On the day of the inspection there were no clients avalable for us to speak to.

We found South Manchester Private Clinic (SMPC) had addessed issues of confidentiality for clients by introducing a new system that involved a password and a coloured disc when clients booked into the clinic, this ensured the clients name was not used in public places of the clinic.

We found protocols had been designed to assist clients with individual specific needs due to impairment who accesssed the service.

We found staff at SMPC had a good awareness of the requirements of the clients accessing the service.

SMPC had good working relationships with all other agencies involved in supporting the clients attending the service.

We found robust safeguarding arrangements were in place at SMPC to ensure the safety of all clients attending the service.

Although staff personnel files were held off site we found documentary evidence during the inspection to demonstrate that staff were supported in their roles.

SMPC had a robust process in place to monitor and evaluate the quality of the service offered to clients. There were up to date policies and procedures in place to ensure the safety of both staff and clients.

Staff told us; "We work well as a team for the good of the clients we support". "We know we are supported by the management and can speak to them at any time if we have any issues". "There is alot of support available here for both clients and staff".

We spoke to a person who confirmed that the staff had explained the procedure to them in and had taken consent from them before the treatment was to commence. The person told us they were happy with the way their confidentiality had been maintained and that the staff treated them with dignity and respect.

The visit was part of a responsive review programme initiated at Fraterdrive Ltd, following concerns raised in relation to breaches of the Abortion Act 1967, at another location. We did not speak with people who used the service on this occasion.

“The leaflets were useful and I was able to ask the staff questions when I arrived".

“The staff have been very caring; they have looked after me well”.

Staff we spoke with during the visit told us :

“The senior nurses are very good and the manager is great. I like working here”.

“We have had safeguarding training and I feel confident that I would be well supported if there was an issue”.

“I do feel well supported, it’s hard work at times but we all feel appreciated”.

There were processes in place to report, investigate and monitor incidents. However, incidents were not always reported appropriately and we were not assured that staff fully understood their role and responsibilities in relation to reporting of incidents. Safeguarding processes were well embedded and clearly understood by all staff. There was high usage of bank and agency staff (nursing) to ensure staffing numbers were in line with planned levels. The service had an induction checklist for new staff (including bank and agency) which included orientation to the service, awareness of policies and competency checks. However, there was no robust system in place to monitor and re-assess staff competencies.

All areas we visited were visibly clean and tidy. Staff adhered to ‘bare below the elbows in clinical areas’ guidance. However, staff did not always adhere to policies and guidelines in relation to hand hygiene and the management of laundry to reduce risk of cross infection. Wards and surgical areas, including theatres were not controlled access areas. This meant that patients, visitors and members of the public could potentially move freely through the service and there was no embedded culture amongst staff to check and challenge people on the premises. The facilities available compromised patients’ privacy and dignity at times as we observed overcrowded wards where all patients were not offered privacy.

The service provided care and treatment that took account of best practice policies and evidence based guidelines. There were robust systems in place to ensure the service adhered to the Abortion Act 1967 and the associated regulations. The service had clear standards agreed with commissioners and key performance indicators to monitor performance and standards of service delivery. Whilst the recommended data was collated in relation to service delivery in line with RSOP 16, the service was not routinely auditing and applying the data to identify and understand issues and then drive service improvement. For example, the number of previous terminations and the uptake of LARC. Records we reviewed were clear, legible and up to date. However, Venous Thrombosis Embolism (VTE) risks assessments were not always completed prior to termination of pregnancy (TOP) surgery and the 5 steps to safer surgery checklist was not always completed fully for each patient undergoing TOP surgery. There were no clear guidelines or risk tools in use to support the recognition of the deteriorating patient.

There was a clear system in place for the service to review medical staff practising privileges. The review process also checked to ensure surgeons were operating within scope of practice. Data showed 100% of medical staff and 95% of nursing staff had received an appraisal from November 2014 to November 2015.

Feedback from people who used the service was mostly positive about the way they were treated. People were treated with dignity and respect by staff and we observed staff being considerate and compassionate towards patients. People were able to access services in a timely manner and the service was performing within the recommended target timeframe of ten days from contact to treatment. Plans were in place for patients with complex needs. However if a patient was identified as high risk, they were referred to a local NHS trust to ensure all their needs were met appropriately. Systems were in place to obtain consent from patients and consent was well documented in the patient record. There was evidence of effective multidisciplinary working amongst teams.

The service had a client philosophy however staff we spoke with were unaware of this at the time of our inspection. Whilst the registered manager and head of clinical services could clearly articulate the vision for the service there was no clearly defined and documented strategy in place. It was clear the management team were committed to improving governance processes but systems were not yet embedded and further work was still required. Learning from audits, incidents and manager meetings should have been cascaded via team meetings. However, due to service demand and the use of bank and agency staff, team meetings did not happen regularly. The management team had recognised this issue and as a result had developed a newsletter that was sent out with monthly payslips. The first edition had been issued in January 2016 and so it was not yet fully embedded at the time of our inspection.