We carried out an announced comprehensive inspection on 28 November 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

ABL Limited are commissioned to provide behaviour change programmes including specialist weight loss and smoking cessation services. Choose to Change (C2C) is a weight management behavioural change programme that adopts additional psychotherapy methods to support the weight loss programmes and encourage lifelong change. It helps people to break down barriers to sustained weight loss; become more active and make positive food choices. Choose to Change programmes are held in different areas of Greater Manchester and Merseyside to ensure easy access for patients. The clinics are run by a variety of support professionals which include doctors, lifestyle coaches, psychologists, dietitians and nutritionists. The course is part of the patient’s ongoing bariatric treatment. (Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity). The service also manages a contract with a specialist enteric feed provider. Enteral feeding is a method of feeding patients through a special tube directly into the stomach. Dietitians employed by ABL are responsible for assessing patients for the type of feed to be provided. ABL staff are not involved in managing the day-to-day delivery of the feed. This is managed by the specialist company and carers who are organised by the appropriate secondary medical services.

Staff employed by ABL Limited includes:

General Practitioners, psychologists, dietitians, nutritionists, lifestyle coaches, physical activity specialists, health trainers and administration staff.

The Chief Executive is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received feedback from 32 patients on the day of inspection, through comment cards and face to face interview. All cards and comments were very positive about the help and support offered during the weight loss treatment and the way patients were treated.

Our key findings were:

• There was an open and transparent approach to safety and an effective system in place to report and record incidents.
• There were well established governance and monitoring systems which were effectively applied throughout the service and fully understood and deployed by staff.
• The service demonstrated a learning and inclusive culture.
• The service acted in accordance with their principle of ‘a better life’ for all who came into contact with the service and stakeholders.
• Patients said they were treated with compassion, dignity and respect. They said they were fully involved in their treatment plans and making decisions about their ongoing treatment.
• Information about services and how to complain was available and easy to understand.
• Clinicians assessed patients according to appropriate guidance and standards such as those issued by the National Institute for Health and Care Excellence (NICE).
• All members of staff maintained the necessary skills and competence to support patients.
• Staff were up to date with all mandatory training and current guidelines and were led by a proactive management team.
• Risks to patients were well documented and managed.
• Staff were kind, caring and competent and put patients at their ease.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 26 January 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

ABL delivers community healthcare programmes across the north of England. They offer support services to people who need to loose weight for health reasons. All patients within these programmes are NHS funded and have been referred to the service for advice and treatment from an NHS practitioner. All services were managed from ABL Limited head office in Bolton but provided in community settings for example: Blackpool, St Helens and Hull. The services of ABL are commissioned by local NHS clinical commissioning groups (CCG’s) or the local authority.

Services offered:

Choose to Change (C2C) is a weight management behavioural change programme that adopts a different stance to other weight loss programmes, encouraging lifelong change rather than short term traditional diets. It helps people to break down their barriers to sustained weight loss, become more active and make positive food choices. Choose to change programmes are held out in the local community ensuring easy access for their patients. The clinics are run by a variety of support professions which include doctors, lifestyle coaches, psychologists, dietitians and nutritionists. It is part of the patient’s ongoing bariatric treatment. (Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity)

Birth understood for mums and partners (BUMPS) is a programme of antenatal advice and support for prospective parents. The aim of this holistic health and well-being service is to help new and prospective parents feel confident and prepared to give their children the very best start in life. This service is offered in Hull only. All patients, within this service, remain under the care for their NHS Midwife for clinical support. These sessions are run by birth educators with the support of a consultant midwife.

The service also offers:

• Training packages. Examples include: Brief advice, intervention and motivational interviewing training, nutritional and physical activity guidance for children and training peer supporters and health champions to deliver health messages in the community.
• Health at Work integrated workplace health and wellbeing service for small to medium sized enterprises.
• Health Young People (HYPE) offering confidential advice and support to young people between the ages of 10 and 19 from across Hull. HYPE offers health advice and information on a wide range of topics including alcohol, drugs, sexual health, mental health, nutrition, physical activity, emotional and lifestyle support.

However all the above programmes are not within the scope of their registration with CQC and were not reviewed as part of this inspection.

Staff employed by the provider include: GPs, psychologists, dietitians, nutritionists, life style coaches, physical activity specialists, health trainers, birth educators and administration staff.

The chief executive is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We spoke to three patients on the day of inspection. They all commented very positively about the help and support offered to them in their weight loss treatment. All said they would not have lost weight or understand how to maintain their weight loss without the programme.

We reviewed 62 Care Quality Commission (CQC) comment cards from patients in the Choose to Change program that provided feedback about the service. All these cards were very positive about the help they received and the manner in which they were treated. All were very positive about the staff running their programme.

We reviewed 22 comment cards from the BUMPs patients. Again these were all very positive about the help and support they received from ABL staff. The only negative comment was that the chairs in the venue were not comfortable for pregnant women.

Our key findings were:

• There was an open and transparent approach to safety and an effective system in place for the reporting and recording of incidents.
• Patients said they were treated with compassion, dignity and respect and they were fully involved in their treatment plans and decisions regarding their on-going treatment.
• Information about services and how to complain was available and easy to understand.
• Clinicians regularly assessed patients according to appropriate guidance and standards such as those issued by the National Institute for Health and Care Excellence (NICE).
• All members of staff maintained the necessary skills and competence to support patients.
• Staff were up to date with all mandatory training and current guidelines and were led by a proactive management team.
• Risks to patients were well documented and managed.
• Staff were kind, caring and competent and put patients at their ease.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.

There were areas where the provider could make an improvement and should:

• Review all location risk assessments with regards to the accessibility of a defibrillator on the premises. As staff worked in locations away from the main provider site portable emergency equipment should be considered.