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InHealth Endoscopy Unit Romford Good

Reports


Inspection carried out on 4 January 2019

During a routine inspection

InHealth Endoscopy Unit Romford is operated by InHealth Endoscopy Limited as part of a network of locations within a specialist services directorate. The service is a community clinic and provides care and treatment to patients who are medically fit and stable.

The clinic has two preparation (admission) rooms, one consultation room, two procedure rooms, four single recovery bays and a seated discharge area with two reclining chairs. The service is commissioned by Barking, Havering and Redbridge Clinical Commissioning Group to provide colonoscopy, flexible sigmoidoscopy and gastroscopy for routine referrals. The service is co-located with a pathology service and breast screening service, which are operated by separate providers in the organisation’s group. Each service has its own registration and we did not inspect the pathology or breast screening services. The clinic has in-house endoscope decontamination facility and trained staff.

The service provides care and treatment to patients referred by the NHS to reduce waiting times.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 4 January 2019.

The service had typically operated four days per week from 8am to 6pm and at the time of our inspection had started to work towards seven-day working. The service had clinical space to accommodate this and the senior team were building staff numbers to ensure expansion was carried out safely.

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 have not previously rated this service. We rated it as Good overall.

We found good practice:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Processes for safe water management were robust and ensured patient’s safety. Staff had taken immediate action where routine testing indicated a risk.
  • The service team acted on audits and quality evaluations to continually identify opportunities for benchmarking and improvement.
  • Safety and risk management processes were clearly embedded in practice and a strict referral system meant staff saw patients only when they had enough information to provide a safe level of care.
  • Staff managed all areas relating to health and safety, such as medicines management and staffing, in line with established processes and protocols. The unit manager ensured protocols were reviewed and updated in a timely fashion to reflect the latest national standards.
  • The provider facilitated a no-blame culture that encouraged open discussion of mistakes and reporting of incidents. This included use of the duty of candour, which staff used to ensure patients were kept informed when things went wrong.
  • The service had a waiting list and managed this well. In the previous 12 months the service had met the standard six-week referral to treatment time (RTT) in 11 months.
  • Governance processes included all staff and helped the team to assess the quality of the service and to drive development and improvement. The governance structure was being expanded and improved as part of a five-year development plan.

We found areas of outstanding practice:

  • The provider was an early adopter of transnasal gastroscopy services, which provided a more comfortable experience for patients and reduced the need for sedation.

However, we also found the following issues that the service provider needs to improve:

  • Two members of staff had significant lapses in safeguarding training that required action.
  • Although overall standards of infection control were good, there were risks in relation to how staff used the decontamination area and discrepancies between service standards and audit criteria.
  • There were some discrepancies between the understanding of the local team in relation to incidents and complaints and the data submitted to us by the provider. Although investigations and learning outcomes were clearly documented, the discrepancies meant there was a lack of assurance they led to embedded new practice.
  • There were gaps in the arrangements for risk management, including in the risk assessments used for patients and in environmental maintenance and safety.
  • In the previous 12 months the service had cancelled seven patient lists due to a shortage of endoscopists.
  • Gaps in documentation for staff competencies and feedback from the staff survey indicated inconsistent supervision practices.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve:

  • Implement consistent standards of practice in relation to the safe management of Controlled Drugs (CDs). This should include effective audit processes.
  • Provide staff with the tools to monitor patients for deterioration and to respond to urgent clinical needs.
  • Implement robust, consistent safety and maintenance processes for emergency equipment.
  • Minimise infection control risks through effective, consistent audits and practice.
  • Review safety monitoring and training to manage risks associated with major haemorrhages and sepsis.
  • Store sufficient quantities of oxygen stored on site to meet patient need, including during unplanned emergencies.
  • Actively embed learning from incidents and other safety issues elsewhere in the organisation.
  • Require all staff, including agency staff, to fully complete induction and orientation processes and document this. 
  • Improve local governance systems and administration to include the quality of complaints reponses and staff induction documentation.

Professor Sir Mike Richards

Chief Inspector of Hospitals