London Hyperbaric Medicine (LHM) Healthcare is operated by LHM Limited. The hyperbaric unit was located within the grounds of Whipps Cross University Hospital, Leytonstone, London. The service provided hyperbaric (high pressure) oxygen therapy for a number of conditions. .

We inspected this service using our comprehensive inspection methodology. We carried out our announced inspection on 26 September 2017.

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?

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 do not rate

We regulate  hyperbaric oxygen therapy services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Staff were aware of their responsibilities for reporting incidents. We saw that lessons from incidents were shared, and actions put in to place to reduce the risk of them happening again.
• Standards of cleanliness and hygiene were high throughout the unit. Infection control procedures were in place to prevent the spread of infection.
• The service was fully staffed. Staff had appropriate skills and experience to provide care and treatment to patients at their level of need.

• Patient audits for decompression illness and severe carbon monoxide poisoning had been implemented by the unit. The service followed up on patient progress after their treatment.

• Patients told us they felt fully informed about the treatment being offered. Appropriate processes were in place for obtaining consent.

• All patient feedback we received was positive. Patients told us that staff were professional and provided an excellent quality of care.

• The service responded rapidly to emergency patients, with the unit open and ready to treat within an hour.

• Staff tried to be flexible when scheduling appointments. Treatment was usually commenced promptly following initial assessment. Cancellations were infrequent, at which time treatments were quickly rescheduled.

• There was clear direction from the managing director and medical director. Managers were regularly visible at the unit, and advocated an ethos of open communication and feedback.

• We observed a staff team that worked well together. Staff turnover and sickness rates were low.

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

• Mandatory training was out of date for a number of the medical staff.
• Not all staff were trained to level two for safeguarding children and adults.
• Medication that was close to its expiry date was not clearly marked and we found some medication that was out of date. Medication stocks were not checked in the absence of the senior hyperbaric nurse.

• Not all nursing, technical and administrative staff within the unit had received a regular appraisal.

• Whilst there were formal arrangements for the use of interpreting services through the host hospital, the unit often used friends or family to translate information.

• There were limited arrangements for information to be provided in different languages other than English, or alternative formats such as braille or large print where required.

• Staff meetings were held at the unit, but not all staff members were able to attend. Staff told us a meeting that included all unit staff would help with sharing of ideas and good practice.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements to help the service improve. We issued the provider with a Requirement Notice. Details are at the end of the report.

The service must:

• Take all reasonable steps to ensure doctors are up-to-date with mandatory training.
• Ensure appropriate staff are trained to a minimum level two for safeguarding children and adults.
• Ensure all nursing, technical and administrative staff receive timely and regular appraisals.

The service should:

• Put in place procedures so that medication close to expiry can be identified and appropriately disposed of.
• Use formal interpreting services for patients whose first language is not English.
• Ensure that all patient information can be accessed and that there are arrangements in place for information to be provided in different languages or alternative formats when required.
• Encourage all unit staff to attend team meetings, in person or by teleconference, so that best practice can be shared.

Amanda Stanford

Deputy Chief Inspector of Hospitals (London)

At the last inspection in February 2013 we found that nursing staff working at the London Wound Healing Centre had not received mandatory training updates, supervision or appraisal. This time we found that staff had received appropriate training, supervision and appraisal.

Appropriate arrangements were in place to obtain consent from patients. Where people lacked capacity, there were protocols in place so that treatment could be provided in their best interests.

Patient files showed that assessments of patients needs were carried out and that treatment was provided in line with these needs.

The environment was suitably designed and adequately maintained. The centre kept up to date maintenance records of all equipment. There were appropriate arrangements in place in relation to health and safety.

Some staff had not received updates on essential training, such as life support, when it was required. In addition, whilst there was evidence of supervision and appraisal arrangements for the doctors, there was no evidence that nursing staff had received supervision or appraisal. Staff were not always appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment to patients safely and to an appropriate standard.

On the day of our visit, there were no appointments so we were unable to speak with patients.