Bristol Plastic Surgery is a small independent acute hospital offering minor plastic surgery services to both private and NHS Patients. There are no inpatient beds at the hospital.

We inspected the hospital on 18 August 2015 as part of our schedule of comprehensive inspections of independent hospitals.

We have not published a rating for this service. CQC does not currently have a legal duty to award ratings for those hospitals that provide solely or mainly cosmetic surgery services.

Are services safe at this hospital?

There was open and transparent reporting of incidents of harm or risk of harm, which were reviewed at regular meetings. When things went wrong patients were informed in a timely manner. However, learning from incidents was not widely shared with staff and there were no records of this happening.

Patient records were inconsistent and often incomplete. Some assessments were not completed and we found loose documents in sets of notes that could easily be lost. However, the clinic had enough staff to meet patients’ needs, and staff were up to date with safeguarding training and were aware of the reporting process if abuse was suspected.

Are services effective at this clinic?

Care provided within the clinic was evidence based. Staff were able to attend external study days and training such as wound care, and able to use this knowledge in practical terms. All policies, incidents and complaints were discussed at the medical advisory committees and a record of all action points was made.

We found patient’s outcomes were not being monitored and there was no benchmarking against other similar services. The clinic did not participate in any national audits.

We found the staff were experienced and competent in delivering the service, appraisals were up to date and learning was completed as required.

Are services caring at this clinic?

We found the service provided to patients to be caring. This was reflected in the feedback by patients. Staff were found to be supportive, kind and considerate.

Are services responsive at this clinic?

The service did not have a waiting list and patients could choose when to have their operations. The clinic was able to meet the needs of patients with mobility issues by the use of a stair lift and access to consulting rooms at ground level. Open evenings were held to give potential patients information and advice about the services the clinic provided.

All complaints were taken seriously and acted upon if required. A complaints report was provided at the medical advisory meetings and was discussed as an agenda item.

There was some service planning in place but we did not see documented evidence of this.

Are services well led at this clinic?

The clinic had leaders who were held in high regard by staff, the culture was open and honest and staff felt able to discuss any concerns. However, the clinic lacked documented evidence of their vision, values and strategy.

Risk assessments had been completed, but there was not a risk register in place. There did not appear to be ownership of the risks and these had not been updated after two instances of needle-stick injury, for example.

However, there were areas of poor practice where the provider needs to make improvements.

Importantly, the provider must:

• Undertake regular audits of the service provided, monitor patients outcomes and ensure that there is documented evidence of action learning processes in place to support the outcomes.

• Ensure that identified risks to people who use the services and others are continually monitored and appropriate action is taken when a risk has increased.

• Improve documentation and record keeping to ensure an accurate and complete patient record is maintained.

• Have an effective recruitment and selection procedures, which should assess the accuracy of the applications and be designed to demonstrate the candidates suitability for the role, while meeting the requirements of the Equality Act 2010.

In addition the provider should:

• Ensure that there are clear guidelines for antimicrobial prescribing to ensure good antimicrobial stewardship.

• Have a written strategy for the clinic that incorporates its values and vision.

Professor Sir Mike Richards

Chief Inspector of Hospitals

As specific key staff were unavoidably absent on the day of the visit, it was not possible to access some documentation. However, discussion with one of the doctors (partner) and support from staff we were able to complete the inspection.

Private and NHS patients attended the clinic for consultations and treatment for reconstructive plastic surgery and cosmetic surgery and diagnosis and treatment for skin cancer. The service also provided non surgical treatments that are not registerable with the Commission.

We spoke to two people who spoke very highly of the service they had received. One person said “Fabulous. The whole experience has made my problems easier to deal with.” Another person said “absolutely fantastic.”

People gave informed consent prior to surgery. The risk and benefits were explained to them by a doctor and people were given time to reflect on their decision unless treatment was for skin cancer when surgery was carried out at the earliest opportunity; often the same day as their consultation. One person using the service said the doctor "gave me time to explain things.” Another person said “didn’t make me feel silly to ask questions.”

There were safeguarding policy and procedures in place and most staff had received up to date training.

The doctor told us the service had not received any complaints within the last year.

We spoke with a person who used the service. This person was pleased with the care that had been given. We were told "I was impressed by the clinic. They looked after me really well". Other people said that staff were courteous and helpful and that they felt safe in their care. We observed that people were treated in a polite and helpful way.

People felt well-informed and involved in their care. They were told about risks associated with their treatment and were asked to give consent before procedures took place. We saw that staff assessed the individual needs of each person that used the service and devised a treatment plan that was appropriate.

There was a system in place to monitor the quality of care and we could see that changes were made to care as a result of quality audits. The clinic took account of comments and complaints that they received and changes were made when necessary.

Staff support was not always present. There was little evidence of staff training and no arrangements in place for continued professional development. Staff did not receive yearly appraisals and there was no documented clinical supervision for nursing staff. However, staff did say that they enjoyed their work and were happy working at the clinic.