London Medical Aesthetic Clinic - 1 Harley Street is operated by Medical And Aesthetic Clinic Limited .The service’s main activity involves non-surgical cosmetic treatments which are not subject to regulation. We did not inspect these services. The clinic also provides pre and post-surgical care made up of pre and post-surgical consultations as well as post-operative follow up of patients. We inspected this part of the service as it is subject to regulation under the Health and Social Care Act 2008. Consultants do not perform surgery at this clinic. Consultants consulting with patients at London Medical Aesthetic Clinic - 1 Harley Street perform surgery at other clinics and hospitals which are not part of this service.

London Medical Aesthetic Clinic - 1 Harley Street offers outpatient services only and patients are self-paying. Patients access the service by contacting the clinic via its website, by telephoning the clinic to book appointments, or by walking into the clinic. The clinic does not provide services to patients under the age of 18. Between January 2016 and December 2016, there were 204 consultations for laser-assisted liposuction and for a cellulite reduction treatment by use of a laser. In the same period, there were 83 surgeries following consultation. There were 332 post-operative follow-up appointments.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 21 February 2017. We did not carry out an unannounced inspection.

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 do not rate

We regulate cosmetic surgery services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• Staff, excluding the consultants, had not had safeguarding training (adults or children). Following the inspection, staff were trained in adult safeguarding at level one. The minimum requirement is level two. Staff had still not been trained in children safeguarding.

• Furthermore, consultants were trained to level one in children safeguarding. The minimum requirement is level two. Following the inspection, the provider told us consultants were trained to level two in children safeguarding but did not provide evidence of this training.

• The safeguarding lead for the service was not trained to level four in line with good practice.Although following the inspection the provider told us the safeguarding lead was trained at level four, the provider did not provide evidence of this training.

• Staff had not had information governance training.

• Staff had not had training on the Mental Capacity Act 2005.

• Staff had limited understanding of the duty of candour.

• There were insufficient governance structures in relation to risk assessment, monitoring and mitigation.

• There were insufficient governance structures in relation to assessing, monitoring and improving the quality and safety of the services provided. For example, there were no regular audits within the service.

• The clinic’s policies were out of date. All policies were dated 2008 to be reviewed in 2009 but there had been no reviews.

• There was no record of staff meetings.

• We did not find risk assessments in all four patient records we checked during the inspection.

• There was no evidence of patients having been given information about the two week cooling off period in two of the four records we checked during the inspection.

• The clinic did not have a risk register and relied on the risk register carried out by the landlord of the building who rented the premises to them.  

• Patients who did not speak or understand English paid for the clinic’s translation services. Staff also reported that patients attended with relatives to aid translation and this was not in line with good practice.

However, we found the following areas of good practice:

• Incident reporting was embedded in the culture of the service and there was evidence of learning from incidents.

• The environment was visibly clean and tidy.

• Patients could access care and treatment in a timely way and patients were given a choice regarding when to access treatment.

• Patients we spoke with during the inspection gave positive feedback about the service. Positive feedback was also reflected in the results of the patient survey of 2015.

• Patients were given information about how to complain.

• Staff said they were happy to work at the clinic and said they were respected and valued.

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 three requirement notices. Details are at the end of the report.

Importantly, the service must take the following action to meet the regulations:

• The service must ensure that all staff are trained in safeguarding (adults and children) at a minimum of level two.

• The safeguarding lead must be trained to level four.

• The service must ensure that persons employed by the service in the provision of the regulated activity receive such appropriate training as is necessary to enable them to carry out the duties they are employed to perform including information governance and Mental Capacity Act 2005 training.

• The service must ensure effective governance arrangements including assessing, monitoring and mitigating any risks relating to the health, safety, and welfare of service users and others who may be at risk from the carrying out of the regulated activity.

• The service must ensure effective governance arrangements to enable the provider to assess, monitor, and improve the quality and safety of the services provided in the carrying out of the regulated activity. This must include but is not limited to a comprehensive audit programme to assess the quality of the service.

Additionally, the provider should take the following action to improve:

• The provider should ensure policies are reviewed regularly, are up to date, and reflect changes in national guidance and legislation.

• The service should keep a record of staff meetings including agenda items and matters discussed.

• The service should ensure risk assessments are carried out for all patients and findings documented in patients’ records.

• The service should ensure that staff are trained on the duty of candour and that duty of candour is part of the clinic’s serious incident policy.

• The service should have staff surveys as a way of engaging staff and obtaining their views on how services can be improved.

• The service should ensure there is access to disabled toilets and facilities for disabled patients.

• The service should include the reporting of near misses in their incident reporting policy.

• The service should ensure a range of personal protective equipment (PPE) is available in the clinic including protective aprons.

• The service should ensure all waste bins are labelled appropriately to reflect the nature of waste to be disposed of in individual bins.

• The service should conduct audits to measure the quality of the service. For example, audits related to infection prevention and control.

Professor Edward Baker

Deputy Chief Inspector of Hospitals

When people first attended the service to discuss a surgical procedure Dr Al-Ayoubi would explain what people's different treatment options were and the risks and benefits of them. Information on procedures and what they involved were also available on the provider's website and on the consent forms that people were asked to sign prior to treatment.

We were not able to speak to people on the day of the inspection as no patients were booked for surgery-related appointments. We looked at the results of the three patient feedback forms returned between November 2011 and September 2013. All respondents indicated they had been given sufficient information about their treatment and that it had been fully explained to them. One person commented that the doctor "explained the treatment in detail".

When people first attended the service to discuss cosmetic surgery options they were asked to complete a form which asked for relevant details about their medical history, lifestyle and any allergies they had. These were reviewed with the doctor who would conduct a full assessment to see if they were suitable candidate for surgery.

People were protected from the risk of infection because appropriate guidance had been followed. Appropriate checks took place before people started working for the service. There was a complaints policy and procedure in place.

We spoke with people using the service and looked at recent patient comments and patient satisfaction survey report. People using the service described it as “outstanding” and “professional, friendly, helpful”. They reported that they were treated with respect and were given information about their care and treatment. They praised the quality of staff who treated them.

People who use services felt that staff are doing their best to protect their privacy and always treat them with respect. Most people we spoke with felt that staff listened to them and offered them choices about their care and treatment as far as possible.

We spoke with people and spent time observing the care being delivered. Overall, the feedback was that people are being cared for and looked after well. People are given choices and have the opportunity to form good relationships with staff.

People we spoke to felt involved in their care and said that staff were friendly and helpful. We saw good interactions between people that use the service and staff.