Prime Endoscopy (Bristol) Limited is part of the InHealth Group. The service has no inpatient beds and facilities consist of a reception and waiting area, two admission rooms, two pre-procedure rooms with ensuite facilities, two procedure rooms and a decontamination unit. In addition, a recovery area consists of four separate rooms and toilet facilities and a private non-clinical room used for consultation after the procedure. The service provides endoscopic procedures for patients who are over the age of 18 years.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 25 October 2018.

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.

The main service provided by this service was endoscopy procedures.

Services we rate

We rated it as Good overall.

• The service ensured there were enough staff who had the appropriate training, skills and experience to maintain patient safety.
• Staff mostly managed infection prevention and control risks well. They monitored equipment and staff complied with policies and best practice guidelines. Decontamination processes of endoscopic equipment were in line with national standards.
• Staff had access to information they needed to care for patients including policies and procedures and information about patients’ current health needs.
• Staff were caring and kind to patients involving and explaining their care and protecting their privacy and dignity.
• The service used agreed pathways of care with NHS providers for patients who had a diagnosis of cancer.
• Patients could access the service at times that suited them, between Monday to Friday of each week and waiting times rarely exceeded six weeks.
• Staff felt respected and valued and were proud of working for this service.
• Suitably experienced and competent managers led the service.
• Staff used systems to report and manage risk. All concerns were investigated, reported and learning shared with staff.
• Comments from patients were taken seriously and used to improve the service. Staff actively encouraged feedback from patients to shape the service.
• Staff were sensitive to patients’ needs and ensured they were supported appropriately.

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

• Staff were trained in basic life support and use of electronic defibrillator but not in the Resuscitation Council (UK) immediate life support.
• There was no formalised agreement between the service and the local NHS trust, for transferring an unwell patient.
• Not all staff followed infection control and prevention guidance in being bare below the elbow in clinical areas and wore jewellery beneath surgical gloves.
• Although staff had access to emergency equipment there was limited written guidance available for staff to use in the case of a major gastrointestinal haemorrhage.
• Policies were not always detailed enough to provide guidance for staff.
• There was a risk that in certain circumstances controlled medicines may not be in the custody of an appropriate professional.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South West)