We spoke with the registered manager a staff member and a number of patients who were receiving treatment at the clinic. This helped us to gain an overview of what people experienced at iSight Limited.

During the inspection we looked at how care and treatment was being delivered. Quality assurance and maintenance records as well as observing the general environment. We also looked at ways the service sought views from people who received treatment at isight Limited.

Comments we received from patients were positive about the way they were treated by staff and the consultant ophthalmic surgeon. They were satisfied with the care and support shown to them during the course of their treatment. Comments included, “It’s been a very good service all the way through”. Also, “Staff put me at ease as soon as I came in. I could recommend t to anyone. Nothing to worry about”.

Patients told us they were consulted throughout the treatment stages and all options were discussed with them. Patients confirmed they gave their consent to any treatment undertaken by the surgeon.

Patients spoke positively about the care they had received. Comments included, “Staff are very helpful and consultants very good." and “I have always been seen by the same consultant which is really good. There is plenty of time to discuss options during the consultation.” The service provided patients with information to assist them with making decisions about their care.

The service kept up to date detailed records of the care and treatment provided. Each record provided comprehensive information about the patient’s current needs and past treatment.

Records showed that professional registration was up to date for all nursing and medical staff. We saw the induction programme for two staff which included time to read all policies and procedures, shadow colleagues and receive supervision of all their clinical duties. The service had a whistleblowing policy in place which supported staff to raise concerns outside of the organisation

Systems were established to identify, assess and manage risks related to the service provided through a series of checks and maintenance schedules including for drugs, laser and electrical equipment, infection control and fire safety.

iSight Limited is an independent ophthalmic hospital, located in Drayton House in Southport, Lancashire providing treatment and care for all eye conditions. The hospital is able to offer a range of treatments and surgery for conditions such as macular disease, cataracts, corneal disease, glaucoma, medical retina disease, oculoplastic procedures, orthoptics and refractive surgery.

The hospital provides surgery services and outpatients and diagnostic imaging for a number of eye conditions. We inspected these services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 July 2017 along with an unannounced visit to the hospital on 12 July 2017.

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.

The main service provided by this hospital was surgery. Where our findings on surgery for example, management arrangements, also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

Services we rate

We rated this hospital as good overall.

We found good practice in relation to surgical care:

• The service used evidence based practice from the National Institute of Health and Care Excellence and the Royal College of Ophthalmologists. There was participation in a national audit and surgical outcomes were monitored.
• There were infection control processes in place and patients said that the hospital was very clean. There had been no reported hospital acquired infections in the period April 2016 to March 2017.
• The hospital was well staffed and all staff had undertaken mandatory training including appropriate safeguarding training. Agency staff used at the hospital had worked there before and were aware of procedures and processes to keep patients safe.
• The consultants worked well together and provided cover for each other if necessary. They were involved in the complaints process and complaints were regularly discussed and any outcomes were disseminated to staff.
• Access and flow of patients through surgery was excellent with processes in place to minimise the risk to patients. Patient feedback was good and the hospital provided quality care to patients.
• Leadership was strong from senior staff and from consultants with regular meetings to review and disseminate information and patient related issues to staff.

We found good practice in relation to the outpatients and diagnostic service:

• The outpatient department (OPD) processes for referral into the service worked well and the provider was able to allocate appointments in a timely manner due to the efficiency of the systems in place and referral to treatment times were always less than 18 weeks.
• There was training and development for staff and the hospital were developing a service for nurse led clinics for age related macular degeneration disease. Staff were given time off to attend and funding for training. The hospital provided training for community orthoptists which contributed to their continuing professional development.
• There were procedures in place for safety of the use of lasers in the OPD. Fire safety was part of the induction process and risk assessments had been completed to reduce the risk of fire in all parts of the hospital.
• We saw that patients were greeted by name on arrival at the hospital and patients were taken to the waiting areas by the staff. There was a good uptake in patients completing the patient survey and 99.6% of patients said that they would recommend the hospital to friends and family.

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

• Medicines needed to be checked according to the hospital policy.
• There was no process audit for the checking of medicnes.
• There was no training for staff on the Mental Capacity Act.
• Incidents were not always graded appropriately and incidents were not always recorded in a consistent way.
• The application of the duty of candour was not included in the incidents policy.
• Additional audit activity needed to be developed for patient outcomes.
• There was little information provided for patients living with a learning disability.
• Access to the building for patients with mobility difficulties needed to be clearly accessible and appropriately signed.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)