6 August 2019
During a routine inspection
The Plastic Surgery Group is operated by The Plastic Surgery Group Limited. The location inspected at 100 Harley Street is used to see patients in an outpatient setting, for surgical pre-assessment and minor procedures and non-surgical aesthetic treatments. All major surgical procedures (such as breast enhancement, liposuction, facelift) are carried out under practising privileges at other separately registered facilities. Post-surgical appointments such as reviews and wound care also take place at 100 Harley Street. Facilities include a consultation room and clinic room.
The service provides cosmetic surgery. The only procedures we regulate taking place on site are labiaplasty and ear fold operations, performed under local anaesthesia (without use of sedation).
We inspected this service using our comprehensive inspection methodology. We gave 48 working hours’ notice of the inspection because evidence gathering in an unannounced inspection would be impacted by the fact that the service undertakes procedures at variable times. We carried out the inspection on 6 August 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.
Services we rate
The is the first time we rated this service. We rated it as Good overall because:
- The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
- Staff completed risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
- The service had enough staff to care for patients and keep them safe. They managed medicines well.
- Staff gave patients enough to drink. Staff followed national guidelines to make sure patients fasted before surgery.
- Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way.
- Staff monitored some of the effectiveness of care and treatment. There was limited evidence that managers used information from the audits to make improvements and achieve good outcomes for patients.
- Healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
- Managers made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to information. Key services were available five days a week.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients.
- The service planned care to meet the needs of their patient population, took account of most patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
- Leaders supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
However:
- Not all medical staff had completed all mandatory training modules.
- The safeguarding policy did not reference female genital mutilation (FGM). Following our inspection, we were provided with evidence that this policy was updated, and senior staff told us training had been given in this area.
- We were not assured that the clinic was using a safer surgical checklist based on the World Health Organisation (WHO) guidance for minor operations performed at this location. There were no WHO checklists in any of the operative notes viewed on the day of inspection. Completion was not audited. Following inspection, the service produced new checklist documentation they told us they would use for any minor procedures at the registered location.
- There were no environmental or hand hygiene audits taking place, as per local policy. There were also no formal infection prevention control meetings, and this was not a standing agenda item at the monthly staff meetings.
- The service had not managed patient safety incidents well historically. We were not assured that staff always recognised and reported incidents and near misses. Managers usually investigated incidents, but staff were not aware of a formal system in place to investigate serious incidents.
- The service could not evidence it provided all care and treatment based on national guidance and evidence-based practice.
- There was no formal access to translation or interpretation services for patients whose first language was not English. The service did not have information leaflets available in other languages or formats on the day of inspection.
- There was no information displayed in the clinic about how to raise a complaint.
- The service had a vision for what it wanted to achieve, but this was not clear. There was no clear strategy to turn the vision into action. Leaders and staff did not understand them and did not know how to apply them and monitor progress.
- Leaders did not operate effective governance processes throughout the service. Staff at all levels were not always clear about their roles and accountabilities. They had regular opportunities to meet, but did not always discuss and learn from the performance of the service.
- The registered nurse at the service had been enrolled on a nurse prescriber course to aid with her professional development but there were not governance structures that would support this at the time of inspection.
- The service collected some data but not all staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were not historically integrated.
- There was limited evidence of patient or staff engagement to plan and manage services.
Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.