Fortify Clinic Limited

Updated 16 January 2023

Fortify Clinic Ltd.’s. registered location is in the Didsbury area of Manchester.

All services are delivered from one of four Manchester NHS Foundation Trust (MFT) hospital locations:

• Wythenshawe Hospital
• Manchester Royal Infirmary (MRI)
• Trafford General Hospital
• North Manchester General Hospital

The service holds contracts with the host trust to deliver consultations, clinics, diagnostic investigations and procedures including surgical procedures to patients on their waiting lists. At present the provider only delivers surgical procedures in relation to urological conditions, whilst providing clinics for both patients with urological conditions and some cancers. This is achieved through contracting current host trust employees, outside their normal contracted hours of employment to perform the necessary clinics and procedures to reduce these waiting lists. All procedures and clinics are held on the host trust premises and use both the host trust’s staff (sub-contracted) and the host trust’s equipment, such as laser equipment that is used during stone removal procedures.

Fortify clinic Ltd. are contracted to provide care and treatment only for part of the patients journey through the health system. Patients seen by Fortify Clinic Ltd. have been referred through Primary care into the secondary care system, where the host trust assumes responsibility for their care. Fortify, who perform these parts of the patients’ care and treatment will take responsibility for only the part of the care provided by them, such as the clinic, pre-operative assessment or surgical procedure. The responsibility for the care of the patient reverts back to the host trust once the patient has, for example, left recovery in the case of surgery, or been referred for diagnostics, treatment or ongoing monitoring should they have been seen in the clinic. The responsibility for the care of patients that are discharged from the clinic reverts to the patient’s own GP.

The provider does not see or accept private patients. The host trust manages the NHS waiting lists and present patients to be seen by the provider, in turn with a view to expedite such waiting times for the benefit of all patients. The provider does not provide care and treatment for children, specialist the host trust paediatric colleagues treat all children.

Patients are informed that their care and treatment is being transferred temporarily to Fortify Clinic Ltd. by letter from the host trust and have at that point the option to “opt out” of this and remain on the waiting list for the required NHS services.

The provider website is: www.fortifyclinic.com

How we inspected this service

The inspection team visited the provider’s main location to discuss elements of governance, such as consideration of risk and quality improvement and then performed two site visits to Wythenshawe Hospital and Manchester Royal Infirmary (MRI).

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection

Updated 16 January 2023

This service is rated as Good overall and for all key questions

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? – Good

We carried out an announced comprehensive inspection at Fortify Clinic Ltd as part of our inspection programme.

This service is registered with CQC under the Health and Social Care Act for all of the services it provides. The service provides care and treatment for patients who have urological health conditions. They use surgical theatres and outpatient clinic facilities at Manchester Foundation Trust (MFT) hospitals when they are not being used for NHS care delivery. Patients on waiting lists at the host trust are referred into this service which is provided specifically to reduce waiting times for patients needing urological care and treatment.

The provider has a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

Our key findings were:

• The provider had systems in place to ensure safety of patients when they interacted with their service but were contractually reliant on the host trust governance arrangements for much of their governance structures. We found that the provider could not demonstrate that they had followed-up on assurances in relation to risk and quality of care from the host provider following their initial due diligence when beginning the contracted work. Following the inspection, the provider demonstrated that they had sought assurances, principally through discussions at monthly contracting and governance meetings. We saw limited documentary evidence the provider had obtained from the host trust.
• The provider’s performance was high, and the service engaged proactively with quality improvement activity. The provider was able to demonstrate that assurances in relation to the quality of services provided were proactively sought from the host trust. We saw that three of the six quality audits shared with us, indicated concrete assurances.
• The provider had systems in place to assess, learn from and act upon patient feedback in relation to the how they felt treated by the service. The provider had surveyed patients, the majority of whom had fed back in a positive way relating to how satisfied they felt with their care. The provider had also actively sought patient feedback in relation to access and waiting times and had responded to people’s needs.
• We found gaps in the governance arrangements and systems of oversight employed by the provider in relation to the seeking of assurances around effective risk management. We found no evidence of harm but the providers contractually obligated reliance on the host trust’s systems had led to gaps in their own systems. Evidence submitted following the inspection provided assurances that systems were limited but in place and working and would benefit from strengthening.

Areas where the provider SHOULD make improvements are;

• Document meetings comprehensively to ensure governance systems are demonstrably in place and effective.
• Establish evidentiary systems to demonstrate that oversight of host site systems are in place and working effectively.
• Ensure that all clinical staff are trained to the appropriate level of safeguarding training commensurate with their role.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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