Queens Clinic

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• 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 found that the service was not providing effective care, because: A continued lack of complete audits sufficient to provide assurance that safe care was being provided and to demonstrate quality improvement. The provider did not demonstrate an understanding of appropriate consent processes, and the need to fully record conversations in the patient record. The service had not implemented any changes to clinical record keeping protocols. For procedures or treatments where there were no National Institute for Health and Care Excellence (NICE guidelines), it was unclear what processes the service was following. There was no clear action plan in place to address shortages in staffing.

This service scored 25 (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 was not able to demonstrate that all management options were being discussed with patients to best demonstrate that their needs were being met. For example, we outlined that National Institute for Health and Care Excellence (NICE) guidelines which the service had said it was following as primary guidance required that risks were discussed and that there were discussions about whether procedures undertaken were required at all, and if they were whether they would be undertaken under general or local anaesthetic. We asked the provider why these discussions were not detailed in the clinical records to show that NICE guidelines were being followed. They reported that they did not feel that recording this level of detail was required.

Leaders were not able to demonstrate that the service was delivering evidence-based treatment in all cases. For example, we asked the provider what guidelines were followed where there were no applicable NICE guidelines. The lead clinician told us that the use of laser rather than surgery for mild stress incontinence (a procedure which is undertaken at the clinic) had been approved by NICE. This is not the case. The specific NICE guideline in this regard is “Interventional procedure overview of transvaginal laser therapy for stress urinary incontinence (May 2021, due for review in May 2024)”, which states – “The evidence on transvaginal laser therapy for stress urinary incontinence does not show any short-term safety concerns. Evidence on long-term safety and efficacy is inadequate in quality and quantity. Therefore the procedure should only be used in the context of research”. On the basis that the lead clinician/provider reported that they were following NICE guidelines, they should not have been undertaking this procedure.

Processes were not able to demonstrate that the service was delivering evidence-based treatment in all cases. The service utilised NICE guidelines but did not have protocols and processes in place for all procedures where NICE guidelines were not in place.

CQC asked the provider if they had a protocol for sharing information with patients’ GPs, and more specifically where there were potentially serious symptoms which required follow up, even where the patient had not consented. This is required so that potentially serious issues may be followed up in the best interests of the patient. The provider was not able to provide a process detailing this.

The provider reported that where the patient consented for information could be shared, this would always be forwarded to a patient’s GP. However, the service was not able to evidence how and where this was recorded on the clinical database.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider indicated that audits would continue to be focused on audits of medical records, rather than outcomes and specific conditions whereby the quality of service may be better quantified. The provider detailed infection control as another area which was audited. The provider could not provide clear assurance of how outcomes were monitored and how this informed learning at the clinic.

The service did not have planned audits for specific conditions or outcomes. The clinical database could not be searched in relation to a safety alert, or to assist in outcome-based audits. The provider reported that they had spoken to the company who provides their database to look at improving it in the future, although no specific details were provided to corroborate this.

The service had templated forms for consent taking. The templates allowed for specific issues to be highlighted or deleted. However, in practice, the forms did not contain the specific information that would need to be discussed with the patient to provide informed consent.

The provider was not able to outline systems by which informed consent could be clearly reflected. The provider indicated that consent was clearly documented, although full details of discussions with patients including risks and benefits and management options were not included in clinical records. On the basis that this is not documented, there can be no assurance that NICE guidelines (which are the guidelines used at the service for this procedure) were being followed. The lack of detail in the record is such that there can be neither assurance the procedure is carried out in line with NICE best practice, nor that the patient had provided informed consent for the procedure to be carried out.