TFHC Limited operates several cosmetic surgery hospitals and clinics across the country including Transform (Pines Hospital) which was opened in November 2004. TFHC Limited was purchased by an investment group in July 2015. The same investment group also purchased another cosmetic surgery provider in July 2016. Both Transform (Pines Hospital) and the other cosmetic surgery provider are co-located within the same hospital and share the same clinical facilities. They have also merged leadership and governance functions. However, both providers currently have different patient pathways. Transform (Pines Hospital) and the other cosmetic surgery provider are different legal entities and are registered separately with the CQC. We inspected and rated the services provided by Transform (Pines Hospital).

Transform (Pines Hospital) is a three storey hospital based in south Manchester. It has 22inpatient beds across two wards (one ward is an overflow ward), two operating theatres, and recovery unit with four beds – these are based on the second floor. Some administrative functions are based on the first floor. The pre-operative consultation and pre-assessment outpatient clinics are based on the ground floors, as are the head office functions. Transform (Pines Hospital) provides various cosmetic procedures, including breast augmentation, rhinoplasty, hair transplants and mastopexy, to patients aged 18 and over. Breast augmentation accounts for approximately 40% of the surgical procedures performed. Services are provided over a seven day period, with a 24 hour on‑call team available as required. Over 41,000 surgical procedures have been performed at Transform (Pines Hospital) since it opened in 2004.

We only regulate surgical procedures carried out by a healthcare professional for cosmetic purposes, where the procedure involves the use of instruments or equipment which are inserted into the body. We do not regulate – and therefore do not inspect - cosmetic procedures that do not involve cutting or inserting instruments or equipment into the body.

We inspected all aspects of hospital’s services that were within our remit using our comprehensive methodology. We carried out the announced part of the inspection on 10 and 11 July2018, along with an unannounced visit to Transform on 25 July 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 Transform (Pines Hospital) was surgery. Where our findings on surgery – for example, governance arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

This is the first time we have rated Transform (Pines Hospital). We rated it as good overall.

We rated Transform (Pines Hospital) as good because:

• Most staff had completed mandatory training and knew how to protect patients from harm or abuse.

• Staff understood their roles and responsibilities in relation to consent and the mental health act.

• Staff treated patients with care and compassion.

• There were high patient satisfaction scores.

• Staff supported and met the needs of individuals.

• Waiting times were managed effectively.

• There was a positive culture and staff engagement had improved.

• There was a clear governance structure.

• We saw evidence of a comprehensive audit programme that was used to drive improvements and provide assurance.

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

• The response bag in the outpatients clinic was not checked as often as it should have been (although none of the equipment was out of date).

• During the inspection we saw records were not always securely stored and equipment that had not always been serviced in a timely manner.

• Transform (Pines Hospital) did not monitor or report clinical outcomes effectively, nor was it taking sufficient steps to ensure it could submit data to the Breast and Cosmetic Implant Registry.

• There was a lack of a clear vision or set of values for the organisation.

• Due to the manual processes involved in monitoring and analysing incidents and complaints, there was a risk that trends could be missed.

• Transform (Pines Hospital) had several policies that were beyond their review date.

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 to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)