Archived: Berkshire West Community Endoscopy Service

Updated 18 December 2018

Berkshire West Community Endoscopy Services (hereafter referred to as BWCES) was  registered with the CQC in 2016. The service is registered to provide the following regulated activity:

• Diagnostics and screening procedures.

During the inspection, we visited the procedure room, the consultation room and the recovery area. We spoke with nine staff including: registered nurses, health care assistants, reception staff, medical staff and senior managers. We spoke with three patients and two relatives and reviewed three sets of patient records.

The service has a registered manager – Annette Panting who has been in post since February 2016, when the service was registered with the CQC. The registered manager will hereafter be referred to as the service manager.

Updated 18 December 2018

Berkshire West Community Endoscopy Services is commissioned by Berkshire West Commissioning Care Group to deliver non-sedation diagnostic endoscopy services for GP practices. The service offers diagnostic endoscopy to people living in Berkshire West including North and West Reading, Newbury, Wokingham and South Reading. The service accepts adult patient referrals and does not see children and young people under the age of 18 years. The service offers clinics on Saturdays and Sundays with some additional clinics on Monday and Friday mornings. There is a booking and administrative team working Monday to Friday mornings to manage referrals. The service is hosted by a private healthcare provider in Reading.

The service carries out two different endoscopy procedures: gastroscopy (thin, flexible tube called an endoscope is used to look inside the oesophagus (gullet), stomach and first part of the small intestine) and flexible sigmoidoscopy (examination of the rectum and the lower (sigmoid) colon using an endoscope). The service is commissioned to carry out between 2000 and 2100 procedures every year.

Facilities include one procedure room, a waiting area, a reception area, a consultation room and a ward area with eight single pods for patients pre- and post-endoscopy.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 29 September 2018. This was the first time we inspected this service since it was registered with the CQC in 2016.

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 requires improvement overall because:

• Compliance with mandatory training varied. The service did not have an overview of medical staff’s mandatory training compliance. The safeguarding lead did not have level three adult safeguarding training.
• There were ineffective arrangements for engineer call out for the endoscope washer-disinfector which meant procedure lists had been cancelled.
• Staff did not always make effective use of national guidance designed to reduce the risks of avoidable harm.
• The service did not always use reliable methods to monitor patients during procedures.
• Not all staff were aware of how to access emergency equipment in the event of a patient suffering a major haemorrhage.
• Staff did not always report near-misses as incidents which was not in line with their policy.
• The service did not collect data about patient outcomes to enable benchmarking of their performance against national standards or for internal use to monitor performance.
• Consent processes were not always managed in line with national guidance.
• The service did not have an audit calendar/programme identifying when audits should be carried out.
• The service did not collect and publish data in accordance with Workforce Race Equality Standards.

However, we found areas of good practice:

• There was a good safety track record. There had been no never events and no serious incidents during the last 12 months.
• Endoscope decontamination processes met national standards.
• There were adequate nursing staff levels to safely meet the needs of patients.
• Patient records were managed in a way that ensured staff had access to up-to-date and accurate information about patients.
• Staff had access to policies, standard operating standards and guidelines reflecting evidence based care and treatment, which had been developed in line with national guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment to patients.
• We observed caring, respectful and compassionate interactions between staff and patients and their relatives.
• Services were planned and delivered in a way that met the needs of the local population. Patients could access the service when they needed to. There were no waiting lists at the time of our inspection.
• The leadership team of the service had the skills, knowledge and integrity to lead the service.
• Staff felt valued and enjoyed working for the service.
• There were systems and arrangements to identify, record and manage risks although these were not regularly reviewed.
• There were systems to engage with patients to capture regular feedback on services.

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 five requirement notices that affected Berkshire West Community Endoscopy Services. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)

Updated 18 December 2018

The service provides diagnostic endoscopy for adults. We rated this service as requires improvement overall. We rated safe and well-led as requires improvement although the service was rated good for caring and responsive. We do not rate the effective domain for independent endoscopy services.