Signature Clinic - Manchester Also known as Rochdale Clinic

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Our rating of responsive stayed the same. We rated responsive as requires improvement.

We identified regulatory breaches in relation to listening and involving others in the key question for responsive, where we have told the service it needs to make improvements.

We found the service did not have effective systems for managing people’s complaints, including around identifying themes, investigating complaints to identify root cause or taking actions to minimise the risk of reoccurrence, particularly around complaints about poor surgical outcomes. The service did not have an effective process for obtaining feedback about people’s experiences, but had plans to improve this.

However, we also found areas of good practice.

The service planned care and treatment to meet people’s needs of local people and took account of people’s individual needs. People could access the service when they needed it, in a way that promoted equality and protected their rights.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who use the service told us their needs and preferences were taken into account. They told us their care and treatment was person-centred and focussed on their needs.

Staff told us people’s needs and preferences were assessed as part of the initial consultation and this enabled them to plan and carry out surgical procedures in accordance with their wishes.

Staff told us they discussed the surgical treatments offered by the clinic with people as part of their pre-operative consultation to enable them to choose what type of treatment was suitable for them. Staff took into account people’s medical needs and lifestyle choices to develop an individualised plan of care, including the advice and support offered as part of the aftercare process following their surgery.

Staff told us they provided person-specific advice, guidance and aftercare support for people with pre-existing health conditions such as diabetes or asthma and those with smoking or alcohol consumption lifestyles because this impacted the post-operative recovery process.

We observed positive interactions between staff and people who used the service. We saw staff understood their needs and provided appropriate care and treatment.

Care records showed discussions took place before, during and after people’s procedures and care and treatment was provided in accordance with people’s needs and preferences.

People told us their care was coordinated well and staff planned and delivered their care and treatment in a way that met their needs.

Staff told us they received all the information they required to plan people’s care and treatment as part of the initial consultation process.

Staff told us people’s surgery was planned in advance so staff and resources could be made available prior to undertaking procedures. They told us they prepared medicines, consumables and single use items in advance of people’s scheduled procedure. Staff told us patient care and treatment was discussed as part of daily safety huddles.

Managers told us they held huddle meetings twice a day to plan people’s care and treatment, manager any risks identified and to ensure sufficient staffing and resources were in place.

The consulting doctors told us the online consultations were scheduled for 20-30 minutes but could be extended if people required further information. People could also choose a face to face consultation with the surgeon carrying out the procedure.

The aftercare team manager told us staff from the aftercare team and the consulting doctors attended daily governance and planning meetings to plan and coordinate people’s care and treatment.

The aftercare team had access to people’s records electronically and were responsible for undertaking post-operative follow up calls with people who had undergone surgery to monitor their post-operative recovery. The frequency of follow ups was dependant on the type of surgery but most people had contact after 24 hours, 7 days, 1 month and 6 months after surgery. The aftercare staff follow up calls were reviewed by nursing staff to monitor their quality and effectiveness.

Routine post-operative follow up appointments with the surgeons were also undertaken as part of the aftercare process following surgery, such as to assess people’s post-operative recovery and for removal of sutures or wound dressing changes.

People who used the service were given information about the aftercare process and contact details for the team as part of the discharge process.

People could contact the service for further advice and if they experienced any complications. Where any post-operative complications were reported, the aftercare team liaised with nurses and the surgeons for any further treatment or advice. The surgeons assessed people remotely or face to face depending on the type of complication. For example, they prescribed further medicines for pain relief or antimicrobials to treat infections and arranged face to face clinic appointments where further treatment or surgery was required, such as for post-operative bleeds.

People who use the service told us staff provided them with the necessary information about their care and treatment verbally and in writing. They also answered any questions they had.

Staff told us they held regular discussions with people who used the service and provided them with relevant information so they were well informed about their care and treatment.

Staff told us they had received training in information security and confidentiality. They told us they could easily access information such as care records, policies and guidance relevant to their role.

Information leaflets about surgical procedures offered were readily available. Information leaflets could be provided in different languages or other formats, such as easy read format, if required.

People could access information on the provider’s website and social media platforms relating to the services they offered.

Managers produced an integrated performance dashboard which included information around performance, patient safety incidents, audit results and patient outcomes. The dashboard information was shared with staff as part of routine meetings.

Information such as policies and guidance was available in paper and electronic format. Electronic care records were easily accessible by staff kept secure with password-protected access.

All staff at the clinic had completed mandatory training in the Data Protection Act. The service had a corporate information governance lead and Caldicott Guardian. There had been no data breaches relating to the service in the past 12 months.

The people we spoke with were unclear about the process for providing feedback about their experience of the service. However, they told us they knew how to raise a complaint or concern. During January 2024 to November 2024, we received negative feedback through our share your experience webform from 7 people who had used the service. The feedback was in relation to their concerns following surgery at the clinic. People reported they had complained to the service because they were not satisfied with the outcome of their surgical procedure. The negative feedback mostly related to blepharoplasty surgery undertaken at the clinic during 2023/24. Common complaint themes were around poor aftercare advice and support, staff being dismissive of people’s complaints and staff unresponsive or taking too long to resolve their complaint.The service collated feedback about people’s experiences from online review sites and reviewed these during monthly governance meetings. Data for September and October 2024 showed the service had received 33 responses, with 22 positive and 12 negative reviews (equating to 20% of overall activity during this period). This indicated a mixed response from people about their experiences using the service. Managers reported the service was working to increase the number of reviews received to increase the validity of this feedback.

Staff told us they understood the policy on complaints and knew how to handle them. They told us information about complaints was discussed during daily huddles and routine staff meetings. Managers told us they had initiated an overall improvement programme aimed at improving people’s outcomes and experience. This included plans to further strengthen governance and clinical processes as well as improving training, education and information provided to staff and people who use services.Implementation of the improvement plan was ongoing at the time of our inspection.

The service received 37 complaints in the past 12 months. Most complaints (24) were about complications or poor outcomes following surgery.

All complainants had an initial response within the provider’s reporting timelines and individual complaints had actions such as duty of candour, fee refunds or further surgeon appointments arranged.

Some complaints about poor surgical outcomes were on-going, such as where people still within their recovery stage had surgeon reviews planned.

Complaints were reviewed at monthly governance meetings. Whilst we saw evidence of actions to address on-going risks for individual complaints, we were not assured managers always fully identified themes, investigated complaints to identify root cause or took appropriate actions to minimise the risk of reoccurrence, particularly around complaints about poor surgical outcomes.

The complaints policy provided guided staff on handling complaints, including how to escalate concerns within the organisation or externally to the Health and Social Care Complaints and Adjudication Partners.

The service reported no complaints had been escalated internally or externally. Whilst people were given information on how to raise complaints, the negative feedback we received from people indicated they either did not fully understand or were not sufficiently supported to escalate their concerns within the organisation or externally.

The service did not have an effective process for obtaining feedback about people’s experiences. Managers reviewed people’s feedback from online review sites as part of monthly governance meetings. Meeting minutes showed feedback was reviewed but there was limited evidence to demonstrate how learning and improvement was shared with staff or with people who posted reviews.

The service planned to implement a formal process for collating feedback about people’s experience through an electronic platform during the aftercare process, but this had not yet been implemented.

People who used the service told us they received treatment in a prompt and timely manner and did not experience long waits when booking their procedure or when they arrived on the day of surgery. They told us they were given clear information on their treatment times.

Staff told us they were able to plan people’s care and treatment in advance so they did not experience delays in their care and treatment.

Staff told us they monitored procedure cancellations and followed up any patients who did not attend their appointments. They told us cancelled procedures were rescheduled promptly to ensure people’s treatment was not delayed.

Managers told us they had sufficient capacity to meet patient needs and provide timely care and treatment. They told us they did not have any patients waiting for access to the services and they monitored access and flow information daily to minimise disruptions to people’s care and treatment.

Managers monitored waiting times and made sure people could access services promptly when needed. People did not experience delays from initial consultation to the day of their surgical procedure. The service did not have any backlogs or waiting lists for people awaiting treatment.

The clinic staff, preoperative and after care teams held daily meetings to plan, coordinate and deliver people’s care and treatment. The theatre teams also carried out daily safety huddles at the start of each theatre list to plan people’s procedures.

The service reported there had been 43 cancellations on the day of surgery during the past 12 months. Most cancelled procedures were either due to people’s own choice or for clinical reasons (such as people unfit for surgery). The cancellation rate was low and equated to 1.8% of all procedures undertaken at the clinic during this time period.

There had only been 2 instances where people did not attend their appointment at the clinic in the past 12 months and staff followed up to determine why they did not attend.

People told us their needs and preferences were assessed and understood by staff. They told us they were treated with equality and in a non-discriminatory way.

Staff told us they treated people equally and without discrimination. They were able to give examples of how they respected the individual wishes of people with protected characteristics, such as those identifying as LGBTQ+ and people with communication or language difficulties.

The service had an equality and diversity policy in place that outlined the processes for equal opportunities including how they ensured they did not discriminate, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions. People with protected characteristics, such as their gender, age, sexual orientation, race and religious and cultural beliefs were taken into account as part of the initial consultation process. The service’s inclusion criteria meant certain people were not eligible for treatment at the clinic, such as people with complex health conditions and people who did not have the capacity to consent to treatment.

The nature of the cosmetic surgery procedures provided by the clinic meant it was difficult to differentiate patient outcomes for people with protected characteristics. However, we looked at data around incidents, complaints and outcomes and this did not identify any disparity in care or adverse outcomes or inequalities for people with protected characteristics.

People who used the service told us the staff discussed their long-term care and treatment plans, expectations and outcomes with them and their preferences were taken into account.

Staff told us they planned and discussed care and treatment plans, including discharge arrangements, prior to people undergoing surgery.

They told us the nature of the services provided meant they did not routinely discuss people’s long-term care needs because people only underwent elective day case cosmetic surgery procedures.

People on palliative care pathways and those with existing ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders in place were assessed against the provider’s inclusion criteria during the initial consultation to determine if they were eligible for admission to the clinic.

Care records showed the details of the surgical procedure, people’s expectations and expected outcomes were discussed with them prior to undergoing surgery. Discharge records showed staff provided information around aftercare plans and post-operative recovery advice.