Stoneygate Eye Hospital is operated by Leicestershire Consultant Eye Surgeons Limited Liability Partnership (LLP).

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection between 5 and 6 September 2017, along with an unannounced visit on 19 September 2017.

The hospital provides surgery, services for children and young people, and outpatient clinics. We inspected surgery, outpatients and services for children and young people. The main service is surgery. Following our visit in September 2017 it ceased offering children’s services in outpatients and surgery and we have not rated this service due to the very low numbers of children treated, and insufficient evidence.

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.

We rated this hospital as requires improvement overall.

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

• Managers did not share learning from incidents with all staff.
• Staff did not always ensure medicines and eye drops were stored securely.
• Staff did not always ensure patient records were stored securely for example, leaving records on desks in open consulting rooms.
• Four out of five patient records we reviewed in outpatients were either not legible, signed, or dated in line with general medical council (GMC) standards
• The service did not monitor the effectiveness of pain relief or document levels of pain in patient records.
• Despite using patient outcome forms the hospital did not audit them to measure clinical effectiveness.
• Managers did not use competency frameworks to assess staff competency in undertaking their duties.
• Nursing staff did not receive regular one to one meetings or team meetings which meant there was no ongoing formal support process for them.
• Patients sometimes experienced long waits once they had arrived in clinic to see a consultant or for their treatment.
• Outpatient services did not have written materials available in other languages for patients whose first language was not English. This included pre-appointment information.
• The hospital had a vision but no medium to long term strategy plan with clear aims and objectives. There were no strategic plans to support the development of quality, safety or performance.
• The hospital did not have fully developed arrangements to manage risk or performance, and lacked quality, safety or performance dashboard for the full range of its activities
• Policies were not tailored to the needs of the hospital
• Management resources were stretched

We found the following areas of good practice:

• Clinicians recorded and analysed any clinical or non-clinical incidents and learned from them. Clinicians acted in line with the duty of candour
• Track record of incidents and infection control compared with similar organisations
• Theatres, diagnostic rooms and consulting rooms were visibly clean and well equipped
• Theatres were staffed with nurses and support staff in line with good practice
• Clinicians assessed patient risks before operations and theatre teams used the World Health Organisation (WHO) Surgical Safety Checklist for Cataract Surgery, and five steps to safer surgery checklist
• Appropriate emergency back up arrangements were in place
• Surgery was based on national guidance and conducted clinical audits. Clinicians kept upto date with best practice.
• Technology was used to monitor patient’s conditions accurately so that clinicians could give the best advice possible
• The service contributed to the Royal College of Ophthalmology expected outcomes audit on cataracts and its results were better than the national average for acuity, with a low complication rates.
• Patients we spoke with found the staff to be reassuring and compassionate and we observed this during operations
• After patients had an operation, nurses explained to them in a very understandable way how they could self-care.
• Patients had a choice of clinic and surgery times including evenings
• Consultants used an interactive display screen which covered a range of languages, to illustrate and explain procedures to patients
• Patients did not have to wait very long for NHS cataract surgery – when we inspected they were waiting approximately nine weeks from referral to surgery
• The service responded to patient views. They installed a larger waiting area, different seating and alternative refreshments in response to patient feedback.
• The hospital had a track record of technical and clinical innovation.

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 notice(s) that affected outpatients and surgery. Details are at the end of the report.

Heidi Smoult

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Deputy Chief Inspector of Hospitals (Central)