Lifestyle Surgery Limited Also known as The Aesthetic Medical Clinic

The service was registered with Care Quality Commission (CQC) on 07 April 2021 and this is the first inspection since registration.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Lifestyle Surgery (The Aesthetic Medical Clinic) on 05 October 2022 as part of our planned inspection programme.

Lifestyle Surgery (The Aesthetic Medical Clinic) is a registered location, and the registered provider is Lifestyle Surgery Limited. The clinic provides services for privately funded patients who self-refer to the service, referrals from GP's and tertiary referrals from other consultants.

Lifestyle Surgery is in the Clifton area of Bristol. There is parking available in a nearby public car park and a public disabled parking space is available.

This service is registered with CQC under the Health and Social Care Act 2008 as Lifestyle Surgery in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to types of regulated activities and services, and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Lifestyle Surgery (The Aesthetic Medical Clinic), provided a range of non-surgical and surgical cosmetic interventions, for example, intense pulsed light (IPL) treatments, skin peels and general skin rejuvenation. These interventions are not regulated activities and as such we did not inspector report on these services. We inspected those procedures offered which are regulated activities, for example minor skin surgeries, hyperhidrosis with botulinum toxin injections (Botox), blood testing, prescriptions, assessment and pre- and post-surgical care.

The provider has one location at the address above in Bristol. The clinic and website are advertised as Simon Lee Plastic Surgeon, The Aesthetic Medical Clinic.

Patients who request major cosmetic surgeries are seen for pre and post-operative assessment and consultation at this location. The surgeries are completed by the provider using the operating and care facilities of a local private hospital.

Lifestyle Surgery (The Aesthetic Medical Clinic) has two company directors. Care and treatment at Lifestyle Surgery are managed by one of the directors who is also the nominated individual and the registered manager. We have referred to this person as the registered manager throughout this report. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are registered people. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider and registered manager is a plastic surgeon and is a full member of The British Association of Plastic, Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.

The other director works at the service in a non-surgical capacity under practicing privileges arrangements and is not involved in the running of the service The service they provide is non-surgical and does not involve any aesthetic role

Staff at the service also included three registered general nurses specialised in Aesthetic (Cosmetic) Medicine two of whom are training to become nurse prescriber and one who is already a nurse prescriber. The service also has a clinic manager, two skin specialists and a receptionist.

Consultations were provided face to face or online. As part of the inspection, we looked at patient feedback via two electronic survey systems available to patients treated at the service.

At this inspection we found:

• Overall, the service had clear systems, processes and operating procedures to keep patients safe, to manage a safe environment, to manage incidents and significant events and to safeguard patients from abuse.

• The service ensured that care and treatment was delivered in line with current legislation, standards and guidance relevant to the service.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The service organised and delivered services to meet patient’s needs, patients had timely access to the service, and the service took complaints and concerns seriously and responded to them appropriately.

• Management had the capacity and skills to deliver high-quality sustainable care. There were clear responsibilities, roles and systems of accountability to support management. There were systems and processes for learning and continuous improvement.

• The provider undertook surgery at the private hospital under practicing privileges and was not part of this registration with CQC. The governance arrangements and risk management processes between the provider and the private hospital where surgery took place were managed by the private hospitals but were not recorded by the provider. However, further work was also needed to ensure that systems and processes relating to recruitment, staff training, and fire safety were operated effectively and fully embedded.

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The areas where the provider must make improvements are:

• The provider must ensure staff recruitment systems are well managed and up to date to ensure patient safety.
• The provider must ensure there are effective systems and processes around fire safety, to include a full fire risk assessment, fire bell check and fire drill to ensure systems were safe and effective.
• The provider must review staff training to ensure that staff have the skills and experience to meet patients’ needs. This should include chaperone training, equality and diversity training, mental capacity training and ensuring that the registered provider is trained to Safeguarding Adults and Children level three.

The areas where the provider should make improvements are:

• The provider should consider an audit record of all medicines stored at the location to ensure medicines audits were complete.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services