The Hyperbaric Medical Centre – Plymouth is operated by DDRC Healthcare. The facility has been operating in its current location since 1996.

The service provides hyperbaric oxygen therapy to patients with a range of conditions, including diving emergencies, complex wounds and those suffering from complications due to radiation treatment. Hyperbaric Oxygen (HBO) therapy is a means of providing additional oxygen to body tissues. During HBO treatment the patient breathes high levels of oxygen, usually through a hood or mask, whilst inside a pressurised chamber.

There are four hyperbaric chambers and nine clinical assessment, treatment and consulting rooms.

Most patients are from the South West, but some patients are from other regions. All NHS-funded patients have either been referred by a specialist consultant or attend as an emergency patient with decompression illness, a life-threatening condition usually affecting divers during which dissolved gases form gas embolisms inside the body. Emergency patients are assessed by a doctor prior to treatment.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 31st October 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?
• Are they effective?
• Are they caring?
• Are they responsive to people's needs?
• Are they well-led?

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 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:

• The patients were put at the centre of care and their individual needs were met.
• All areas of the facility were clean and well maintained.

• Health and Safety procedures were robust.
• The consent process was thorough and well-documented.
• Patients received compassionate care and staff were respectful and professional.
• There was a strong focus on audit, research and improvement.
• Children and vulnerable adults were protected from abuse through clear reporting processes.
• The service worked closely with local acute NHS Trusts and specialist services. They also collaborated well with the wider hyperbaric and research communities.
• There was a good working culture and respect between work colleagues and towards managers.
• Staff received ample training opportunities and professional development was encouraged and supported.
• Communication was very effective and staff had the opportunity to contribute thoughts and ideas to the organisation.
• There was a desire to improve and the organisation responded well to incidents and feedback.
• Leadership at the service was strong and their vision and strategy was well-defined.

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

• There was no framework provided for assessing the level of harm caused by an incident. This was needed to ensure that the service was identifying incidents that met the criteria of a serious incident and managed them appropriately.
• There was lack of clarity around the methodology used for investigation of serious incidents.
• Drug allergies were sometimes not recorded on the patient’s drug charts.
• Some employees had not received an annual appraisal.
• The service did not give clear information to service users about where to go if their complaint was not resolved to their satisfaction.
• The service did not actively promote its organisational values to the staff or service users.
• Some non-clinical staff had not received safeguarding training.
• The service did not have an organisational risk register through which senior managers and trustees could gain assurance that appropriate controls were in place to minimise risks to service delivery.

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.

Amanda Stanford

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People who used the service told us they were pleased with the care and treatment that they had received. They said "This place is amazing, everyone is happy and smiling and I feel completely safe here". "All of the staff have gone out of their way to make the treatment as pleasant as it could be. I am very pleased with the results". People were treated in a friendly and helpful way.

People felt well-informed and involved in their care. They were told about risks associated with their treatment and were asked to give consent before procedures took place. We saw that staff assessed the individual needs of each person that used the service and devised a treatment plan that was safe and appropriate.

We could see that people's dignity was maintained and their privacy protected. There were enough qualified, skilled and experienced staff to meet people's needs. Staff were aware of the importance of good nutrition and hydration.

There was a system in place to monitor the quality of service provided. We saw evidence that comments were listened to and that further investigation took place if necessary. Information gained from audits was analysed and used to inform future practice.