We visited the service on 22 October 2012, and telephoned people who use the service on 23 October 2012.

We spoke with three people who were patients at the Midlands Diving Chamber about their experiences of the service provided to them. We also spoke with two members of staff and the manager who supported patients.

Patients we spoke with told us that staff went through all the details of their treatment. They told us the risks were explained about the treatment and there was an informed process. We saw that patients had consented to the treatment they were to receive.

Patients we spoke with told us that the treatment matched their treatment plan. They told us they knew what was happening during the treatment and they were clear on what treatment they would receive. We saw treatment plans were person centred and reflected patient's needs.

We spoke with three staff members about their training and experience. We saw the manager had a training matrix to identify when staff required any refresher training.

We saw the manager had a system in place to ensure the checks on equipment were completed regularly. Staff we spoke with told us why what the equipment was used for and how often checks needed to be undertaken.

We saw records were stored in a secured area and patients had signed to say they understood how their records would be used.

Midlands Diving Chamber (MDC) is operated by Midlands Diving Chamber Ltd. It is located in an independent unit within the grounds of St Cross Hospital, Rugby. The service does not have any beds. Facilities include a ten seat hyperbaric chamber, a reception area and offices. Emergency hyperbaric oxygen therapy was available 24 hours a day, 7 days a week, 365 days each year. MDC has a sister unit based in London, the London Diving Chamber. MDC is one of ten hyperbaric chambers across England.

The service provides a hyperbaric decompression chamber offering NHS funded recompression to divers with decompression sickness (DCS) together with other Hyperbaric Oxygen Therapy (HBOT) treatments.

Hyperbaric oxygen treatment involves breathing 100% oxygen at higher than atmospheric pressures in an enclosed chamber. At the time of our inspection, the service had a category two, ten-person, ‘walk-in’ hyperbaric chamber which was installed in 2009. There are four categories of hyperbaric oxygen chambers, a category two chamber is capable of receiving elective or emergency referrals for any accepted application of hyperbaric oxygen therapy but excluding patients who are critically ill at the time of referral or are considered likely to become so. Patients can spend between two to eight hours in the oxygen chamber depending on the treatment pathway.

The service treats mainly adults but can treat children in certain specific emergency situations and only if accompanied by a paediatric qualified clinician. The minimum age for scuba diving is ten years old.

The Midlands Diving Chamber is a recompression chamber offering consultation and hyperbaric oxygen therapy treatment for:

• Air or Gas Embolism

• Carbon Monoxide Poisoning

• Carbon Monoxide Poisoning Complicated By Cyanide Poisoning

• Clostridial Myositis and Myonecrosis (Gas Gangrene)

• Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias

• Decompression Sickness

• Arterial Insufficiencies

• Enhancement of Healing In Selected Problem Wounds

• Severe Anaemia

• Intracranial Abscess

• Necrotizing Soft Tissue Infections

• Osteomyelitis (Refractory)

• Delayed Radiation Injury (Soft Tissue and Bony Necrosis)

• Compromised Grafts and Flaps

• Acute Thermal Burn Injury

• Idiopathic Sudden SensorineuralHearing Loss

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 13 and 14 December 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.

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:

• Policies and procedures were in place which kept staff and patients safe and free from harm.

• Staff followed recommended infection prevention and control procedures, patients were provided with appropriate clothing to wear whilst in the chamber.

• A thorough and detailed planned maintenance system was in place for the hyperbaric chamber, staff had specialist training in order to maintain the equipment was safe to use. All equipment used was checked and serviced regularly.

• Procedures were in place to follow in the event of an emergency. Staff read and signed to say they understood the procedures once every three months.

• Patient records we reviewed were accurate, complete, up to date and stored securely. Details of each therapy session were recorded in the patient record including improvements in condition or any adverse effects.

• Thorough risk assessments were carried out for each patient prior to treatment, staff worked to a set of exclusion criteria. Patients were constantly monitored throughout the therapy session.

• Each therapy was supported by a full hyperbaric team of four staff as recommended by the British Hyperbaric Association.

• Emergency scenarios were tested regularly so staff understood their roles in the event of an emergency.

• Treatments were based on evidence based care and policies based on best practice guidance.

• The service submitted information to the NHS England specialised services quality dashboard to enable benchmarking with other hyperbaric oxygen services.

• Staff were highly competent in the specialist service they delivered.

• Patients spoke very highly about the care and treatment they received at Midlands Diving Chamber and the thoughtful and considerate way they were treated by staff.

• Midlands diving chamber tailored services to meet the needs of individuals, appointments were flexible and emergency care could be delivered throughout the 24hour period.

• The buildings and oxygen chamber were wheelchair friendly and staff could cater for patients with communication difficulties.

• Leaders were competent to carry out their duties, staff respected and valued one another, strategic objectives were realistic and included improving care for patients and developing staff.

• Quality and performance was monitored and analysed for areas for improvement, changes were made as a result.

• Expertise in the specialist field of hyperbaric oxygen therapy was maintained by investing in staff training and development and being members of specialist societies and associations.

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

• Include reference to female genital mutilation in safeguarding policies and raise staff awareness. Following our inspection an updated policy was submitted which included information about female genital mutilation.

• Review the storage of oxygen cylinders and safety signage. Following our inspection we received evidence that safety signage had been obtained and was clearly displayed.

• Develop a checklist for the resuscitation trolley based on the resuscitation council guidance. Following our inspection the provider submitted an updated checklist based on resuscitation council guidance.

• Implement cleaning schedule checklists for the chamber and chamber room. Following our inspection we saw evidence of an updated cleaning schedule checklist.

• Consider centralising information technology systems.

• Ensure HR policy reflects relevant employment regulations for future recruitment processes.

• Implement a risk register for the service.

Following this inspection, we told the provider of some improvements it should make, even though a regulation had not been breached, to help the service improve, Details are at the end of the report.

Name of signatory

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)