We spent half a day in the unit and spoke with three patients attending for treatment. They told us they were well informed about their medical condition and the treatment options. They had been told about the risks and benefits of the proposed treatments and had been given opportunities to ask questions. Staff had been trained to obtain consent in accordance with legal requirements and understood their responsibilities to support people who lacked mental capacity. However the documentation used to record consent in these circumstances needed to be developed so that there was a clear audit trail of the decision making process.

People received safe, convenient and co-ordinated care because the provider liaised with and co-operated with other providers of care. GPs were informed promptly about their patients' treatment and advised about on-going management of their medical condition.

The provider had robust systems in place to ensure that medicines were available and managed safely.

Patients were complimentary about the staff who cared for and treated them and told us they had confidence in their skills and knowledge. The provider had effective recruitment processes to ensure that people were cared for by staff with appropriate skills, knowledge and experience.

Medical records were maintained securely, were accessible and were mostly clear, accurate and complete.

We visited the Cirencester Hospital’s endoscopy unit on a day when Prime Diagnostics were operating. We spoke with the unit’s manager and nursing and care staff. We also spoke with the Prime Diagnostics operations manager and the endoscopist. We spoke with two patients who had undergone a diagnostic procedure and we looked at some patients’ records.

Patients told us that they felt well informed about their medical condition and the treatment options. They were satisfied with the timescales in which they were seen and the quality of the care and treatment they received. One person told us “I am more than satisfied. Everybody from the receptionist to the doctor has been lovely."

We looked at processes in place to decontaminate diagnostic equipment and the systems in place to ensure that equipment was regularly serviced and maintained. We were satisfied that these systems were robust and ensured people’s safety.

People told us they were confident in the skills and knowledge of the staff who provided their care and treatment. The provider had systems in place to monitor and report on quality and safety, although meaningful clinical outcome data was not available due to the short time that the unit had been operational. Staff told us they were well supported with training and we saw evidence that the endoscopist's practice was observed and assessed.

​InHealth Endoscopy Unit – Cirencester Hospital is operated by InHealth Limited. The service is commissioned by Gloucester Clinical Commissioning Group to deliver diagnostic services. The service is hosted by local NHS trust through contractual arrangements. The service offers clinics on Mondays and Thursdays only at this location. It accepts adult patient referrals and does not see any children or young people under the age of 18 years.

The endoscopy unit is located on the first floor of the building. The premises were refurbished in 2010 to ensure it met accreditation standards. The unit consists of a dedicated waiting area, admission/consent room, one procedure room, separate clean and dirty decontamination rooms with pass through washers. There is a recovery area with three cubicles, a second stage seated recovery area and a discharge room located outside of the main unit. There were two offices used for the unit manager and for reception/administration.

The inspection was unannounced meaning the service did not know we were coming to inspect. We carried out the inspection on 3 January and 14 January 2019, using our comprehensive inspection methodology.

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.

Services we rate

This was the first time the service was rated, although it had been previously inspected in 2014.

We rated it as Good overall.

• Staff had completed their mandatory safeguarding training and knew which actions to take if they had concerns about patients.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service provided care and treatment based on national guidance.
• The service gained Joint Advisory Group (JAG) accreditation in July 2018.
• There was effective multidisciplinary working with other healthcare providers to ensure patients received the right care.
• Staff were compassionate and supportive to patients and relatives in their care.
• Staff communicated with patients in manner that met their needs and offered opportunities for patients to ask questions.
• Patients’ dignity was maintained at all times.
• There were effective arrangements to involve relatives as much as patients wanted.
• Feedback from patients and relatives was positive.
• The service took account of patients’ individual needs and made reasonable adjustments to meet these as required.
• Leaders had the right skills and experience to run a service providing high-quality sustainable care.
• We observed a positive culture amongst staff and they felt supported by their leaders and by InHealth.
• There was an effective governance structure, which ensured effective monitoring of the service and communication pathways.
• There were systems to identify risks and mitigating actions to manage these.
• Staff had access to relevant and current information about patients to deliver safe care.

However, we found areas of practice that require improvement.

• Medicines were not prescribed and administered in line with national guidance and legislation.

• Documentation used for consenting was ambiguous and did not confirm that risks had been discussed with patients. Staff did not always assess if patients had mental capacity to consent to procedures.
• The service did not always meet the needs of local people. There was a waiting list of patients waiting to attend for an endoscopy procedure.
• The service did not meet targets for referral to treatment in nine of 12 months between October 2017 and September 2018.
• Meetings were not always held as often as they should be in accordance with the schedule of regular meetings.
• Paper-based patient records were not disposed of safely.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)