The Surrey Park Clinic is operated by The Surrey Park Clinic (IHG). The service opened in 2005 to provide specialist women’s healthcare with a focus on the treatment of gynaecological issues, hormone treatment, fertility and pregnancy care. It is a private clinic in Guildford, Surrey. Facilities include one treatment room used for scanning, three consulting rooms, a phlebotomy room, a pharmacy for outpatient dispensing and a number of offices for administration purposes.

We previously completed a comprehensive inspection in October 2016 when we rated the service overall as required improvement. There were three regulatory breaches. The service provided an action plan to demonstrate how it would improve. In July 2017, we completed a follow up announced inspection where we focussed on the action plan and found the service had taken positive actions to improve and there were no breaches of regulation. We did not rerate the service following the 2017 inspection as we only reviewed actions taken to address the breaches of regulation.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the clinic on 9 January 2019.

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 service provides diagnostic and outpatient services including minor procedures and ultrasound scans, mostly for adults but included eight young people aged 16 to 17 years during the reporting period (August 2017 to July 2018). We inspected the outpatients and diagnostic imaging core services.

The main service provided by The Surrey Park Clinic was outpatients. Where our findings on outpatients for example, management arrangements – also apply to other core services, we do not repeat the information but cross-refer to the outpatient’s section of the report.

Services we rate

Our rating of this service improved. We rated it as Good overall.

We found areas of good practice in relation to outpatient care that had improved since the last comprehensive inspection.

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. When things went wrong, staff apologised and gave patients honest information and suitable support.

• The service provided care and treatment based on national guidance and a new audit plan was established to check effectiveness.

• The service had suitable premises and equipment and looked after the general environment well, flooring and furnishings had improved and were easy to keep clean.

• Staff kept detailed records of patients’ care and treatment using an electronic system with security safeguards. Records were clear, up-to-date and easily available to all staff providing care.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care.

• The service had a vision for what it wanted to achieve which it developed with staff.

• Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

Other areas of good practice:

• The service provided best practice when prescribing, dispensing, recording and storing medicines.

• The service made sure staff were competent for their role and supported their staff with clinical supervision.

• Staff cared for the patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• The service planned and provided services in a way that met the needs of patients. The service took account of patient’s individual needs.

At this inspection, we found one breach of regulation as substances hazardous to health were not stored securely and in line with policy. We told the provider that it should make other improvements to help the service improve.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South)

The Surrey Park Clinic is operated by The Surrey Park Clinic (IHG) Ltd. Facilities include one treatment room for minor outpatient surgical procedures, a pre and post-surgical rest room, three consulting rooms and a pharmacy for outpatient dispensing. The service provides specialist female healthcare including a gynaecological clinic, hormonal clinic, minor outpatient procedures and ultrasound scans, mostly for adults.

We visited this clinic in October 2016 as part of our national programme to inspect and rate all the independent healthcare providers.

At that time, we rated the service overall as requires improvement. However, we rated well-led as inadequate because of the lack of formal governance structures and governance oversight. There was no registered manager and processes for granting and maintaining practising privileges did not have the oversight of a clinician.

There were three regulatory breaches. We told the hospital it must give us an action plan showing how it would bring services into line with the regulations. The hospital provided a plan.

At this announced follow up inspection, we focussed on the action plan and found the hospital had taken positive action to improve.

The hospital had taken action to comply with the regulations and had:

• Obtained registered manager status for an appropriate member of staff

• Formalised governance arrangements

• Implemented processes to ensure the granting and reviewing of consultant practising privileges was correct.

• Taken action to ensure staff understood and discharged the duty of candour.

• Put monthly hand hygiene audits in place and started a process to ensure flooring in the clinical areas complied with national guidance Health Building Note 00-09; Infection control in the built environment.

During our inspection we also looked at the two actions from the last report the hospital should take to improve:

• Action to measure and benchmark patient outcomes in a way that does not involve over reliance on patient satisfaction feedback.

• Ensure all clinical staff received an appropriate level of safeguarding training in line with national guidance

We found those actions had also been achieved.

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.

Following this inspection, we told the provider that it that it should continue to make improvements, even though a regulation had not been breached, to help the service improve.

Professor Edward Baker

Chief Inspector of Hospitals

The Surrey Park Clinic is operated by The Surrey Park Clinic (IHG) Ltd. Facilities include one treatment room for minor outpatient surgical procedures , a pre and post surgical rest room, three consulting rooms and a pharmacy for outpatient dispensing.

The service provides outpatient services including minor outpatient surgical procedures and ultrasound scans, mostly for adults but including 40 children and young people aged 13 - 18 (July 2015 – June 2016). We inspected outpatient services and include services for children and young people within this core service report because of the very low number of children and young people attending as patients.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 17 October 2016. We rated the service overall as requires improvement. However, caring was good, and leadership was inadequate because of the lack of formal governance structures and clinical oversight.

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 outpatients. We rated this service as requires improvement overall.

We found areas of practice that require improvement:

• Senior staff who investigated incidents and complaints had not been trained in root cause analysis which meant that investigations were not always sufficiently robust.
• Measures taken to prevent incidents recurring were not always successful, indicating that the reason for the incident occurring had not been adequately understood.
• Staff did not understand their responsibilities under the duty of candour and we saw examples where the service had failed to discharge their responsibilities under this duty.
• There were limited audits within the service to assure managers that staff were following the correct pathways and policies which kept patients safe, for example there were no regular hand hygiene audits.
• Although patient records were mostly stored securely, complete contemporaneous records were not available as consultant notes were not stored on site.
• Staff did not all have the required level of safeguarding training for both adults and children and young people.
• The service had levels of bank staffing which were consistently worse than the average rate for other independent services.
• The clinic’s policies and procedures were nearly all outside of their review date, which meant that staff might not have worked to the relevant and current evidence-based guidance, standards, best practice and legislation.

We found areas of practice that were inadequate:

• The service did not have a formal clinical governance committee or medical advisory committee to review clinical practice and address clinical issues, and there was no clinical risk register to log and monitor risks.
• The clinic owner and general manager, who were both non-clinical staff, took responsibility for the granting and reviewing of practicing privileges. The absence of a consultant or doctor to advise on these processes meant it might have been difficult for the senior management team to assess the competencies and suitability of doctors applying for practicing privileges.
• There had been repeated incidents where a patient had been informed of another patient’s test results which was a breach of the Data Protection Act and indicated that the service had failed to understand why this had happened.
• The service did not have access to interpreters and used family members instead. This meant the clinic might not have had assurance all patients who did not speak English understood, or felt involved in, all aspects of their care. Staff, including members of the senior management team, did not appear to understand that using family members to interpret was not best practice.
• There was no registered manager at the time of the inspection and the service had failed to take any action to remedy this. However, the general manager responded promptly immediately after the inspection and submitted an application.

We found areas of good practice in relation to outpatient care:

• Equipment was correctly labelled with details of service dates and we saw evidence of daily checklists for the resuscitation trolley.
• We saw documentation of patient allergies and evidence of antibiotic cover in the patient records we examined.
• The service had an on-call rota to enable them to see patients out of hours should they have any complications following labiaplasty.
• There were multi-disciplinary team meetings each month demonstrating a coordinated approach to patient care.
• Patient feedback on the service received at the clinic was consistently positive, with many commenting on the degree to which staff gave them privacy and time to make decisions.

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. We also issued the provider with three requirement notices that affected outpatients. Details are at the end of the report.

Professor Edward Baker

Deputy Chief Inspector of Hospitals