Transform Milton Keynes is operated by TFHC Limited. The service provides cosmetic surgery outpatients and diagnostic services. The service has no beds or wards. Facilities include two clinical consulting rooms and administrative areas.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 2 May 2017 along with an unannounced visit to the clinic on 12 May 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, 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.

We regulate cosmetic surgery services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• Patient information was not always kept confidentially or securely.

• There were no arrangements in place to allow patients who did not speak English to consent for procedures and family members were permitted to consent on patients’ behalf.

• A significant amount of equipment was found to be past its expiry date and there were no stock management systems in place to prevent this occurring.

• We could not be assured safeguarding training was in line with national guidance. Staff did not have an understanding of the level of safeguarding training they required to carry out their roles or an understanding of the level of safeguarding training they had received. Staff were unaware of a safeguarding policy in place to assist them.

• There were a number of governance concerns identified during the inspection in relation to identifying risks within the service, such as monitoring of did not attend rates and access to up to date policies.

• There were no clear risk registers or strategies at corporate or local level.

• There were not clear mechanisms in place for learning from incidents or complaints.

• Cleaning equipment was not stored in a secure way, leaving it accessible to patients using both services located in the building.

• Patient feedback was not routinely collected or monitored within the service.

• There were not clearly defined responsibilities for the shared premises.

However, we found the following areas of good practice:

• Patients were provided with choices with regard to location and which surgeon would carry out their procedures. Evening and weekend clinics were available.

• There was a wide range of written information for patients to take away and use to inform their decisions.

• There was a good culture among staff, who enjoyed their roles within the organisation.

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 four requirement notices that affected cosmetic surgery outpatient services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)