procedures which were not in place to direct and support staff practice, such as child protection policy, no incident reporting policy, no lone working policy and no policy re kidney stones in children.

  • The service did not have regular formal meetings with the radiation protection advisor and medical physics in line with Ionising Radiation (Medical Exposure) Regulations, 2017.

  • There was a lack of clarity of responsibility for patient safety. There were no regular or annual meetings to review the contracts and discuss performance with NHS providers to review contracts.

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

However:

  • 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.

  • There was a clear company structure which showed different people’s responsibility.

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

  • Staff felt there wellbeing was looked after by Focus Medical Services.

  • Staff described the culture of the service as supportive and having a ‘team mindset.’

  • Staff felt the culture of the service was ‘open’ and ‘friendly’ and they would feel confident to raise any concerns with the directors.

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

  • The services monitored patient feedback but did not use the information to improve services.

Checks on specific services

Diagnostic imaging

Requires improvement

Updated 3 January 2020

Start here...