Manchester Children's Clinic

Manchester Children’s Clinic is operated by M C Medical Limited. The service has ward with one bed which is used for day-case patients only and a consultation room. There is one operating theatre and outpatient facilities.

The service provides surgery and outpatient services for children and young people up to the age of 18. We inspected the services for children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 November 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.

Services we rate

We rated the service as Good overall.

We found areas of good practice in services for children and young people:

• The provider ensured that all staff had completed mandatory training in key skills.

• Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The provider controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

• The service had suitable premises and equipment and looked after them well.

• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

• The provider 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.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• The provider followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose, at the right time.

• The service knew how to manage patient safety incidents. Staff knew how to recognise and report incidents and had received appropriate training. The provider had no clinical incidents in the reporting period from August 2017 to July 2018.

• The provider provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

• Staff assessed and monitored patients regularly to see if they were in pain. Suitable pain relief was given to ease pain.

• Managers monitored the effectiveness of care and treatment and used the findings to improve.

• The provider made sure that staff were competent for their roles. Managers made sure that staff had an up to date appraisal and had the required competencies to carry out their role.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurse and other healthcare professionals supported each other to provide good care.

• There was a thorough pre-operative assessment and consent process in place to ensure that patient risks were identified and patients who were not suitable for surgery in the facility were identified and signposted to receive surgery elsewhere.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.Feedback about the service was 100% positive.

• Staff provided emotional support to patients to minimise their distress. Staff were reassuring to patients and their families and explained everything in a way that was easily understandable.

• Staff involved patients and those close to them in decisions about their care and treatment. Patients and their carers said that questions and queries were dealt with promptly and professionally, information was clear and easy to understand and good aftercare information was provided.

• The provider was a paediatric-only medical facility offering outpatient consultations for urinary incontinence, paediatric urology and day-case paediatric surgical procedures which met the needs of local children who needed non-urgent surgery.

• The service took account of patients’ individual needs and was accessible to patients and carers with reduced mobility.

• People could access the service when they needed it. Patients could receive a pre-operative assessment and surgery within a few weeks.

• The service had received no formal complaints but had a clear complaints process in place and learned lessons from informal concerns.

• Managers had the right skills and abilities to run a service providing high quality, sustainable care. Leaders were experienced and had the capability to make sure that a quality service was delivered and risks to performance were addressed.

• The service had workable plans for sustainability and growth of the business to deliver a wider service to paediatric patients.

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

• The provider used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. The service had clear governance roles and responsibilities that were divided between the chief executive (the consultant surgeon) and the registered manager (the clinic manager).

• The service collected, analysed, managed and used information well to support its activities, using secure electronic systems with security safeguards.

• The service engaged well with patients and staff to plan and manage appropriate services. Staff reported that they had been part of putting the business together and the views of patients and carers were always sought to drive improvements.

• There was a commitment to improving services by learning from things went well and when they went wrong, promoting research and innovation.

However:

We found areas of practice that require improvement in services for children and young people:

• The provider could improve their safeguarding policy by including the “PREVENT” government strategy on suspected radicalisation and contact information to better inform staff how to make a safeguarding referral to the local authority safeguarding team.

• Although there was an emergency procedure flowchart and policy for emergency procedures in the event of a deteriorating patient or cardiac arrest, the provider did not have pathways in place to recognise and manage the deteriorating patient in individual conditions, such as asthma or hypoglycaemia.

• The provider did not have a formal clinical and non-clinical incident recording system in place to identify trends and record incidents formally to enable learning.

• The provider did not make information accessible in a written or other format for patients and carers who had information or communication needs relating to a disability impairment or sensory loss in a way that they could read, receive and understand.

• The provider did not have a formal risk register in place to record risks identified, actions taken and plans to reduce risks.

• There was no named Level four safeguarding lead, either in the provider or the local authority, for staff to approach for more specialist advice when required.

• The medical advisory committee meeting minutes were brief and did not reflect whether the meetings were effective.

• There was a limited audit programme in place.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)