There was a small team of staff at the unit who all seemed to work well together. We found the technical director and nurse manager to be knowledgeable and skilled. They had a positive ethos towards good quality care. Both the technical director and nurse manager were visible and approachable.

We found the staff at the hyperbaric unit to be compassionate and caring. We saw staff had empathy and were aware of the whole care experience for patients, not just their hyperbaric treatment in isolation. The timing of the morning and afternoon sessions meant that most patients did not have to travel very early or return home late. There was flexibility for elective patients to attend sessions to fit in around their own routine.

We found emergency access to the service was good. Staff could be called in and the unit opened within an hour. Staff told us the average wait from referral to treatment was two months. We found this to be longer than some other hyperbaric units, which employ more staff and hence have more treatment sessions. The average wait for treatment in such other units was approximately two weeks.

There was no clear vision or set of values for North of England Hyperbaric Medical Services. This meant staff could not understand their role in achieving the vison for the service, and there was no way to monitor progress towards delivering any goals. The technical director told us there was no need for a strategy as staff demonstrated the values by the work carried out. We found no performance framework to identify, assess, monitor, and respond to performance issues. Staff told us they did not receive an annual appraisal. There were no staff surveys, staff meetings or ways the staff could be involved in developing the service.

Staff told us there was a strong focus on patient safety. Environmental audits commenced in August 2015 and were due to take place on a monthly basis. Maintenance records indicated staff carried out checks on a daily basis, for example, the oxygen and carbon dioxide levels within the chamber. However, we found the resuscitation equipment inside the chamber such as the ‘medic’ bag and airway bag were only checked on a monthly basis.

Staff were expected to complete mandatory training in their substantive posts outside the service. The nurse manager kept records of when mandatory training was due or completed by staff; however, we saw that mandatory training was out of date for several of the 10 staff. There was a potential service risk in medical support to the service highlighted in an external 2014 report and confirmed at inspection. The NHS England service specification indicated a paediatric consultant should oversee the treatment of children; we found this was not the case at North of England hyperbaric unit.