Manchester Surgical Services was led by the Clinical Services Manager and a Registered Manager from another location. The Clinical Services Manager was employed on a part time basis and also worked full time at Trafford Healthcare NHS Trust as the Head of Nursing. The team directly employed by Manchester Surgical Services consisted of an administrator and a service manager who oversaw the daily running of the service.

We were not able to speak with any patients as there were no people receiving treatment on the day of our inspection. We were able to access satisfaction surveys which gave us a good indication of the experience of the patients.

Patients who had completed a satisfaction survey said "very quick appointment, the consultant was friendly and approachable and inspired confidence in me".

We found records were stored in a secure manner. All paper based records were kept securely in the office area. The office door was kept locked and was accessible via a keypad. We found the provider had information which was out of date stored electronically. The provider told us they would update the system in line with their data management policy.

We could see there was good written communication between consultants, patients, general practitioners (GP's) and hospital staff which meant people were receiving good care consistent with their needs.

We were not able to speak with any people who use the service as there were no people receiving treatment on the day of our inspection.

Manchester Surgical Services is an independent healthcare provider based at Trafford General Hospital within Trafford Healthcare NHS Trust in Trafford, West Manchester. The service operates in a collaborative partnership with Trafford General Hospital, who are the facility provider for their clinical pathways.

The main service provided by this service is surgery. There are outpatient services, but these are limited to initial consultations, pre-assessment appointments, post-operative appointments and pain management. There are no general outpatient or diagnostic services provided. The service provides treatment for NHS patients that includes general surgery, orthopaedic surgery and ear nose and throat surgery. There is also an endoscopy service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 2 and 4 March 2017, along with an unannounced visit to the service on 17 March 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? 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.

We rated this service as good overall.

We found the following areas of good practice:

• Patient safety was monitored and incidents were investigated to assist learning and improve care. Staff assessed and responded to patients’ risks and followed the ‘five steps to safer surgery’ procedures during surgery.
• Care and treatment was delivered by staff working under casual worker arrangements and consultants under practicing privileges. The staffing levels and skills mix was sufficient to meet patients’ needs.
• There were no serious patient safety incidents, healthcare-acquired infections or surgical site infections reported in relation to the service between January 2016 and December 2016.
• Staff followed the host hospital’s policies and procedures relating to medicines management, infection control and maintenance of the environment and equipment. Patient records were completed appropriately.
• Most patients received treatment within 18 weeks of referral and waited less than 6 weeks from referral for a diagnostic test. The service monitored performance against waiting time targets to reduce delays in treatment.
• There were only four operations cancelled for non-clinical reasons between April 2016 and December 2016. All the patients were treated within 28 days of the cancellation date. There had been no new or follow up appointments cancelled by the service within two weeks of the appointment date between April 2016 and December 2016.
• There were processes in place to protect vulnerable patients and those identified at risk of abuse. Patients understood how to make a complaint or raise a concern and their concerns were listened to.
• We spoke with 12 patients and the relative of a patient. They all spoke positively about the care and treatment they received. Patient satisfaction surveys also showed patients were positive about the services provided.
• Patient consent was obtained prior to commencing treatment. Patients were involved in their care and staff provided emotional support when needed.
• The services provided effective care and treatment that followed national clinical guidelines and staff used care pathways effectively. Patient outcomes were measured through patient feedback and the routine monitoring of key processes.
• Care and treatment was provided by suitably trained, competent staff who worked well as part of a multidisciplinary team. All the core staff had completed their appraisals. The majority of staff had completed their mandatory training.
• The service had a clearly defined vision and values. Regular meetings took place to monitor performance against objectives. Key risks to the services were recorded and managed through the use of local and corporate level risk registers.

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

• The service did not have a registered manager in place at the time of our inspection. It is a condition of the provider’s registration that there is a registered manager in place. There had been no registered manager since March 2014. This is a breach of the condition of the provider’s registration.

• Reported concerns such as recorded patient complaints, an unplanned return to theatre and an unplanned patient readmission had not been formally reported as incidents.
• This meant that although these concerns had been reviewed and appropriately resolved by staff, there was no standardised process for identifying and monitoring incidents in one place, which may help to identify themes or patterns.
• Patients were seated in close proximity to each other in their surgical gowns in the theatres area wait room. We saw that staff were present nearby however this arrangement may impact on patients’ privacy and dignity.
• The service did not carry out routine infection control audits. The service received the minutes from the host hospital’s infection, prevention and control committee, however trust activities did not include weekends so these were not entirely representative.
• There were two registrars who had signed contracts with the service but we did not see any evidence to show appropriate recruitment checks had been carried out, such as General Medical Council (GMC) registration status, appraisal records or Disclosure and Barring Service (DBS).

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, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)