Farjo Medical Centre (the Centre) is operated by Advanced Hair Technology Limited and was founded in 1993. The Centre moved to its current location in central Manchester in 2013 and the premises are solely owned and operated by provider. Facilities are spread over four floors and include three surgery and treatment rooms, consulting rooms, training and meeting rooms, and a lecture theatre. The Centre also has a small photographic studio to take before and after pictures of patients. Each floor contains accessible toilets, and kitchens for staff use. The Centre has access to robotic equipment that extracts hair grafts for transplantation (although this can also be done manually).

The Centre provides hair transplant surgery and non-surgical treatments including medicines and low level laser therapy to adult patients (aged 18 and over). We only regulate surgical procedures carried out by a healthcare professional where the procedure involves the use of instruments or equipment which are inserted into the body. We do not regulate – and therefore do not inspect - cosmetic procedures that do not involve cutting or inserting instruments or equipment into the body.

There is currently no accredited qualification for hair transplant surgery in the United Kingdom. However, the surgical steps of the procedure should only be performed by a General Medical Council licenced doctor. The surgical steps include the harvesting of donor hair by the strip follicular unit transplant method, making the follicular unit excision incisions, and making the recipient site incisions.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 14 November 2018.

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.

The main service provided by this hospital was surgery.

This is the first time we have rated the Centre.

We rated it as Good overall because:

• The Centre controlled infection risk well.

• The premises were suitable for the purposes they were intended for.

• Staff had the right skills to do their job and had opportunities to develop.

• The Centre provided evidenced-based care and treatment and used technology well to improve its effectiveness.

• The Centre actively monitored patient outcomes to improve quality and its services.

• Staff were competent in their role and had high levels of experience.

• The service actively supported staff to acquire and develop new skills and ensured that they shared best practice. The Centre recognised this was integral to ensuring high quality care.

• Staff frequently presented at national and international conferences.

• The Centre took patients’ individual needs into account when providing a service.

• Patients could access the service when they needed to, including if they were in another country.

• The Centre worked with a charitable organisation to offer treatment for patients that had suffered burns.

• The Centre had a clear complaint policy and process. Whilst there had been no formal complaints in the 12 months prior to the inspection, staff could explain how a patient concern had led to changes.

• Managers at all levels had the right skills and abilities to run a high‑quality service.

• There was a positive culture at the Centre and staff were encouraged to learn and share ideas.

• There was a comprehensive yearly audit, the results of which were presented to staff and used to help shape the service.

• There was positive staff and patient engagement.

• There were clear examples of how the Centre strived to continually improve its service.

However, we also found the following issues that the service provider needs to improve:

• Not all staff had received appropriate mandatory or safeguarding training, or understood what a safeguarding incident was.

• The Centre did not have a comprehensive incident reporting policy.

• The service did not have a formal process for ensuring that patients that did not speak English as a first language had support from someone that could translate complex medical information.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)

We spoke with four people who had recently used the service. People commented: "the care was right up there" and "the best". People reported that they were treated with respect and were given information about their care and treatment. All the people confirmed that they were treated with dignity and respect at all times. They praised the quality of staff that treated them.

This was summed up by people stating that the lead surgeon as someone who "really knows what he is doing" and "leading and pioneering in the field". People told us that they were very happy with the service they received. One person when asked if they were confident that their complaints would be looked into replied: "Yes, I would because the manager is very receptive and responsive".

The provider was meeting all the standards we looked at on this inspection including standards relating to involvement and respect, care and welfare, safeguarding, suitability of premises, maintaining appropriate staffing levels and managing complaints.