The Rostra Clinic

On this page

• 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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed eight patient records. We found all eight of these were lacking vital information. For example, no observations as well as post-operative treatment or information were included in any. Furthermore, no prescription sheet or information for local anaesthetic was included in four patient records. This meant we could not ensure patient records contained all key clinical and background information to keep people safe.

The service was available every weekday as required, so could respond to immediate patient demand.

The clinic’s first consultation was free of charge to patients. This meant some people booked online and then did not attend or attended just for a second opinion. The RM told us they were always honest with patients who qualified for NHS treatment. They would confirm and provide patients with the relevant information. The RM sent all patients who attended for a clinic consultation a report. This summarised their discussion and options in accordance with the NICE guidelines.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Managers told us they provided and updated their care and treatment based on national guidance and evidence-based practice. They offered procedures based on the best proven outcomes for most people. For example, the RM followed NICE guidance to offer patients endothermal or endovenous laser ablation (EVLA) using a heated radiofrequency or laser energy to seal veins closed. The RM was aware this procedure had more evidence-based effective benefits than ultrasound guided sclerotherapy (UGST), which may need to be repeated.

After our on-site assessment we were sent the provider’s protocol for this procedure. However, the procedure mentioned their ‘clinical audit programme will report against the procedure’. On-site we found staff still undertook no formal or periodic clinical audits, as part of a programme or otherwise. This meant they did not adhere to the procedure and could not assess how effective it was to monitor and improve outcomes.

The RM reviewed guidelines from the Royal College of Anaesthetists and the British Hypertension Society. They also constantly reviewed NICE guidelines and guidance around deep vein thrombosis (DVT) prophylaxis.

The RM followed the DVT prophylaxis risk assessment. This risk was often negligible but escalated slightly if patients had comorbidities. However, their patient demographic was generally younger, healthy and low risk. Many sought vein procedures more for cosmetic than clinical reasons. Some patients self-referred to avoid NHS varicose vein treatment waiting times.

The RM ensured foam sclerotherapy patients were aware of and consented to the risk of stroke as per the National Institute for Health and Care Excellence (NICE) guidelines. The RM chose the acceptable maximum level of foam agreed to use during this patient procedure, based on published data. They had reviewed the common factors, or any correlations involved in the very small number of global cases to prevent future risk to patients.

The RM attended Vascular Society UK events every two years, and the venous forum to hear about examples of poor practice. They then reviewed and updated their documentation accordingly.

The clinic lead was nursing and midwifery council (NMC) registered as a consultant nurse. The service was information commissioner’s office (ICO) accredited.

The consultant nurse adhered to procedural ultrasound competencies during procedures we observed. This ensured they were able to provide safe and effective imaging during endo-venous laser ablation. Staff explained their findings to the service user throughout.

However, the competencies contained no version number, header, owner, origin or review dates. This meant we could not confirm how long the document had been in use.

We could not ensure clinic leads reviewed and updated relevant policies. We requested but did not receive any updated documentation examples discussed on-site. This meant we could not ensure staff had adhered to latest protocols during procedures.

We observed no counts of sharps or guidewires during procedures. This meant there was a risk clinical equipment was unaccounted for and could go missing.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service employed one vascular consultant nurse for all clinical procedures under their scope of regulated activities. They acted as clinical lead and were supported by a healthcare assistant during procedures.

One patient told us the RM had sought further advice and guidance from their pharmacist to treat them safely and considerately. The patient had an allergy to antibiotics, and an autoimmune disease.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Clinical staff ensured patients were given and understood all relevant information pre-and post-procedure. They ensured patients were fully informed and consented. All alternative treatments and options were clearly explained and included in the post-consultation letter.

Staff gave post-operative patients a written leaflet with instructions for best recovery and aftercare. They promoted and signposted information and resources on health and wellbeing.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Patients told us staff ensured they were fit and fully recovered before they left. The RM reviewed all patients who had a varicose veins procedure at follow up appointments. They ensured all patients were satisfied with their recovery and outcome. They added that patients were more likely to recommend their service when they maintained high standards. However, a lack of reliable clinical data meant we were not assured the service’s patient recovery times and outcomes were consistently good and improved their quality of life.

The RM told us they had undertaken a widescale follow up audit review five to ten years before our assessment. This entailed 1500 patient reviews five to ten years post procedure. The review found only around 4% of patients still had varicose issues. Therefore, they felt any further outcomes review or audit was irrelevant, as their procedures were the same.

We requested but did not receive this audit by the given deadline. This meant we could not evidence the audit figures quoted on-site.

The service still lacked a robust audit process. For example, we found staff still undertook no formal or periodic audits to assess, monitor and improve the quality and safety of the services provided under regulated activities. Executive board meeting minutes we reviewed contained no audit information from the last 12 months.

Managers could not evidence if or how they improved the patient experience. The RM had no procedural peer review or external assurance to compare or monitor performance. They had no appraisals with their provider’s medical director (MD). This meant they could not evidence improved clinical practice or patient outcomes.

However, the RM could contact the MD on an ad-hoc basis to discuss clinical issues. The RM planned mentoring with two recent patients treated for varicose veins who were senior nurses.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff did not gain consent from patients for their care and treatment in line with legislation and guidance. The service did not comply with the Royal College of Surgeons (RCS) recommended two weeks (14 days) cooling off period for cosmetic surgical procedures. They maintained no agreed cooling off period with patients. This period was implied, rather than defined by the RM telling patients they would not be contacted to book a procedure date. Instead, patients who wished to proceed had to contact the RM.

Staff did this in response to receiving positive feedback about not harassing people into procedures. The service also did not request payment until post-procedure.

Seven of the eight consent forms we checked were not dated. This meant the service had no record of when these patients had agreed to treatment.

Staff did not always follow a clear process to gain patient’s consent. We reviewed the service’s in-date informed patient consent policy. This referred to Department of Health guidance and General Medical Council (GMC) requirements.

Parts of the policy were not relevant to the service and mentioned non-existent groups, committees and staff roles. The policy stated consent forms and relevant training were subject to audit. On-site we found staff carried out no consent checks or audits. This meant they did not comply with this policy.

However, staff checked with patients they wanted to proceed with treatment. Patients signed a consent form pre-procedure. This was separate from their main medical record. Their consent was gained again at their second consultation on the day of their surgery. Staff and patients told us the RM confirmed with them several times when setting up if they were sure they wanted to go ahead.

The service used an informed consent form describing the procedure, risks and discomforts, potential complications, alternative treatments and potential benefits.

After our on-site assessment we were sent the provider’s in-date mental health capacity act policy. However, on-site staff could give no examples of assessing people’s lack of capacity or best interests. This meant we could not evidence they would follow the policy.