InHealth Endoscopy Unit - Bicester

InHealth Endoscopy Unit - Bicester is operated by InHealth Endoscopy Limited and forms part of a network of locations. The service is a community clinic and provides care and treatment to patients who are medically fit and stable. It accepts adult patient referrals and does not see any children or young people under the age of 18 years.

The clinic has one consultation/admission room, one procedure room, two single preparation/recovery rooms and a seated discharge area with two reclining chairs. The service is commissioned by NHS Oxfordshire Clinical Commissioning Group to provide colonoscopy, flexible sigmoidoscopy and gastroscopy for routine referrals. The clinic has an in-house endoscope decontamination facility and staff trained in its use.

The service provides care and treatment to patients referred by the NHS as part of an initiative to reduce waiting times.

We inspected this service using our comprehensive inspection methodology. We gave the service 24 hours' notice to ensure relevant staff were available and carried out a short-notice announced inspection on 1 October 2019.

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 have not previously inspected this service since it opened in October 2018. We rated it as Good overall.

We found the following good practice:

• The service 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.
• Processes for safe water management were robust and ensured patient’s safety. Staff had taken immediate action where routine testing indicated a risk.
• The management team acted on audits and quality evaluations to continually identify opportunities for benchmarking and improvement.
• Staff managed areas such as medicines management and staffing, in line with established processes and protocols. The lead nurse ensured protocols were reviewed and updated in a timely fashion to reflect the latest national standards.
• The service had a waiting list and managed this well. Since opening in October 2018, the service had met the six-week diagnostic waiting time standard.
• Governance processes included all staff and helped the team to assess the quality of the service and to drive development and improvement. The governance structure was being expanded and improved as part of a five-year development plan.
• There was effective multidisciplinary working with other healthcare providers to ensure patients received the right care.
• Staff were compassionate and supportive to patients and relatives in their care. Staff communicated with patients in a manner that met their needs and offered opportunities for patients to ask questions.
• Patients’ dignity was always maintained and there were effective arrangements to involve relatives as much as patients wanted.
• Feedback from patients and relatives was positive.

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

• The service needed to improve overall compliance rates for mandatory and service specific training requirements.
• Although security throughout the unit was effective, we found some doors to clinical areas did not close properly and keys were left in doors that were meant to be kept secure.
• The cabinet containing cleaning fluids had a broken lock and these hazardous substances could not be safely stored
• Medical gases were not always safely stored.
• Although overall standards of infection control were good, some staff were seen to be not bare below the elbow or have tied their hair back.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)